INTIMATE PARTNER VIOLENCE, DEVELOPMENTAL TRAUMA, AND
IMPAIRED EXECUTIVE FUNCTIONING IN PRESCHOOL-AGE CHILDREN
By
Joseph “Audie” S. Black

A DISSERTATION
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
Psychology
2012

ABSTRACT
INTIMATE PARTNER VIOLENCE, DEVELOPMENTAL TRAUMA, AND
IMPAIRED EXECUTIVE FUNCTIONING IN PRESCHOOL-AGE CHILDREN
By
Joseph “Audie” S. Black
The current research integrates Perry et al.’s (1995) traumatic stress theory, De Bellis et
al.’s (1999a/1999b) developmental trauma theory, and Blair’s (2010) contextual stress and
executive function theory to investigate why exposure to chronic traumatic events in early
childhood is often related to deleterious social, emotional, and behavioral outcomes. Intimate
partner violence (IPV) is considered a prototypic traumatic event for consideration in the present
research due to IPV’s chronic course and that young children are disproportionately exposed to
IPV. The current study tested a novel model in which preschool-age children’s executive
functioning (EF) mediated the relationship between IPV exposure, dissociative and hypervigilant
traumatic stress symptoms, and behavior problems. The study recruited 143 child-mother dyads
from the local CACS Head Start preschools, which provided a sample of high-risk preschool-age
children. Maternal and teacher report measures of the children’s executive functioning and
behavior problems were administered. Additionally, the children’s executive functioning was
assessed using developmentally sensitive lab-based tasks.
Several notable findings emerged in the present study. Preschool-age children’s traumatic
stress reactions were differentially related to maternal and teacher reported behavior problems,
such that greater levels of hypervigilance predicted teacher reported externalizing behavior
problems, whereas greater levels of dissociation predicted both maternal reported internalizing
and externalizing behavior problems. Exploratory and confirmatory analyses were used to

examine the underlying structure of the children’s EF. Contrary to expectations, the children’s
EF was best explained by a single, global EF factor that was highly contextually dependent (i.e.,
at home, school, and in the lab), rather than the three hypothesized sub-components (i.e.,
attentional control, working memory, and inhibitory control). Dissociation predicted worse
maternal reported EF, but no direct relationships between traumatic stress symptoms and either
teacher reported EF or lab-assessed EF emerged. However, structural models testing whether EF
mediated the relationship between IPV exposure, traumatic stress reactions, and behavior
problems at home and schools revealed a more nuanced picture. Consistent with predictions, EF
fully mediated the proposed relationships when EF and behavior problems were considered
within a single context (e.g., at home or at school). Models evaluating the mediational
relationship for EF and behavior problems measured across contexts (e.g., maternal reported EF
and teacher reported behavior problems) offered mixed support for EF as a mediator. Results
from the lab-assessed EF suggest that in novel environments, preschool-age children’s
hypervigilance may temporarily improve their EF performance on highly structured tasks,
presumably due to increased physiological arousal.
Overall, the pattern of results indicated that EF is an important mediating variable
between exposure to IPV, traumatic stress symptoms, and preschool-age children’s behavior
problems reported at home and school. Clinical implications for the assessment of preschool-age
children exposed to chronic family violence and future research directions are discussed.

DEDICATION
To my wonderful and loving wife, Jessica:
This work would not have been possible without
your constant support, encouragement, and inspiration…

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ACKNOWLEDGEMENTS
This manuscript represents the pinnacle achievement of my professional career to date;
however, the research detailed within represents only one of the many turning points along the
way to becoming a clinical psychologist. Although complete – and much deserved – recognition
of every person who has contributed to my personal and professional development is beyond the
scope of what is possible in these brief remarks, I would like to acknowledge the following
individuals and organizations:
First and foremost, I would like to thank my advisor, Dr. Alytia Levendosky, for her
steadfast support the past six years. Dr. Levendosky has set the bar high for me as a future
professional by demonstrating how to simultaneously achieve lofty professional goals, while
investing in the meaningful moments of life outside of academia, including interpersonal
relationships. Additionally, my past and current research would never have come to fruition
without her constant guidance, advice, and encouragement. Thank you, Alytia.
The past six years, my training has immeasurably benefited from the input from the
following committee members (across three separate committees) who supported me every step
of the way: Drs. Anne Bogat, Robert Caldwell, Judith Danovitch, and Ellen Whipple. I would
like to take the opportunity to additionally recognize two committee members, in particular, with
whom I worked with in several capacities over the course of my graduate training: Drs. Margaret
Semrud-Clikeman and Alexander von Eye. You two have selflessly served as informal advisors
throughout the many phases of my training. I deeply appreciate your mentorships and hope to
live up to your examples as my career unfolds.
The research detailed in this manuscript culminated in a study that was the result of a
unique collaboration with the CACS Head Start organization. Three Head Start administrators, in

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particular, have my profound gratitude for their incredible efforts: Lucy McClintic, Teresa
Spitzer, and Marta Kermiet. To the parents, teachers, and children who participated in the study:
I hope the research within does justice to your experiences. Your courage to share these difficult
experiences is remarkable and an inspiration.
Without equivocation, this project would not have been possible without the
extraordinary contributions of my fellow graduate student colleague, Lia Field Martin. Beyond
the innumerable ‘tricks of the trade’ Lia taught me based upon her previous experiences
managing research projects, Lia also reminded me through her daily examples to approach our
participants and community partners with dignity and humility. Thank you, Lia, for not only
being the best research partner I could have hoped for, but also a wonderful friend who helped
me navigate the past six years.
One or two individuals never accomplish a project of this magnitude and this study was
no different. With gratitude, I proudly shine the spotlight on the following undergraduate (URA)
and graduate (GRA) research assistants who worked tirelessly, seven days a week, for nearly 10months to make this study possible: Aziza Adawe (URA), Madison Colegrove (URA), Eric
Collins (URA), Floyd East (URA), Stephanie Emhoff (URA), Katlin Harwood (URA), Maggie
Huls (URA), Ashlea Klahr (GRA), Kirstin Kraushaar (URA), Amber Markey (URA), Katie
Meyer (GRA), Nicki Motley (URA), Katey Smagur (GRA), Jenna Stocks (URA), Ivan Wu
(GRA), and Matt Yalch (GRA).
The following organizations granted generous financial support, without which the
current study would not have been possible: International Society for the Study of Trauma and
Dissociation; Michigan State University’s College of Social Sciences, Graduate School, and
Department of Psychology.

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Drs. Daniel Greenberg and Brenda Lovegrove Lepisto played a central role in my clinical
training at Michigan State University and have shaped my future career more than they will ever
know; they also provided nurturing encouragement and thoughtful feedback throughout the
course of this research. For all that they do, Drs. Greenberg and Lepisto have my profound
appreciation.
Doctoral studies are more akin to a slow jog around the world than a marathon. As such, I
believe it is impossible to successfully complete a doctoral program without friends to help the
eternal student (and spouse) re-juvenate, re-focus, and re-commit. Fortunately, Jess and I never
had to find out, as we were blessed by the unwavering support from several dear friends outside
of graduate school, including most notably, Matt Oppenheimer, James Upson, Meg and Mo
Fitzmaurice, Austin Weeks, Janessa Chastain, and Bill and Sarah Punkoney.
I would not be the man nor professional I am today without the transformative education
and personal attention offered to me more than ten years ago by a core group of faculty at the
College of Idaho Faculty. Drs. John Thuerer, Jann Adams, Tim Shearon, and Jill Haunold each
provided humanistic and professional archetypes that continue to inspire. Two additional faculty
mentors continue to shape my values, despite the passage of time: Patti Copple and John
Rember.
Lastly, and most importantly, I am eternally grateful and humbled by the love and
support I receive from my (very large!) family. To my parents, grandparents, siblings, and
extended family: thank you for putting up with me and entertaining all of my hair-brain ideas. I
could not have accomplished a fraction of what I did without you.
Which reminds me, “I’ve been thinking…”

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TABLE OF CONTENTS
LIST OF TABLES.................................................................................................................. x
LIST OF FIGURES ..............................................................................................................xii
CHAPTER 1
Introduction…......................................................................................................................... 1
CHAPTER 2
IPV Exposure and Preschool-age Children’s Behavior Problems.......................................... 8
Preschool-age Children’s Exposure to IPV ................................................................ 8
Observed Behavior Problems and Preschool-age Children’s Exposure to IPV ....... 10
CHAPTER 3
IPV Exposure and Preschool-age Children’s Traumatic Stress............................................ 14
IPV Exposure as a Traumatic Event ......................................................................... 15
The Nature of Preschool-age Children’s Traumatic Stress: Dissociative and/or
Hypervigilant Responses .................................................................................... 16
IPV Exposure and Preschool-age Children’s Traumatic Stress Responses.............. 18
Relation between Preschool-age Children’s Traumatic Stress Symptoms and
Child Behavior Problems.................................................................................... 21
CHAPTER 4
Executive Dysfunction and Child Behavior Problems ......................................................... 25
Definition of EF in Preschool-age Children ............................................................. 26
Three Sub-Components of EF: Attentional Control, Working Memory, and
Inhibitory Control ............................................................................................... 27
Developmental Trajectories and Structure of EF in Preschool-age Children........... 32
Executive Dysfunction and Preschool-age Children’s Behavior Problems.............. 37
CHAPTER 5
Traumatic Stress and Preschool-age Children’s Executive Dysfunction ............................. 43
Theory of Dissociative and/or Hypervigilant Responses and Executive
Dysfunction......................................................................................................... 44
Review of Extant EF Studies in Children Experiencing Chronic Traumatic
Stress ................................................................................................................... 49
Future Directions of EF Research for Preschool-age Children Experiencing
Traumatic Stress.................................................................................................. 54
CHAPTER 6
Towards an Integrated Model: Summary of Extant Findings and Future Directions........... 56
Global Summary of Previous Research: Establishing What We Already Know ..... 56
Critique of Two Previous, Noteworthy Studies........................................................ 58
Future Directions: Towards an Integrated Model..................................................... 60

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CHAPTER 7
Rationale & Hypotheses ....................................................................................................... 66
CHAPTER 8
Methods…............................................................................................................................. 69
Participant Recruitment ............................................................................................ 69
Procedures................................................................................................................. 72
Measures ................................................................................................................... 75
CHAPTER 9
Results.….............................................................................................................................. 81
Missing Data and Imputation.................................................................................... 83
Basic Descriptives..................................................................................................... 88
Preliminary Analyses ................................................................................................ 90
Hypotheses Testing................................................................................................. 102
CHAPTER 10
Discussion…............ ........................................................................................................... 124
Relationship between Dissociation and Hypervigilance......................................... 124
Differential Relationships between Two Traumatic Stress Reactions and
Behavior Problems............................................................................................ 128
Underlying Structure of Preschool-age Children’s Executive Functioning ........... 129
Relationship between Traumatic Stress and Executive Functioning...................... 132
Executive Functioning as a Mediating Mechanism between IPV Exposure,
Traumatic Stress, and Preschool-age Children’s Behavior Problems .............. 134
Strengths of the Present Study ................................................................................ 138
Limitations of the Present Study............................................................................. 139
Clinical Implications of the Present Study’s Findings............................................ 141
Future Directions .................................................................................................... 142
APPENDICES
Appendix A – Copy of Recruitment Flyer.............................................................. 147
Appendix B – Telephone Screening Interview....................................................... 149
Appendix C – Verbal Introduction to Study and Consent Process......................... 157
Appendix D – Mother’s Consent Form .................................................................. 159
Appendix E – Teacher Release Form Signed by Mother ....................................... 164
Appendix F – Teacher Consent Form..................................................................... 166
Appendix G – Child Assent Form .......................................................................... 169
Appendix H – Copies of Measures ......................................................................... 171
Appendix I – Additional CFA Figures and Tables Not Included in Text............... 214
Appendix J – Additional SEM Figures and Tables Not Included in Text .............. 219
REFERENCES ................................................................................................................... 238

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LIST OF TABLES
Table 1:

Demographic Characteristics of Study Participants (N = 143) ................... 71

Table 2:

Alphabetical List of Variables Used in Present Study’s Analyses................ 82

Table 3:

Correlation Matrix of Pattern of Missingness for Imputed Measures
and Key Demographic Variables.................................................................. 86

Table 4:

Means, Standard Deviations, and Ranges of Values for Variables in
Preliminary and Hypotheses Testing Analyses……………………………..88

Table 5:

Co-morbidity between Dissociation and Hypervigilance ............................. 89

Table 6:

Predicting Lab-Assessed EF Scores by Child’s Chronological Age ............ 91

Table 7:

Correlation Matrix of 10 EF Variables Entered Into the PCA Model ......... 94

Table 8:

Pattern Matrix for PCA Model ..................................................................... 95

Table 9:

Structure Matrix for PCA Model .................................................................. 96

Table 10:

Correlations between Three Rotated EF Components ................................. 97

Table 11:

CFA Model Modifications Required............................................................. 98

Table 12:

Correlation Matrix of 11 Variables Used in Hypothesis Testing
Analyses ...................................................................................................... 104

Table 13:

Predicting Internalizing Behavior Problems by Traumatic Stress
Symptoms .................................................................................................... 106

Table 14:

Predicting Externalizing Behavior Problems by Traumatic Stress
Symptoms .................................................................................................... 107

Table 15:

Predicting Executive Functioning by Traumatic Stress Symptoms ............ 109

Table 16:

SEM Specifications and Modifications ....................................................... 112

Table 17:

Fit Indices for CFA Model #1: AC, WM, and IC Latent Factors ............... 216

Table 18:

Fit Indices for CFA Model #2: MR, TR, and LA Latent Factors................ 218

Table 19:

Fit Indices for SEM #1: Maternal Reported EF and Behavior Problems .. 221

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Table 20:

Fit Indices for SEM #2: Teacher Reported EF and Behavior Problems.... 223

Table 21:

Fit Indices for Attempted SEM Replication of Milot et al.’s (2010)
Findings: Teacher Reported Behavior Problems ....................................... 226

Table 22:

Fit Indices for Attempted SEM Replication of Milot et al.’s (2010)
Findings: Maternal Reported Behavior Problems ..................................... 227

Table 23:

Fit Indices for SEM #3: Maternal Reported EF and Teacher Reported
Behavior Problems...................................................................................... 230

Table 24:

Fit Indices for SEM #4: Teacher Reported EF and Maternal Reported
Behavior Problems...................................................................................... 233

Table 25:

Fit Indices for SEM #5: Lab Assessed EF and Maternal Reported
Behavior Problems...................................................................................... 235

Table 26:

Fit Indices for SEM #6: Lab Assessed EF and Teacher Reported
Behavior Problems...................................................................................... 237

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LIST OF FIGURES
Figure 1:

Proposed Mediational Model of Preschool-age Children’s Behavior
Problems ......................................................................................................... 6

Figure 2:

Regression Equations for Controlling for Effects of Child’s Age on
Lab-Assessed EF........................................................................................... 91

Figure 3:

CFA Model #1: AC, WM, and IC Latent Factors ....................................... 100

Figure 4:

CFA Model #2: MR, TR, and LA Latent Factors........................................ 101

Figure 5:

SEM #1: Maternal Reported EF and Behavior Problems .......................... 115

Figure 6:

SEM #2: Teacher Reported EF and Behavior Problems............................ 116

Figure 7:

SEM #3: Maternal Reported EF and Teacher Reported
Behavior Problems...................................................................................... 118

Figure 8:

SEM #4: Teacher Reported EF and Maternal Reported
Behavior Problems...................................................................................... 119

Figure 9:

SEM #5: Lab Assessed EF and Maternal Reported
Behavior Problems...................................................................................... 122

Figure 10:

SEM #6: Lab Assessed EF and Teacher Reported
Behavior Problems...................................................................................... 123

Figure 11:

T-scores of Parameter Estimates for CFA Model #1: AC, WM, and
IC Latent Factors........................................................................................ 215

Figure 12:

T-scores of Parameter Estimates for CFA Model #2: MR, TR, and
LA Latent Factors ....................................................................................... 217

Figure 13:

T-scores for SEM #1: Maternal Reported EF and Behavior Problems...... 220

Figure 14:

T-scores for SEM #2: Teacher Reported EF and Behavior Problems ....... 222

Figure 15:

Standardized Estimates for Attempted SEM Replication of Milot et al.’s
(2010) Findings: Teacher Reported Behavior Problems............................ 224

Figure 16:

T-scores for Attempted SEM Replication of Milot et al.’s (2010)
Findings: Teacher Reported Behavior Problems ....................................... 225

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Figure 17:

Standardized Estimates for Attempted SEM Replication of Milot et al.’s
(2010) Findings: Maternal Reported Behavior Problems.......................... 227

Figure 18:

T-scores for Attempted SEM Replication of Milot et al.’s (2010)
Findings: Maternal Reported Behavior Problems ..................................... 228

Figure 19:

T-scores for SEM #3: Maternal Reported EF and Teacher
Reported Behavior Problems...................................................................... 230

Figure 20:

T-scores for SEM #4: Teacher Reported EF and Maternal
Reported Behavior Problems...................................................................... 232

Figure 21:

T-scores for SEM #5: Lab Assessed EF and Maternal
Reported Behavior Problems...................................................................... 234

Figure 22:

