Mt. Hope Family Cty Center, University of Rochester;
Elizabeth D. Handley
Mt. Hope Family Cty Center, University of Rochester
Justin Russotti
Mt. Hope Family Cty Center, University of Rochester
Fred A. Rogosch
Mt. Hope Family Cty Center, University of Rochester
Dante Cicchetti
Institute of Child Development, University of Minnesota
Acknowledgement: Fred A. Rogosch was a senior author of this article but passed away prior to publication. We are deeply grateful to him for his many contributions to this study.
This research was supported by grants received from the National Institute on Drug Abuse (NIDA; R01DA17741), the Spunk Fund, Inc., and the National Institute of Child Health and Human Development (NICHD; P50HD096698).
Throughout the adolescent years and into emerging adulthood, there are rapid changes in biological, social, and psychosocial systems. Priorities shift to identity exploration and pursuing new possibilities related to work, education, and relationships. In emerging adulthood (defined by contemporary society as the developmental period between approximately 18–25 years old succeeding the adolescent years;
Typical development of decision-making capacities and related executive functions is multiply determined throughout childhood, adolescence, and into adulthood through complex interactions between cognitive and affective development, hormonal changes, and the social context (
Studies lend support for this model. For example, lower executive function performance relates to higher self-reported risk-taking behaviors for adolescents and emerging adults (
Substantial variation exists in the stability and safety of the family environment and the ability of a caregiver to provide sufficient support for the development of self-regulatory skills. Sensitive and responsive caregivers provide children with positive formative experiences with the social environment and help children to develop regulation skills needed to competently complete developmental tasks (
Childhood maltreatment, defined by behaviors enacted by a caregiver that harm and/or endanger a child, is one kind of severe relational adversity. In 2018, 678,000 children were victims of childhood maltreatment (
Advances in operationalization of maltreatment have increased awareness of the importance of considering maltreatment exposures as complex, often overlapping traumatic experiences. Children exposed to maltreatment who are identified by child protective services often experience more than one subtype of maltreatment (sexual abuse, physical abuse, emotional maltreatment, and/or neglect, as described in
The early caregiving environment is the proximal context for the development of a variety of competencies, including decision making, emotion regulation, and problem solving. The study of children who have been exposed to adverse and/or traumatic early experiences in their caregiving environments provides information about how developmental trajectories may be influenced by lack of sufficiently predictable and supportive caregiving, and by contrast provides information about typical developmental processes (
Maltreatment exposure increases odds of risk behaviors in adolescence and emerging adulthood, including higher rates of risky sexual behaviors (
Decision-making capacities draw on executive functioning and use of these abilities under different affective states, such as anger, excitement, or sadness (
Maltreatment exposure also disrupts emotional and behavioral regulation capacities needed to enact adaptive decision-making abilities (
Cognitive and affective processes transact to influence decision making and risk taking. For example, emotion regulation influences the ability to use executive functioning skills from moment to moment in daily life (
Attention processes are inherently complex and multisystemic. Attention can be conceptualized as the encoding part of perception that initiates the processing of social information and emotion generation and regulation cascades (
Neurocognitive difficulties, such as underdeveloped executive functioning, impulsivity, and memory difficulties, are common symptoms of attention deficit hyperactivity disorder (ADHD) in children. Although ADHD is conceptualized as a neurocognitive developmental disorder, it frequently presents with social cognition deficits (
This investigation has two major aims: (a) to determine if individuals with and without documented histories of maltreatment show different patterns of risk taking in emerging adulthood, and (b) to identify longitudinal associations between childhood maltreatment, attention problems in childhood, and decision-making performance in emerging adulthood in a racially/ethnically diverse sample of individuals recruited as children from families experiencing financial adversity. This study utilizes prospective measurement of maltreatment, ascertained from coded CPS records, and a multimethod approach of assessing attention in childhood. Specifically, a latent construct of attention was modeled with four indicators: two based on behavioral ratings of attention problems, and two based on performance measures that assess executive attention abilities, attention to detail, impulsivity, and memory. This investigation, therefore, provides a multi-method longitudinal approach to study the impact of maltreatment on broad attention processes and subsequent decision making in emerging adulthood. It is well documented that childhood maltreatment co-occurs with poverty (
The study of maltreated children’s development across childhood and into emerging adulthood provides an opportunity to understand the organization and adaption, or maladaptation, of multiple developmental systems (
Participants (n = 379) included emerging adults who participated in a research summer camp as children (Wave 1) and a follow-up study approximately 10 years later (Wave 2). The original study included 659 socioecomically disadvantaged, ethnically diverse maltreated (n = 339) and nonmaltreated children (n = 320) recruited for a summer research camp from 2004–2007. Recruitment of families and children with and without maltreatment was necessary to ascertain groups comparable in size and socioeconomic status. Children in the maltreated group had substantiated investigations of child maltreatment according to Department of Human Services (DHS) Child Protective Services (CPS) records; demographically comparable nonmaltreated children without CPS or preventive records were from families receiving Temporary Assistance to Needy Families. A DHS recruitment liaison contacted a random sample of eligible families from both groups via mail. If families were interested and chose to participate, their contact information was shared with research staff. The demographics of families who declined participation were not disclosed by DHS.
