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Research Articles
Introduction
Poor impulse control is a common feature in patients with traumatic brain injury (TBI; McAllister, 2008). High impulsivity might result in a wide range of problematic behaviors, such as irritability, aggression, loss of temper, impatience, suicidal behaviors, or poor decision making, which may impede community and vocational reintegration and are considered as obstacles to rehabilitation. Several lines of thought suggest that a failure of inhibition-related mechanisms in patients with TBI might account for difficulties in inhibiting impulsive and habitual behaviors and socially inappropriate responses (Ponsford, Sloan, & Snow, 2013; Rao & Lyketsos, 2000; Tate, 1999). Because inhibitory control is associated with frontal-subcortical areas that are frequently damaged after a TBI (e.g., Levin & Kraus, 1994), we might expect these patients to show high levels of impulsivity and inhibition impairments. Crucially, a recent meta-analysis emphasized that prepotent response inhibition (the ability to inhibit a dominant or automatic motor response) in classic response inhibition paradigms such as the stop-signal task revealed a moderately sized impairment in adults with mild to severe TBI (Dimoska-Di Marco, McDonald, Kelly, Tate, & Johnstone, 2011). In the current study, both impulsivity and inhibition are considered as multidimensional constructs, which should allow a more specific understanding of the cognitive mechanisms associated with impulsive behaviors after a TBI.
Some authors recently underscored the need to consider the various facets of impulsivity. More specifically, Whiteside and Lynam (2001) developed the Urgency-Premeditation-Perseverance-Sensation seeking (UPPS) Impulsive Behavior scale, which measures four dimensions of impulsivity: urgency (the tendency to experience strong reactions, frequently under conditions of negative affect); (lack of) premeditation (the tendency to think and reflect on the consequences of an act before engaging in that act); (lack of) perseverance (the ability to remain focused on a task that may be boring or difficult); and sensation seeking (the tendency to enjoy and pursue activities that are exciting and openness to trying new experiences). This multidimensional conception of impulsivity allows researchers to demonstrate significant relationships between the four dimensions of impulsivity and several psychopathological states and/or problematic behaviors, such as addiction, aggressivity, antisocial conduct, attention deficit and hyperactivity disorders, and risky sexual behaviors in non-brain-damaged persons (e.g., Miller, Flory, Lynam, & Leukefeld, 2003). Recently, a short version of the...