T-scores for SEM #6: Lab Assessed EF and Teacher
Reported Behavior Problems...................................................................... 236

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CHAPTER 1
Introduction
Intimate partner violence (IPV) is a common form of violence. Within the past two
decades, several national studies were conducted to determine the prevalence rate of IPV in the
United States. Based on best estimates, approximately 25% of women will experience IPV
within their lifetime (Breiding, Black, & Ryan, 2008; Tjaden & Thoennes, 2000). Although IPV
is traditionally defined as male-to-female partner violence (e.g., Marshall, 1992), there is
considerable evidence that both men and women perpetrate IPV (e.g., Breiding et al., 2008;
Fantuzzo, Fusco, Mohr, & Perry, 2007; Fusco & Fantuzzo, 2009; McDonald, Jouriles,
Ramisetty-Mikler, Caetano, & Green, 2006) and that the violence may be unidirectional (i.e.,
male-to-female or female-to-male) or bidirectional (Caetano, Vaeth, & Ramisetty-Mikler, 2008;
Goodlin & Dunn, 2010). Furthermore, longitudinal studies suggest that most families experience
multiple incidences of IPV over a period of several years (Caetano, Field, Ramisetty-Mikler, &
McGrath, 2005). The current research defines IPV as any incident of physical assault, sexual
violence, psychological control/coercion, or threats of physical and/or sexual violence
perpetrated by either a male or female partner, consistent with previous investigators (Breiding et
al., 2008; Marshall, 1992).
Young children under the age of five are disproportionately at risk for being exposed to
IPV (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997), with approximately 7.5 million
preschool-age children exposed to IPV each year in the United States (based on figures provided
by Fantuzzo et al., 1997; Fusco & Fantuzzo, 2009; McDonald et al., 2006). Preschool-age
children exposed to IPV appear to be particularly deleteriously impacted by the violence.
According to two recent meta-analyses (Evans, Davies, & DiLillo, 2008; Wolfe, Crooks, Lee,

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McIntyre-Smith, & Jaffe, 2003), preschool-age children exposed to IPV are at an increased risk
for developing both internalizing and externalizing behavior problems. Furthermore, preschoolage children frequently experience significant traumatic stress reactions in response to the
violence (e.g., Levendosky, Huth-Bocks, Semel, & Shapiro, 2002; Margolin & Vickerman,
2008; Zerk, Mertin, & Proeve, 2009). What is not well understood, however, is why children
exposed to IPV in early life develop such widespread behavior problems and what mechanisms
may mediate this relationship. The current research argues that the relationship between IPV
exposure in early childhood, subsequent traumatic stress symptoms, and behavior problems are
mediated by children's executive functioning (Note: ‘EF’ will hereafter represent executive
function, executive functions, or executive functioning).
The impetus for such a model comes from the integration of the traumatic stress
literatures (both psychological and physiological) and the broader neuropsychology literature.
According to Perry, Pollard, Blakley, Baker, and Vigilante’s (1995) traumatic stress theory,
children’s psychological traumatic stress responses are best conceptualized as occurring on a
continuum anchored by dissociative experiences on one end and hypervigilance on the other.
Dissociative and hypervigilant responses to traumatic events are proposed to influence young
children’s EF through the cognitive correlates of these traumatic stress reactions which influence
children’s capacity to engage with their environments. Understanding the distinction between
these two types of traumatic stress is critical, as these reactions are proposed to have different
biological and psychological mechanisms and behavioral outcomes (e.g., Hankin, Badanes,
Abela, & Watamura, 2010). In particular, dissociative experiences are marked by a withdrawal
from the sensory environment and an experienced fragmentation of sensory perception,
cognition, and memory (APA, 2000; DePrince & Freyd, 2007). In contrast, children who are

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hypervigilant in response to a traumatic event are on constant physiological alert for potential
threats (e.g., Levendosky, 2002; Levendosky et al., 2011).
Additionally, these two psychological stress responses are differentially related to
children’s biological stress systems. For instance, dissociative symptoms are associated with a
suppressed physiological stress response, expressed as hypocortisol (Simeon et al., 2007),
whereas hypervigilance is associated with a hypercortisol response (MacMillan et al., 2009).
Children may experience both dissociative and hypervigilant responses over the course of
chronic traumatic stress (e.g., Mertin & Mohr, 2002); however, the relationship between this
mixed response and the physiological stress systems is not well understood. Chronic activation
of the physiological stress systems is associated with both structural and functional changes in a
wide-variety of cortical and sub-cortical sites, including the prefrontal cortex, limbic system,
hippocampus, corpus callosum, and temporal lobes (Brewin, 2008; Jackowski, de Araujo, de
Lacerda, Mari, & Kaufman, 2009; Karl et al., 2006; Schore, 2002). These neurological sites are
implicated in EF (e.g., Diamond, 2002) and thus impaired development in these regions would
be expected to result in executive dysfunction (e.g., Blair, 2010).
Executive dysfunction does not represent a single, discrete construct, but rather refers to
impaired functioning across one or more sub-components of EF (Anderson, 2002; Gioia, Isquith,
& Guy, 2001). Executive dysfunction is related to a wide variety of internalizing and
externalizing problems in young children (e.g., see Anderson, 2002, for a review; Kusche, Cook,
& Greenberg, 1993; Zhou et al., 2007). In particular, three sub-components of EF in preschoolage children (attentional control, working memory, and inhibitory control) have each been shown
to predict young children's social, emotional, and behavioral functioning (e.g., Eisenberg et al.,

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2010; Hughes & Ensor, 2008; Rueda, Checa, & Rothbart, 2010) and thus represent important
sub-components of EF for further investigation.
IPV is considered a prototypic traumatic event for the current empirical investigation for
three reasons. First, IPV is one of the most salient traumatic events children can experience
(Margolin & Gordis, 2000; Margolin & Vickerman, 2008) and as a result, is often associated
with greater impaired functioning than other forms of traumatic events (Ybarra, Wilkens, &
Lieberman, 2007). Second, IPV is usually chronic in duration (Caetano et al., 2005), often
resulting in long-term traumatic stress responses (Briggs-Gowan, Carter, Clark, Augustyn,
McCarthy, & Ford, 2010; Levendosky et al., 2002; Zerk et al., 2009). This chronic traumatic
stress response is associated with greater activation across both physiological stress systems,
which subsequently result in substantive neurological changes. In turn, these changes are
proposed to result in more disrupted EF development. Studying a chronic traumatic event
resulting in long-term traumatic stress responses provides the opportunity for a clearer picture for
the current exploratory research. Third, children are usually first exposed to the violence in their
early years (Fantuzzo et al., 1997), which is considered a critical neurodevelopmental period for
emerging EF (e.g., Diamond, 2002).
Similarly, the preschool years represent an ideal developmental period for the current
research for several reasons. As noted before, children under the age of five are
disproportionately exposed to IPV (Fantuzzo et al., 1997). Although EF development begins in
infancy (Diamond & Taylor, 1996), the preschool period is marked by some of the greatest
advances in EF abilities during childhood (Carlson, 2005; Garon, Bryson, & Smith, 2008).
Chronic traumatic stress during this critical developmental period is proposed to be a significant
risk factor that may alter a child’s neuropsychological trajectory. Lastly, for many children, the

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preschool period marks the first time they begin spending significant amounts of time away from
their caregivers, form peer groups, and enter an academic environment. Therefore, it is important
to understand how chronic traumatic stressors, such as IPV exposure, impacts children’s social,
emotional, and behavioral development, as these novel experiences will lay important
foundations for later social and academic success.
The current research study tests the following theoretical model (see Figure 1 below):
Preschool-age children exposed to IPV frequently exhibit dissociative and/or hypervigilant
responses (e.g., Levendosky et al., 2002; Rossman, Bingham, & Emde, 1997; Perry & Pollard,
1998; Perry et al., 1995), which are differentially related to children’s biological stress systems’
reactivity. These transactional psychological and physiological stress responses (De Bellis et al.,
1999a/1999b; Perry & Pollard, 1998; Perry et al., 1995) are related to children’s executive
dysfunction (Blair, 2010). Thus, preschool-age children’s dissociative and hypervigilant
responses are hypothesized to be differentially related to their attentional control, working
memory, and inhibitory control. Specifically, dissociative symptoms are hypothesized to be
related to impairments in attentional control and working memory, which mediate the
relationship between the children’s traumatic stress symptoms and their internalizing behavior
problems across several environments (e.g., at preschool and at home). In contrast, symptoms of
hypervigilance are proposed to be associated with executive dysfunction across all three EF subcomponents – most notably a combination of attentional control and inhibitory control problems
– which is thought to mediate the relationship between traumatic stress symptoms and
externalizing behavior problems at home and at school.

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Figure 1
Proposed Mediational Model of Preschool-age Children’s Behavior Problems

The current research is novel and makes several important theoretical and empirical
contributions. Theoretically, the research integrates Perry et al.’s (1995) traumatic stress theory
with De Bellis et al.’s (1999a/1999b) developmental trauma theory, and Blair’s (2010)
contextual stress and EF theory. The current research extends these theories by testing whether
EF mediates the relationship between preschool-age children’s dissociative and/or hypervigilant
traumatic stress responses to IPV and their behavioral functioning. This is the first study to
examine this mediational pathway. The current study also has several methodological strengths,
including assessing multiple aspects of IPV, the use of developmentally appropriate traumatic
stress symptom measures, and a comprehensive examination of preschool-age children’s
emotional, behavioral, and EF functioning through multiple methods and reporters, including
lab-based assessments, and maternal and teacher reports.
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The following manuscript is organized into 9 additional chapters. Chapter 2 provides
background information by detailing preschool-age children's IPV exposure and the association
between early childhood IPV exposure and observed behavior problems. Chapter 3 reviews
Perry et al.’s (1995) traumatic stress theory and the empirical literature regarding preschool-age
children’s dissociative and/or hypervigilant responses to IPV. Additionally, Chapter 3 examines
the relationship between children’s psychological traumatic stress responses and subsequent
behavior problems. Chapter 4 introduces EF and the theoretical models for each of the three subcomponents considered in the current research. Chapter 4 also reviews the empirical literature
regarding the association between EF and differential child behavior problems. Chapter 5
provides a theoretical argument for how chronic traumatic stress may be related to executive
dysfunction in preschool-age children and reviews the limited, available evidence establishing a
relationship between children's traumatic stress reactions and impairments in attentional control,
working memory, and inhibitory control. Chapter 6 provides an overall summary of the findings
presented in the previous four chapters and proposes a mediational model of IPV exposure in
early childhood, subsequent traumatic stress, EF, and behavior problems. Chapters 7 – 9 detail
the study's rationale and hypotheses, methods, and results. Chapter 10 provides an in-depth
discussion of the study’s results, including possible clinical implications and future directions for
research.

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CHAPTER 2
IPV Exposure and Preschool-age Children’s Behavior Problems
Children are frequently exposed to IPV (e.g., Edleson, 1999; McDonald et al., 2006) and
children under the age of five are exposed to disproportionally more IPV than older children
(Fantuzzo et al., 1997). These first few years of life are a period of critical biopsychosocial
development (e.g., Camille, Vargas, Ryan, & Barnett, 2010; Romine & Reynolds, 2005).
Unfortunately, research programs examining the effects of IPV exposure on children are
relatively new, only having been widely established within the past fifteen years (Fantuzzo &
Mohr, 1999). Furthermore, despite the advances in examining childhood exposure to IPV –
especially in school-age children and adolescents (e.g., Edleson, 1999; Wolfe et al., 2003) –
contemporary researchers have only recently began to research the effects of IPV exposure with
preschool-age children (e.g., Levendosky et al., 2002; Zerk et al., 2009). Early childhood IPV
exposure is associated with significantly higher risk of developing later psychopathology (e.g.,
Briggs-Gowan et al., 2010), including both internalizing and externalizing behavior problems.
The current chapter examines the relationship between preschool-age children’s IPV exposure
and subsequent behavior problems as this relationship forms one of the foundational paths of the
current model.
Preschool-age Children’s Exposure to IPV
McDonald and colleagues (2006) provided the best estimate of the total number of
children (ages 0 – 17) living in households with IPV. The authors randomly selected a very large
sample across 48 states, oversampling for Blacks and Hispanics, and assessed for incidences of
unidirectional and bidirectional violence that occurred the previous year. They extrapolated their
figures to match the US Census and determined that nearly 15 million children were exposed to

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some form of IPV in the previous year, with 7 million children residing in households in which
severe IPV was reported (McDonald et al., 2006). As the authors note, these figures are likely an
underestimate as they are based exclusively on dual-parent households and thus do not include
incidences of children exposed to IPV in single parent households (McDonald et al., 2006). One
of the notable strengths of McDonald and colleagues’ study is the assessment of both
unidirectional and bidirectional IPV. Unfortunately, McDonald et al. do not provide a breakdown
of IPV exposure by age; however, other independent samples have reported that nearly 50% of
all children exposed to IPV are preschool-age and younger (e.g., Fantuzzo et al., 1997; Fusco &
Fantuzzo, 2009). Thus, based on the three studies cited (i.e., Fantuzzo et al., 1997; Fusco &
Fantuzzo, 2009; McDonald et al., 2006) it is possible that nearly 7.5 million preschool-age
children live in households with IPV each year.
Historically, research examining the effects of IPV on children usually relies on a
parent’s endorsement – typically maternal report (e.g., Levendosky et al., 2002) – of the child
directly witnessing one or more incidences of violence. This approach likely underestimates the
number of children exposed to IPV (Fusco & Fantuzzo, 2009) and also misidentifies children
categorized in research studies based on their exposure status. Edleson (1999) noted that parents
often assume that their children are unaware of IPV if they do not directly witness any of the
violent acts themselves. However, Edleson and others (Fantuzzo & Mohr, 1999) have
documented additional ways in which children may be exposed to IPV other than directly
witnessing the event, including other sensory exposure to the event (e.g., hearing the violence,
but not seeing it), hearing about the violence after it has occurred from a sibling or caregiver,
seeing the effects of the violence (e.g., seeing injuries caused by the violence, police
intervention), or being used as a weapon within psychological violence (e.g., being interrogated

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by a parent about the other parent). Fusco and Fantuzzo (2009) used a novel research method in
examining the empirical evidence for the many ways in which children are exposed to IPV. They
had police officers responding to IPV calls record whether children were present at the time of
the violence and what form of sensory exposure the children experienced. Fusco and Fantuzzo
reported that in 95% of the cases in which IPV occurred and children were present in the home,
the children had at least one type of sensory exposure to the violence. Most of the children both
witnessed and heard the violence, while nearly one quarter of the children only heard the
violence (Fusco & Fantuzzo, 2009).
Previous findings of preschool-age children’s behavior problems following exposure to
IPV also offer supporting evidence that classifying children based upon maternal reports of the
child witnessing incidences of IPV are likely unreliable (e.g., Fusco & Fantuzzo, 2009). For
instance, in one sample, there was no difference for either externalizing or internalizing behavior
problem scores when comparing groups of children dichotomized based upon maternal reports
witnessing or not incidences of IPV, when all of the children lived in households in which IPV
occurred (Levendosky et al., 2002).
Based upon these findings, the current research endorses Fantuzzo and Mohr’s (1999)
call for examining ‘exposure to’ IPV rather than only assessing for and considering incidences of
IPV that the children directly witness. Additionally, the current research assumes that children
living in homes in which IPV occurs will have at least one type of sensory exposure to the
violence at some point in the child’s lifetime.
Observed Behavior Problems and Preschool-age Children’s Exposure to IPV
Two recent meta-analyses have examined the relationship between childhood exposure to
IPV and subsequent behavior problems. Wolfe et al. (2003) included data from 41 studies and

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found that IPV exposure in early childhood was associated with the second-largest effect size for
both internalizing and externalizing behavior problems, second only to school-age children.
More recently, Evans et al. (2008) examined data from 60 studies. The authors also included
studies that assessed for bidirectional IPV, rather than only including studies with unidirectional
male-to-female partner violence. Evans et al. reported a medium effect size for IPV exposure and
preschool-age children’s behavior problems. The relationship was partially moderated by gender,
with preschool girls exposed to IPV experiencing significantly more internalizing, but not
externalizing, problems; whereas preschool boys exposed to IPV had significantly higher rates of
both types of behavior problems (Evan et al., 2008).
One limitation with both Wolfe et al.’s (2003) and Evans et al.’s (2008) meta-analyses is
that we cannot determine the course of the children’s behavior problems relative to the trajectory
of their IPV exposure. Two longitudinal studies address this gap in the literature. Litrownik,
Newton, Hunter, English, and Everson (2003) examined the association between children’s
behavior problems at age six with their IPV exposure, controlling for their behavior problems at
age four. The authors reported that exposure to IPV during the preschool years is predictive of
aggressive behavior problems, and anxious/depression-related symptoms two years later
(Litrownik et al., 2003). Huang, Wang, and Warrener (2010) conducted a large, multisite five
year longitudinal study and reported that maternal experiences of IPV that occurred before the
children were age one had a direct effect on the children’s internalizing and externalizing
behavior problems five years later, even after controlling for possible mediating factors.
Although the findings from this particular study are limited by the fact that Huang et al. only
assessed unidirectional male-to-female partner violence at one time point, the results converge

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with Litrownik et al.’s findings that early exposure to IPV can have long-lasting and pernicious
effects on children’s functioning.
As many children exposed to IPV are also maltreated (e.g., Finkelhor, Ormrod, & Turner,
2007; Hamby, Finkelhor, Turner, & Ormrod, 2010), it is possible that the observed behavior
problems (e.g., Evans et al., 2008; Wolfe et al., 2003) are the result of maltreatment, not IPV
exposure (Lieberman, van Horn, & Ozer, 2005). To control for this possibility, Ybarra et al.
(2007) recruited a sample of preschool-age children exposed to IPV but who were not
maltreated, as well as a demographically matched control group of children not exposed to IPV.
Their results suggest that IPV exposed only (i.e., not maltreated) preschool-age children had
significantly elevated internalizing problems compared with controls. Lieberman et al. (2005)
used a similar approach and reported that severity of IPV significantly accounted for a significant
portion of the variance in preschool-age children’s internalizing and externalizing problems.
Lieberman et al. may have found more wide-spread behavior problems in their sample (i.e., both
internalizing and externalizing problems) than Ybarra et al., due to their use of a clinical sample
and thus the children, on average, displayed higher levels of behavior problems than those
reported in Ybarra et al.’s sample. However, the findings from Lieberman et al. and Ybarra et al.
indicate that IPV exposure alone (i.e., in the absence of possible co-morbid maltreatment) is
related to elevated behavior problems.
In summary, IPV consists of both perpetrated and threatened physical, sexual, and
psychological violence (e.g., Breiding et al., 2008; Marshall, 1992), is perpetrated by both men
and women (Fusco & Fantuzzo, 2009; McDonald et al., 2006), and disproportionately impacts
children during the preschool years (Fantuzzo et al., 1997; Fusco & Fantuzzo, 2009). Preschoolage children are exposed to IPV through a variety of ways, including direct and indirect sensory

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exposure to the violence (Edelson, 1999; Fantuzzo & Mohr, 1999; Fusco & Fantuzzo, 2009).
IPV exposure is associated with high levels of both internalizing and externalizing behavior
problems in preschool-age children (Evans et al., 2008; Wolfe et al., 2003), above and beyond
controlling for possible comorbid maltreatment (e.g., Ybarra et al., 2007). These effects are
observed across time (Huang et al., 2010) and suggest that early exposure to IPV has pernicious,
long-lasting effects on child social-emotional development. Beyond documented behavior
problems, early IPV exposure is also a salient traumatic event and frequently results in clinically
significant traumatic stress symptoms (e.g., Levendosky et al., 2002; Zerk et al., 2009), which
will be reviewed in-depth in the next chapter.

