Behaviour analysis

group (r=.74, p=.001). An initial one-way ANOVA found no significant difference between the ABI and NH group for self-reported behavioural difficulties (F (1, 38) = 2.20, p=.147). An ANCOVA controlling for SES revealed that the ABI group scored

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significantly higher than the comparison group on self-report behavioural difficulties (F (1, 37) =4.57, p=.039). The mean estimates for both groups were close to

average. Parent-reported behavioural difficulties were significantly higher for the ABI group compared to the NH group (F (1, 38) =8.63, p=.006). The mean score for the NH group was close to average and the mean score for the ABI group was slightly raised. Hypothesis 4, that the ABI group will display more behavioural difficulties than the NH group was supported.

6.7.8 Relationships between moral reasoning and behaviour. For the ABI group, there were no significant relationships between Time 1 SRM-SF scores and self-report behavioural difficulties (r=.13, p=.577) or parent-report behavioural difficulties (r= -.27 p=.254).There were no significant relationship between Time 1 SRM-SF scores and self-report behavioural difficulties (r= -.14, p=.562) or parent- report behavioural difficulties (r= -.36, p=.154) for the NH group. Hypothesis 5, that there will be a significant negative relationship between scores on the SRM-SF and behavioural difficulties for the ABI and NH group was not supported.

For the ABI group, Time 1 So-Mature scores were significantly related to self-report behavioural difficulties (r= -.52, p=.020) but not to parent-report

behavioural difficulties (r= -.09, p=.712). Time 1 So-Mature scores did not correlate with self-report behavioural difficulties (r= -.04, p=.860) or parent-reported

behavioural difficulties (r= -.25, p=.327) for the NH group. Hypothesis 6, that there would be a significant negative relationship between So-Moral scores and

behavioural difficulties was partially supported for the ABI group but not for the NH group.

6.7.9 Exploratory analyses. Exploratory analysis was performed to explore differences in moral reasoning scores for the TBI and nTBI subgroups of the ABI group, and also to explore the effect of injury severity and age at injury An independent t-test found no significant difference between the TBI and non-TBI subgroups on SRM-SF scores (t (18) =.98, p=.448). There was no significant difference between the TBI and non-TBI subgroups on So-Mature scores (t (18) = .23, p=.393). Injury severity data was incomplete for the nTBI subgroup so could not be used for analysis. For the TBI subgroup (n=11), seven had a mild TBI, one a moderate TBI, two had a severe TBI and the severity was unreported for one participant. Comparing the mild (n=7) to moderate and severe TBIs (n=3), there were no significant difference between SRM-SF scores (t (8) =1.17, p=.393) or So- Mature scores (t (8) = .61 p=.322).

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For the ABI group as a whole there was no significant relationship between age at injury and So-Mature scores at Time 1 (r=-.03, p=.912) or SRM-SF scores at Time 1 (r=.43, p=.057), although the latter neared significance. For the TBI

subgroup there was no significant relationship between age at injury and So-Mature scores at Time 1 (r=-.11, p=.753) or SRM-SF scores at Time 1 (r=.34, p=.309). For the nTBI subgroup there was no significant relationship between age at injury and So-Mature scores at Time 1 (r=.09, p=.829) or SRM-SF scores at Time 1 (r=.52, p=.154).For the ABI group as a whole there was no significant relationship between time since injury and So-Mature scores at Time 1 (r=.09, p=.706) or SRM-SF scores at Time 1 (r=-.19, p=.433). For the TBI subgroup, there was no significant

relationship between time since injury and So-Mature scores at Time 1 (r= -.06, p=.853) or SRM-SF scores at Time 1 (r= -.40, p=.221). For the nTBI subgroup, there was no significant relationship between time since injury and So-Mature scores at Time 1 (r= .27, p=.489) or SRM-SF scores at Time 1 (r= -.16, p=.683).

The police contact questions were added as exploratory variables. In total, three participants reported some police contact. These participants were all male, with an average age of 16 years (SD 2.15). Only one parent reported that their child had had some police contact, which was a parent of one of the three who self- reported police contact. The two participants who had self-reported police contact only were from the NH group. Both reported having been in trouble with the police for their behaviour, and one reported being cautioned once. The participant with self and parent-reported police contact was from the ABI group (TBI; severity unknown) and reported being in trouble with the police because of their behaviour, and

arrested and cautioned once. The same information was reported by their parent. For this ABI participant, their SRM-SF score at Time 1 was 206 (Stage 2) which is a stage lower than the mean for the ABI group in this study (transition Stage 3 (2)). Their So-Mature score at Time 1 was 38 (transition from Stage 2-3), which matches the mean stage of the ABI group in this study.

