Preliminary investigation of autonomy in adolescent survivors of traumatic brain injury




Kodalen, Kent Marshall

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Objective: The primary goal of this study was to investigate the possibility of a relationship between traumatic brain injury (TBI) and adolescent autonomy. Adolescents and their parent reported on lhree types of autonomy; renective autonomy, reactive autonomy, and functional independence. Adolescent cognitive skills, reading ability, and affective states, along with parent perceptions of !.he adolescents' executive functioning and parent-related stress were assessed in an attempt to elucidate the mechanisms through which TBI and autonomy interact. Participants and Methods: Participants included 20 adolescents, 12 to 19 years of age, with a history ofTS! and 19 age· and gender·matched adolescents wilh no history of TBI. Each adolescent was accompanied by one parent who completed parental reports while the adolescent underwent testing and completed questionnaires. Adolescents were screened for cognitive functioning and reading ability using subtests ofthe Reynolds Intellectual Assessment Scale (RIAS) and the Wide Range Achievement Test _ 4th Edition (WRAT4). Adolescents then completed questionnaires to assess depression (Beck Depression Inventory - 2nd Edition, SOl-TO and anxiety (Beck Anxiety Inventory, BAI). Lastly but most importantly. the adolescents completed questionnaires to assess reflective autonomy using a modified version of the Ryff Psychological Well Being Scale, and reactive autonomy (Adjectives Checklist, ACL). Meanwhile, parents completed a brief demographics questionnaire, a report of their adolescent's functional independence (Adaptive Behavior Assessment System II. ABAS-IO. executive functioning (Behavior Rating Inventory of Executive Functioning, BRIEF), and parenting-related stress (Stress Index for Parents of Adolescents, SlPA). Results: Significant group differences were noted on measures of reflective autonomy, but not on reactive aUlonomy. A history ofTBI was also influential in parent ratings of functional independence and executive functioning, but not levels of parent stress. The adolescents with TBI did not repon higher levels of depression or anxiety. Within the TBI group, significant correlations were found between parent ratings of adolescent functional independence and executive functioning, yet no correlations were found between adolescent and parent reports of autonomy, adolescent reports of autonomy and affect, or between parent ratings of adolescent functional independence/executive functioning and parent stress levels. Conclusions: These findings provide some indication of a potential relationship between TBI and both self-repons and parent repons of autonomy. Adolescent's with a history of TBI in this sample felt less in control of their decision making process regarding actions/behaviors, and were viewed by their parents as are less functionally independent. These findings do not provide any indication of a potential relationship between TBI and an adolescent's ability to resist external innuence. However, the number of participants was limited and there were several other factors which complicate the interpretation of this lack of difference between adolescents with and without TBI. Clearly. further investigation of this phenomenon is warranted, yet these findings suggest that clinicians working with adolescents with brain injury might benefit by considering both internal and external perceptions of autonomy in treatment implementation.



brain injury, adolescent, autonomy