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CHAPTER 3
IPV Exposure and Preschool-age Children’s Traumatic Stress
It is an ultimate irony that at the time when the human is most vulnerable to the effects of trauma
– during infancy and childhood – adults generally presume the most resilience.
-(Perry et al., 1995; pg. 272)
The findings from the past two decades of research provide clear evidence that preschoolage children who have been exposed to IPV are at an increased risk of experiencing significant
traumatic stress (see Margolin & Gordis, 2000, and Margolin & Vickerman, 2008, for two
reviews). The current research applies Perry et al.’s (1995) traumatic stress theory that argues
psychological traumatic stress responses occur on a continuum anchored by dissociative
experiences on one end and hypervigilance on the other. Although additional aspects of young
children’s traumatic stress responses have been well documented and constitute significant
problems, such as distorted representations of self and others (e.g., Cook et al., 2005; van der
Kolk et al., 2009), these domains of impaired functioning are considered to be less related to
behavioral problems and thus not of central focus of the current research. This chapter
distinguishes IPV as a traumatic event, reviews Perry et al.’s traumatic stress theory, examines
the extant evidence for preschool-age children’s traumatic stress responses following exposure to
IPV, and documents the associations between these stress responses and observed behavior
problems.
Before proceeding, a distinction between the terms ‘posttraumatic stress’ and ‘traumatic
stress’ is necessary. Throughout much of the trauma literature, an individual’s affective and
behavioral response following the traumatic event is classified as ‘posttraumatic,” most notably
in the case of Posttraumatic Stress Disorder (PTSD) (APA, 2000). However, for the purposes of
the current research, traumatic stress is argued as the most appropriate term, as IPV is not

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generally a single, easily demarcated incident, but rather a systematic pattern of behavior that
continues for a significant period of time (Caetano et al., 2005). PTSD criteria, by definition,
require a marked change in functioning from a clearly defined pre-trauma baseline period (APA.
2000). Most preschool-age children who have previously been exposed to IPV will continue to
be raised within the same violent family and thus the children’s behavior and functioning is
concurrent to the violence itself and not easily demarcated from a baseline level of functioning
pre-traumatic event (Margolin & Vickerman, 2008). Therefore, the term ‘traumatic stress’ is
argued to be the most appropriate description of children’s affective and behavioral responses to
the IPV exposure, which does not necessitate a post-traumatic event reaction. Hereafter,
traumatic stress will be used as the default term, except when referring to the specific PTSD
literature.
IPV Exposure as a Traumatic Event
Unlike other potentially traumatic events (e.g., non-violent death of a family member or
natural disaster), IPV exposure in early childhood has been identified as one of the most salient
forms of traumatic events a young child can experience (e.g., Cook et al., 2005; Margolin &
Vickerman, 2008; Terr, 1991). Three reasons underlie the salience of IPV as a traumatic event,
compared to other events: (1) the violence is interpersonal in nature, which is related to the most
deleterious outcomes for both children and adults across all types of traumatic events (Cloitre et
al., 2009; Cook et al., 2005; Spinazzola et al., 2005), (2) the violence involves caregivers
(attachment figures) to the child, which means the child must simultaneously depend on the
caregiver while managing his/her fear and negative affect towards the caregiver (Freyd, 1996;
Margolin & Vickerman, 2008), and (3) the violence is usually chronic, occurring many times

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over a lengthy period (Caetano et al., 2005; Margolin & Vickerman, 2008). As a result of these
unique characteristics, IPV exposure is particularly traumatic.
As noted in the previous chapter, much of the prominent IPV research conducted over the
past two decades (e.g., Tjaden & Thoennes, 2000) only examined male-to-female partner
violence and did not assess any female-to-male violent incidences. From the child’s perspective,
however, incidences of unidirectional female-to-male or bidirectional violence are plausibly just
as distressing than male-to-female partner violence due to conflict arising from the mother
serving simultaneously as the principal attachment figure (Bowlby, 1979) and the aggressor. In
the case of bidirectional violence, the child might be especially vulnerable given the lack of a
safe, non-violent, protective caregiver that could help buffer the child from the deleterious
effects of the violence (e.g., Belsky, 1984). Unfortunately, no empirical research to date has
examined the relative breadth and severity of children’s traumatic stress responses to these
different forms of IPV. At minimum, future research examining child outcomes associated with
IPV exposure must assess both unidirectional and bidirectional violence.
The Nature of Preschool-age Children’s Traumatic Stress: Dissociative and/or Hypervigilant
Responses
The current research applies Perry et al.’s (1995) traumatic stress theory, which posits
that traumatic stress responses to perceived threat, whether real or imagined, occur on a
continuum anchored by dissociative experiences on one end and hypervigilance on the other.
Thus, according to Perry et al.’s, traumatic stress responses are not categorical typologies, but
rather idiosyncratic traumatic stress profiles consisting of both dissociative and hypervigilant
symptoms, the proportion of which varies across individuals. Dissociative experiences are
characterized by a widespread breakdown across multiple aspects of cognitive processing

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(DePrince & Freyd, 2007), including memory systems (DePrince & Freyd, 2001) and perception
of the environment (APA, 2000). This systemic breakdown often results in a fragmented sense of
self-identity (Macfie, Cicchetti, & Toth, 2001a/200b; Ogawa et al., 1997). Dissociative
experiences are first identifiable in preschool-age children (Putnam, 1991) and are not readily
dichotomized (i.e., dissociated versus not-dissociated). Dissociation occurs on a continuum from
developmentally normative dissociative behaviors (e.g., having an imaginary friend, engaging in
extensive imaginary play) in early childhood (Macfie et al., 2001b; Ogawa et al., 1997) to severe
dissociative experiences that can impair an individual’s functioning throughout the lifespan
(APA, 2000). In young children, dissociation is often expressed as “freezing” behavior (Perry &
Pollard, 1998; Perry et al., 1995), which is analogous to animals feigning death in the face of
imminent threat (Porges, 2007).
In contrast to the suppressed physiological response that characterizes dissociative
experiences (e.g., freezing behavior), children’s hypervigilance is marked by increased central
nervous system activity across several areas of the brain associated with basic survival strategies
(e.g., “fight or flight”) (e.g., Kearny et al., 2010; Perry & Pollard, 1998; Perry et al., 1995;
Porges, 2007). Behaviorally, children experiencing hypervigilance will startle more easily in
response to common stimuli (e.g., loud noises, quick moving visual objects) and may appear
more physically restless than before the traumatic event (APA, 2000).
Perry et al. (1995) further hypothesized that an individual’s idiosyncratic traumatic stress
response to an original traumatic event is a salient psychological and physiological
organizational experience (covered in greater detail in Chapter 5), which subsequently
predisposes an individual to respond similarly to perceived threats in the future. Over time, the
authors argue, these traumatic stress responses begin to generalize to other, milder stressors.

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Because young children’s brains are sensitive to external experiences during critical structural
and functional neural developmental periods, Perry et al. noted that young children’s immediate
traumatic stress “states” are likely to become semi-permanent “traits” though the process of
increasing sensitization and generalization of the traumatic stress responses. Consistent with this
prediction, Scheeringa (2008) noted that traumatic stress symptoms that begin in early life appear
to be more unremitting and entrenched than those observed in adults.
Based upon their extensive clinical work with a large group of children exhibiting high
levels of traumatic stress, Perry et al. (1995) observed that young children exposed to repeated
traumatic events – especially those that involve ineffectual caregivers, such as in IPV – will
frequently move into the dissociative end of the continuum. The authors hypothesized that young
children may be particularly prone to dissociative states due to children’s greater reliance on
their caregivers to help them regulate their stress responses to real or perceived threats. However,
in the case of violent caregivers, young children are unable to benefit from their caregiver(s)’
assistance and thus may be particularly prone to perceive the situation as hopeless and to freeze
in response (Perry et al., 1995). In order to assess these claims, the empirical evidence for
preschool-age children’s traumatic stress responses following exposure to IPV will be reviewed
next.
IPV Exposure and Young Children’s Traumatic Stress Responses
The most significant limitation to Perry et al.’s (1995) traumatic stress theory at the time
of publication was the authors’ reliance on experimental animal research due to the paucity of
reliable human data other than the author’s own clinical samples of severely traumatized
children. Fortunately, additional researchers have paid increasing attention to these research
questions during the past fifteen years. Evidence from cross-sectional studies indicate that

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preschool-age children exhibit both dissociative and hypervigilant traumatic stress responses
when exposed to IPV. One of the earliest studies to assess dissociative symptoms in preschoolage children exposed to IPV reported elevated dissociative symptoms in children who witnessed
IPV (Rossman et al., 1997). Macfie et al. (2001a) provided a more detailed picture in their
research. They reported that both severity and chronicity of family violence was positively
correlated with dissociative symptoms. Furthermore, nearly 20% of preschool-age children
exposed to family violence in Macfie et al.’s sample exhibited clinical levels of dissociation. In
contrast, not a single child spared from experiencing family violence exhibited clinical levels of
dissociation (Macfie et al., 2001a). This finding has been replicated in other samples within the
same population, as well (e.g., Macfie et al., 2001b).
Two longitudinal studies have examined the nature and development of dissociative
symptoms in preschool-age children exposed to family violence. Ogawa et al. (1997) reported
that exposure to family violence in infancy through early childhood is associated with later
dissociative symptoms in preschool and school age children. Although the authors did not assess
children’s exposure to IPV specifically during their first several waves of data, the authors
measured IPV exposure beginning during the early elementary years and reported that IPV
exposure predicated dissociative symptoms above and beyond other forms of family violence
(Ogawa et al., 1997). These results should be interpreted as preliminary evidence, however, as
the authors measured dissociative symptoms based upon selectively chosen items from several
other child outcome measures and thus did not employ a well-validated measure of dissociation.
Extending Ogawa et al.’s findings using a better measure of child dissociative symptoms, Macfie
and colleagues (2001b) conducted a longitudinal examination of dissociative experiences in
preschool-age children exposed to family violence. Macfie et al. documented a normative decline

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in dissociative symptoms for children not exposed to family violence (e.g., having imaginary
friends) in contrast to a significant increase in dissociation for preschool-age children exposed to
family violence over the same period of time. This finding is consistent with Perry et al.’s (1995)
assertion that children’s traumatic stress responses are likely to become more sensitive and thus
generalize from immediate threats to more varied environments.
Findings from cross-sectional studies indicate that a substantial portion of preschool-age
children also exhibit hypervigilance following exposure to IPV. Using a maternal-report
questionnaire of hypervigilant symptoms based upon Scheeringa, Zeanah, Drell, and Larrieu’s
(1995) modified, developmentally appropriate criteria, Levendosky et al. (2002) reported that
91% of their sample of preschool-age children exposed to IPV exhibited two or more symptoms
of hypervigilance. Although this figure is the highest prevalence rate of clinically significant
hypervigilance reported in the literature, other independent samples have also documented high
levels of hypervigilance in preschool-age children exposed to IPV (e.g., Graham-Bermann et al.,
2008; Zerk et al., 2009). A recent, unpublished investigation found that hypervigilant responses
were the most common PTSD-related traumatic stress symptoms for young children
(Levendosky et al., 2011).
No longitudinal studies have investigated the predictors or course of young children’s
hypervigilance. Thus, it is not possible to conclusively determine whether children’s
hypervigilant response to traumatic events increases over time (i.e., becomes more sensitized) or
generalizes to other, milder stressors, as Perry et al. (1995) predicted. Despite the lack of
longitudinal data, it is clear that hypervigilance is a prevalent traumatic stress response in older
children. For instance, clinically significant hypervigilance has been reported in 25% to 89% of
school-age children exposed to IPV (Graham-Bermann & Levendosky, 1998; Mertin & Mohr,

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2002). Although we currently lack longitudinal evidence for symptoms of hypervigilance
generalizing beyond immediate traumatic events (e.g., Perry & Pollard, 1998; Perry et al., 1995),
evidence from cross sectional studies suggest that a substantial sub-set of young children who are
repeatedly exposed to a traumatic event, such as IPV, develop new fears than they exhibited
before the traumatic event (e.g., Graham-Bermann et al., 2008; Scheeringa, 2008; Zerk et al.,
2009). These findings indicate that children’s immediate traumatic stress responses to the
original traumatic event may, in some children, generalize to other perceived threats consistent
with Perry et al.’s theory.
According to Perry et al.’s (1995) traumatic stress theory, it is possible for children to
experience both dissociative and hypervigilant symptoms; however, there are no reliable
estimates for the degree of overlap between these responses. For instance, although Mertin and
Mohr (2002) assessed both dissociative and hypervigilant symptoms, they did not report the
degree of overlap between these symptoms within the same children and it is not possible to
determine the overlap using the results (e.g., tables, graphs) they provide. The authors did report
that dissociative symptoms were moderately correlated with total PTSD symptoms in their
sample (Mertin & Mohr, 2002). A similar relationship is reported in other samples (e.g.,
Rossman et al., 1997). In the absence of empirical data, the degree of co-morbidity between
dissociative and hypervigilant responses to IPV remains unknown.
Relation between Preschool-age Children’s Traumatic Stress Symptoms and Child Behavior
Problems
Few extant studies of preschool-age children have investigated the association between
chronic traumatic stress and child behavior problems, which is likely an artifact of the general
paucity of research on young children’s responses to traumatic events (e.g., Levendosky et al.,

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2002; Zerk et al., 2009). Of the few studies that have assessed both child behavior problems and
preschool-age children’s traumatic stress symptoms in the same sample (e.g., Levendosky et al.,
2002; Zerk et al., 2009), the findings indicate that increased traumatic stress symptoms are
associated with high rates of clinically significant internalizing (Levendosky et al, 2002) and
externalizing (Zerk et al., 2009) behavior problems. Research with older children provides clear
evidence for a relationship between chronic traumatic stress and both internalizing and
externalizing behavior problems (e.g., Cook et al., 2005; Terr, 1991; van der Kolk, 2005; van der
Kolk et al., 2009). What remains unclear, however, is the differential relationship between
dissociative and hypervigilant responses and internalizing and/or externalizing problems. In
Macfie et al.’s (2001b) study of preschool-age children exposed to several forms of family
violence, dissociative symptoms were associated with elevated internalizing and externalizing
behavior problems, with no gender differences reported.
Milot and colleagues (2010) examined whether preschool-age children’s traumatic stress
symptoms mediate the relationship between childhood maltreatment and teacher-reported
behavior problems. The authors used a total PTSD score in their models and found that PTSD
symptoms fully mediate the relationship between maltreatment and both internalizing and
externalizing behavior problems, even after removing items on the behavior checklist that
overlap with PTSD symptoms (Milot et al., 2010). Furthermore, the authors reported that they
found similar results when they examined each of the PTSD clusters as independent mediators;
however, they did not provide any figures to support this assertion, thus it is not possible to
determine from their published results how well hypervigilance mediated the relationship
between maltreatment and observed behavior problems. Additionally, Milot et al. did not assess
for dissociative symptoms, thus it is unclear whether dissociative symptoms following a

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traumatic event (e.g., Perry & Pollard, 1998; Perry et al., 1995) would also mediate the
relationship.
In summary, preschool-age children exposed to IPV often exhibit clinically significant
traumatic stress symptoms (e.g., Graham-Bermann et al., 2008; Levendosky et al., 2002; Zerk et
al., 2009). These symptoms occur on a continuum anchored by dissociation and hypervigilance
(Perry & Pollard, 1998; Perry et al., 1995). Young children’s traumatic stress responses are
associated with externalizing and internalizing behavior problems (e.g., Levendosky et al., 2002;
Zerk et al., 2009). Preliminary evidence indicates that preschool-age children’s traumatic stress
responses may mediate the relationship between exposure to a repeated traumatic event, such as
IPV, and observed behavior problems across several environments (e.g., Milot et al., 2010).
What remains unknown, however, is whether dissociative versus hypervigilant symptoms are
differentially related to internalizing and/or externalizing behavior problems.
A final overall critique of the traumatic stress literature is warranted. Despite the
documented incidences of preschool-age children developing clinically significant dissociative
symptoms in response to incidences of family violence (e.g., Macfie et al., 2001a/2001b; Ogawa
et al., 1997; Rossman et al., 1997), dissociation is frequently not assessed in empirical research.
In part, this likely reflects the current psychiatric nosology, which clearly demarcates
posttraumatic stress symptoms from dissociative symptoms (see APA, 2000). As others (e.g.,
Bremner, 1999) have noted, the DSM-IV-TR (APA, 2000) currently includes dissociative
symptoms as a core feature of Acute Stress Disorder and yet does not require a single
dissociative symptom for PTSD. As a result, researchers who investigate the long-term traumatic
stress reactions of individuals (e.g., children exposed to IPV) using the current diagnostic
nosology alone will not assess for dissociative experiences, unless they intentionally add an

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additional measure to do so. The failure to measure dissociative symptoms in young children
exposed to repeated traumatic events results in an incomplete picture of children’s traumatic
stress responses. The current research assesses dissociative symptoms, in addition to symptoms
of hypervigilance, in order to attempt to answer these research questions.

