The association between complex trauma and executive functioning among an adolescent inpatient population

The purpose of this study was to examine the association between executive functioning and complex trauma within an adolescent inpatient population. This study utilized archival data on 39 subjects from the University of Massachusetts Continuing Care Adolescent Treatment Program, an inpatient long-term psychiatric facility that is funded by the Massachusetts Department of Mental Health. The study explored the contribution of theory through a developmental transactional model and attachment perspective, and reviewed the neurobiological underpinnings typically present among individuals with a history of chronic and severe trauma. Using a descriptive group comparison approach, the study hypothesized that adolescents with complex trauma, defined as history of being in custody of the Massachusetts Department of Children and Families (DCF), would have decreased executive functioning scores on standardized neuropsychological testing measures. Clinical restraint was also explored as a potential behavioral indicator of executive functioning. Predictor variables were condensed using exploratory factor analysis. Results suggested lower performance in the executive realm of categorization, switching and inhibitory skills in the DCF custody group. A higher incidence of restraint over course of hospitalization was found among adolescents with a history of DCF custody. However, when controlling for trauma history using stepwise linear regression, no relationship was found between executive functioning skills and incidence of clinical restraint. This finding suggests that contributions other than executive functioning skills may play a role in incidence of restraint, such as language and history of trauma. The results suggest a vulnerability to ongoing risk for neurodevelopmental challenges in adolescents with a chronic and severe trauma history. Future research might strive to identify effective strategies to improve cognitive outcome and potentially diminish the long-term consequences of child abuse and neglect.