Identifying conflict monitoring as a specific executive component that contributes to impaired self-awareness in patients with acquired brain injury.

Objective: Impaired self-awareness (SA) after acquired brain injury (ABI) has traditionally been linked to deficits in executive functions. However, conflicting findings about this relationship have been reported in the literature. This inconsistency is probably due to the multicomponent nature of both constructs, as not all aspects of executive functions may be equally relevant to all components of self-awareness. This study explored whether offline SA (i.e. metacognitive knowledge) and online SA (i.e. error detection) relate to a less studied executive component, conflict monitoring/resolution.

Method: Twenty-six patients with ABI performed the Three-Conflict Cognitive Control Task (3CCT), an experimental task that allowed to measure the ability to monitor and solve three different types of conflicts (Distractors-filtering, Spatial Stroop and Simon). Measures of SA were collected: offline SA was based on self-informant discrepancy about patient's everyday functional difficulties, and online SA was based on error detection abilities during a performance-based naturalistic task (The Breakfast Conflict Task).

Results: After controlling for global cognition, the conflict monitoring measure of 3CCT demonstarted incremental validity in predicting offline and online SA measured in naturalistic tasks.

Conclusions: Conflict monitoring/resolution seems to be an important component of SA. This finding contributes to further understand the relationship between executive functions and SA. In addition, conflict monitoring/resolution is an executive component that should be considered when designing assessment and intervention strategies to deal with ISA.