OBJECTIVE: To measure metacognition in adults aging with moderate-severe traumatic brain injury (TBI) through objective (task-based) and subjective (self-report) measures to determine association between measures, and ability to predict executive functioning (EF), emotional functioning, and functional outcome.METHOD: 130 individuals (TBI n = 102; healthy controls (HC) n = 28) were included. Participants completed objective tasks of metacognition and EF, and self-reported measures of metacognition (MCQ-30), psychiatric symptoms (BSI-18), and community participation (PART-O). The objective metacognitive task and MCQ-30 subscales were used as predictors of EF, anxiety, and community participation. Post-hoc analyses examined the association between objective and subjective metacognitive measures in TBI subgroups (overconfident, metacognitively accurate). RESULTS: The objective metacognitive task and one self-report subscale predicted EF [F(2) = 9.69, p < 0.001, R2 = 0.17]. Two self-report subscales predicted anxiety [F(2) = 19.15, p < 0.001, R2 = 0.28]. No variables predicted community participation. There was a significant interaction between the metacognitive groups (overconfident, accurate) and MCQ-30 on objective metacognitive performance [R2 = 0.23, p = 0.037].CONCLUSION: Individuals aging with TBI demonstrated metacognitive deficit 45% of the time and when they did, ~90% over-estimated their ability. Both objective and subjective metacognitive measures predicted aspects of functional outcomes. However, self-report and objective metacognitive measures are related only when objective metacognitive performance is high, confirming long-standing concerns that self-report may be unreliable when awareness of deficit is present. These findings challenge the predictive validity of self-report measures of metacognition.
Metacognition in Individuals Aging with Traumatic Brain Injury
