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 skills?

    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 child or young 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
    • doesn't have an awareness of limitations or difficulties they are experiencing, either physical or cognitive
    • has unrealistic goals, plans or expectations

    What strategies might help?

    • Encourage the child or 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.

    When to see a doctor?

    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 Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

    Reviewed September 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit


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