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1 Augusti y Melinder - 2013 - Maltreatment Is Associated With Specific Impairmen
1 Augusti y Melinder - 2013 - Maltreatment Is Associated With Specific Impairmen
BRIEF REPORT
Maltreatment Is Associated With Specific Impairments in Executive
Functions: A Pilot Study
Else-Marie Augusti and Annika Melinder
The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway
Child maltreatment is associated with a host of adverse consequences. Few studies exist that map maltreated children’s performance on
neurocognitive tests particularly sensitive to brain and behavior associations. The aim of the present study was to investigate whether
maltreated children differed in their executive functioning compared to their nonmaltreated peers, and if they did so in specific ways. Tasks
aimed at measuring set shifting, spatial working memory, and inhibition were administered. Trauma-related symptomatology was further
assessed to study the potential effect of maltreatment-related psychopathology on executive functioning. A univariate analysis of variance
showed that maltreated children (n = 21) performed significantly poorer compared to their nonmaltreated peers (n = 22) on the Spatial
Working Memory task. Symptoms of trauma-related psychopathology were not associated with performance on the executive functions
tests. In conclusion, maltreatment was not associated with a global deficit in children’s executive functions. Thus, when considering
maltreated children’s cognitive functioning, specific measures of executive functions should be applied.
The life-cycle model of stress (Lupien, McEwen, Gunnar, as anxiety, depression, or posttraumatic stress disorder (PTSD),
& Heim, 2009) identifies children from the age of 8 years all of which are associated with problems in executive functions
and into early adulthood at a developmental stage where the (Phillips, Drevets, Rauch, & Lane, 2003).
prefrontal cortex (PFC) is particularly prone to be affected by Several studies have examined executive functions in mal-
stressors such as child maltreatment (Lupien et al., 2009). The treated children (e.g., DeBellis, Hooper, Spratt, & Woolley,
PFC is largely subserving executive functions (Sowell, Trauner, 2009; Samuelson, Krueger, Burnett, & Wilson, 2010). In a sam-
Gamst, & Jernigan, 2002). ple of individuals with maltreatment-related PTSD, DeBellis
Executive functions may be defined as the skills essential et al. (2009) found a negative association between maltreat-
for purposeful, goal-directed activity. Miyake et al. (2000) pro- ment and executive functions. Although maltreatment-related
posed a model of executive functions, comprising shifting be- PTSD was associated with the most severe executive function
tween mental sets or tasks, updating and monitoring of informa- deficits, maltreated children without PTSD performed poorer
tion in working memory, and inhibition of dominant responses. than nonmaltreated controls.
These three subsets of executive functions are inter-related but However, previous studies have tested a diversity of execu-
also distinct abilities (Miyake et al., 2000). tive functions and not grouped executive functions as clearly
Maltreatment might affect executive functions either through within inhibition, shifting, and working memory updating. The
the direct effect of stress on PFC development and associated neuropsychological tests used in studies on maltreated children
executive functions (Lupien et al., 2009), or indirectly through have been critiqued for relying on several executive functions
the development of maltreatment-related psychopathology such simultaneously, whereas in this study we aimed at using brain–
behavior sensitive tests known to be tapping specific executive
functions (Luciana & Nelson, 2002). According to Myiake’s
We thank all the children and their parents for participating in the study. We model, not all executive functions need to be similarly affected
are also grateful to Diane Amundsen for invaluable help with recruiting par- by for instance stress. Thus, it is important to investigate what in
ticipants. The study was supported by grants from the Norwegian Directorate particular maltreated children struggle with within this frame-
for Children, Youth, and Family Affairs (06/34707) to both authors.
work. Although studies have compared maltreated groups with
Correspondence concerning this article should be addressed to Else-Marie and with-out PTSD (DeBellis et al., 2009), symptom scales
Augusti, Department of Psychology, University of Oslo, P.O. Box 1094 Blin-
dern, 0317 Oslo, Norway. E-mail: e.m.augusti@psykologi.uio.no of different trauma-related emotional problems have not been
consistently included and accounted for in previous cognitive
Copyright C 2013 International Society for Traumatic Stress Studies. View
this article online at wileyonlinelibrary.com research on this group of children, the present study aimed to
DOI: 10.1002/jts.21860 address this gap.
780
Executive Functions in Maltreated Children 781
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
782 Augusti and Melinder
neurocognitive measures consisted of several variables mea- eral cognitive functioning between the maltreated (M = 89.05,
suring different aspects of working memory, set shifting, and SD = 10.85) and nonmaltreated (M = 95.68, SD = 10.57)
inhibition abilities, respectively. To explore group differences children. Lastly, to assess potential associations between psy-
on the main neurocognitive variables all variables were stan- chiatric symptoms and the dependent measures on executive
dardized using z scores and subsequently subvariables address- functions, Pearson correlations were performed between vari-
ing same executive function were combined into one mean z ables on the abovementioned TSCYC subscales and executive
score each. First, three univariate ANOVAs were carried out en- function measures for each group separately. None of the cor-
tering separately three mean scores; Spatial Working Memory, relations turned out significant (rs = −.37 to .13). Thus, these
Intra-/Extradimensional Set Shift, and inhibition as dependent symptom scales are not further considered.
