Executive functions in trauma-exposed youth: a meta-analysis

[Formula: see text] Environmental predictors of children's executive functioning development

Executive functioning (EF) abilities develop through childhood, but this development can be impacted by various psychosocial environmental influences. Using longitudinal data from the Health Outcome and Measures of the Environment (HOME) Study, a prospective pregnancy and birth cohort study, we examined if psychosocial environmental factors were significant predictors of EF development. Study participants comprised 271 children and their primary caregivers (98.5% mothers) followed from birth to age 12. We identified four distinct EF developmental trajectory groups comprising a consistently impaired group (13.3%), a descending impairment group (27.7%), an ascending impairment group (9.95%), and a consistently not impaired group (49.1%). Higher levels of maternal ADHD and relational frustration appear to be risk factors for increased EF difficulty over time, while higher family income may serve as a protective factor delaying predisposed EF impairment. Important intervention targets might include teaching positive and effective parenting strategies to mothers whose children are at risk for EF dysfunction.

Executive functioning in antisocial behavior: A multi-level systematic meta-analysis

Neurobiological information - including executive functioning - is increasingly relevant for forensic clinical practice, as well as for the criminal justice system. Previous meta-analyses report that antisocial populations show impaired performance on executive functioning tasks, but these meta-analyses are outdated, have limitations in their methodological approach, and are therefore in need of an update. The current multi-level meta-analysis including 133 studies (2008-2023) confirms impaired performance in executive functioning (d=.42), but studies are heterogeneous. Several moderator analyses showed that neuropsychological test used, type of executive function component, and control group characteristics moderated the overall effect. Specifically, matching psychiatric problems in the non-antisocial control group eliminated any differences in executive functioning between groups. No moderation effects were found for assessment quality, hot or cold executive functions, and various population characteristics. These results could indicate that the assessment of executive functioning in antisocial populations may be less relevant for recidivism risk assessment than thought, although this should first be assessed in prospective longitudinal studies. Executive functioning could potentially be used to identify or screen for individuals with certain treatment needs or be used as a responsivity factor, especially in disorders which are often underdiagnosed in criminal justice settings.

Inhibitory control as possible risk and/or resilience factor for the development of trauma related symptoms-a study of the Utøya terror attack survivors

PTSD symptomatology is known to be associated with executive dysfunction. Inhibitory control is a core component of executive functioning, and inhibitory skills are essential both for adequate functioning in everyday life and important in situations following trauma. The aim of the present study was to examine the relationship between trauma exposure, inhibitory control and PTSD symptomatology in adolescent survivors of the terror attack at Utøya, Norway on the 22nd of July, 2011. In this cross-sectional case-control study, 20 trauma exposed adolescents and 20 healthy controls matched in age and gender were compared on a neuropsychological test of cognitive inhibition (Color-Word Interference Test) and a self-report measure of inhibition ability (BRIEF-A). Our analyses revealed that the trauma exposed group differed significantly on the self-reported measure of inhibitory control compared to the control group, but there were no differences between groups on the objective measures of cognitive inhibition. Follow-up analyses with subgroups in the trauma exposed group based on PTSD symptomatology (PTSD + and PTSD-) and the control group revealed that the PTSD- group showed significantly better results than both the PTSD + and the control group on the measures of inhibitory control. Moreover, the follow-up analyses showed that the PTSD + group showed significantly poorer results from the other two groups on the measures of inhibitory control and self-reported inhibition. We conclude that impaired inhibitory control, measured both objectively and by self-reported questionnaire, is related to PTSD symptomatology. Findings suggest that inhibitory dysfunctions may be a vulnerability factor for the development of PTSD symptomatology in trauma exposed adolescents, and thus it seems that the ability to exhibit inhibitory control could be a possible resilience factor to prevent the development of PTSD symptoms.

Working memory performance is related to childhood trauma but not psychotic-like experiences in a nonpsychiatric sample

OBJECTIVE

This project seeks to clarify the impact of childhood trauma and psychotic-like experiences (PLEs) on working memory (WM) and explore gender differences in these relationships. The effect of childhood trauma on WM performance has yet to be explored in individuals with PLEs, despite consistent associations between trauma, psychosis spectrum symptoms, and WM performance.