Child participants at Wave 1 were 10–12 years old (Mage = 11.27, SD = .97) and 49.5% were female. The original sample was diverse in regard to race and ethnicity (71.5% African American, 12.0% White, 12.6% Hispanic, 3.9% Other race). Parents provided informed consent for their child’s participation. During the week of summer camp, camp counselors conducted recreational activities with the same groups of 8–10 children (35 hours of direct contact and observation). After providing assent, child participants self-reported on their experiences and behaviors and completed computerized tasks. Camp counselors provided independent ratings of childhood functioning and behavior after the end of the week. For a more detailed description of the summer research camp procedures, see
At Wave 2, participants who were children at Wave 1 were recontacted via phone or mail and invited to participate in a voluntary follow-up study. Participants were 18–23 years old at Wave 2. After providing informed consent, Wave 2 participants completed three research visits, which included interviews, computerized tasks, and self-report questionnaires. All procedures for this study were approved by the University of Rochester Research Subjects Review Board (study title: Chronic Stress of Maltreatment: Drug Use Vulnerability; Protocol 46062). A total of 427 participants completed assessments at Wave 2. The present study includes a subset of individuals who completed Wave 2 (n = 379; 51.5% female; Mage = 19.68, SD = 1.12) who completed key measures of interest at Waves 1 and 2. There were 48 individuals who completed some assessments at Wave 2 who were not included in the present study due to missing or incomplete data on performance tasks analyzed herein and/or maltreatment subtype information.
Participants (n = 379) included 199 children who experienced maltreatment during childhood (52.5%) and 180 individuals who did not experience maltreatment in childhood. Subjects were racially/ethnically diverse (77.3% Black/African American, 11.1% White, 7.7% Hispanic, 4.0% Other race). At Wave 1, 86.6% of families were receiving full or partial financial assistance (mean family income: $22,530). The majority (69.4%) of families at Wave 1 were headed by a single caregiver. There were no differences on gender (χ
Wave 1
Maltreatment Classification System
CPS records were coded with the Maltreatment Classification System (MCS;
Consistent with recent literature that documents the common co-occurrence of maltreatment subtypes (
Wechsler Intelligence Scale for Children, 4th edition (WISC-IV;
Children’s cognitive functioning was assessed using six subtests of the WISC-IV. A Full Scale IQ (FSIQ) was ascertained along with two factors: Verbal Comprehension (subtests: Similarities, Vocabulary, Comprehension) and Perceptual Reasoning (subtests: Block Design, Picture Completion, Matrix Reasoning). In this sample, the mean FSIQ is 87.23, SD = 12.68.
Wave 1 Measures of Child Focus/Attention:
Wave 2
Cambridge Gambling Task (CGT)
The Cambridge Gambling Task (CGT) was administered as part of the Cambridge Neuropsychological Testing Automated Battery (CANTAB; Cambridge Cognition) at Wave 2. CANTAB is a computerized assessment battery used extensively to assess neuropsychological functioning in adult populations with and without psychiatric and neurological conditions. The CGT is a performance-based task that assesses decision making abilities and risk taking behaviors outside of a learning context. Specifically, the CGT is “hot” executive function task. Unlike some gambling tasks, it can be considered a “decision under risk” paradigm, meaning that the probability of winning varies in a systematic way that is easily discerned by information provided on each trial. Probability of winning one trial is not based on the past trials. Additionally, participants do not benefit from betting on an unlikely outcome. They are able to choose how much they bet on each trial.