variables. Fixed factor comprised the group of maltreated and Significant group differences were revealed on the Spatial
nonmaltreated children, respectively. If any significant differ- Working Memory measure (η2 = .10, p = .047) when the Spa-
ences between the groups emerged on any of the mean variables, tial Working Memory mean score was entered as the dependent
separate univariate ANOVAs were carried out to investigate the variable. Maltreated children performed significantly poorer on
specific associations between maltreatment status and the dif- this measure compared to the contrast group. Furthermore, a
ferent neurocognitive subvariables. At this point, all significant significant main effect of group was revealed in relation to the
levels were Bonferroni corrected to avoid family wise error. Spatial Working Memory strategy (η2 = .12, p = .017). Post hoc
Only results significant on a p = .05 or below will be reported comparisons revealed that maltreated children showed signif-
and commented upon. icantly poorer performance on the strategy measure than their
nonmaltreated peers (p = .017, r = .36). No significant group
Results differences were revealed on the Spatial Working Memory error
Chi-square analysis revealed no significant difference on eth- score. The Intra-/Extradimensional set shift and inhibition mean
nic origin between the two groups, and ethnicity was therefore variables did not yield significant between-group differences.
not considered in any further analysis investigating group differ-
Discussion
ences. A repeated measures ANOVA with scores on the relevant
variables from the TSCYC varied within and maltreatment sta- A negative association between working memory strategy and
tus as a between-subjects factor was carried out. The between- maltreatment was found, with the maltreated group using a
subjects factor turned out to be significant, F(2, 34) = 6.96, poorer strategy to complete the Spatial Working Memory task
p = .012. Follow-up one-way ANOVA revealed that children compared to their nonmaltreated peers. This is in line with re-
in the maltreatment group had significantly more problems on search suggesting that central executive dependent tasks, such
all symptom scales, except from dissociation, compared to the as strategies used in working memory, are particularly prone to
contrast group (see Table 1). Two separate one-way ANOVAs be affected by stress (Eysenck, Derakshan, Santos, & Calvo,
revealed no significant gender differences or differences in gen- 2007; Gathercole, Pickering, Ambridge, & Wearing, 2004).
Table 1
Means and Standard Deviations on Neuropsychological Measures and Symptom Scales for Maltreated and Nonmaltreated Children
Maltreated Nonmaltreated
n = 21 n = 22
Variable M SD M SD F (1, 40)
Intra-/extradimensional set shift mean score 8.66 3.72 7.81 3.80 2.70
Spatial working memory mean score 38.28 11.12 30.97 15.09 4.18*
Spatial working memory errors 40.23 19.65 31.90 21.78 1.69
Spatial working memory strategy 36.33 3.56 30.04 11.05 6.71*,a
Inhibition mean score 10.90 2.31 10.17 1.42 .07
n = 17 n = 20
PTSD 59.23 19.49 46.31 6.19 8.01*
Dissociation 48.76 8.04 45.00 2.92 3.63b
Anxiety 56.00 19.60 45.94 7.75 4.35*
Depression 54.70 15.93 45.42 5.55 5.46*
Note. PTSD = posttraumatic stress disorder.
a Bonferroni corrected for family-wise error. b 19 nonmaltreated children are included in this analysis.
*p < .05.
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Executive Functions in Maltreated Children 783
Surprisingly, the number of errors were not affected, which Cambridge Cognition. (2006). CANTABeclipse version 3. Test ad-
suggests that children exposed to high levels of stress at home ministration guide. Cambridge, England: Cambridge Cognition
Limited.
might use more mental energy to arrive at the same result as
their peers, but that the overall effectiveness in working mem- De Bellis, M. D., Hooper, S. R., Spratt, E. G., & Woolley, D. P. (2009).
ory is not negatively affected. In line with attentional control Neuropsychological findings in childhood neglect and their relationships to
pediatric PTSD. Journal of the International Neuropsychological Society,
theory (Eysenck et al., 2007), effectiveness and efficiency in 15, 868–878. doi:10.1017/S1355617709990464
working memory are to some extent independent of each other,
that is, stress and anxiety may pose challenges on strategies in Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive
Function System. San Antonio, TX: Psychological Corp.
working memory without having negative effects on accuracy.
