Self and parent ratings of executive functioning after adolescent traumatic brain injury.

OBJECTIVE: To examine the level of agreement between adolescents with traumatic brain injury (TBI) and their parents in standardized ratings of executive functioning, and to determine correlates of discrepancies between those ratings.

PARTICIPANTS: Ninety-eight 11- to 16-year-old adolescents with TBI and their parents, and 97 neuropsychologically healthy controls.

METHOD: Five-year consecutive series of rehabilitation referrals for TBI.

MEASURES: Behavior Rating Inventory of Executive Function-Self Report (BRIEF-SR) and Behavior Rating Inventory of Executive Function (BRIEF) parent report versions.

RESULTS: Self and parent ratings were moderately positively correlated in both the TBI group and the control group, but parents generally identified more executive dysfunction than did the adolescents. Parent-adolescent discrepancies were statistically significantly greater in the TBI group than in the control group on the Metacognitive index but not the Behavioral Regulation index. The degree of the former discrepancy was predicted by duration of coma in the TBI group.

CONCLUSIONS: Adolescents with more severe TBI may underestimate their own degree of executive dysfunction in daily life, particularly aspects of metacognitive abilities, possibly, in part, because of an organic-based lack of deficit awareness.