AQ Syllabus

Impaired self-awareness of deficits is frequently observed in persons who have suffered moderate or severe TBI. Such impaired self-awareness can complicate rehabilitation by limiting patient motivation for treatment or resulting in selection of inappropriate long-term goals. Some authors have stated that degree of impaired self-awareness is a major factor in determining outcome after TBI. Sherer, Bergloff, and colleagues (1998b) found that degree of impaired self-awareness was predictive of employment outcome after TBI. Given the apparent importance of impaired self-awareness to employment outcome, it is important to have reliable, valid measures of impaired self-awareness.

A number of methods have been used to measure self-awareness in various investigations. The Patient Competency Rating Scale, developed by George Prigatano and colleagues, is the most commonly used scale in studies of self-awareness after TBI. The PCRS is also described on the COMBI. The AQ was developed as an alternative to the PCRS. The AQ requires persons with TBI to compare their post-injury abilities to their pre-injury abilities while the PCRS only requires patients to rate their current abilities. The significance of this difference as well as the overlap between the two scales are being investigated as part of the Collaborative Study of Impaired Self-awareness after TBI (Principal Investigators - Mark Sherer and Tessa Hart, NIDRR Grant #H133A980067).

Four indices of self-awareness can be derived from the three forms of the Awareness Questionnaire. Clients who have impaired self-awareness will rate themselves as less impaired in cognitive, behavioral, and motor functioning than will family members or clinicians. Two indices of the degree of impaired self-awareness can be calculated by subtracting the total for the 17 family/significant other ratings from the total for the 17 client self-ratings and by subtracting the total for the first 17 clinician ratings from the total for the client self-ratings. The larger the difference scores, the greater the impairment of self-awareness. In a method similar to that described by Anderson and Tranel (1989), client self-ratings on cognitive items can be compared to scores on neuropsychological tests to produce a third index of impaired self-awareness. Finally, the direct clinician rating of accuracy of self-awareness provides a fourth measure of impaired self-awareness.

Anderson, S.W., & Tranel, D. (1989). Awareness of disease states following cerebral infarction, dementia, and head trauma: Standardized assessment. The Clinical Neuropsychologist, 3, 327-339.