Thus, the present results support a differentiation of the effects Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety
of stress on working memory (Eysenck et al., 2007). and cognitive performance: Attentional control theory. Emotion, 7, 336–353.
doi:10.1037/1528-3542.7.2.336
In contrast to other studies that have demonstrated an asso-
ciation between maltreatment and inhibitory control (Lewis, Gathercole, S. E., Pickering, S. J., Ambridge, B., & Wearing, H. (2004). The
Dozier, Ackerman, & Sepulveda-Kozakowski, 2007), the structure of working memory from 4 to 15 years of age. Developmental
Psychology, 40, 177–190. doi:10.1037/0012-1649.40.2.177
present study did not reveal any such differences. One potential
reason for this lack of effect might be the operationalization Harnishfeger, K. K. (1995). The development of cognitive inhibition: Theories,
of inhibition in the present study. The color-word interference definitions, and research evidence. In F. N. Dempster & C. J. Brainerd
(Eds.), Interference and inhibition in cognition (pp. 175–204). New York,
task used in the present study is considered to represent cogni- NY: Academic Press.
tive inhibition (Harnishfeger, 1995), and it might well be that
children who have endured maltreatment only show deficits in Kitzman, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child wit-
nesses to domestic violence: A meta-analytic review. Journal of Consulting
other types of inhibition (e.g., behavioral). and Clinical Psychology, 71, 339–352. doi:10.1037/0022-006X.71.2.339
Small effect sizes, and small to modest correlations, might
be one reason for not detecting an association between psy- Lewis, E. E., Dozier, M., Ackerman, J., & Sepulveda-Kozakowski, S. (2007).
The effect of placement instability on adopted children’s inhibitory control
chopathology and executive functions in the present study. The abilities and oppositional behavior. Developmental Psychology, 43, 1415–
subclinical nature of the present group of maltreated children 1427. doi:10.1037/0012-1649.43.6.1415
might be an explanation for the lack significant associations be-
Luciana, M., & Nelson, C. A. (2002). Assessment of neuropsychological func-
tween psychopathology and executive functions. Also, parents tion through use of the Cambridge Neuropsychological Testing Automated
as informants might be less reliable than other raters (Treutler Battery: Performance in 4- to 12-year-old children. Developmental Neu-
& Epkins, 2003). The present study suggests that children’s ropsychology, 22, 595–624. doi:10.1207/S15326942DN2203_3
life experiences may to some degree shape their neurocognitive Lupien, S. J., McEwen, B. S., Gunnar, M. R., & Heim, C. (2009). Effects of
functioning irrespective of psychopathological symptoms. stress throughout the lifespan on the brain, behaviour and cognition. Nature
The composition of the maltreatment group is heterogeneous Reviews Neuroscience, 10, 434–445. doi:10.1038/nrn2639
and the complexity of maltreatment represented in this rela- Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A.,
tively small group might have affected the results. It has been & Wagner, T. D. (2000). The unity and diversity of executive functions
found that differences in symptomatology and functioning de- and their contributions to “frontal lobe” tasks: A latent variable analysis.
Cognitive Psychology, 41, 49–100. doi:10.1006/cogp.1999.0734
pend on the type of maltreatment experienced (Pears, Kim, &
Fisher, 2008), but all types of maltreatment result in cognitive Pears, K. C., Kim, H. K., & Fisher, P. A. (2008). Psychosocial and cognitive
impairments (Kitzman, Gaylord, Holt, & Kenny, 2003; Pears functioning of children with specific profiles of maltreatment. Child Abuse
and Neglect, 32, 958–971. doi:10.1016/j.chiabu.2007.12.009
et al., 2008). In line with this, the present study indicates asso-
ciations between stress in the home environment that calls for Phillips, M., Drevets, W., Rauch, S., & Lane, R. (2003). Neurobiology of emo-
CPS involvement or a need for the caregiver and children to tion perception I: The neural basis of normal emotion perception. Biological
Psychiatry, 54, 504–514. doi:10.1016/S0006-3223(03)00168-9
seek shelter from an abusive partner, and children’s executive
functions. Psychological Corp. (1999). Wechsler Abbreviated Scale of Intelligence (WASI)
Future studies on maltreated children should replicate the manual. San Antonio, TX: Psychological Corp.
present study using larger and more homogenous samples. In Samuelson, K. W., Krueger, C. E., Burnett, C., & Wilson, C. K. (2010). Neu-
conclusion, although limited by a small sample size, the present ropsychological functioning in children with posttraumatic stress disorder.
study revealed that maltreatment is not associated with a global Child Neuropsychology, 16, 119–133. doi:10.1080/09297040903190782
deficit in executive functions, but rather specifically associated Sowell, E. R., Trauner, D. A., Gamst, A., & Jernigan, T. L. (2002). Development
with spatial working memory. of cortical and subcortical brain structures in childhood and adolescence:
A structural MRI study. Developmental Medicine & Child Neurology, 44,
4–16. doi:10.1111/j.1469-8749.2002.tb00253.x
References
Briere, J., Johnson, K., Bissada, A., Damon, L., Crouch, L., Gil, E., . . . Ernst, Treutler, C. M., & Epkins, C. C. (2003). Are discrepancies among child, mother,
V. (2001). The Trauma Symptom Checklist for Young Children (TSCYC): and father reports on children’s behavior related to parents’ psychological
Reliability and association with abuse exposure in a multi-site study. Child symptoms and aspects of parent–child relationships? Journal of Abnormal
Abuse & Neglect, 25, 1001–1014. doi:10.1016/S0145-2134(01)00253-8 Child Psychology, 31, 13–27. doi:10.1023/A:1021765114434
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
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