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Journal of Traumatic Stress

December 2013, 26, 780–783

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

Method is imposed. Both general set shifting as indexed by the num-


ber of errors prior to, and on the extradimensional shift (i.e.,
Participants
Pre-Extradimensional Set Shift and Extradimensional Set Shift
Forty-four 8- to 12-year-olds participated. Four children were errors) as well as stages reached (i.e., 1–9) are included in
excluded from the final sample, two due to an Intelligence Quo- the present study. Higher scores on the error measures indi-
tient (IQ) score of 70 or below, and two due to technical diffi- cate poorer Intra-/Extradimensional Set Shift, whereas a higher
culties with the computer program. The final sample consisted score on the Intra-/Extradimensional Set Shift stages measure
of 21 (14 girls; M age = 9.48 years, standard deviation [SD] = is indicative of better Intra-/Extradimensional Set Shift perfor-
1.54) maltreated children (physically abused and witnessed vi- mance. A mean Intra-/Extradimensional Set Shift score was
olence: 23.8%, n = 5; witnessed domestic violence: 61.9%, n = composed of the three subscales (z scores).
13; or neglected: 14.3%, n = 3) who were recruited through the
Child Protective Services (CPS) and domestic violence shelters. Delis-Kaplan Executive Function System Color-Word
Another 22 (15 girls; M age = 9.50 years, SD = 1.50) children Interference Test. The Delis-Kaplan Executive Function
served as the contrast group (nonmaltreated) and were recruited System Color-Word Interference Test (Delis, Kaplan, &
through schools in the same areas as children who had endured Kramer, 2001) is characterized by inhibiting prepotent re-
maltreatment. Parents of 17 maltreated children and 20 non- sponses to read color words, and instead name the color in
maltreated children completed the TSCYC. One nonmaltreated which words are printed. In the present study, mean scores on
child had an invalid score on the dissociation scale and is ex- number of errors, the associated response time measure for
cluded in the overall analysis and the follow-up analysis for the this condition, and the contrast time score are used as an in-
dissociation subscale in particular. Eleven children in the mal- dex of inhibition. The contrast score is a measure based on
treatment group were Europeans, whereas 10 were of a Middle the discrepancy between reading words and the inhibition of
Eastern and African descent. In the nonmaltreatment group, 16 reading words. Raw scores were age normed before included in
were of European descent, but also Middle Eastern (n = 5) and analyses.
Asian (n = 1) children participated. Children in the two groups
Trauma Symptom Checklist for Young Children. The
were matched on age and IQ.
Trauma Symptom Checklist for Young Children (TSCYC;
Measures Briere et al., 2001) is a 90-item parent-report measure on chil-
dren’s trauma- and abuse-related symptomatology. Responses
Wechsler Abbreviated Scale of Intelligence. The Wech- were given on a 4-point scale ranging from never to almost
sler Abbreviated Scale of Intelligence (WASI; Psychological all the time, and assessed the child’s behavior during the last
Corp., 1999) provides a brief estimate of intelligence that is month. Standardized t scores on clinical symptom scales of
normed for participants between the ages of 6 through 89 years. Posttraumatic Stress-Total, Dissociation, Anxiety, and Depres-
The primary variable of interest in the present study was the sion were included. Higher scores on these scales indicate more
combined standardized t score of the two subtest’s vocabulary symptoms. Clinical scales on the TSCYC have all reached good
and matrix reasoning. reliability (Cronbach’s α = .87–.93).
Cambridge Neuropsychological Test Automated Battery Procedure
(Cambridge Cognition, 2006). The Spatial Working Mem-
ory test measures updating and monitoring in working memory. Testing was carried out in a quiet room during a single session.
Participants have to find blue, squared tokens in boxes displayed Parents completed the TSCYC and a form asking about CPS
on the screen. Gradually, the number of boxes increases from involvement, which is the basis for grouping the children into
three to eight. Touching a box where the participant already has different maltreatment subtypes. The regional ethic committee
found a token is considered an error. The variables of interest for approved the study.
the current study were total errors and strategy. A low score on
Statistical Analysis
Spatial Working Memory total errors indicates good working
memory. The Spatial Working Memory strategy variable is an Chi-square analysis and one-way ANOVA were carried out
index of the strategy used by the participant to remember where to investigate differences between the two groups on demo-
blue tokens were previously found. A high score on this vari- graphic variables such as gender and ethnicity. Additionally,
able represents poor use of an efficient strategy. A mean Spatial trauma-related psychopathology was assessed and differences
Working Memory score was composed of the two subscales between the maltreated and nonmaltreated children on these
(z scores). variables were investigated also using one-way ANOVA. To
The Intra/Extradimensional Set Shift task is designed to as- explore the association between neuropsychological function-
sess shifting abilities. In the Intra-/Extradimensional Set Shift ing and trauma-related psychopathology, Pearson’s correla-
task, the subject is presented with two simple, color-filled tions were employed. In the case of significant correlations,
shapes. The subject must learn which of the two stimuli is the significant symptomatology measures were included in the
correct by touching it. During the task, a dimensional shift main analysis as covariates. As reported above, each of the

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

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as informants might be less reliable than other raters (Treutler Battery: Performance in 4- to 12-year-old children. Developmental Neu-
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functioning irrespective of psychopathological symptoms. stress throughout the lifespan on the brain, behaviour and cognition. Nature
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found that differences in symptomatology and functioning de- and their contributions to “frontal lobe” tasks: A latent variable analysis.
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Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.

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