The association between complex trauma and executive ...

[Pages:20]THE ASSOCIATION BETWEEN COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING

AMONG AN ADOLESCENT INPATIENT POPULATION

A dissertation presented by Lauren Gallo Ziady

Submitted to The Department of Counseling and Applied Educational Psychology in partial

fulfillment of the requirements for the degree of

Doctor of Philosophy in the field of

Counseling Psychology Northeastern University Boston, Massachusetts

September, 2012

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING ii Abstract

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

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING iii 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.

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING iv Acknowledgments

I would like to extend my deepest appreciation to the members of my dissertation committee. First, my sincere thanks to my chair and program advisor, Dr. Karin Lifter. You involved me in your developmental play research from the very beginning of my studies, introducing me to the importance of a developmental and ecological framework, while supporting and encouraging my own academic interests. I especially appreciate the many hours you spent with me early on in my dissertation process, meeting at flexible times and locations (Starbucks!) and for continually reminding me to "keep going," and that "we are almost there!" I would also like to thank Dr. Debra Franko for your willingness to participate on my committee and for your important methodological insights. Your feedback prompted the necessary finetuning that allowed me to progress forward successfully, from the proposal onward. I would also like to thank Dr. Ann Helmus, who has been an instrumental person in my professional life. Early on in my career as a student, you believed in my ability, nurtured my writing skills and honed my understanding of the neuropsychological perspective. Your support over the years, as I've entered and re-entered the working world to start my family, has meant so much to me. Finally, I can't thank you enough for your invitation to continue my training at NESCA. You have no idea how that job offer propelled my dissertation forward!

I would also like to thank Dr. Jeffrey Gaines, my former neuropsychology supervisor at Westborough State Hospital. Without your mention and offer to use the data collected at the hospital, none of this research would have been possible.

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING v Throughout this long process, you honored your commitment to me and for that I am extremely grateful. I would also like to thank Drs. Bruce Meltzer and Dan Lambert for your support of my project. Many thanks to Dr. Lambert in particular, for your guidance and assistance throughout the Department of Mental Health IRB process. I also extend my deepest appreciation and respect for the adolescents who allowed me into their lives for a brief time during my pre-doctoral internship.

I would like to express my deep love and respect for each and every one of my family members. I constantly marvel at how lucky I am to have been born into such a loving family and accepted into yet another amazing family through marriage. My husband Eric has supported me every step of the way with sound advice, from the doctoral program application process through the final printing of my dissertation. You always know just what to say and I am so fortunate to be spending my life with such an honorable and loving man.

This dissertation is dedicated to my parents, who have provided me with unconditional love, acceptance and support. My breathing evens and my heart stops beating quite so fast, simply after a phone call with either one of you reassuring me that I can tackle whatever problem I am presented with. Without you, truly none of this would have been possible. I would also like to thank my sweet sister, Andrea, my mother-in-law Ginny, and my sisters-in-law, Joan and Danielle for your thoughtful calls and sweet encouragement.

I am very thankful to my late father-in-law, John, who always emphasized the importance of higher education and encouraged me to press forward, reminding me

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING vi and Eric that the "short term pain, is worth the long term gain." Lastly, I would like to express my love to my children, Matthew, Lindsey and Courtney. You are my true loves and my inspiration always to be the best that I can be.

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING vii Dedication

This dissertation is dedicated to my mother and father, who taught me to persevere. Without your unending support, love and guidance, this accomplishment would not have been possible.

COMPLEX TRAUMA AND EXECUTIVE FUNCTIONING viii

Table of Contents

Abstract....................................................................................... ii

Acknowledgments.......................................................................... iv

Dedication................................................................................... vii

List of Tables................................................................................ x

Chapter One................................................................................. 1

Statement of the Problem......................................................... 1 Trauma and Distinctions Among Traumatic Events.......................... 3 Diagnostic Categorization as a Result of Trauma............................. 5 Developmental Trauma Disorder and DSM-5 Planning...................... 15 Indicators and Consequences of Complex Trauma............................ 17 Summary and Rationale for the Current Study................................. 31

Chapter Two................................................................................. 34

Introduction......................................................................... 34 Consequences of Trauma......................................................... 34 Background of the Trauma Diagnosis........................................... 37 Diagnosing PTSD in a Chronically Traumatized Population................ 41 An Expanded Trauma Diagnosis: Complex PTSD/DESNOS................ 43 Theoretical Explanations that Link Early Experience with

Later Psychological Disturbance......................................... 47 Developmental Transactional Theory........................................... 47 Attachment Theory................................................................. 50 Neurobiological Perspectives on Trauma....................................... 56 Neuropsychology: Pathways to Understanding the Impact of

Complex Trauma On Cognitive and Behavioral Development....... 64 Neuropsychological Assessment................................................... 65 Conclusions and Study Directions................................................. 76 Study Goals........................................................................... 78

Chapter Three................................................................................. 80

UMASS Continuing Care Adolescent Program................................. 80 Population Served.................................................................... 81 Diagnostic Work-Ups and Development of Treatment Plans.................. 82 Confidentiality........................................................................ 83 Development of the Neuropsychological Database of Patients on the

UMASS-CCA-TP Unit..................................................... 85

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download