During the CGT, participants were asked to bet on the location of a token, which was hidden from view under 10 colored squares (red and blue) presented in a line on the top of the screen. On each trial the colored boxes appeared at the top of the screen in a different ratio of red to blue boxes (see
Betting amounts for each trial were calculated by the computer. Bet options included amounts that were 5%, 25%, 50%, 75%, and 95% of the current point total. Bets were automatically shown on the screen, one at a time, either in ascending or descending order for each trial. Participants used the touch screen to select the bet they wish to place. The first and second block of trials completed were ascending trials. On ascending trials, low bets (starting at 5% of total accrued points) appeared on the screen and increased every few seconds. Bet option increases were accompanied by a tone that went up in pitch. Participants selected the bet they wished to place by touching their desired bet when it appeared on screen. If participants failed to select a bet, their bet for that trial was the highest bet available (95% of total accrued points). On descending trials (completed in the third and fourth blocks), the highest bet (95% of total accrued points) was presented first. Bets then decreased every 2 seconds (accompanied by a tone). Participants who did not select a bet automatically wagered the lowest bet (5%) on that trial.The CGT was scored to produce two main variables, Risk Taking and Risk Adjustment, that were of particular interest in this study. Risk taking scores are the average bet (% of total accrued points) placed for trials where participants bet on the majority color (e.g., betting on red when presented with 7 red and 3 blue boxes). Risk taking scores were computed for ascending and descending conditions and for each box ratio (6:4, 7:3, 8:2, 9:1). Higher risk taking scores indicated a greater proportion of points were bet across trials. The risk adjustment score summarizes betting adjustment across box ratio trials and conditions (ascending and descending). Risk adjustment was calculated by summing two times the mean proportion of points risked on 9:1 and 8:2 trials, minus twice the mean proportion of points risked on 7:3 and 6:4 trials, all divided by mean proportion of points bet on all trials. Higher risk adjustment indicates that the participant modified their betting based on the probability of winning or losing, and lower risk adjustment indicates a betting pattern less sensitive to trial risk. Risk adjustment was scored overall and for ascending and descending trials.
Additional scored variables were considered to further investigate performance differences between individuals with and without histories of maltreatment. Quality of Decision Making is the proportion of trials where the participant bet on the more likely color (i.e., the color with a greater number of boxes). Delay Aversion is a score that reflects the difference in betting on ascending and descending trials (Delay Aversion = Risk Taking descending − Risk Taking ascending). Higher delay aversion scores are interpreted as less willingness to wait for low bets on descending trials, when high bets are presented first.
Data Analytic Plan
A set of t-tests and repeated measures ANOVAs were conducted to investigate patterns of betting (measured with CGT Risk Taking) across trial risk (indicated by box ratio) and for ascending and descending conditions on the Cambridge Gambling Task (CGT). T-tests were conducted to investigate maltreatment group differences on CGT quality of decision making, delay aversion, and risk adjustment (ascending and descending). One repeated-measures ANOVA was conducted with trial condition order (ascending/descending) as a within-subjects factor and maltreatment and gender as between-subjects factors. Then, two ANOVAs investigated the effect of box ratio (9:1, 8:2, 7:3, 6:4) for Trials × Maltreatment × Gender (male/female) within ascending and descending trials to investigate patterns of risk taking across trials that differed in probability of winning.