METHOD

In 466 undergraduates, positive PLEs (Prodromal Questionnaire) and trauma (Childhood Trauma Questionnaire) were examined to determine contributions to WM performance on a spatial n-back task. We conducted hierarchical linear regressions on the total sample and stratified by gender to examine the effects of childhood trauma, positive PLEs, and their interaction on WM performance. Supplemental analyses explored attenuated negative and disorganized symptoms.

RESULTS

Controlling for age, there were no significant main effects of positive PLEs, childhood trauma, their interaction, or three-way interaction including gender in predicting WM. After stratifying by gender, childhood trauma was significantly associated with poorer WM in females only. Post hoc analyses revealed that in the full sample, physical neglect predicted WM performance and was a trend for females, while sexual abuse trended toward predicting WM in males. Supplemental analyses of attenuated negative and disorganized symptoms revealed childhood trauma significantly predicted WM in the full sample and females only for negative symptoms.

CONCLUSIONS

Females who have experienced childhood trauma may be at greater risk for WM problems, irrespective of co-occurring PLEs, suggesting that cognitive difficulties may be partially attributable to history of trauma. These findings have potential implications for intervention strategies in trauma-exposed individuals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Early executive control buffers risk for adolescent psychopathology during the COVID-19 pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on youth mental health, and there is a critical need for research examining individual factors that contribute to increased psychopathology during the pandemic. The current study explored whether executive control (EC) abilities in early childhood interact with COVID-related stress to attenuate risk for adolescent psychopathology during the first 6 months of the pandemic.

METHODS

Participants were 337 youth (49% female) living in a small midwestern city in the United States. Participants completed EC tasks when they were approximately 4.5 years old as part of a longitudinal study investigating cognitive development. At annual laboratory visits during adolescence and before the pandemic, participants (Mage  = 14.57) reported on mental health symptoms. In July and August of 2020, participants (Mage  = 16.57) reported on COVID-related stress and depression, anxiety, and trauma symptoms.

RESULTS

COVID-related stress was associated with increased internalizing problems after controlling for prepandemic symptom levels. Further, the impact of COVID-related stress on adolescent internalizing problems was moderated by preschool EC, with higher levels of EC buffering the effects of COVID-related stress on adolescent internalizing problems.

CONCLUSIONS

Findings highlight the importance of promoting EC early in development, as well as screening for EC deficits and implementing targeted intervention strategies across the lifespan to help reduce the impact of stress on adolescent internalizing problems.

Childhood adversities and mental disorders in first-year college students: results from the World Mental Health International College Student Initiative

BACKGROUND

This study investigates associations of several dimensions of childhood adversities (CAs) with lifetime mental disorders, 12-month disorder persistence, and impairment among incoming college students.

METHODS

Data come from the World Mental Health International College Student Initiative (WMH-ICS). Web-based surveys conducted in nine countries (n = 20 427) assessed lifetime and 12-month mental disorders, 12-month role impairment, and seven types of CAs occurring before the age of 18: parental psychopathology, emotional, physical, and sexual abuse, neglect, bullying victimization, and dating violence. Poisson regressions estimated associations using three dimensions of CA exposure: type, number, and frequency.

RESULTS

Overall, 75.8% of students reported exposure to at least one CA. In multivariate regression models, lifetime onset and 12-month mood, anxiety, and substance use disorders were all associated with either the type, number, or frequency of CAs. In contrast, none of these associations was significant when predicting disorder persistence. Of the three CA dimensions examined, only frequency was associated with severe role impairment among students with 12-month disorders. Population-attributable risk simulations suggest that 18.7-57.5% of 12-month disorders and 16.3% of severe role impairment among those with disorders were associated with these CAs.

CONCLUSION

CAs are associated with an elevated risk of onset and impairment among 12-month cases of diverse mental disorders but are not involved in disorder persistence. Future research on the associations of CAs with psychopathology should include fine-grained assessments of CA exposure and attempt to trace out modifiable intervention targets linked to mechanisms of associations with lifetime psychopathology and burden of 12-month mental disorders.

Increased top-down control of emotions during symptom provocation working memory tasks following a RCT of alpha-down neurofeedback in PTSD

BACKGROUND

Posttraumatic stress disorder (PTSD) has been found to be associated with emotion under-modulation from the prefrontal cortex and a breakdown of the top-down control of cognition and emotion. Novel adjunct therapies such as neurofeedback (NFB) have been shown to normalize aberrant neural circuits that underlie PTSD psychopathology at rest. However, little evidence exists for NFB-linked neural improvements under emotionally relevant cognitive load. The current study sought to address this gap by examining the effects of alpha-down NFB in the context of an emotional n-back task.

