Understanding the impact of trauma on executive function in care experienced children: neurodevelopment, staff training and attributions
Background Children who are cared for away from their biological families represent a highly vulnerable population where early childhood trauma, abuse, and neglect are highly prevalent. As technology and theory have advanced it has now been recognised that traumatic experiences in early life can lead to a variety of neurodevelopmental differences, deficits, and delays. Importantly, executive function - a set of cognitive abilities which allow individuals to plan, monitor and adjust their behaviour in order to interact with their environment effectively - has been shown to be particularly sensitive to the impact of traumatic experiences in youth. The core skills in executive function are recognised as cognitive flexibility, working memory, and inhibitory control, skills which have been evidenced to be significantly reduced in children and young people in care, even in comparison with other traumatised youth. However, the specific mechanisms and variables which influence this vulnerability for children within the care system have yet to be understood. Aims This thesis therefore aims to explore the combined impact of trauma and experience of alternative care on the development of executive function. This will include a systematic review of the evidence around executive function difficulties in children in alternative care, and two empirical articles, looking at the impact of an online training course for residential childcare workers which is focussed on the developmental impact of trauma on the executive function of children in care and how this can be supported. The two papers present the acceptability and feasibility of the course, as well as the effect of the course on knowledge gain and the attributions of staff towards challenging behaviour. Methods In Chapter One, a systematic search for papers relating to the executive function of children in care who have experienced trauma was conducted across eight bibliographic databases. Sixteen papers were quality assessed and their results were synthesised in a narrative format. Chapters Two, and Three, describe the development and evaluation of an online training course in executive function for residential workers working with children in care. In Chapter Two, the course is evaluated for acceptability, feasibility and its impact on knowledge gain. In Chapter Three, the course is evaluated for its impact on the attributions of residential childcare workers towards challenging behaviour. Results It was not possible to draw definitive conclusions from the systematic review due to heterogeneity in the papers included. However, the overall direction of results, indicate that children within the care system are not only highly vulnerable to executive functioning difficulties due to their early experiences, but that their specific experiences within the care system may further impact upon the development of these skills. The empirical papers demonstrated that online training around the neurodevelopmental impact of trauma on executive function was feasible and acceptable to residential support workers. The course significantly increased knowledge of executive function after completion and altered staff attributions towards challenging behaviour, by significantly reducing perceptions that the causes of challenging behaviour are internal to the child and within their control, and significantly increasing perceptions that the causes are global and stable across the child’s life. Implications for clinical practice, future training, and ongoing research are discussed.