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CHAPTER 4
Executive Dysfunction and Child Behavior Problems
As reviewed in Chapter 2, early childhood exposure to IPV frequently results in high
levels of internalizing and/or externalizing behavior problems in preschool-age children (see
Wolfe et al., 2003, and Evans et al., 2008 for two meta-analyses). IPV exposure also constitutes a
traumatic event that precipitates a psychological traumatic stress response in a significant portion
of preschool-age children exposed to family violence (Briggs-Gowan et al., 2010; Levendosky et
al., 2002; Zerk et al., 2009). Prior research, however, lacks an adequate model for understanding
how and why exposure to a repeated traumatic event during early childhood, such as IPV, and
subsequent dissociative and/or hypervigilant responses result in the observed behavior problems.
The current research argues that preschool-age children’s EF mediates the relationship between
exposure to IPV (as a traumatic event), traumatic stress, and observed behavior problems.
The following three chapters further develop the theoretical groundwork for the current
research. This chapter provides a theoretical overview of EF, argues for the examination of three
EF sub-components, details their normative development in early life, and briefly reviews the
available research documenting the associations between EF and behavior problems in young
children. Chapter 5 presents two possible pathways (one psychological and the other biological)
between children’s stress responses systems and EF and then reviews the few studies that have
previously investigated EF in traumatized children (e.g., DePrince, Weinzierl, & Combs, 2009).
Lastly, chapter 6 integrates the findings from the previous chapters and proposes a model of
traumatic stress and EF in preschool-age children exposed to IPV.

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Definition of EF in Preschool-age Children
EF research began in earnest after it was recognized that individuals with frontal lobe
damage often had significant difficulty organizing their behavior, planning ahead, regulating
their negative affect, focusing their attention, and exhibited numerous other changes in
functioning (Anderson, 2002; Anderson, Damasio, Tranel, & Damasio, 2000). As a result, for
several decades executive dysfunction was thought to be a syndrome related to frontal lobe
dysfunction or injury (e.g., Anderson, 2002; Carlson, 2005). We now know that EF is
functionally connected to almost every lobe in the brain (see Gazzinga, Ivy, & Mangun, 2009;
Semrud-Clikeman & Ellison, 2009, for two overviews). The close connection between EF
abilities and neural development has important implications for EF research, which will be
discussed in greater depth in the next chapter.
Contemporary researchers generally agree that EF comprises all of the abilities to
effectively marshal one’s internal cognitive, affective, sensory, and other physiological resources
in a coherent, purposeful pursuit of one’s internal or external goals (e.g., Gazzinga et al., 2009;
Lezak, 1995). In particular, EF is activated in novel situations that require an unlearned response
or render automatic responses inappropriate/ineffectual (e.g., Diamond, 2006). Thus, demands on
EF are reduced in situations where a highly skilled or practiced response is required (Diamond,
2006), such as when a violinist is performing a piece that she has extensively practiced.
Although many different abilities have been identified as sub-components of EF (see
Anderson, 2002, for a review), the current research focuses on three: attentional control (AC),
working memory (WM), and inhibitory control (IC). These three sub-components are ideal for
the current research as AC, WM, and IC are considered the building blocks of more complex EF,
such as planning and organizational abilities (e.g., Miyake, Friedman, Emerson, Witzki, &

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Howerter, 2000) and have been implicated in children’s behavior problems (e.g., Hughes &
Ensor, 2008; Olson, Lopez-Duran, Lunkenheimer, Chang, & Sameroff, 2011; Raaijmakers et al.,
2008). AC is defined as an individual’s ability to intentionally focus his/her attention on relevant
tasks and to simultaneously ignore non-relevant stimuli in the service of accomplishing a goal
(Gazzinga et al., 2009). One of the primary tasks for the AC system is to shift an individual’s
attention (Hanania & Smith, 2010; Posner & Petersen, 1990), from one stimulus to another, as
required by external demands (e.g., a teacher asking a child to look at a different problem on the
board) or in accordance with internal goals. Throughout the literature, several terms are used for
this AC task, including set-shifting (e.g., Miyake et al., 2000) or attention-shifting (e.g., Hanania
& Smith, 2010). WM consists of a short-term information system that processes novel sensory
information or manipulates recalled information (e.g., retrieved previously learned facts that
require synthesization in a novel manner) (e.g., Gathercole, 1998). Information in WM must be
continuously updated (Baddeley & Hitch, 1974) in order for the quality of the information not to
rapidly degrade and cease to be processed in WM. IC is defined as the capacity to intentionally
inhibit a prepotent (e.g., dominant or habitual) cognitive or behavioral response, and, when
required, to provide a non-dominant response (Barkley, 2001; Carlson, 2005). For instance, IC is
required during several classic children’s games (e.g., Simon Says) in which children are
required to inhibit a natural response (e.g., copying another person’s behavior) unless given the
command to do so. Each of these three sub-components of EF will be reviewed next.
Three Sub-Components of EF: Attentional Control, Working Memory, and Inhibitory Control
Attentional Control
Posner and Petersen (1990) proposed the most widely accepted model of AC. According
to Posner and Petersen’s model, AC is comprised of three major tasks: disengagement, shifting,

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and re-engagement. For instance, we must be able to disengage our attention at will, re-orient or
shift our attention to the stimuli of interest/importance, and then focus our attention towards the
new stimulus or task (Posner & Petersen, 1990). Gazzinga et al. (2009) proposed that AC can be
considered the “source” of attention, while the sensory or cognitive system the attention is
directed towards can be considered the “site” of attention. Thus, AC represents the executive
aspect of the attentional system (Konrad et al., 2005).
For the purposes of the current research, attentional shifting will be examined as an
indicator of AC. In part, this decision reflects one of the primary challenges facing researchers
investigating preschool-age children’s EF i.e. the relative paucity of well-validated, reliable
measures of AC and other domains of EF for young participants (e.g., Anderson, 1998;
Anderson, 2002; Carlson, 2005). For instance, until the mid-1990’s no nationally-normed parent
or teacher report questionnaire of EF existed. Gioia, Isquith, Guy, and Kenworthy’s (2000)
Behavior Rating Inventory of Executive Functioning provided the first easy, reliable, and widely
available measure of EF for young children. The preschool-age measure contains a ‘shifting’
subscale, which assesses both attentional shifting and behavioral shifting (Gioia, Espy, & Isquith,
2003). Unfortunately, no standardized clinician-administered batteries of other aspects of AC for
preschool-age children exist. For instance, AC is often measured through continuous
performance tests; however, none of these computerized measures are available for this age
group. Thus, researchers rely on published experimental tasks, such as the Dimensional Change
Card Sort (Frye, Zelazo, & Palfai, 1995), which assesses children’s ability to shift their attention
between competing relevant stimuli as they sort cards according to the examiner’s directions. In
large part, the lack of EF assessment batteries for preschool-age children reflects the relatively

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recent (e.g., Diamond & Taylor, 1996; Garon et al., 2008) acknowledgement that young children
have EF abilities, which can be measured.
Working Memory
Memory disturbances are one of the more commonly studied aspects of neurocognitive
impairment associated with traumatic stress in both adults and children (see Golier & Yehuda,
2002, for a thorough review; and Brewin, Kleiner, Vasterling, & Field, 2007, for a metaanalysis), which is not surprising given that memory disturbances are an essential feature of
PTSD (APA, 2000). However, virtually all of the previous research has focused on aspects of
long-term memory, which is not considered a sub-component of EF. Contrary to long-term
memory, information in WM can only be maintained for approximately two seconds before it
begins to quickly degrade and, without further updating, will be permanently lost before it can
stored in our long-term memory (Gathercole, 1998). WM is considered an essential subcomponent of the overall human memory system, involved in some capacity or another, at each
of the three major steps in memory formation and learning: (1) the initial encoding of incoming,
new information or stimuli, (2) storage, and (3) the later retrieval of the information at the
requisite time (Gazzinga et al., 2009).
Baddeley and Hitch (1974) proposed what is widely considered the most influential
model of WM (Garon et al., 2008) that continues to receive empirical support, albeit with
adjustments (e.g., Gathercole, 1998; Wolters & Raffone, 2008). Baddeley and Hitch proposed
that WM is comprised of three basic components: (1) a phonological loop, which is responsible
for processing verbally encoded information (e.g., words, or individual units of language), (2) a
visuo-spatial sketchpad, which processes both visual and spatial information, and (3) a central
executive, responsible for commanding the various operations within the other two components,

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including a critical task of employing memory strategies designed to help us more efficiently and
effectively process information. More recently, Baddeley (2000/2003) added a fourth component
to the WM model: an episodic buffer that is responsible for connecting with long-term storage
and integrating information from different sources into the WM. Information that is processed in
either the phonological loop or visuo-spatial sketchpad (Baddeley & Hitch, 1974) comes from
two primary sources: representations retrieved from our long-term memory that is relevant to
current tasks (Palmer, 2000; Pickering, 2001; Wolters & Raffone, 2008), and novel information
that enters our WM via our five senses (Wolters & Raffone, 2008). WM abilities are closely
related with the capacity to achieve goal-directed behavior. For instance, children who have WM
impairments often fail to complete a task, despite understanding the directions and the necessary
steps for completing the task (Marcovitch, Boseovski, & Knapp, 2007).
Inhibitory Control
Inhibition has been investigated as both a quality of temperament (e.g., Kagan, Reznick,
Clarke, Snidman, & Garcia-Coll, 1984) and EF. Rothbart (1989) distinguished between effortful
and passive inhibition (e.g., fearfulness). According to this distinction, passive inhibition is a
feature of children’s temperament (e.g., Rothbart, Ahadi, Hersey, & Fisher, 2001) and bears
resemblance to Carver and White’s (1994) theory of behavioral inhibition/activation systems
(Blair & Peters, 2003). In contrast, IC is defined as the capacity to intentionally inhibit a
prepotent response, and, when required, to provide a non-dominant response (e.g., Barkley,
2001; Carlson, 2005). The current research focuses on this second type of inhibition. IC is the
most widely researched EF component in preschool-age children (Garon et al., 2008), which
reflects its central importance in self-regulation that is rapidly developing during the preschool
years. Eisenberg et al. (2009) further clarified the distinction between temperamental inhibition

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and IC by noting that negative reactivity is considered a temperamental trait, whereas IC is a
central component of self-regulation.
Tasks measuring IC can be classified according to several different criteria. For instance,
Metcalfe and Mischel (1999) proposed the distinction between “hot” and “cool” tasks, referring
to whether the inhibition required taps into the reward/motivation system. A common example of
a “hot” IC measure is the delayed gratification task, in which a child is presented with a tempting
food item (e.g., a cookie or marshmallow) and told that they can eat the food item now or wait a
few minutes and get two of the items (see Mischel’s 1972 marshmallow experiment for the
classic version of this task). In contrast, “cool” IC tasks do not tap the reward/motivation system
and require children to engage in neutral stimuli (Garon et al., 2008). These tasks are further
divided into those that require simple motor inhibition and those that require the inhibition of a
prepotent response and for children to provide a non-dominant response. For instance, on the
Day/Night task (Gerstadt, Hong, & Diamond, 1994), participants are shown two different cards:
one depicts a sun and a daytime scene, and the other is painted black with a moon to represent
nighttime. When the children are shown the daytime card, they must respond “night,” and vice
versa.
There is substantial empirical support for classifying IC into “hot” and “cool” systems
(Garon et al., 2008; see Willoughby, Kupersmidt, Voegler-Lee, & Bryant, 2011 for a recent
factor analysis); however, the two IC factors are only minimally correlated (e.g., Crone, Vendel,
& van der Molen, 2003; Geurts, van der Oord, & Crone, 2006). The current research examines
preschool-age children’s “cool” IC, as these forms of IC reflect cognitive processes rather than
motivational states (Garon et al.). Prepotent and motor inhibitions are also more theoretically

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related to AC and WM, as defined in the present research (i.e., as sub-domains of EF, rather than
facets of temperament).
Developmental Trajectories and Structure of EF in Preschool-age Children
Recent developmental studies have subsequently demonstrated that all three subcomponents of EF considered in the current research begin to emerge in infancy (e.g., Diamond,
2006; Klenberg et al., 2001) and continue to develop in domain-specific ‘spurts’ (Anderson,
2002) thereafter until nearly the third decade of life (e.g., De Luca et al., 2003). For AC, young
preschool-age children are able to attend to relevant stimuli (Diamond, 2002) and orient their
attention when WM and IC demands are minimized (Hanania & Smith, 2010). By about 4 years
of age, children are able to demonstrate significantly better AC in more complex tasks (e.g.,
Diamond, 2006; Hanania & Smith, 2010; Zelazo, 2006).
The development of WM follows a different, more complicated pattern than the relatively
linear development demonstrated for AC. For instance, Palmer (2000) reported that 3 year-old
children utilized no verbal WM strategies and were unable to articulate how they completed WM
tasks; whereas 6 and 7 year-old children utilized both verbal and visual WM and were able to
verbally reflect what strategies they used. Based on her findings, Palmer concluded that
children’s WM development (at least from preschool age through part of middle childhood) is
accomplished in three primary stages: (1) young preschool-age children rely almost exclusively
on visual WM, which automatically retrieves information from the children’s long-term memory
with little control, (2) school-age children enter a stage of what Palmer describes as ‘dual
encoding’, where they are simultaneously encoding information using both visual and verbal
WM strategies, which is inefficient but important for future mastery over coding strategies, and
(3) after a period of dual encoding, when the children are approximately 6.5 years old, they begin

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exclusively using automatic, efficient verbal encoding in the phonological loop (Palmer, 2000),
marking a permanent shift towards a primary utilization of auditory WM observed in most adults
(Gathercole, 1998).
In a sample comprised of over 600 preschool-age children drawn from several of the
author’s previous studies, Carlson (2005) reported significant age effects on tasks of IC during
the preschool period. In particular, on tasks that require participants to inhibit a prepotent
response and to respond with a non-dominant response (e.g., the Day/Night task; Gerstadt et al.,
1994), 3 year olds perform significantly worse than 4 or 5 year olds, with less than half of the 3
year olds performing the task correctly (Carlson, 2005). Reflecting the rapid neural development
occurring during the preschool age period (Diamond, 2002), preschool-age children evidence
significant gains in IC performance from 3 – 5 years old (Carlson, 2005).
Despite the evidence for unique AC, WM, and IC development during the preschool-age
period, there is considerable disagreement among prominent EF researchers regarding the
structure of EF (e.g., Anderson, 2002; Barkley, 1997; Diamond, 2006; Garon et al., 2008; Miller
& Cohen, 2001). As Garon and colleagues (2008) noted in their comprehensive review of the EF
literature, this disagreement can be distilled down to the question of whether EF constitutes a
single unitary construct, as advocated by Rothbart & Posner (2001), or is an umbrella term for
several distinct, but related constructs that are associated with higher-order cognitive functioning
(e.g., Diamond, 2002). Recent empirical attempts to resolve these divergent positions have shed
needed light on the issue. In the most widely-cited factor analytic study of EF structure, Miyake
et al. (2000) used a college-age sample and nine lab-based EF tasks to evaluate alternative factor
structures. The authors reported that EF is comprised of three independent, but highly correlated
constructs (attentional set shifting, working memory, and inhibitory control). Due to the

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substantial portion of variance shared by these three constructs, the authors argue that EF should
be considered a unitary construct comprised of dissociable sub-components (Miyake et al.,
2000). In their review, Garon et al. argue that the unitary construct identified by Miyake et al.
represents a central attention system, similar to earlier models of EF (Posner & Rothbart, 1998).
The rationale for specifying the unitary construct as a central attention system is the
overwhelming evidence that AC influences nearly every other domain of EF (Garon et al., 2008;
Posner & Rothbart, 1998).
While groundbreaking, Miyake et al.’s (2000) factor analytic study used a questionable
analytic technique that may reduce the reliability of their findings. Specifically, the authors first
tested a three-factor model and then for the second model, they fixed the correlations between
the three factors to one, arguing this was the best technique to test whether a unitary EF factor
best described the data. However, setting the correlations between the three latent factors is
different than specifying a model with a single latent construct with all (9) indicators loading
onto a single factor. Miyake et al. tested a much more stringent, and arguably unrealistic, model
that presumes each of the factors perfectly correlated with each other, which is not theoretically
or empirically equivalent to testing whether all nine indicators load onto a single latent factor.
Although the model with the three latent factor correlations set to one demonstrated significantly
worse fit than the three-factor model, the fit indices were close to those suggested by Hu and
Bentler (1999), suggesting that a single factor model (e.g., loading all nine indicators onto a
single factor) may demonstrate adequate fit. If this alternative model were tested and
demonstrated adequate fit, as hypothesized, then the unitary EF model would be more
parsimonious.

