Distractor avoidance is achieved by active control rather than passive exclusion.

Traumatic brain injury (TBI) is a complex neurological condition caused by external mechanical forces that cause temporary or permanent impairment of brain function with wide-ranging physical, cognitive, and psychosocial consequences []. Personality change is considered one of the most disabling but least understood effects of TBI, affecting social adjustment, family life, and impacting rehabilitation outcomes []. Studies vary in how they define personality change including constructs spanning apathy to disinhibition []. As a result, it is often unclear which constructs are integral to personality change itself, as opposed to being part of broader cognitive or behavioral shifts. This diversity of definitions has led to various ways of classifying personality change making it hard to report comparable prevalences and, therefore, estimate the risk of personality change after TBI []. Patients and families affected by brain injury cite information about outcomes as important during the early stages of injury [] but to date, there has been no systematic synthesis of the long-term prognosis of post-TBI personality change. Similarly, treatment options for secondary personality change have not been based on a systematic analysis of the literature [] and it is not clear which treatments are used in those affected by post-TBI personality change. Finally, acquired personality change is traditionally associated with damage to the prefrontal cortex []. However, studies on other forms of acquired brain injury, such as tumor resection [] and acquired brain injury more broadly [], indicate that secondary personality change is associated with a far wider range of lesions. Understanding the diversity of lesions associated with post-TBI personality change may be useful in characterizing the clinical presentation and neurocognitive basis of changes in affected patients. Consequently, we completed a systematic review and meta-analysis to i) understand the most common symptoms associated with post-TBI personality change; ii) provide a meta-analytic prevalence of personality change after TBI; iii) review long-term outcomes and treatment, and; iv) review lesion locations associated with TBI-related personality change.