Impulsivity and Traumatic Brain Injury: the Relations Among Behavioral Observation, Performance Measures, and Rating Scales

Objective: To assess the interrelations of neuropsychological tests and rating scales with in vivo behavioral observation of impulsive behavior, accounting for the mode of expression (verbal or motor).

Design: Cross-sectional, correlational.

Setting: An urban, inpatient rehabilitation facility in the Midwestern United States.

Participants: Forty patients who were hospitalized in the traumatic brain injury unit.

Main Outcome Measures: Impulsivity Rating Scale and Agitated Behavior Scale (completed by rehabilitation therapists), Barratt Impulsivity Scale (patient self-report), neuropsychological tests, and in vivo behavioral observation of impulsivity using a structured checklist during rehabilitation therapy.

Results: Relations of impulsivity rating scales and performance tests to in vivo behavior dissociated. Verbal impulsivity was best assessed by rating scales and was largely unrelated to performance measures of impulsivity, whereas motor impulsivity was best assessed by performance tests and was unrelated to rating scales. Performance tests also had poor specificity, showing equally strong associations with tests of other neuropsychological domains.

Conclusions: Impulsivity is a multidimensional construct that should be assessed in a variety of ways. Using either rating scales or neuropsychological tests alone will not likely yield a comprehensive representation of TBI patients' impulsive behaviors. In vivo observation in the clinical setting showed strong ability to identify impulsivity in the presence of global deficits.