Journal of the International Neuropsychological Society

Special Series

Effects of Moderate to Severe Traumatic Brain Injury on Anticipating Consequences of Actions in Adolescents: A Preliminary Study

Lori G. Cooka1a2 c1, Gerri Hantena3a4, Kimberley D. Orstena4, Sandra B. Chapmana1a2, Xiaoqi Lia3, Elisabeth A. Wildea3a5a6a7, Kathleen P. Schnellea3 and Harvey S. Levina3a5a7

a1 Center for BrainHealth, The University of Texas at Dallas, Dallas, Texas

a2 School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, Texas

a3 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas

a4 Department of Psychology, Rice University, Houston, Texas

a5 Department of Neurology, Baylor College of Medicine, Houston, Texas

a6 Department of Radiology, Baylor College of Medicine, Houston, Texas

a7 Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas


For this pilot study, we compared performance of 15 adolescents with moderate–severe traumatic brain injury (TBI) to that of 13 typically developing (TD) adolescents in predicting social actions and consequences for avatars in a virtual microworld environment faced with dilemmas involving legal or moral infractions. Performance was analyzed in relation to cortical thickness in brain regions implicated in social cognition. Groups did not differ in number of actions predicted nor in reasons cited for predictions when presented only the conflict situation. After viewing the entire scenario, including the choice made by the avatar, TD and TBI adolescents provided similar numbers of short-term consequences. However, TD adolescents provided significantly more long-term consequences (p = .010). Additionally, for the Overall qualitative score, TD adolescents’ responses were more likely to reflect the long-term impact of the decision made (p = .053). Groups differed in relation of the Overall measure to thickness of right medial prefrontal cortex/frontal pole and precuneus, with stronger relations for the TD group (p < .01). For long-term consequences, the relations to the posterior cingulate, superior medial frontal, and precentral regions, and to a lesser extent, the middle temporal region, were stronger for the TBI group (p < .01). (JINS, 2013, 19, 1–10.)

(Received May 02 2012)

(Revised October 02 2012)

(Accepted October 02 2012)

(Online publication January 14 2013)


  • TBI;
  • Adolescence;
  • Virtual reality;
  • Social;
  • Decision making;
  • Brain structure


c1 Correspondence and reprint requests to: Lori G. Cook, Center for BrainHealth, The University of Texas at Dallas, 2200 W. Mockingbird Lane, Dallas, TX 75235. E-mail: