Kids Health Info

Brain injury - Monitoring and insight

  • Monitoring and insight skills enable people to think about, evaluate and anticipate the consequences of their actions. Sometimes these skills are affected by a brain injury.

    What are monitoring and insight?

    There are a collection of cognitive, or thinking, skills that are often discussed as a group and called 'higher level thinking skills' or 'executive functions'. These skills include monitoring and insight. These skills help people to reflect, evaluate and anticipate the consequences of their actions so they can work effectively and interact appropriately with others.

    Examples of problems with monitoring and insight

    The following list outlines some of the common difficulties that could indicate problems in this area.  These difficulties would tend to be seen on an everyday basis.

    The person:

    • produces work that has a number of mistakes, or appears to have been completed in a careless manner
    • monopolises conversations
    • keeps talking when others are no longer interested
    • exhibits unawareness of limitations or difficulties they are experiencing, either physical or cognitive
    • has unrealistic goals, plans or expectations.

    What strategies might help?

    • Encourage the child/young person to regularly check their work, and to make this a routine step when doing tasks.
    • Agree upon a signal which indicates it is time to stop talking.
    • Encourage taking turns in conversations.
    • Have external aides which illustrate ongoing performance on different tasks.
    • Gently remind the person of their difficulties and limitations.
    • Explain the positive and negative effects of certain actions.
    • Work through possible consequences that can occur in different types of situations.

    Who do I see and how is it diagnosed?

    Difficulties with monitoring and insight, as well as other cognitive difficulties, are formally identified by having a neuropsychological assessment. A neuropsychologist can help develop compensatory and management strategies that are suitable for each individual child and their particular cognitive strengths and weaknesses. A clinical psychologist may also be able to provide individual strategies to help a child or adolescent cope with monitoring and insight problems.

    Key points to remember

    • Monitoring and insight belong to a group of skills that are often referred to as higher level thinking skills, or executive functions.
    • There are strategies that can be used to help children who have poor monitoring and insight.
    • Difficulties with monitoring and insight are formally identified in a neuropsychological assessment.

    For more information

    Developed by the RCH Paediatric Rehabilitation Service, based on the Monitoring and Insight factsheet produced by the Brain Injury Service, The Children's Hospital at Westmead.First published February 2007. Updated November 2010.

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This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.