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Miyake et al.’s (2000) sample also consisted exclusively of college students. Factor
analytic results are strongly contingent upon the samples from which the data is drawn and thus
the underlying factor structure of EF identified by the authors may not represent the factor
structure in young children due to developmental processes. Lehto, Juujarvi, Kooistra, and
Pulkkinen (2003) addressed this possibility and largely replicated Miyake et al.’s results using a
sample of school-age children (ages 8 – 13). The few studies (e.g., Shing et al., 2010; Wiebe et
al., 2008/2011) that have examined the structure of EF in preschool-age children offer initial
evidence that a single construct best describes EF abilities. For instance, Wiebe et al. (2008)
examined the underlying structure of EF in 2 – 6 year olds using measures of WM and IC. The
authors used confirmatory factor analyses to test two alternative models and found strong
evidence suggesting that a single EF factor best described the observed data over models that
separated IC and WM. Given the significant cognitive developmental that takes place from two
to six years old, which could impact EF (e.g., Diamond, 2002), the authors subsequently reevaluated the latent EF structure using a sample comprised entirely of 3 year olds and confirmed
a single EF factor best described the children’s performance across nine lab tasks (Wiebe et al.,
2011). Shing, Lindenberger, Diamond, Li, and Davidson (2010) empirically examined whether
the factor structure for WM and IC tasks is developmentally dependent with children ranging in
age from 4 to 14. They found significant developmental differences in the underlying EF
structure, such that before 9.5 years old, WM and IC loaded onto a single factor, while for older
children a two-factor solution provided optimal fit to the data, consistent with other factor
analytic studies (Lehto et al., 2003; Miyake et al., 2000).
The results of these previous factor analytic studies with preschool-age children must be
treated cautiously and may not generalize to the present study for two reasons. First, the question

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remains whether the single latent factor reported for WM and IC (Shing et al., 2010; Wiebe et
al., 2008/2011) represents the actual underlying structure of EF in preschool-age children or is an
artifact of the specific measures used to assess EF. For instance, tasks commonly used to assess
IC in preschool-age children often require substantial WM abilities, as well (e.g., Carlson, 2005;
Diamond, 2006). These tasks are termed “complex inhibitory control” measures, because of this
demand on WM (Garon et al., 2008). A common feature of these complex tasks is that
participants are required to remember two or more simultaneous rules that govern their
responses. Young preschool-age children (i.e., approximately 3 – 3.5 years old) often perform
poorly on these complex tasks of IC, because the WM demands may exceed their developmental
abilities (Carlson & Moses, 2001; Davidson, Amso, Anderson, & Diamond, 2006; Diamond,
2006). By approximately 4 years old, preschool-age children are able to demonstrate better
(although not perfect) performance on tasks of IC, including the more complex tasks that require
significant WM (Garon et al., 2008).
The results from the previous factor analytic studies (i.e., Shing et al., 2010; Wiebe et al.,
2008/2011) with preschool-age children may also not generalize to the present study, as the other
researchers only assessed two sub-domains of EF and did not include measures of AC. Hrabok,
Kerns, & Muller (2007) examined aspects of AC using a preschool-age sample and found
significant age-related differences in performance, but only for higher-order AC tasks that also
require substantial inhibition. For lower-order AC tasks that did not require as much IC, the
authors found that even young preschool-age children were able to complete the tasks with a
reasonable degree of success (Hrabok et al., 2007), suggesting that AC and IC are differentiated
in young preschool-age children and can specifically be measured if the correct measures are
given. Hrabok et al.’s results underscore the importance of using basic EF tasks when assessing

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individual EF sub-components during the preschool-age period. Their results indicate that it is
possible that if more basic EF measures of AC, WM, and IC were administered to a preschoolage sample, a factor analysis would reveal more than one latent variable, consistent with EF
factor analyses with older populations (e.g., Lehto et al., 2003; Miyake et al., 2000).
In summary, despite the high correlations reported for tasks of AC, WM, and IC in
preschool-age children (e.g., Hrabok et al., 2007; Shing et al., 2010; Wiebe et al., 2008/2011), it
is important to assess all three sub-components during this critical period when differential EF
abilities begin to emerge. The consistent findings of rapid age-related increases in EF
performance for AC (e.g., Hanania et al., 2010), WM (e.g., Palmer, 2000; Shing et al., 2010),
and IC (Carlson, 2005; Shing et al., 2010) during the preschool period also underscore the
importance of accounting for proportion of EF performance due to age-related development,
before examining the unique proportion of variance due to other variables, such as traumatic
stress symptoms.
Executive Dysfunction and Preschool-age Children’s Behavior Problems
Internalizing and externalizing behavior problems can be conceptualized as differential
failures of self-regulation, in terms of either over- or under-modulation (Derryberry & Rothbart,
1997). Self-regulation involves both passive and active processes (Rothbart, 1989). Consistent
with this model, Lezak (1995) documents two neural routes of the affect regulation system. The
first involves a rapid, automatic response to reflexive signals mediated via the amygdala and
thalamus. Individuals have minimal control over this automatic affective response and may not
be conscious of their affect in the moment (Lezak, 1995). In contrast to this automatic and thus
passive system, the second path involves active, effortful control of our affective system (Lezak,
1995). EF has thus been implicated as one of the most salient processes involved in effortful

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control (e.g., Eisenberg et al., 2010; Liebermann, Giesbrecht, & Muller, 2007). In this regard, it
is unsurprising that executive dysfunction has been associated with both internalizing and
externalizing problems (e.g., Hughes & Ensor, 2008), and is considered a robust predictor of
later behavior problems in longitudinal studies (e.g., Eisenberg et al., 2009; Hughes & Ensor,
2008).
AC has been argued to be one of the most important EF sub-components involved in
effortful control as part of the broader self-regulatory system (e.g., Rueda et al., 2010). A
breakdown within any of the three AC tasks i.e., disengaging, re-orienting/shifting, and then reengaging (e.g., Posner & Petersen, 1990) can become highly problematic for young children in a
wide-variety of settings. AC has not only been shown to predict academic preparedness (see
Duncan et al., 2007, for a meta-analysis), but is also an important factor in young children’s
socialization (Rueda et al., 2010). Impaired AC has widely been investigated as an important
factor in internalizing problems, specifically anxiety-related symptoms. Unfortunately, no
research has explicitly examined the relationship between preschool-age children’s AC and
internalizing problems. However, evidence from research using older children and adolescents
suggests AC may play a role in the regulation of internalizing experiences, such as anxiety. For
instance, in a study of school-age children, Muris, de Jong, and Engelen (2004) reported that
children’s AC predicted internalizing behavior problems above and beyond the children’s levels
of neuroticism. Derryberry and Reed (2002) reported that college students who evidenced good
AC were better able to manage their anxiety during a threat-related experimental paradigm;
whereas those students with poor AC had greater difficulty voluntarily shifting their attention
away from the threat related stimuli. These results suggest that AC plays an important role in
internalizing behavior problems. It is also possible that AC is related to externalizing problems,

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as well, which will be reviewed near the end of the current chapter along with the evidence for
IC.
WM is not only an essential feature in cognitive processes (e.g., manipulation of
information; Gazzinga et al., 2009), but WM also plays an important role in children’s social and
affective functioning. For instance, social interactions are often governed by a complex system
of explicit and implicit rules, which an individual must follow if he/she hopes to have a
successful experience. However, these rules must be held in an individual’s WM when engaging
in an interaction (e.g., remembering who holds what position in a group situation marked by a
clear hierarchy). Difficulties maintaining this information in WM may reflect goal neglect, which
occurs when a child understands the directions for a given task, but fails to complete the task,
because he/she cannot maintain the goal in his/her mind (e.g., Marcovitch, Boseovski, Knapp, &
Kane, 2010). Marcovitch et al. (2007/2010) conducted a series of studies examining goal neglect
in preschool-age children and found that when children are presented with a task in which they
are required to constantly update the information in the their WM (Baddeley & Hitch, 1974), the
children actually performed better than when they were faced with seemingly easy tasks that did
not require as frequent memory updating to be successful. These results suggest that when young
children are not required and unable to maintain pertinent information (e.g., rules, directions) in
their WM – either due to the task demands or underlying executive dysfunction – they will
exhibit worse performance on goal-directed behaviors.
In a longitudinal study, Hughes & Ensor (2008) measured preschool-age children’s WM
and tasks of IC and found that executive dysfunction at age three significantly predicted overall
behavior problems at age four, even after controlling for other possible predictors, including
socioeconomic status, verbal ability, and behavior functioning at age three. Unfortunately, due to

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a small sample size, the authors created composite scores for EF and behavior problems and thus
the differential predictive effects of WM versus IC could not be ascertained from their data. Nor
could separate effects for internalizing versus externalizing behavior problems be examined.
Despite these limitations, however, Hughes and Ensor’s findings indicate that preschool-age
children’s EF may be a salient predictor of later social and emotional functioning.
Externalizing problems are marked by under-modulated affect and behavior (Derryberry
& Rothbart, 1997), which is likely associated with impaired IC. Socially desirable behavior is
substantially dependent on an individual’s ability to inhibit their impulses long enough to
consciously chose the appropriate response (Diamond, 2006; Liebermann et al., 2007).
Unsurprisingly, preschool-age children who exhibit low IC are more likely to be highly
aggressive with their peers (Raaijmakers et al., 2008) and to engage in other forms of
inappropriate social behavior. This pattern (i.e., low IC associated with high levels of aggression)
has been reported in other, independent samples, as well (e.g., Dennis & Brotman, 2003).
Three longitudinal studies have examined the relationship between preschool-age
children’s IC and their social and behavioral outcomes. Brocki, Nyberg, Thorell, and Bohlin
(2007) administered several tasks of IC found that poor IC was both concurrently and
predictively associated with greater levels of externalizing behavior problems, as measured by
symptoms of ADHD. In a separate study, Thorell, Bohlin, & Rydell (2004) assessed preschoolage children’s IC and their externalizing problems, three years later when the children were in
elementary school. The authors reported that low IC at age five significantly predicted
externalizing behavior problems three years later, after taking into account temperamental
inhibition. Ciairano, Visu-Petra, and Settanni (2007) investigated the relationship between
school-age children’s IC and their level of peer cooperation (as measured by a joint task) one

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year later. They reported that children’s IC levels predicted later peer cooperation, in the
expected direction, such that children with worse IC were less cooperative during the joint task
compared with children who exhibited higher levels of IC. Taken together, these results (Brocki
et al., 2007; Ciairano et al., 2007; Thorell et al., 2004) suggest that children’s emerging IC
abilities (e.g., Carlson, 2005) may be particularly important to understand given their role in later
externalizing problems.
Recently, researchers have started to examine whether different patterns of EF (as
opposed to unitary EF sub-components) may alternatively predict internalizing versus
externalizing behavior problems. For example, in addition to IC, AC may also play a role in
preschool-age children’s externalizing problems, rather than just being associated with regulation
of anxiety (e.g., Derryberry & Reed, 2002; Muris et al., 2004). Children who are unable to
control their attention in learning environments or in peer-interactions may be disruptive if they
also have low IC (e.g., acting out while not attending to a teacher), which establishes a negative
social developmental trajectory. In a longitudinal study beginning during the preschool years,
Olson and colleagues (2011) examined predictors of peer aggression using measures of
temperamental affectivity and a composite measure of effortful control, which measured both
AC and IC. They authors reported a significant interaction, such that children with medium to
high levels of maternal reported anger and poor effortful control had the highest rates of peer
aggression. In a separate, longitudinal study of older children and preadolescents, Eisenberg et
al. (2009) reported that poor AC and IC together predicted high levels of externalizing behavior
problems, whereas poor AC only was related to high levels of internalizing behavior problems.
The findings from these two longitudinal studies (Eisenberg et al., 2009; Olson et al., 2011)

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indicate that unique EF profiles may differentially be related to both internalizing and
externalizing behavior problems in preschool-age children.
In summary, there is evidence to suggest that AC, WM, and IC may be differentially
related to internalizing and externalizing behavior problems in preschool-age children.
Specifically, impaired AC in the absence of IC problems is likely associated with internalizing
problems (e.g., anxiety-related symptoms) (e.g., Eisenberg et al., 2009), whereas the combination
of impaired AC and low IC is plausibly associated with externalizing behavior problems (e.g.,
Olson et al., 2011). Because WM abilities are strongly related to AC (e.g., Garon et al., 2008), it
seems likely that WM deficits may be related to both internalizing and externalizing problems,
although this possibility has not been previously investigated. Additional studies are needed to
investigate the various EF profiles that are associated with varied behavior problems –
particularly in preschool-age children. Such lines of inquiry are especially salient to the current
research, as different profiles of EF performance may be related to the heterogeneous traumatic
stress responses observed following repeated traumatic events in early childhood, such as
exposure to IPV (e.g., Evans et al., 2008; Wolfe et al., 2003).

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CHAPTER 5
Traumatic Stress and Preschool-age Children’s Executive Dysfunction
The following chapter proposes how preschool-age children’s experiences of chronic
traumatic stress, such as exposure to repeated IPV, might be related to executive dysfunction.
The theoretical underpinnings for this chapter come from three primary sources (i.e., Blair, 2010;
De Bellis et al, 1999a/1999b; Perry et al., 1995). Based primarily on the animal literature and
their own clinical research with severely traumatized children, Perry et al. (1995) observed that
immediate traumatic stress “states” (i.e., either dissociative or hypervigilance) would generalize
to become enduring “traits” over time. The authors hypothesized that this was due to complex
changes within the developing brain in which the neural developmental trajectories might be
responding to the demands of the external environment (i.e., the traumatic events). De Bellis et
al. (1999a/1999b) further advanced our understanding of how chronic traumatic stress can impair
individual’s cognitive functioning by detailing the relationship between individual’s
psychological traumatic stress responses, subsequent alterations in their physiological stress
responses, and long-term neural changes in the brain. Blair (2010) recently applied these theories
to EF specifically. Blair argued that early exposure to poverty is a chronically stressful
experience that is likely related to alterations in young children’s stress response systems, which
further impair healthy neural development (e.g., De Bellis et al., 1999b) in regions that are
associated with EF. Notably, however, the evidence Blair reviewed for such pathways in children
living in poverty was mixed. As Blair noted, poverty may not elicit a strong enough stress
response to result in the hypothesized relationships. In essence, Blair’s theory may be correct,
but only for children exposed to sufficiently salient, repeated stressors.