Structural equation modeling was then used to estimate longitudinal pathways between child maltreatment and adjustment of risk taking behavior on the CGT. First, measurement modeling was conducted in Mplus v7.1.4 to establish a latent construct for childhood attention. The four measures of attention (DMS, ANT conflict, TRF attention problems subscale, CCQ ADHD sort) were used as indicators of a latent variable. DMS scores were reversed so that high scores indicated worse performance on the DMS task. Adequate measurement model fit was determined by nonsignificant values of the χ
A structural equation model (SEM) was then estimated to test relationships between maltreatment experiences (# subtypes), the latent construct of childhood attention, and performance on the Cambridge Gambling Task, measured by the risk adjustment variable. Childhood attention was predicted by childhood IQ and number of subtypes of maltreatment. Predictors of Wave 2 (emerging adult) risk adjustment included number of maltreatment subtypes, the childhood attention latent construct, and gender. The same indices of fit (χ
There were no differences in Quality of Decision Making between emerging adults who had been maltreated (Mmal = .83, SD = .14) and those who did not experience maltreatment (Mnonmal = .85, SD = .14; Mdiff = −.019, SEdiff = .014; t(377) = −1.35, p =.18), indicating that the groups chose the majority color at similarly high rates. A repeated-measures ANOVA (Bet Order × Gender × Maltreatment) was conducted on the risk taking variable, which is scored as the proportion of points bet on trials when participants chose the more likely outcome. There was a main effect of trial order, indicating that individuals bet significantly more on descending trials, when bets started high and decreased (M = .83, SE = .008) than ascending trials, when bets started low and increased (M = .36, SE = .009; F(1, 375) = 1758.50, p < .001). Males (M = .63, SE = .009) bet significantly more than females (M = .56, SE = .009; F(1, 375) = 28.08, p < .001). Individuals who experienced maltreatment (M = .61, SE = .009) bet more than nonmaltreated peers (M = .58, SE = .009; F(1, 375) = 6.74, p = .010). The only significant interaction was between order and gender (F(1, 375) = 17.31, p < .001). The pattern of means showed that males bet more than females on ascending trials (Mdiff = .12) but this pattern was diminished on descending trials (Mdiff = .022). There was no significant Maltreatment × Order interaction (F(1, 375) = .064, p = .80), Gender × Maltreatment interaction (F(1, 375) = .14, p = .70), or Maltreatment × Gender × Order interaction (F(1, 375) = .002, p = .96). A t-test was conducted on the delay aversion score, and there was no difference between maltreated and nonmaltreated groups (Mdiff = .0092, SEdiff = .023, t(377) = .41, p = .69), indicating that the increase in betting on descending trials, as compared to ascending trials, was similar as across groups.
Additional analyses were conducted to determine if maltreatment history was associated with differential betting patterns (across box ratio) on ascending and descending trials. History of maltreatment was related to worse risk adjustment overall (Mdiff = −.23, SEdiff = .081, t(377) = −2.79, p = .006) and specifically on descending trials (Mdiff = −.16, SEdiff = .070, t(377) = −2.31, p = .022). There were no differences between groups for ascending trial Risk Adjustment (Mdiff = −.19, SEdiff = .14, t(377) = −1.42, p = .16). Repeated measures ANOVAs were conducted to probe differences in risk taking patterns on ascending and descending trials. Box ratio (9:1, 8:2, 7:3, 6:4) was a within-subjects factor; high box ratio (e.g., 9:1) represents a less risky trial than a low box ratio (e.g., 6:4). Between-subject factors included maltreatment status (maltreated/nonmaltreated) and gender (male/female). A Greenhouse-Geisser adjustment was used to correct within-subject tests to account for violation of sphericity (Mauchly’s test ascending: χ
On ascending trials, the within subjects effect of box ratio was significant (F(2.39, 893.16) = 147.14, p < .001), indicating participants lowered their bets as the odds of winning became lower. Males bet more than females across ascending trials (F(1, 374) = 34.96, p < .001). Additionally, there was a significant box ratio by gender interaction (F(2.39, 893.16) = 15.94, p < .001), with males adjusting to better odds by betting more on those trials (see
On descending trials, there was also a main within subjects effect of box ratio (F(2.11, 762.69) = 90.03, p < .001), indicating that participants generally decreased bets as the likelihood of winning decreased. Across descending box ratio trials, maltreated individuals bet more than nonmaltreated individuals (F(1, 361) = 5.88, p = .016). The interaction of Box Ratio × Maltreatment was significant (F(2.11,) = 3.22, p = .038) such that maltreated individuals did not adjust their bets (i.e., decrease their bets) as much as nonmaltreated individuals as trials became riskier (see
Correlations between variables were investigated prior to conducting the Measurement model and SEM. Worse CGT risk adjustment was significantly correlated with higher scores on indicators of the attention problems latent construct (TRF attention problems, ADHD CCQ, DMS, and ANT conflict; rs = −.12 to −.13, ps < .05). Greater number of maltreatment subtypes was associated with worse risk adjustment (r = −.12, p = .024). Notably, childhood WISC IQ was significantly (ps < .05) correlated with all study variables at the bivariate level. All bivariate correlations between variables included in the SEM are presented in
For each indicator of the latent variable, (TRF attention problems, CCQ ADHD, DMS, and ANT), higher scores indicated greater difficulty with facets of attention (See
The specified model showed good fit to the data (χ
