Moral reasoning and decision-making in adolescents who sustain traumatic brain injury

ABSTRACT

Objective: Emerging evidence suggests that moral processes are disrupted by traumatic brain injury (TBI). The objective of this study was to explore moral reasoning (MR) and decision-making in adolescents with TBI, and to examine potential associations with global manifestations of social competence.

Design: This retrospective, cross-sectional research design compared MR and decision-making in adolescents with mild TBI (n = 20), moderate-severe TBI (n = 23) and typically developing controls (n = 93).

Methods: Participants completed a visual task of socio-moral reasoning (SoMoral) and the Index of Empathy for Children and Adolescents. Their parents completed questionnaires documenting their child’s behavior (Child Behavior Checklist) and adaptive functioning (Adaptive Behavior Assessment System-Second Edition).

Main results: Adolescents with both mild and moderate-severe TBI displayed more immature MR than typically developing peers. Participants with TBI also provided fewer socially adapted decisions. Closer inspection revealed that this difference was apparent only in the mild TBI group. No significant group differences were observed for empathy, behavior or adaptive skills.

Conclusions: Sustaining TBI appears to affect adolescents’ ability to provide mature moral justifications when faced with moral dilemmas representative of everyday social conflicts. These difficulties do not appear to be associated with behavior problems, reduced empathy, or adaptive functioning.

KEYWORDS:

• Moral reasoning
• social cognition
• traumatic brain injury
• adolescence

Disclosure Statement

The authors report no conflicts of interest. This study was funded in part by the Fonds québecois de la recherche en santé (MB) and the Victoria Neuroatrauma Initiative (MB, VA, JD), as well as a scholarship to EV from the Government of Chile (CONICYT). The funding bodies were not involved in the study design, collection, analysis or interpretation of data, nor in the writing of the manuscript and the decision to submit the article for publication.

Additional information

Funding

This work was supported by the Victoria Neurotrauma Initiative; Fonds de la recherche en Santé du Québec; and a Government of Chile scholarship to E.V-E.