6.8 Summary

The aims of this study were to a) examine the psychometric properties of two measures of moral reasoning, the SRM-SF and So-Mature, b) use these measures to compare moral reasoning levels of an ABI and NH group, and c) investigate how behaviour differs between the ABI and NH group, and whether low moral reasoning is related to behavioural difficulties.

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Results indicated that the SRM-SF and So-Mature had satisfactory

psychometric properties for the ABI and NH group. The test-retest reliability of the SRM-SF and So-Mature was good or excellent for both groups. Internal consistency of the SRM-SF was higher for the NH group than the ABI group, which was more inconsistent, being moderate at Time 1 and excellent at Time 2. This suggests that adolescents with ABI may be less consistent in their reasoning across different moral values (e.g. truth, affiliation, legal justice). Internal consistency of the So- Mature was overall higher than for the SRM-SF, ranging from substantial-excellent for the ABI and NH group. The So-Moral and So-Mature measures involve

participants imagining they are in situations (presented on a computer screen), making a response decision and then explaining that decision. This may lead to more consistent reasoning compared to reasoning about a wide range of moral values on the SRM-SF, “e.g. why is it very important/important/not important for people to keep promises, if they can, to friends?” The SRM-SF and So-Mature showed convergent validity for the NH group but not for the ABI group. This suggests that for adolescents with ABIs, moral reasoning about values does not correlate with moral reasoning about response decisions they have made in certain situations. Again, this would suggest an inconsistency of moral reasoning across values and situations for adolescents with ABI. The ABI group had significantly lower general intellectual functioning than the NH group, which may impact on the ability to apply moral reasoning about values to specific situations.

The ABI group were on average reasoning at transition Stage 3 (2) and the NH group were on average reasoning at Stage 3 on the SRM-SF but the difference in score was not significant. A significant difference between groups was found for the So-Mature, with the ABI group reasoning at the transition from Stage 2-3 while the NH group were reasoning at the transition from Stage 3-4. Exploratory analysis found no significant differences between the TBI and nTBI subgroup on either the SRM-SF or So-Mature, suggesting that both TBIs and ABIs can have an effect on moral reasoning maturity. No significant differences were found between mild and moderate/severe TBIs, which is in line other studies (Beauchamp et al., 2012; Dooley et al., 2012) but may also be due to the small number of TBI participants with reported severity information (n=10). The sub-group analyses should be interpreted with caution as they were exploratory and may have been

underpowered. The significant difference between the ABI and NH group for So- Mature but not SRM-SF scores suggests that reasoning about moral values is not as affected following an ABI than reasoning about moral response decisions.

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Adolescents with ABIs may have difficulty with moral or social decision-making rather than an understanding and appreciation of moral values; they understand moral values but may struggle to apply them to their own decision-making. It has been found that how people act in moral dilemmas differs from how they say they will act in such situations (Patil, Cogoni, Zangrando, Chittaro, & Silani, 2014); this effect may be more pronounced in adolescents with ABIs, but further research is needed in this area.

In terms of behaviour, the ABI group displayed more behavioural difficulties than the NH group. The ABI group scored significantly higher on self-reported behavioural difficulties than the NH group, after controlling for SES. The ABI group also scored significantly higher on parent-reported behavioural difficulties than the NH group. Self-report difficulties were close to average for both groups but ‘slightly raised’ on the parent report for the ABI group, which may suggest a lack of insight into one’s own behavioural difficulties among the ABI participants, which has been found following brain injuries (Ownsworth, McFarland, & Young, 2002; Sherer, Hart, & Nick, 2003). In addition, the self and parent report behavioural difficulties were more strongly related for the NH group than the ABI group. For the NH group, there were no relationships between moral reasoning and behaviour. For the ABI group, there was a significant negative relationship between self-report behavioural

difficulties and scores on the So-Mature, but no relationship between behaviour and scores on the SRM-SF. The relationships between behaviour and So-Mature but not SRM-SF scores may reflect the fact that the So-Mature involves reasoning about response decisions made in everyday situations, so scores on this measure may more closely relate to behaviour, compared to reasoning about values measured in the SRM-SF. A lack of relationships between the So-Mature and behaviour for the NH group is in contrast to previous research which has found relationships between the So-Mature and aggressive behaviour for TD adolescents (Dooley et al., 2010).

Police contact questions were added as exploratory variables, as an initial investigation into whether moral reasoning scores are related to offending behaviour in an adolescent ABI sample. Only three of the 40 participants reported any police contact, with only one of these being from the ABI group. The moral reasoning scores for this participant was comparable with the mean scores for the ABI group on the So-Mature, but one stage lower than the mean for the ABI group on the SRM-SF. Future studies using samples of adolescents with ABIs who have been

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involved in offending behaviour could further explore the relationship between moral reasoning and offending in this population.

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