This longitudinal study investigates antecedents of decision-making performance in emerging adulthood in a sample of individuals with exposure to childhood maltreatment and poverty. Results indicate a mediated pathway from childhood maltreatment experiences to less sensitive risk adjustment during a gambling task in emerging adulthood via attention problems in childhood. The results of this study contribute to an existing literature (e.g.,
The Cambridge Gambling Task (CGT) was used in this study to assess facets of decision making, including risk taking (i.e., bet amounts) and adjustment of risk taking across trials that differed in the probability of winning (risk adjustment). In prior studies the CGT has been used to investigate differences in decision-making performance for individuals with substance abuse and gambling addiction versus healthy controls (
Performance patterns on this task showed that although maltreated and nonmaltreated individuals did not differ in their decision making regarding the box color they bet on, did bet more on the task overall and adjust for odds of winning to a less degree than their nonmaltreated peers. The CGT first presents trials with low bet options that increase (ascending trials) and then descending trials. Clinical and nonclinical samples of individuals both show increased overall bets on descending trials on the CGT (
Throughout adolescence, there is generally a decline in risk taking on “decision under risk” performance tasks (
On ascending trials, there was no main or interactive effect of childhood maltreatment. However, there was a significant effect of gender. Males bet more and adjusted their bets based on trial risk more sensitively than females. Males consistently score higher on measures of sensation seeking and exhibit more behavioral risk taking (
A main goal of this study was to investigate whether a multimethod assessment of broad executive attentional processes represents a mechanism by which maltreatment negatively impacts decision-making abilities. Results indicated that attentional difficulties, indeed, are one process by which maltreatment experiences negatively affect decision-making performance in emerging adulthood. Attention problems in childhood were measured four ways in this study: two observational measures were completed rating children’s attention deficit symptoms, such as hyperactivity and problems following directions, in a social setting. Two performance tasks were completed in a 1:1 setting: one required memory for details of shapes and sustained focus, and another task that required children to use executive functions to resolve conflict in response to visual stimuli. Confirmation of the latent factor structure provides evidence that behavioral regulation in social settings and focused attention on tasks completed in a controlled environment are influenced by a broader higher-order process, best characterized as executive attention. Consistent with the measurement of this construct, research suggests executive attention has neurobiological underpinnings that influence a broad span of behavior and cognitive abilities, including emotional control, detection and resolution of conflict, and shifting/focusing attention (
The current findings suggest that maltreatment has a significant and detrimental effect on executive attention in childhood, which, in turn, increases risk for poorer decision-making capacities in emerging adulthood. This finding is consistent with theoretical and empirical literature that suggests that decision making relies on the use of logic and planning as well as emotion regulation and behavioral control (
This study adds to decades of literature documenting the detrimental effects of maltreatment on multiple domains of functioning throughout childhood and into adulthood (
In childhood, attention problems are common behavioral concerns across school and home contexts. It is important that interventions that aim to help children with problems in attention and executive functions take a contextual view of childhood attention problems that includes the possible strong influence of trauma as well as biological factors influenced by adversity that contribute to challenges with attention and executive functioning (
The present findings suggest that executive functioning difficulties that emanate from maltreatment experiences are not isolated to childhood and extend into emerging adulthood. Therefore, childhood interventions that target executive functioning and attention skills, particularly school-based interventions, may provide children with important practice in building executive functioning skills that will continue to benefit them into adulthood. Children who have been exposed to trauma who display behavioral problems may benefit from trauma-informed treatments, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), which is effective in treating symptoms of trauma and improving emotional and behavioral regulation skills (
Strengths of the present study include its longitudinal design and use of independent and multi-informant measures of child maltreatment, child attention performance and behavioral ratings, and emerging adulthood decision-making performance in a socioeconomically disadvantaged sample of racially/ethnically diverse individuals. However, limitations should be noted. First and foremost, the present study assesses the contribution of childhood maltreatment on cognitive development but does not take into consideration other likely influences (i.e., effects of parental executive functioning, supportive factors, or other facets of parenting, education, and/or genetic variation) on children’s cognitive development (e.g.,
Childhood maltreatment represents exposure to parenting dysfunction and interpersonal trauma and affects many facets of development (
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Submitted: February 16, 2020 Revised: November 13, 2020 Accepted: December 9, 2020