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The current research extends the previous theoretical work of Perry et al. (1995), De
Bellis et al. (1999b), and Blair (2010) by arguing that preschool-age children exposed to a
repeated traumatic event, such as IPV, are at significant risk for developmental trauma (e.g., De
Bellis et al., 199b). Contrary to Blair who considered poverty as a contextual stressor, exposure
to IPV may be more appropriate stressor for this research for two primary reasons: (1) IPV
exposure in early childhood has been found to increase preschool-age children’s risk of
developing clinically significant traumatic stress symptoms (Briggs-Gowan et al., 2010;
Levendosky et al., 2002; Zerk et al., 2009), and (2) IPV frequently occurs repeatedly, over a long
period of time (Caetano et al., 2005).
Theory of Dissociative and/or Hypervigilant Responses and Executive Dysfunction
Young children who have experienced chronic traumatic stress are proposed to be at
greater risk for executive dysfunction through two independent, yet highly related pathways: one
psychological (e.g., Perry & Pollard, 1998; Perry et al., 1995) and the other biological (e.g., De
Bellis et al., 1999a/1999b). The psychological pathway between traumatic stress and executive
dysfunction has received little attention. In contrast, the physiological pathways are better
understood and will be briefly reviewed second. Although both the psychological and
physiological pathways between traumatic stress responses and executive dysfunction are
recognized, the current research is primarily concerned with the psychological pathways, as these
are the variables that are most likely to be assessed in a clinical setting when a child is evaluated
by a mental health professional. The physiological mechanisms are briefly discussed, but are not
measured in the current research.
The first pathway by which dissociative and hypervigilant responses (Perry et al., 1995)
may be related to executive dysfunction in preschool-age children is through the psychological

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correlates of these responses and AC, WM, and IC tasks. By definition, traumatic stress implies
that children are responding to perceived threats in their environment. As Perry et al. (1995)
posited, chronic traumatic stress alters the organizational experiences of young children and
predisposes them to respond to future stressors, including mild stressors, in ways consistent with
previous responses. It is plausible that for children confronted with repeated traumatic events in
their caregiving environment, such as IPV, their responses will generalize even further and begin
to represent approach styles to their everyday environment. If so, this would have profound
impact on children’s EF in everyday contexts. For instance, children who exhibit dissociative
responses in response to repeated traumatic evens may be less engaged with their immediate
environment (DePrince & Freyd, 2001/2007). Thus, these children may have greater difficulty
with their AC, when they are required to shift their internal resources according to environmental
demands (e.g., a teacher or parent asking the child to execute a task) or to accomplish a goal
(e.g., the engage in a new, desirable activity). These hypothesized AC difficulties would be
related to WM deficits, as individuals cannot properly encode information into their WM without
appropriate attentional resources (e.g., Baddeley & Hitch, 1974; Gazzinga et al., 2009). In
contrast, children who exhibit predominantly hypervigilant responses to an immediate threat may
begin to feel more anxious in general (Perry et al., 1995) and be on constant alert for perceived
threats. When hypervigilant, children’s primary behavioral inclination may be to either “fight or
flight” (e.g., Perry & Pollard, 1998; Perry et al., 1995) and thus their attention is likely to be
focused on salient stimuli related to the perceived threats. In addition, children experiencing
hypervigilance may be less behaviorally inhibited, as their bodies are preparing for immediate
action. Therefore, it seems possible that children who exhibit predominantly hypervigilant
responses will exhibit potential disruptions in all three sub-components of EF.

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The second pathway by which young children’s chronic traumatic stress responses may
be related to executive dysfunction is via the biological stress response systems and associated
neural functioning (e.g., Blair, 2010; De Bellis, 2001; De Bellis et al., 1999a/1999b). EF is
inextricably connected to complex neural systems (e.g., Anderson, 2002; Diamond, 2002;
Gazzinga et al., 2009), including nearly every lobe of the brain and many sub-cortical structures.
Therefore, any external or internal conditions that might alter the developmental trajectory or
impair these neural systems (e.g., De Bellis et al., 2002) would arguably result in executive
dysfunction. Although a complete review of these physiological pathways is beyond the scope of
the current research, we have better evidence compared to the psychological pathways for how
children’s biological responses to chronic traumatic stress may be related to executive
dysfunction in young children. Briefly, perceived threats activate two independent, but highly
related nervous systems. First, the sympathetic nervous system releases epinephrine and
norepinephrine (a.k.a noradrenaline), which allows for quick fight or flight responses (Heim,
Meinlschmidt, Nemeroff, 2003). Second, the hypothalamic-pituitary-adrenal (HPA) axis releases
glucocorticoids (Heim et al., 2003), which bind to receptor sites throughout the brain. The most
widely-studied glucocorticoid, cortisol, alerts the brain to switch critical energy expenditures
over to the fight or flight response, while also setting off a cascading-effect throughout the body
that prepares it for action (e.g., increasing blood flow to critical muscle groups) (Teicher,
Andersen, Polcari, Anderson, & Navalta, 2002). These two biological stress response systems
are jointly moderated by cortropin-releasing factor, which is diffuse throughout the brain,
including within the amygdala and hippocampus (Heim et al., 2003). However, these two
systems are biologically indicated for acute stress responses (Cicchetti & Rogosh, 2001); that is,
these systems are not designed to respond to chronic stressors, such as IPV.

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Children exposed to family violence have consistently shown significant alterations in
their biological stress response systems, particularly relating to the HPA axis (Cicchetti &
Rogosh, 2001; for a comprehensive reviews on the role of cortisol in stress-related
psychopathology, see Heim, Ehlert, & Helmhammer, 2000). Some research indicates that
individuals exposed to traumatic events exhibit marked cortisol elevations, thus indicating an
overactive HPA-axis (e.g., Bruce, Fisher, Pears, & Levine, 2009); whereas other research
indicates that individuals exhibit depressed cortisol levels (e.g., MacMillan et al., 2009). These
seemingly contradictory findings may reflect children’s varied psychological responses to a
traumatic event (i.e., dissociative and/or hypervigilant responses), which may be differentially
related to HPA-axis activity. For instance, preliminary research indicates that individuals with
high levels of dissociative symptoms show a blunted HPA-axis response to a stressful task, as
indicated by hypocortisolism (e.g., Simeon et al., 2007; Simeon, Yehuda, Knutelska, &
Schmeidler, 2008), whereas individuals with significant hypervigilance exhibit hypercortisolism
(e.g., Simeon et al., 2008). In addition to HPA-axis dysregulation, children exposed to family
violence may have altered sympathetic nervous systems, including the release of high levels of
epinephrine and norepinephrine when exposed to a potential threat (De Bellis, Baum, Birmaher,
Keshavan, Eccard, Boring, et al., 1999a). Thus, there is mounting evidence that in contrast to
low-grade stressful situations (e.g., poverty; Blair, 2010), chronic exposure to family violence is
likely to result in an altered stress response across both the HPA-axis and sympathetic nervous
systems.
As De Bellis (2001) and others (e.g., Blair, 2010; Weber & Reynolds, 2004; Weiss, 2007)
have previously noted, chronic activation of biological stress responses is associated with
numerous, profuse structural and functional neurological impairments in both adults and

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children. For instance, in adults, clinically significant levels of psychological traumatic stress
have been associated with decreased white matter volume (Karl et al., 2006), reflecting fewer
and/or demyelinated axonal tracts that are responsible for connecting the various
structures/regions of the cortex with each other (Gazzinga et al., 2009). Reviews of the child
trauma literature suggest that chronic psychological traumatic stress is associated with
significantly smaller frontal lobes, decreased white matter, and greater ventricle volume (see
Jackowski et al., 2009, for a comprehensive review). Altered biological stress response systems
may not be linearly related to changes in neural structures, however. In their review of the rodent
literature, Holmes and Wellman (2009) determined that the relationship between glucocorticoid
levels and changes observed in the prefrontal cortex follows a U-shape, with either hypo- or
hyper-cortisol levels resulting in significant alterations in the prefrontal cortex, which is one of
the primary areas of the brain associated with EF (e.g., Diamond, 2002; Struss & Alexander,
2000).
In one of the few neuroimaging studies to date that assessed both dissociative symptoms
and hypervigilance in children exposed to family violence, De Bellis et al. (1999b) reported that
dissociative symptoms were negatively correlated with adjusted volumetric differences in the
corpus callosum (regions 4, 6, and 7, as well as total volume). In contrast, hypervigilant
symptoms were negatively correlated with total ventricle volume and one different region of the
corpus callosum (region 5). These preliminary results indicate that children’s chronic
psychological traumatic stress responses (i.e., dissociation and/or hypervigilance; Perry et al.,
1995) may be differentially related to neural developmental trajectories. These differential
trajectories are likely related to children’s psychological and biological stress responses (e.g.,
Blair, 2010; De Bellis et al., 1999a; Perry & Pollard, 1998; Perry et al., 1995) through a complex

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transactional process. Following this theoretical review of the possible pathways between
children’s chronic traumatic stress responses and executive dysfunction, the available empirical
evidence relating to executive dysfunction in traumatized children is reviewed next.
Review of Extant EF Studies in Children Experiencing Chronic Traumatic Stress
Attentional Control
The majority of the extant research examining attention in children exposed to traumatic
events has relied on affective experimental paradigms that measure children’s ability to control
their attention when faced with threatening cues. These studies suggest that school-age and older
maltreated children may over-attend to threat related cues (i.e., angry faces) in their
environments compared to non-maltreated peers (Pollak, Vardi, Bechner, & Curtin, 2005; Pollak
& Tolley-Schell, 2003). Furthermore, maltreated children have been shown to disengage their
attention from these cues just as quickly as non-abused children, but required more cognitive
energy to do so, as measured by Event-Related Potentials (Pollak & Tolley-Schell, 2003). In two
different studies, maltreated children responded to threat-related cues significantly faster than
non-abused children, suggesting a natural benefit of hypervigilance in potentially threatening
environments (Pine et al., 2005; Pollak & Tolley-Schell, 2003).
Much less is known about children’s AC in response to neutral stimuli, however, or how
AC performance may be impaired in preschool-age children. Only two studies have examined
traumatized children’s attention to neutral stimuli and both studies measured elements of
sustained attention and thus do not provide good evidence regarding AC, as a sub-component of
EF. DePrince et al. (2009) reported that school-age children (mean age = 10 years old) exposed
to family violence had significantly worse performance on a measure of sustained auditory
attention than either children exposed to non-familial traumatic events, or children who had not

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experienced any type of traumatic event. DePrince et al. also measured both PTSD symptoms
and dissociative symptoms. They reported that both PTSD symptoms and dissociative symptoms
independently predicted poorer auditory attention across the overall sample, providing
supporting evidence that there may be multiple pathways to executive dysfunction in children
experiencing chronic traumatic stress (e.g., Perry et al., 1995). De Bellis, Hooper, Spratt, and
Woolley (2010a) measured sustained visual attention performance in younger school age
children (mean age = 7) and found that visual attention performance is moderately impaired in
the presence of PTSD, but was not related to PTSD symptom severity.
Taken together, these two studies (De Bellis et al., 2010a; DePrince et al., 2009) suggest
that traumatic stress symptoms, specifically PTSD and/or dissociative symptoms, may be related
to impaired attention in school-age children. However, the generalizability of the results from
both of these studies to the current research is constrained by several important limitations. First,
neither sample assessed preschool-age children. In light of the findings from previous
developmental studies (e.g., Carlson, 2005; Shing et al., 2010) of EF that demonstrate significant
age-related differences in EF performance, as well as rapidly developing neural structures
associated with AC (e.g., Diamond, 2002), it is possible that preschool-age children’s AC will be
differentially impacted compared to older children. Second, neither study (De Bellis et al.,
2010a; DePrince et al., 2009) measured AC, as a sub-component of EF. Both of the studies used
measures of sustained attention, which does not assess for executive components of attention,
such as attention shifting (e.g., Garon et al., 2008). Thus, future research must employ different
measures to better understand EF in children who are exposed to chronic traumatic events, such
as IPV.

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Working Memory
Six studies (Beers & De Bellis, 2002; De Bellis, Hooper, Woolley, & Shenk, 2010b;
DePrince et al., 2009; Jouriles et al., 2008; Samuelson, Krueger, Burnett, & Wilson, 2010; Yasik,
Saigh, Oberfield, & Halamandaris, 2007) have explicitly measured WM in children experiencing
chronic traumatic stress. Overall, the WM findings reported are inconsistent with some
researchers finding significantly worse WM performance in children who experienced a
traumatic event and subsequent traumatic stress (De Bellis et al., 2010b; DePrince et al., 2009;
Jouriles et al., 2008; Yasik et al., 2007), whereas other researchers have reported no differences
(Beers & De Bellis, 2002; Samuelson et al., 2010). It is likely that these divergent findings are
due to methodological differences and problematic operational definitions of EF and associated
measures. For instance, Beers and De Bellis (2002) used a very small sample (N = 14) and
assessed WM with the California Verbal Learning Test (CVLT), which contains an indicator of
short-term memory (Strauss, Sherman, & Spreen, 2006), and a digit span subtest from an
intelligence battery. The null finding reported in the authors’ study may be due to the limited
power afforded by the small sample size (i.e., increasing the risk of a Type-II error) or the result
of using a less robust indicator of WM compared to those administered by other studies
(DePrince et al., 2009).
In addition to the problems associated with using a small sample size, several of the
extant studies use problematic measures of EF. For instance, De Bellis et al. (2010b) stated that
they were examining EF performance in a sample of maltreated children and adolescents;
however, the authors used a long-term visual memory task as a proxy for visuo-spatial WM,
which is not equivalent to using a WM task that assesses information that must be continuously
updated (Baddeley & Hitch, 1974) in order to be retained. Thus, although the authors reported

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that maltreated children’s’ performance on visual memory tasks accounted for a significant
portion of the variance in observed PTSD symptoms, the results cannot be generalized to WM
performance. Similarly, Jouriles et al. (2008) measured explicit memory functioning in a
preschool sample exposed to IPV and found that children exposed to IPV (including
bidirectional IPV) is associated with worse explicit memory functioning, above and beyond
controlling for harsh parenting. However, WM and explicit memory are two different, albeit
related constructs that are differentially impacted by stress-related changes (e.g., Luethi, Meier,
& Sandi, 2011). WM is a sub-component of EF (e.g., Gazzinga et al., 2009; Miyake et al., 2000),
while explicit memory is a component of long-term memory and each use different neural
networks (e.g., Rugg et al., 1998).
In contrast to the problematic definitions and associated measures of WM used in the
research reviewed previously (e.g., Beers & De Bellis, 2002; De Bellis et al., 2010b; Jouriles et
al., 2008), two other studies administered more valid and robust measures of WM in larger
samples. Yasik et al. (2007) examined three groups of children: (1) children exposed to traumatic
events, including interpersonal violence, with PTSD, (2) children who experienced a traumatic
event, but did not have PTSD, and (3) non-trauma exposed children and found that the children
with PTSD performed significantly worse on several measures of WM. DePrince et al. (2009)
reported that children exposed to family violence exhibited significantly worse performance
across the WM subtests compared to children who had not experienced a traumatic event and
those that were exposed to single-incident, non-interpersonal traumatic event. In addition, WM
performance was also deleteriously related to PTSD symptoms (DePrince et al., 2009). Taken
together, the findings from these two studies suggest that WM performance may be worse in

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children experiencing high levels of traumatic stress, consistent with the model advanced by the
current research.
Inhibitory Control
Despite IC’s widely acknowledged importance in self-regulation processes (e.g., Barkely,
2001; Eisenberg et al., 2009), only two studies have examined children experiencing chronic
traumatic stress and their IC performance and neither study examined young children. In the
same sample reported previously, DePrince et al. (2009) used a variant of a go/ no-go task to
measure school-age children’s ability to inhibit a prepotent motor response. Similar to their other
reported findings from the study, the children who were exposed to family violence performed
significantly worse on the two IC tasks than the other two groups of children. Carrion, Garrett,
Menon, Weems, and Reiss (2008) examined a small sample of adolescents exposed to different
forms of family violence using an event related fMRI paradigm coupled with a go/ no-go task. In
contrast to DePrince et al., the authors reported that the maltreated adolescents performed
equally well on the IC task, but exhibited a different pattern of neuronal activation compared to
controls (Carrion et al., 2008). In particular, their results suggested that while the adolescents
exposed to chronic traumatic stress may require a more profuse neural network to experience the
same degree of motor inhibition (Carrion et al., 2008).
The apparent discrepancy between the findings reported from DePrince et al. (2009) and
Carrion et al. (2008) should be interpreted with caution. In particular, Carrion et al. used a very
small sample that increases the chance of a Type II error (e.g., Field, 2009). Both samples offer
converging evidence, however, that some aspect of IC may be impaired in children exposed to
chronic traumatic stress in terms of either poorer performance (DePrince et al., 2009) on tasks of
IC or in terms of requiring greater cognitive resources to accomplish the same degree of

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inhibition observed in children not experiencing to traumatic stress (Carrion et al., 2008). To
date, nothing is known about preschool-age children’s IC performance on laboratory tasks.
However, given the strong association between exposure to a chronic traumatic event, such as
IPV, traumatic stress, and subsequent externalizing behavior problems (Evans et al., 2008; Wolfe
et al., 2003), it seems plausible that young children may experience some deficits in IC.
Future Directions of EF Research for Preschool-age Children Experiencing Traumatic Stress
In summary, several researchers have recently begun to investigate the
neuropsychological functioning of children exposed to chronic traumatic stress (usually in the
form of family violence) (e.g., De Bellis et al., 2010a/2010b; DePrince et al., 2009; Samuelson et
al., 2010). These investigations provide preliminary evidence for disruptions across the three
sub-components of EF considered in the current research. However these previous studies have
been marked by numerous, significant limitations, including the use of very small sample sizes
(Beers & De Bellis, 2002), overreliance on PTSD as the sole indicator of traumatic stress (e.g.,
De Bellis et al., 2010a/2010b; Samuelson et al., 2010), poor operalization of EF and thus
inadequate measures of the domains of EF examined (e.g., De Bellis et al., 2010a), and little to
no measurement of the children’s social-emotional behavior problems (e.g., De Bellis et al.,
2010a/2010b; DePrince et al., 2009; Jouriles et al., 2008; Samuelson et al., 2010).
In addition to the above limitations, two problems persist in the literature. First, with two
notable exceptions (i.e., De Bellis et al., 2010b; Jouriles et al., 2008), there is minimal
understanding for how chronic traumatic stress may be related to preschool-age children’s
executive dysfunction. With rapid developmental changes in the structural and functional
networks associated with EF occurring during the preschool period (e.g., Carlson, 2005;
Diamond, 2006), any deleterious impact on typical neural development (e.g., due to exposure to

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traumatic stress) should be carefully studied. Preschool-age children are disproportionately
exposed to IPV (e.g., Fantuzzo et al., 1997) and thus at risk for experiencing chronic traumatic
stress. As a result, the void in the literature regarding the lack of empirical evidence for how
chronic traumatic stress is related to executive functioning is particularly problematic. The
second major limitation of the extant research is the troubling absence of empirical work
grounded in trauma theory. Many of the studies reviewed (e.g., De Bellis et al., 2010a;
Samuelson et al., 2010) relied on PTSD as the sole indicator of traumatic stress and in doing so,
considered traumatic stress to be a unitary construct measurable by a single sum score. However,
the current research argues that traumatic stress represents a heterogeneous response to a
potentially traumatic event and is experienced on a continuum of dissociative symptoms on one
end and hypervigilance on the other (Bremner, 1999; Lanius et al., 2010; Perry et al., 1995). Of
the studies reviewed, only two (DePrince et al., 2009; Jouriles et al., 2008) examined executive
dysfunction in the context of current traumatic stress theory. DePrince et al. measured
dissociative symptoms in their sample, representing the only research reviewed to do so; while
Jouriles et al. measured hypervigilance and tested whether this sub-facet of traumatic stress
mediated the relationship between family violence exposure and observed executive dysfunction.
Based upon the preliminary results of these findings, it is too early to determine whether
predominantly dissociative versus hypervigilant responses will result in different patters of
dysfunction within the three sub-components (as opposed to across the sub-components). The
current research builds upon these recent advances, while also examining whether EF mediates
the relationship between chronic traumatic stress and children’s behavior problems.

