Understanding the Potential Role of Executive Function Deficits in the Association between Childhood Trauma and Psychosis Among Adolescents in an Inpatient Psychiatric Treatment Program

Despite the growing evidence for the association between childhood trauma and psychosis, there remain gaps in understanding the specific mechanisms linking the two phenomena. An understudied, but potential moderating factor in this association is executive function deficits, as individuals with a history of trauma and those in the prodromal stage of developing psychosis have been found to exhibit greater executive disturbances. Additionally, few studies have explored the link within an inpatient psychiatric population, where adolescents have been found to have higher rates of traumatic experiences and to exhibit poorer executive skills. Thus, using a retrospective medical chart review, the present study was designed to 1) characterize the executive functioning profiles of inpatient adolescents with a diagnosis of a depressive disorder who experience psychosis-like symptoms, 2) compare these profiles between those with and without a history of childhood trauma, and 3) investigate the potential moderating effect of executive function on the known association linking childhood trauma and psychosis. Results indicated that 1) adolescents with and without endorsement of attenuated symptoms of auditory or visual hallucinations and/or delusions exhibited similar executive functioning profiles, 2) among the group of adolescents who reported psychosis-like symptoms, those with and without a history of physical, emotional, and/or sexual abuse also displayed similar executive functioning profiles, and lastly, 3) neither the presence of trauma, executive function as a composite score, nor the interaction of these factors was found to be a significant predictor of the presence of psychosis-like symptoms. Null results may be related to small sample size, the inpatient psychiatric setting, and the limited ability to capture characteristics of mood, trauma, and psychosis. Continued work in the broader efforts to develop a model of the potential pathways from childhood maltreatment to psychosis may inform neuropsychological practice, from evaluation to treatment to prevention in the progression to psychosis