Self-regulation abilities in children with severe traumatic brain injury: a preliminary investigation of naturalistic action.

Research suggests that the occurrence of a traumatic brain injury (TBI) in childhood may disrupt self-regulation abilities, putting children at risk for difficulty on everyday tasks requiring self-regulation throughout their development. In the current exploratory study, a novel age-appropriate task assessed the ability to perform three familiar tasks using real objects while adhering to specific rules. Performance of children (ages 8-16) with severe TBI (n = 11) on the naturalistic task was compared to that of typically developing children (n = 21), including measures of the amount/types of errors and number of broken rules. The children with TBI exhibited significantly increased use of distractor objects in place of target objects as compared to the non-injured children. Additionally, children with TBI demonstrated trends of increased breaking of rules during the task and failure to include necessary steps. The preliminary results support the theory that children with severe TBI possess inefficient supervisory processes of self-regulation, corresponding to a decreased ability to carry out goal-based top-down processing. They may instead exhibit a bias towards a bottom-up approach, depending primarily on environmental cues such as the objects present to guide their actions, thus impeding self-regulation abilities.