METHODS

We conducted a 20-week double-blind randomized, sham-controlled trial of alpha-down NFB and collected neuroimaging data before and after the NFB protocol. Participants performed an emotional 1-back and 2-back working memory task, with interleaved trauma-neutral and trauma-relevant cues in the fMRI scanner. Data from 35 participants with a primary diagnosis of PTSD were analyzed in this study (n = 18 in the experimental group undergoing alpha-down NFB, n = 17 in the sham-control group).

RESULTS

Firstly, within-group analyses showed clinically significant reductions in PTSD symptom severity scores at the post-intervention timepoint and 3-month follow-up for the experimental group, and not for the sham-control group. The neuroimaging analyses revealed that alpha-down NFB enhanced engagement of top-down cognitive and emotional control centers, such as the dorsolateral prefrontal cortex (dlPFC), and improved integration of the anterior and posterior parts of the default mode network (DMN). Finally, our results also indicate that increased alpha-down NFB performance correlated with increased activity in brain regions involved in top-down control and bodily consciousness/embodied processing of self (TPJ and posterior insula).

CONCLUSION

This is the first study to provide mechanistic insights into how NFB may normalize dysfunctional brain activity and connectivity in PTSD under cognitive load with simultaneous symptom provocation, adding to a growing body of evidence supporting the therapeutic neuromodulatory effects of NFB. This preliminary study highlights the benefits of alpha-down NFB training as an adjunctive therapy for PTSD and warrants further investigation into its therapeutic effects on cognitive and emotion control in those with PTSD.

Effects of Maternal and Child Lifetime Traumatic Stress Exposures, Infant Temperament, and Caregiving Quality on Preschoolers' Executive Functioning

We examined effects of maternal and child lifetime traumatic stress exposures, infant temperament, and caregiving quality on parent ratings of preschoolers' executive functioning (EF). Maternal lifetime trauma was associated with preschoolers' EF problems; this association was mediated by greater child trauma exposure. Infant temperament was associated with EF abilities, particularly among females. Among males, infant extraversion/surgency mediated the association of maternal lifetime trauma with poorer child EF. Caregiving quality was negatively associated with maternal and child trauma exposures but did not predict child EF. Findings have implications for interventions to identify children at risk for poor EF and optimize outcomes.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.

Examining the effectiveness of trauma-focused cognitive behavioral therapy on children and adolescents' executive function

BACKGROUND

Children and adolescents impacted by childhood trauma often demonstrate executive function difficulties, which negatively affect self-regulation and potentiate the risk for trauma-related psychopathology and functional impairment. Evidence-based treatments for traumatized youth such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) aim to equip youth directly with skills for effective self-regulation and may thus also improve executive function. Moreover, adolescence is a sensitive period for executive function development, and interventions aimed at improving executive function may confer greater benefits for adolescents relative to school-aged children. No study has examined executive function improvements during TF-CBT or the potential differences in these outcomes between children and adolescents.

OBJECTIVE

In the current study, we examined changes in caregiver-reported executive function difficulties during TF-CBT among children ages 6 to 11 and adolescents ages 12 to 17.

PARTICIPANTS AND SETTING

Participants were 278 racially and ethnically diverse youth with interpersonal trauma histories and their caregivers enrolled in a community-based effectiveness trial of TF-CBT in an urban setting. Caregivers reported on youth executive function at pre, mid, and posttreatment assessments.

RESULTS

Both children and adolescents demonstrated reductions in global executive function difficulties during TF-CBT. Improvements were seen across domains of emotional, behavioral, and attentional control and problem solving, with larger effect sizes for adolescents. Follow-up analyses indicated that executive function improvements were positively associated with PTSD symptom reduction in adolescents, but not in children.

CONCLUSIONS

Findings add to the growing evidence of the effectiveness of TF-CBT among youth and highlight caregiver-reported executive function as a potential treatment target during TF-CBT.

Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis

Childhood adversity is a major risk factor for multiple forms of psychopathology, and recent efforts have focused on understanding the underlying psychological mechanisms. One outstanding candidate is emotion regulation, which has been associated with both childhood adversity, and psychopathology. Based on the available evidence, the present meta-analysis set out to investigate the mechanistic involvement of emotion regulation in the relation between childhood adversity and psychopathology. Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 215 eligible studies. Using meta-analytic structural equation modeling, we fitted a partial mediation model to the available data across studies, in which childhood adversity was related to psychopathology both directly and through emotion regulation. Multiple emotion regulation dimensions were analyzed, including emotion regulation difficulties and the habitual use of rumination, distraction, reappraisal, and suppression. Measures of psychopathology included a wide range of internalizing and externalizing symptoms in both clinical and non-clinical samples. The results indicated that childhood adversity was positively associated with emotion regulation difficulties, as well as with the habitual use of rumination and suppression. In turn, these measures of emotion regulation were positively associated with psychopathology. Habitual reappraisal use showed negative relations with both childhood adversity and psychopathology. All these emotion regulation measures were supported as mediators in the relation between childhood adversity and psychopathology. In contrast, distraction was not related to childhood adversity or psychopathology, and its mediator role was not supported. These results suggest that altered emotion regulation is a consistent marker of childhood adversity and contributes to risk of psychopathology.

Relationship of parent-rated and objectively evaluated executive function to symptoms of posttraumatic stress and attention-deficit/hyperactivity disorder in homeless youth

Compared to their stably housed peers, homeless, and highly mobile (HHM) youth experience disproportionately greater adversity and risk leading to a wide variety of poor developmental outcomes, and targeted interventions have the potential to mitigate such outcomes. A growing literature highlights the need for accurate diagnosis in high-risk populations given the considerable overlap between posttraumatic symptomology and behaviorally based disorders such as ADHD. Objective testing inferring neurobiological and circuit-based abnormalities in posttraumatic stress disorder (PTSD) and ADHD may provide a useful clinical tool to aid accurate diagnosis and treatment recommendations. This novel, exploratory study examined the relation between executive function (EF) as measured by objective testing and parent ratings with symptoms of posttraumatic stress and ADHD in 86 children (age 9 to 11) living in emergency homeless shelters. Parent-rated EF problems suggested broad impairment associated with ADHD symptoms but specific impairment in emotional/behavioral function associated with posttraumatic stress symptoms. While measures of inhibition and shifting EF were strongly associated with symptomology in bivariate correlations, they explained minimal variance in regression models. Internalizing behavior problems were associated with posttraumatic stress symptoms, while externalizing behavior problems were associated with ADHD symptoms. Implications for clinical practice and future research are discussed.

Associations of Early-Life Threat and Deprivation With Executive Functioning in Childhood and Adolescence: A Systematic Review and Meta-analysis

IMPORTANCE

Many studies have demonstrated an association between early-life adversity (ELA) and executive functioning in children and adolescents. However, the aggregate magnitude of this association is unknown in the context of threat and deprivation types of adversity and various executive functioning domains.

OBJECTIVE

To test the hypothesis that experiences of deprivation are more strongly associated with reduced executive functioning compared with experiences of threat during childhood and adolescence.

DATA SOURCES

Embase, ERIC, MEDLINE, and PsycInfo databases were searched from inception to December 31, 2020. Both forward and reverse snowball citation searches were performed to identify additional articles.

STUDY SELECTION

Articles were selected for inclusion if they (1) had a child and/or adolescent sample, (2) included measures of ELA, (3) measured executive functioning, (4) evaluated the association between adversity and executive functioning, (5) were published in a peer-reviewed journal, and (6) were published in the English language. No temporal or geographic limits were set. A 2-reviewer, blinded screening process was conducted.

DATA EXTRACTION AND SYNTHESIS

PRISMA guidelines were used to guide data extraction and article diagnostics (for heterogeneity, small study bias, and p-hacking). Article quality was assessed, and data extraction was performed by multiple independent observers. A 3-level meta-analytic model with a restricted maximum likelihood method was used. Moderator analyses were conducted to explore heterogeneity.

MAIN OUTCOMES AND MEASURES

Primary outcomes included measures of the 3 domains of executive functioning: cognitive flexibility, inhibitory control, and working memory.