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CHAPTER 6
Towards an Integrated Model: Summary of Extant Findings and Future Directions
The current chapter transitions from reviewing the extant literature to proposing the
model guiding the current study. To facilitate this transition, the current chapter first provides a
global summary of the extant research and then provides an in-depth critique of two previous,
and particularly noteworthy, studies that have established valuable precedent. Then, the chapter
considers several remaining research questions left unanswered by prior investigators and
proposes a future direction for the current research guided by an integrative theoretical model.
Global Summary of Previous Research: Establishing What We Already Know
Young children are disproportionately exposed to IPV (Fantuzzo et al., 1997), which is
perpetrated by both men and women (Caetano et al., 2008; Goodlin & Dunn, 2010), and often
occurs over many years (Caetano et al., 2005). IPV involves incidents of physical, sexual, and/or
psychological violence or the threats of such violence (Breiding et al., 2008; Marshall, 1992).
Unfortunately, IPV is a common form of family violence with an estimated 7.5 million
preschool-age children living in households with IPV each year (i.e., Fantuzzo et al., 1997;
Fusco & Fantuzzo, 2009; McDonald et al., 2006). Young children living in homes with IPV are
likely to be exposed to the violence through one or more sensory modalities (Fantuzzo & Mohr,
1999; Fusco & Fantuzzo, 2009). Findings from recent meta-analyses of cross-sectional research
(Evans et al., 2008; Wolfe et al., 2003), as well as longitudinal studies (e.g., Huang et al., 2010;
Martinez-Torteya et al., 2009), provide clear evidence that preschool-age children exposed to
IPV in early childhood are at increased risk for developing significant internalizing and/or
externalizing behavior problems.

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Exposure to IPV during early childhood is also predictive of clinically significant
traumatic stress symptoms (e.g., Levendosky et al., 2002; Margolin & Gordis, 2000; Margolin &
Vickerman, 2008). According to Perry et al.’s (1995/1998) theory, two particularly salient
aspects of preschool-age children’s traumatic stress responses that may be related to IPV
exposure are dissociative and hypervigilant symptoms. Exposure to general family violence (e.g.,
Macfie et al., 2001a), and IPV specifically (e.g., Rossman et al., 1997), is associated with
concurrent dissociative symptoms and predictive of longitudinal levels of dissociation (Ogawa et
al., 1997). Additionally, exposure to IPV has consistently been documented to result in
hypervigilance in a substantial portion of preschool-age children (Graham-Bermann et al., 2008;
Levendosky et al., 2002; Zerk et al., 2009). These heterogeneous traumatic stress responses are
also associated with young children’s observed behavior problems (e.g., Macfie et al., 2001b)
and may partially mediate the relationship between IPV exposure and children’s behavior
problems (Milot et al., 2010).
In the broader clinical literature, executive dysfunction has also been implicated in
children’s behavior problems (e.g., Anderson, 2002; Gioia et al., 2000). In particular, EF is
considered one of the most salient domains involved in effortful control (e.g., Eisenberg et al.,
2010; Liebermann et al., 2007). Thus, it is unsurprising that executive dysfunction has been
associated with both internalizing and externalizing problems (e.g., Hughes & Ensor, 2008), and
is considered a robust predictor of later behavior problems in longitudinal studies (e.g.,
Eisenberg et al., 2009; Hughes & Ensor, 2008). The preschool period is a critical period for
emerging EF (Carlson, 2005; Diamond, 2002) and thus any disruption to EF development is
argued to have a more pernicious effect than later disruptions. Within the EF domain, three sub-

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components appear particularly associated with young children’s behavior problems: AC (e.g.,
Rueda et al., 2010), WM (Hughes & Ensor, 2008), and IC (e.g., Raaijmakers et al., 2008).
Preschool-age children’s heterogeneous traumatic stress responses to IPV exposure may
be differentially related to executive dysfunction. This relationship is likely mediated through a
complex transactional process between psychological processes and physiological stress systems
(e.g., Blair, 2010; De Bellis et al., 2002). Preliminary empirical investigations indicate that
school-age children with significant traumatic stress symptoms may have greater AC problems
(De Bellis et al., 2010a; DePrince et al., 2009), WM impairment (e.g., De Bellis et al., 2010b;
Yasik et al., 2007), and IC deficits (DePrince et al., 2009). Taken together, these findings
indicate that preschool-age children exposed to IPV may develop executive dysfunction that
might further mediate the relationship between the traumatic event, their traumatic stress
response, and observed behavior problems.
Critique of Two Previous, Noteworthy Studies
Two studies (DePrince et al., 2009; Jouriles et al., 2008) detailed in the previous chapter,
represent the most noteworthy attempts yet to examine EF in children exposed to chronic
traumatic stress. However, both studies suffer from significant theoretical and methodological
constraints that limit the ability to generalize their findings to the current research. DePrince et
al. (2009) assessed three sub-components of EF (attention, WM, and IC) in school-age children
(mean age = 10.39); however, the authors’ measure of attention appeared to lack internal
validity, loading more on WM than AC.
Jouriles et al. (2008) conducted the first EF study of preschool-age children exposed to
IPV. The authors assessed bidirectional IPV – representing the only EF study to do so – using a
well-validated measure of physical IPV in contrast to DePrince et al. (2009) who relied on a

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single question to determine IPV exposure. Despite its strengths, Jouriles et al.’s research design
limits its generalizability to the current research. First, the researchers collected a relatively small
sample size (N = 69), which may partially explain some of their null findings due to the
increased likelihood of Type II error (e.g., Field, 2009). Second, Jouriles et al. only assessed
older preschool-age children and early school-age children (4 – 6 year olds) and thus their results
may not apply to younger preschool-age children given the rapid EF and neurological
development that occurs during the early preschool years (Carlson, 2005; Diamond, 2002/2006).
Additionally, the authors’ measure of memory assessed more long-term memory than WM and
thus their findings cannot be validly extrapolated to WM performance in preschool-age children.
One of the primary critiques advanced in the previous chapter for EF studies in general
was the lack of grounding in adequate trauma theory. Fortunately, DePrince et al. (2009) and
Jouriles et al. (2008) made important advances on this point, yet each did so incompletely.
DePrince et al. measured dissociative symptoms in their sample, which represents the first study
of EF in IPV exposed children to do so; however, rather than also assessing hypervigilance (e.g.,
Perry & Pollard, 1998; Perry et al., 1995) the authors used a global measure of PTSD and did not
examine hypervigilance separately form the other two PTSD symptom clusters (i.e., reexperiencing and avoidance symptoms). In contrast, Jouriles et al. assessed symptoms of
hypervigilance, but failed to assess dissociative symptoms. In addition, Jouriles et al.’s measure
of hypervigilance had low internal consistency (per the authors’ acknowledgement) and thus did
not seem to be a reliable measure of the construct. This is likely due to the authors’ use of the
DSM-IV-TR hypervigilance criteria as the basis of their measure, which does not evidence
adequate validity for preschool-age children due to lack of developmentally appropriate items
(e.g., Scheeringa et al., 2003; Scheeringa et al., 1995).

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Lastly, neither DePrince et al. (2009) nor Jouriles et al. (2008) measured child behavior
problems (Note: DePrince et al. assessed an anxiety problems subscale, but no other forms of
internalizing or externalizing problems), and thus the nature of the relationship between IPV
exposure, traumatic stress, EF, and behavior problems within the population of IPV exposed
children remains unknown.
Future Directions: Towards an Integrated Model
Despite the advances made in recent years towards understanding the effects of children’s
repeated exposure to traumatic events, such as IPV, on their psychological functioning and
social-emotional development, several important research questions remain. Specifically, are
preschool-age children’s dissociative and/or hypervigilant responses to IPV exposure
differentially related to their behavior outcomes? Are preschool-age children’s dissociative
and/or hypervigilant traumatic stress responses differentially related to levels of AC, WM, and
IC? If so, do AC, WM, and/or IC functioning mediate the relationship between exposure to IPV,
subsequent dissociative and/or hypervigilant symptoms, and observed behavior problems?
The current research seeks to address these questions by integrating Perry et al.’s (1995)
traumatic stress theory, De Bellis et al.’s (1999a/1999b) developmental trauma theory, and
Blair’s (2010) chronic contextual stress and executive dysfunction theory. Each of these three
theories describe the possible relationships between exposure to a salient stressor, children’s
chronic, psychological traumatic stress responses, and how these responses are related to
deleterious alterations of the body’s physiological stress response systems and subsequent
neurological development. However, Perry et al.’s theory was developed largely in response to
the extant animal literature and has not been adequately tested in humans. De Bellis et al.
(1999a/1999b) focused exclusively on overall PTSD symptoms in order to further advance the

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psychiatric conceptualization of childhood trauma. In doing so, the authors failed to adequately
address other traumatic stress symptoms that play an important role in children’s responses,
namely dissociation. Blair’s theory advanced the literature by considering the possible effects of
chronic psychological and physiological stress responses on EF; however, Blair applied his
model to a contextual stressor that failed to elicit a strong enough response (i.e., poverty). The
current research extends these three theories beyond their specified application by examining the
possible mediational role young children’s EF may play between their exposure to early
childhood IPV, subsequent psychological traumatic stress symptoms, and observed behavior
problems.
According to this novel model guiding the current research, early childhood exposure to
repeated IPV, whether unidirectional or bidirectional (e.g., Breiding et al., 2008), psychological,
physical, or sexual (e.g., Breiding et al., 2008; Marshall, 1992) represents a particularly salient
series of traumatic events (Margolin & Vickerman, 2008) that has profound implications for an
exposed child’s biopsychosocial development (e.g., Evans et al., 2008; Huang et al., 2010; Wolfe
et al., 2003). Preschool-age children exposed to this form of family violence are both
psychologically and physiologically vulnerable to the cascading effects of the traumatic stress
responses that ensue (Cicchetti & Rogosh, 2001). However, not all children respond to IPV
exposure in the same manner. Some of the children experience dissociative symptoms (Ogawa et
al., 1997; Macfie et al., 2001a/2001b; Rossman et al., 1997) as they struggle to make sense of the
overwhelming violence within the caregiving system. These children may feel utterly hopeless in
the face of such terror as they watch or hear one or both of their caregivers assault each other
(e.g., DePrince & Freyd, 1999; Perry et al., 1995). The implied message clearly indicates that no
one is safe in the home. Unable to adequately intervene and stop the violence, or terrified that the

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violence will result in serious harm to either caregiver or the child himself/herself (Perry et al.,
1995), a child may psychologically retreat from harsh reality and depersonalize the event (e.g.,
watching the event unfold as if from a safe bystander’s perspective) and/or derealize the situation
(e.g., the event appears to be a scene from a movie, not reality) (e.g., APA, 2000; DePrince &
Freyd, 2001/2007).
Other children when faced with the overwhelming terror of watching or hearing the
violence between their caregivers unfold may feel a sudden surge of energy. These children may
feel compelled to physically intervene in the conflict by possibly attacking one/or more of the
perpetrators of the violence, or to run away from the situation (e.g., Perry & Pollard, 1998; Perry
et al., 1995). These children experience a rapid escalation in heart rate (e.g., Heim et al., 2003)
and seem to have acute sensory perception – they are only able to focus on salient aspects of the
conflict itself while all other visual or auditory stimuli fades into the background.
Other children are thought to experience a combination of these two responses (Perry et
al., 1995). Perhaps in the immediate context of a severely violent episode, they freeze, unable
able to move and hoping their father does not remember they are in the next room. Later, when a
flashback of the fight pops into their mind, while at school, they experience a sudden urge of
energy and quickly become either affectively or behaviorally dysregulated. In this manner, a
child experiences an oscillating psychological and physiological response, depending on the
level of threat present and who is responsible for a threat (e.g., another child or a seemingly
omnipotent caregiver). For instance, when they perceive a slight from another child on the
playground (e.g., accidentally bumped while waiting in line), they may become angry and
reactively attack the child.

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As young children are repeatedly exposed to varying incidences of IPV that wax and
wane in both severity and frequency (e.g., Caetano et al., 2005), their original psychological
reactions to the particularly salient episodes of violence appear to strengthen with each
successive incident and begin to generalize to other, milder stressors (e.g., a challenging task at
home or school) (Perry et al., 1995). Children with predominantly dissociative experiences
perhaps begin to “check out” more frequently across multiple environments. These daydreams
begin to interfere with their ability to socialize properly or to accomplish their tasks at school
(e.g. Rueda et al., 2010). As they begin to experience the negative consequences associated with
not properly attending to their immediate environments (e.g., a teacher constantly reminds the
child to follow the established rules), these children perceive the negative environmental
feedback as a threat to their self-esteem and thus are even more inclined to psychologically
distance themselves from the potential pain. Even in situations when they want to be more
engaged, such as when playing with a close friend, these children may notice that it is difficult to
remain engaged in the desirable activity or to shift their attention along with the rapidly changing
nature of the task (e.g., an evolving, impromptu playground game). Parents and teachers also
note that their “daydreamer” has difficulty remembering basic directions or fails to complete
tasks, despite knowing the steps necessary to complete the task (e.g., putting a coat up on the
hook) (e.g., Marcovitch et al., 2010). When prompted, the child is able to follow explicit
directions, but appears to have difficulty focus his/her attention long enough to follow-through
with the directions before either drifting off into his/her own world or being distracted by another
stimulus.
In contrast, other children exposed to repeated incidences of IPV who appear affectively
and behaviorally reactive to their environments seem to have greater trouble self-regulating.

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These children also appear to perceive threats where they might not actually exist (e.g.,
misinterpreting a peer’s neutral comment or a teacher’s ambiguous gesture as threatening) (e.g.,
Pollak et al., 2005). In response, these children may overreact to the situation, either rapidly
distancing themselves from the apparent threat (e.g., “this game is stupid, I don’t want to play
anymore”) or inappropriately engaging the perpetrator of the threat with aggression (e.g., kicking
another child). Similarly to the children who experience more dissociative symptoms in response
to the original traumatic events, these hypervigilant children appear to have significant difficulty
controlling their attention compared to most other children. As a result, they too, have problems
remembering information, even for a very short period of time and thus their learning begins to
suffer. When they are able to appropriate attend to information for a more sustained period of
time, they seem to learn the material as well as the other children; however, their difficulty
shifting and then re-engaging their attention as required appears impaired. Physically on edge
and exhibiting difficulty following the rules either at home or at school, these children may be
disciplined more often for their acting out behavior.
As described above, the model assumes that preschool-age children exposed to IPV will
experience a wide variety of psychological and biological stress responses to the traumatic
events. The psychological responses involve dissociative and/or hypervigilant symptoms (Perry
& Pollard, 1998; Perry et al., 1995), which are differentially related to children’s biological stress
systems’ reactivity. Children who predominantly dissociate in the face of significant stressors
may exhibit an attenuated HPA-axis and sympathetic nervous response (e.g., Simeon et al.,
2007) akin to animals feigning death when under threat (e.g., Porges, 2007). Children who
experience a strong “fight or flight” response (e.g., Perry et al., 1995), may experience an
elevated biological stress response (e.g., Bruce et al., 2009) and general physiological arousal as

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they prepare to either confront the treat or to quickly escape the situation (e.g., Cicchetti &
Rogosh, 2001). These transactional psychological and physiological stress responses (De Bellis
et al., 1999a/1999b; Perry & Pollard, 1998; Perry et al., 1995) are related to children’s executive
dysfunction (Blair, 2010), as their initial stress reactions occur repeatedly in response to chronic
IPV at home begin to generalize to other environments and milder stressors (Perry et al., 1995).
As children’s EF becomes disrupted their internalizing and/or externalizing behavior problems
become more pronounced across several environments (e.g., at preschool and at home).
Specifically, dissociative symptoms are expected to be related to AC and WM impairments and
thus mediate the relationship between dissociative symptoms and internalizing behavior
problems. In contrast, hypervigilance is expected to be related to EF across all three subcomponents – most notably AC and IC – which is proposed to mediate the relationship between
symptoms of hypervigilance and externalizing behavior problems.