RESULTS

A total of 91 articles were included, representing 82 unique cohorts and 31 188 unique individuals. Deprivation, compared with threat, was associated with significantly lower inhibitory control (F1,90 = 5.69; P = .02) and working memory (F1,54 = 5.78; P = .02). No significant difference was observed for cognitive flexibility (F1,36 = 2.38; P = .12). The pooled effect size of the association of inhibitory control with deprivation was stronger (Hedges g = -0.43; 95% CI, -0.57 to -0.29) compared with threat (Hedges g = -0.27; 95% CI, -0.46 to -0.08). The pooled effect size of the association of working memory with deprivation was stronger (Hedges g = -0.54; 95% CI, -0.75 to -0.33) compared with threat (Hedges g = -0.28; 95% CI, -0.51 to -0.05).

CONCLUSIONS AND RELEVANCE

Experiences of both threat and deprivation in childhood and adolescence were associated with reduced executive functioning, but the association was stronger for exposure to deprivation. Efforts to address the consequences of ELA for development should consider the associations between specific dimensions of adversity and specific developmental outcomes.

Unity or diversity of executive functioning in children and adolescents with post-traumatic stress symptoms? A systematic review and meta-analysis

For some children, psychological reactions to a traumatic event develop into severe or persistent post-traumatic stress symptoms (PTSS) or the clinical condition of post-traumatic stress disorder (PTSD). Cognitive problems in children with PTSS have been reported, but it is not clear which specific functions are affected. Executive functions is a domain of particular interest, given its importance for academic performance and social and emotional functioning. A systematic literature search was performed, and 12 studies with 55 comparisons of executive functions in children with PTSS and healthy controls were eligible for meta-analysis. A subset of the studies also included a comparison group of children with traumatic experienced but without PTSS. Overall, across all tasks and measures, children with PTSS showed lower executive functioning than healthy controls (SMD = -0.57). The effect sizes between the subdomains complex tasks, verbal fluency, inhibition, shifting and working memory were not significantly different from each other, but was largest for verbal fluency (SMD = -1.45). Analyses comparing children with traumatic experiences with and without PTSS similarly showed overall lower executive functioning in the PTSS group (SMD = -0.34) and no significant differences in effect sizes between subdomains. The results have implications for assessment and clinical work with youth exposed to traumatic events. We should be aware of the poor executive functioning that may be an issue for some children with a history of trauma and subsequent development of PTSS, and the impact this could have on everyday functioning.

Longitudinal Associations Between Trauma Exposure and Executive Functions in Children: Findings from a Dutch Birth Cohort Study

This study is the first to distinguish two possible predictive directions between trauma exposure and executive functioning in children in a community sample. The sample consists of 1006 children from two time points with a seven years’ time interval of a longitudinal Dutch birth cohort study, the ABCD-study (Van Eijsden et al., 2011). We analyzed the longitudinal associations between trauma exposure and executive functioning using structural equation modeling. The results demonstrated that (after controlling for prenatal substance exposure and mothers’ educational level) trauma exposure before age 5 is predictive of poorer executive functioning at age 12 and trauma exposure between age 6 and 12. However, the association between executive functioning at age 5 and trauma exposure between age 6 and 12 was not statistically significant. Our results indicate that early life trauma exposure has a long term impact on later executive functioning and not the other way around. On top of that, trauma exposure seems to accumulate across childhood when children are exposed to a traumatic event before the age of 5. When looking at the potential moderating role of parenting behavior we found no evidence for such a moderating effect of parenting behavior. Our findings showed that children exposed to trauma early in life may experience problems in executive functioning later in life and they seem at higher risk for cumulative trauma exposure. Clinical practice should take this into account in both the way they provide (early) mental health care and in prevention and recognition of early trauma exposure.

Sex-Specific Associations Between Trauma Exposure, Pubertal Timing, and Anxiety in Black Children

Recent research has linked early life stress (ELS), such as trauma exposure, with early puberty. Early puberty has also been identified as a risk factor for poor mental health outcomes. However, these two paths have primarily been examined independently. In addition, more studies have examined these associations in girls than boys, and findings for boys remain mixed. We hypothesized that early puberty (relative to peers) would be positively associated with both prior trauma exposure and concurrent anxiety symptoms. We anticipated that these associations might differ by sex. We tested these hypotheses within a cross-sectional sample of 133 8- to 13-year-old Black girls and boys with trauma exposure. The association between trauma and accelerated pubertal timing was sex-specific: it was positive for girls and negative for boys. We stratified subsequent analyses by sex. Regression analyses indicated that early puberty relative to peers predicted more anxiety symptoms for girls but not boys, after accounting for trauma exposure. A statistical mediation analysis indicated that, for girls, the positive association between trauma exposure and anxiety was partially mediated by pubertal timing. These results indicate that trauma exposure may have sex-specific effects on pubertal timing and anxiety risk in Black children. We also found that, for girls, trauma may increase risk for adverse outcomes by prompting earlier puberty, which is linked to higher anxiety. These findings are consistent with cascading effects of trauma across development, and highlight the need for further study of sex-specific mechanisms.

Current Posttraumatic Stress Symptoms Mediate the Relationship Between Adverse Childhood Experiences and Executive Functions

Adverse childhood experiences (ACEs) and posttraumatic stress disorder (PTSD) are both associated with lower performances on executive function tasks. However, few researchers have evaluated ACEs, posttraumatic stress (PTS) symptoms, and executive function difficulties in conjunction. Using an online micropayment service, the current study assessed whether PTS symptoms mediated the relationship between ACEs and executive functions. In total, 83 participants (54.2% female, age: M = 28.86, SD = 7.71) were administered the ACE questionnaire, PTSD Checklist for DSM-5 (PCL-5), and the Executive Function Index (EFI). A higher number of reported ACEs was related to greater PTS symptom severity (β = .40, p < .001) and worse self-rated executive functions (β = -.32, p = .002). Controlling for the number of reported ACEs, current PTS symptom severity was related to worse executive functions (β = -.45, p < .001). A bootstrapped 95% confidence interval (CI) indicated a significant indirect effect, β = -.18 (95% CI: -.30, -.08), by which current PTS symptoms mediated the relationship between the number of reported ACEs and executive functions. These results suggest that psychological interventions targeting PTS symptoms, in the context of a history of childhood trauma, may concurrently improve executive functions in adult populations.

Do cognitive training applications improve executive function in children with adverse childhood experiences? A pilot study

Executive function (EF) is comprised of inhibitory control, working memory and cognitive flexibility, core components which more complex skills and abilities develop from, including problem solving, reasoning and planning. Adverse childhood experiences (ACE) negatively impact the development of these skills and in turn life outcomes. This pilot-study explores the use of computerized cognitive training applications (CCTA) (software-based training programs) in school, to improve these skills in children aged 6-11 with ACE. A pre-post-test, between-subject experimental design using an experimental and a placebo-control group was used. The control group were matched to the experimental group by prior academic attainment level and age. A one-way multivariate analysis of covariance (MANCOVA) assessed changes in EF across two time-points between the experimental and the control group. Both groups of participants were selected based on an ACE parent-report questionnaire score of 4+ (n = 32). EF was measured using the Behavior Rating Inventory of Executive Function (BRIEF), assessing far-transfer of training to behavioral measures of EF. Results show CCTA had a significant positive impact on executive function, particularly on working memory. This small-scale pilot study presents exciting directions for future research into the role of CCTA in order to confirm conclusions drawn.

The direct and indirect impact of trauma types and cumulative stressors and traumas on executive functions

The goal was to measure the effects of trauma types, cumulative trauma, posttraumatic stress disorder (PTSD), existential annihilation anxiety (EAA), and posttraumatic growth (PTG) on executive functions. The study sample consists of 1155 from Egypt and Kuwait. Measures included adults working memory deficits (WMD) and inhibition deficits (ID), and cumulative stressors and traumas (CST) and trauma types, PTSD, EAA, and PTG. We used Stepwise regression and PROCESS macro to analyze the data. Results indicated that survival and cumulative traumas have direct effects on a lower WMD and ID, attachment traumas and gender discrimination by parents have direct impacts on higher WMD and ID, while personal identity, status identity, secondary trauma, gender discrimination by society, community violence do not have any direct effects on WMD or ID. All traumas have indirect effects on higher WMD or/and ID via PTSD. Gender discrimination by society, community violence, and CST has an additional indirect higher impact on WMD and ID via EAA. There were indirect trajectories from survival trauma, personal identity, status identity trauma, secondary trauma, gender discrimination by society, and CST on lower WMD or/and ID via PTG. Attachment trauma, gender discrimination by parents, perpetration traumas, and community violence were not associated with PTG and its trajectories of lower WMD or/and ID. We discussed the research and clinical implication for these results.

Inhibitory control in trauma-exposed youth: A systematic review

The aim of this systematic review was to provide insight in inhibitory control (prepotent response inhibition and interference control) in trauma-exposed youth from a developmental perspective and exploring the effects of prolonged stress. A systematic search was conducted, resulting in 1722 abstracts. Of those, 33 studies met inclusion criteria. Twelve studies measured prepotent response inhibition (Go/no-go and Stop-signal task), 20 studies measured interference control (Flanker and Stroop task), and one measured both. Some studies indeed found evidence for prolonged trauma exposure impeding both subcomponents of inhibitory control, although others did not. At a later age, inhibitory control problems on task performance seem to disappear. However, distinct patterns of brain activity may suggest that those individuals employ compensation strategies. Together, the findings may suggest that non-specific inhibitory control problems occur after prolonged trauma exposure, with older youth possibly employing compensation strategies on the tasks. Future studies may provide a clearer picture of the compensation strategies and the circumstances in which they become visible.

'Caring for children who have experienced trauma' - an evaluation of a training for foster parents

BACKGROUND

Foster children, mostly maltreated in their birth families, may be fostered by parents who know little about the impact of traumatic experiences.

OBJECTIVE

The present study investigated whether the training Caring for Children who Have Experienced Trauma for foster parents can break the negative circle of traumatic stress. The hypothesis was that improvement in parents' knowledge on trauma and mind-mindedness would be associated with a reduction of their parenting stress, children's post-traumatic stress symptoms, and behaviour problems.

METHOD

Forty-eight foster parents (n female = 35) participated in a pre-test (T1), post-test (T2), and follow-up (T3) assessment. Questionnaires on knowledge on trauma, parenting stress, child post-traumatic stress symptoms, the child's behaviour, and the evaluation of the training were administered. Parents' mind-mindedness was assessed using the describe-your-child interview.

RESULTS

Foster parents highly appreciated the training, their knowledge on child trauma increased at T2 and this growth persisted at T3. The parents who gained most knowledge experienced a small decrease in parenting stress at T2. Although the general mind-mindedness did not significantly change, foster parents' mind-mindedness with positive valence substantially increased at T2 and T3, while their mind-mindedness with neutral valence decreased. Foster parents' report on child PTSS declined at T3 compared to T2, but not compared to T1. No changes were found in children's behaviour as reported by the foster parents. The proportion of foster children receiving trauma-focused treatment increased at T2 and T3.

CONCLUSION

This study provides evidence that training in trauma-informed parenting can be effective in improving foster parents' knowledge on the impact of traumatic experiences and in increasing a positive mental representation of their foster child as well as in reducing children's post-traumatic symptoms.

Overlapping frontoparietal networks in response to oculomotion and traumatic autobiographical memory retrieval: implications for eye movement desensitization and reprocessing

Background: Oculomotor movements have been shown to aid in the retrieval of episodic memories, serving as sensory cues that engage frontoparietal brain regions to reconstruct visuospatial details of a memory. Frontoparietal brain regions not only are involved in oculomotion, but also mediate, in part, the retrieval of autobiographical episodic memories and assist in emotion regulation. Objective: We sought to investigate how oculomotion influences retrieval of traumatic memories by examining patterns of frontoparietal brain activation during autobiographical memory retrieval in post-traumatic stress disorder (PTSD) and in healthy controls. Method: Thirty-nine participants (controls, n = 19; PTSD, n = 20) recollected both neutral and traumatic/stressful autobiographical memories while cued simultaneously by horizontal and vertical oculomotor stimuli. The frontal (FEF) and supplementary (SEF) eye fields were used as seed regions for psychophysiological interaction analyses in SPM12. Results: As compared to controls, upon retrieval of a traumatic/stressful memory while also performing simultaneous horizontal eye movements, PTSD showed: i) increased SEF and FEF connectivity with the right dorsolateral prefrontal cortex, ii) increased SEF connectivity with the right dorsomedial prefrontal cortex, and iii) increased SEF connectivity with the right anterior insula. By contrast, as compared to PTSD, upon retrieval of a traumatic/stressful memory while also performing simultaneous horizontal eye movements, controls showed: i) increased FEF connectivity with the right posterior insula and ii) increased SEF connectivity with the precuneus. Conclusions: These findings provide a neurobiological account for how oculomotion may influence the frontoparietal cortical representation of traumatic memories. Implications for eye movement desensitization and reprocessing are discussed.