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CHAPTER 7
Rationale & Hypotheses
The current study is guided by three primary research questions: (1) are preschool-age
children’s dissociative and/or hypervigilant responses to IPV exposure differentially related to
their behavior outcomes, (2) are preschool-age children’s dissociative and/or hypervigilant
responses differentially related to levels of AC, WM, and IC, and (3) do AC, WM, and/or IC
functioning mediate the relationship between exposure to IPV, dissociative and/or hypervigilant
traumatic stress responses, and observed behavior problems?
The current research is unique in several ways. Theoretically, the study integrates Perry
et al.’s (1995) traumatic stress theory, De Bellis et al.’s (1999a/1999b) developmental trauma
theory, and Blair’s (2010) contextual stress and EF theory. Furthermore, the study extends these
theories by proposing EF mediates the relationship between exposure to IPV, children’s
dissociative and/or hypervigilant responses, and their internalizing and/or externalizing behavior
problems. The current research is the first time a study has tested this mediational model.
The current study has several methodological strengths. First, the study examines
children during the preschool period, which is a critical period for emerging EF (e.g., Carlson,
2005; Diamond, 2002/2006; Shing et al., 2010). In addition, the sample consists of
predominantly low-income families, providing a natural control for possible covarying effects of
everyday stressors associated with poverty (e.g., Blair, 2010). Multiple methods and reporters are
also used in the current research. For instance, both maternal and teacher reports of the children’s
EF and behavior problems were collected, which provides a comprehensive view of the
children’s functioning across multiple environments. EF was also assessed using lab-based
paradigms using well-validated tasks. In regards to assessing traumatic events and traumatic

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stress responses, the current study applies the knowledge gained from recent advances in the
field. For instance, a more complete picture of IPV was obtained through assessment of bidirectional violence (e.g., Breiding et al., 2008) – as opposed to male-to-female violence only –
and multiple forms of IPV, including psychological, physical, and sexual violence.
Developmentally appropriate measures of dissociation and hypervigilance (e.g., Putnam,
Helmers, & Trickett, 1993; Scheeringa et al., 1995) were also assessed.
Specific Hypotheses
The following hypotheses are organized according to the primary research questions.
Primary Research Question 1: Are preschool-age children’s dissociative and/or hypervigilant
responses to IPV exposure differentially related to behavior outcomes?
1.a

Dissociation will predict greater levels of internalizing behavior problems,
whereas hypervigilance will not.

1.b

Hypervigilance will predict greater levels of externalizing behavior problems,
whereas dissociation will not.

Primary Research Question 2: Are preschool-age children’s dissociative and/or hypervigilant
responses differentially related to levels of AC, WM, and IC (measured by parent report and
teacher reports, and lab-based tasks) after controlling for the children’s age?
2.a

Dissociative and hypervigilant symptoms will each predict lower AC.

2.b

Dissociative and hypervigilant symptoms will each predict lower WM.

2.c

Only hypervigilant symptoms will predict lower IC.

Primary Research Question 3: Do AC, WM, and/or IC (measured by parent report and teacher
reports, and lab-based tasks) mediate the relationship between IPV exposure, dissociative and/or
hypervigilant traumatic stress responses, and observed behavior problems?

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3.a.i EF (as indicated by AC, WM, and IC) will partially mediate the relationship
between IPV exposure, traumatic stress symptoms, and reported internalizing
problems at home and at school.
3.a.ii. Dissociative, but not hypervigilant, symptoms will significantly load onto
the traumatic stress latent variable in the internalizing behavior problems
model.
3.a.iii. AC and WM, but not IC, will significantly load onto the EF latent variable
in the internalizing behavior problems model.
3.b.i EF (as measured by AC, WM, and IC) will partially mediate the relationship
between IPV exposure, traumatic stress symptoms, and reported externalizing
problems at home and at school.
3.b.ii. Hypervigilance, but not dissociation, will significantly load onto the
traumatic stress latent variable in the externalizing behavior problems
model.
3.b.iii. AC, WM, and IC will significantly load onto the EF latent variable in the
externalizing behavior problems model.

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CHAPTER 8

Methods
The Healthy Moms – Healthy Kids Study was a collaborative research project between
the author and a fellow graduate student principal investigator, Lia Field. While the study jointly
recruited participants and used data from many of the same measures, the ultimate product is two
separate dissertations. All information contained within the current methods section only pertains
to the current research, unless noted.
Participant Recruitment
From June 2011 through December 2011, the Healthy Moms - Healthy Kids study
recruited 156 child-mother dyads from the Capital Area Community Services Head Start
(hereafter referred to as Head Start) preschool locations in the greater Lansing metropolitan area,
per a signed agreement with Head Start. The local Head Start preschools serve approximately
1600 children across Ingham, Eaton, Clinton, and Shiawasee County (CACS Head Start and
Early Childhood Programs Annual Report, 2008 – 2009). Identification of potential participants
involved several closely-coordinated efforts, including in-person recruitment by the two graduate
principal investigators at fall orientation meetings, parent information meetings, and meetings
with the classroom social services liasons. One of the most effective recruitment methods
involved school bus drivers personally distributing recruitment flyers to parents from each the
Head Start schools (see Appendix A for a copy of the recruitment flyer). Importantly, at no point
during recruitment, either in-person or via the flyer, was IPV mentioned to potential participants.
Thus, the participants were not self-selecting on the basis of this criterion. Through each
recruitment method, a confidential phone number and study e-mail address were provided for

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interested participants to contact the study staff. Alternatively, at in-person recruiting events,
interested participants were also provided an option to leave their contact information and have a
research assistant call or e-mail with additional information.
The following inclusion and exclusion criteria were used to identify possible participants:
the child had to be between the ages of 3:0 and 5:11 years old and attend one of the Head Start
locations; the mother had to be a biological parent and have legal custody of her child; the child
must have resided with his/her biological mother for a majority of the previous year; the mother
spoke English as a first language OR was reasonably fluent in reading and writing English (e.g.,
6th grade level); and, the child had not been diagnosed with mental retardation or another
significant developmental delay. Out of the 156 mother-child dyads that attended the in-person
interview at MSU, 12 of the research visits terminated prematurely due to a child either refusing
assent or withdrawing his/her assent during the visit. Another child was suspected of having an
unidentified developmental delay based upon stereotypic movements and a lack of appropriate
social communication. Therefore, these 13 children and their mothers were excluded from all
subsequent analyses, resulting in a final sample size of 143 dyads (see Table 1 below for a
breakdown of the sample’s demographics).

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Table 1
Demographic Characteristics of Study Participants (N = 143)
Age of Mother
Age of Child

M = 29.02 (SD = 4.87)
M = 4.25 (SD = 0.66)

Gender of Child
Boy
Girl

72 (50.3%)
71 (49.7%)

Racial/Ethnic Group of Mother
Caucasian, White
Black, African
American
Multiracial
Latina, Hispanic
Asian American,
Pacific Islander
Native American

61 (42.7%)
48 (33.6%)
16 (11.2%)
12 (8.4%)
4 (2.8%)
2 (1.4%)

Racial/Ethnic Group of Child
Multiracial
Black, African
American
Caucasian, White
Latina, Hispanic
Asian American,
Pacific Islander
Native American

47 (32.9%)
44 (30.8%)
42 (29.4%)
6 (4.2%)
3 (2.1%)
1 (0.7%)

Mother’s Marital Status
Single, never married
Married
Divorced
Separated

94 (65.7%)
31 (21.7%)
11 (4.9%)
7 (4.9%)

Mother’s Occupation Status
Unemployed
Full-time employment
Part-timeemployment
SSI Disability

74 (51.7%)
32 (22.4%)
28 (19.6%)
9 (6.3%)

Monthly Family Income

M = $1564.27 (SD = $831.55)

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Procedures
The current study received all necessary approvals from Michigan State University’s
Institutional Review Board and CACS Head Start’s Executive Director before recruiting any
participants or conducting research interviews.
When interested participants contacted the study, they were read a brief description of the
study and asked to verbally consent before completing the initial intake screening interview (see
Appendix B for a copy of the telephone screening interview). The women were informed that
they had the right to not answer any item, as well as to terminate the intake interview at any point
without reprecussion from either MSU or Head Start. The intake interview assessed basic
demographic information, as well as inclusion/exclusion criteria. Additionally, the intake
interview assessed several items from the Revised Conflict Tactics Scales (Straus, Hamby,
Boney-McCoy, & Sugarman, 1996) to ensure adequate representation of women who had
experienced IPV in the sample.
Eligible mother-child dyads attended a 2 – 2.5 hour interview at the MSU Psychology
builing. All interviews were conducted by a team of graduate and undergraduate research
assistants. Graduate students always interviewed the mothers, per Head Start’s request, as the
interviewers assessed experiences of IPV and were responsible for obtaining consent. The
children worked with either graduate or undergraduate research assistants. At the start of the
interview, the mothers were read an introduction to the study and signed a written consent form
(see Appendices C and D). The mothers were informed that they had the right to not answer any
of the questions and that they could stop the interview at any point and would still receive
financial compensation. In addition, the mothers were informed that any decisions they made
during the interview would not impact their relationship with MSU or Head Start. To ensure the

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women fully understood their rights, they were explicitely asked if they had any questions about
the interview. All questions were answered by the training graduate research assistants or one of
the graduate principal investigators.
As the study also collected data on preschool-age children, the mothers were asked to sign
a written consent agreeing to let their children participate in the interview. After a brief (5 - 10)
warm-up period to let the children acclimate to the novel environment, the children were asked if
they would like to play games and spend time with the research assistant (see Appendix G for the
verbal assent form). The children were informed that they did not have to do any task that they
did not want to and that they could stop the visit at any time. As previously noted, 12 children
either refused to provide initial assent or withdrew their assent during the visit. In each case, the
research staff emphasized to the mothers that this was a normative response given the strange,
novel environment (in order to reduce any possible anxiety or frustration) and the families were
financially compensated per the study’s procedures.
After the consenting/assenting procedures, the mothers filled out questionnaires (see
“Measures” section below), while the children played with a research assistant to further
acclimate to the novel environment. Approximately 20 minutes into the interview, the dyads
completed a saliva collection procedure, as part of the data collection for another dissertation
study. As part of this other study, the children then completed a mild stress task (walking on a
balance beam) and subsequent reunion with their mothers, which lasted approximately 10
minutes. Following the reunion, the children were provided non-structured play time with the
research assistant for approximately 5 – 10 minutes. The children then completed the EF tasks,
with brief play breaks, as necessary. During this time, the children also took two breaks to
complete two additional saliva collections for the other study.

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At the completion of each interview, the mothers were financially compensated for their
time with a cash payment ($75 for a completed visit; $30 for an incomplete visit). A receipt of
payment was signed by each of the mothers in accordance with University guidelines. In
addition, each child received a gift bag with several small toys, juice, and a snack (approximate
value $5). All participants were provided with a comprehensive community resources referral
list. In addition to the financial compensation, participants were provided parking passes, which
enabled them to park in the lot closest to the Psychology building free of charge for the duration
of the visit. Participants without their own vehicles, or who could not secure a ride with a family
member or friend, were reimbursed bus fare for each member of the family attending the visit.
Undergraduate research assistants also provided childcare during the visits for any additional
children.
Each mother was also asked to sign a release form giving the study permission to contact
her child's teacher (see Appendix E). The mothers were informed that they had the right to refuse
participation in this part of the study without reprecussion, as well; however, despite this option,
all 143 mothers consented for the study staff to contact their child’s teacher. The teachers
received a copy of the mother's signed release form along with a teacher specific consent form
(see Appendix F). In their consent form, the teachers were informed of their right to refuse
participation in the study. Additionally, the consent form noted that no information provided by
the mothers or children would be shared with Head Start under any condition. Only five teachers
chose not to participate in the study (96.5% response rate). The remaining 138 teachers filled out
two rating forms: one assessing the child’s EF and the other assessing the child’s behavior
problems at school. Each teacher who returned the completed consent form and rating forms

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promptly received $10 cash per child (e.g., if a teacher had more than one child in the study,
he/she earned $10 for each child).
Measures
Mother & Teacher Reports
Demographics: A demographic questionnaire assessed a wide-variety of socio-economic
variables pertaining to the mother-child dyad (e.g., maternal level of education, family monthly
income, and assistance received from social service organizations), information about the
mother’s past and current romantic partners, and basic demographic information about her child.
See Appendix H for copies of all measures.
Intimate Partner Violence: The mother’s experiences of physical, sexual, and
psychological violence (both receiving and perpetrating) since her child was born were assessed
with the 78-tem Revised Conflict Tactics Scales (Straus et al., 1996). Each item was scored on a
seven-point scale ranging from “Never” to “More than 20 times.” All items were used, except
the Negotiation subscale items, which are indicative of positive dyadic interactions. Additional
items assessed the mother’s experience of psychological violence (both receiving, as well as
perpetrating) since her child was born with the Psychological Maltreatment of Women Inventory
– Short Version (PMWI-S; Tolman, 1995). The original PMWI-S has 14 items; however, the
mother also reported tactics she may have used towards her partner(s), resulting in a total of 28
items. Mothers rated the frequency of her experiences on a 5-point scale ranging from “Never” to
“Very Frequently.” For the purposes of the present study, the CTS2 items were weighted
according to their severity (mild, moderate, or severe) according to the authors’ suggested
guidelines (Straus et al., 1996), which have demonstrated good validity for previous research
applications. Two sum scores were calculated across all of the weighted items from the CTS2

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and the raw PMWI-S items. The first score represents the total violence perpetrated by the
mother against her romantic partner(s) since her child was born, while the second score
represents the total violence perpetrated by the mother’s partner(s) since her child was born.
Straus et al. (1996) reported good internal consistency for the CTS2 sub-scales (range .79 for
psychological aggression to .95 for injury). Tolman (1999) reported good internal consistency for
the PMWI-S (range of .88 for the domination/isolation subscale and .92 for the verbal/emotional
subscale). Internal consistency across all items for each measure in the present sample was
excellent for items assessing maternal perpetration (CTS2 ! = .90; PMWI-S ! = .89) and
partner(s) perpetration (CTS2 ! = .93; PMWI-S ! = .96).
Executive Functioning: The Behavior Rating Inventory of Executive Functioning –
Preschool version (BRIEF-P; Gioia et al., 2003) is a 63-item, caregiver and teacher report of
young children’s executive functioning measured by their observable behavior. Scores from
three BRIEF-P subscales were used: (1) inhibition, (2) shifting (a measure of AC), and (3)
working memory. All subscale raw scores were converted to t-scores using age-adjusted norms
(Gioia et al., 2003). In a community sample, the BRIEF-P indices demonstrated good to
excellent internal consistency for parent report (.80 - .95) and for teacher report (.90 - .97) (Gioia
et al., 2003). In the present sample, internal consistency across the three subscales ranged from
good for shifting (maternal report ! = .83; teacher report ! = .82) to excellent for inhibition
(maternal report ! = .88; teacher report ! = .94) and WM (maternal report ! = .91; teacher
report ! = .92).
Emotional and Behavioral Functioning: The children’s emotional and behavioral
functioning was assessed using a parent and teacher report version of the Child Behavior
Checklist. The parent report version of the Child Behavior Checklist - Preschool (CBCL1 ! - 5;

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Achenbach & Rescorla, 2000) is a 99-item measure of internalizing and externalizing behavior
problems. The teacher report version of the Child Behavior Checklist – Teacher Report Form
(TRF; Achenbach & Rescorla, 2000) is a 99-item measure resulting in the same two broadband
scores. The four raw broadband scores (two parent and teacher reported scores) were converted
into age and gender normed t-scores (Achenbach & Rescorla, 2000). In a preschool-age sample
of children exposed to IPV, Zerk et al. (2009) reported excellent internal consistency for both the
internalizing and externalizing scales (.90 and .91, respectively). In the present sample, internal
consistency across all items ranged from very good to excellent for both maternal report
(internalizing ! = .85; externalizing ! = .90) and teacher report (internalizing ! = .90;
externalizing ! = .95).
Traumatic Stress Symptoms: The children’s traumatic stress symptoms were assessed
with two measures. Six items from Posttraumatic Stress Disorder Semi-Structured Interview and
Observational Record (PTSDSSI; Scheeringa et al., 1995) assessed for hypervigilance according
to the authors’ modified DSM-IV criteria for preschool-age children (items P45 – P50). Each of
these items was dichotomized (i.e., presence/absence) and then a sum score was calculated to
result in a 6-point continuous scale, with higher values indicating greater hypervigilance. The
PTSDSSI has shown adequate interrater reliability (Cohen’s " = .75) in a previous study of
young children (Scheeringa et al., 2003). Interrater reliability was not calculated for the current
research interviews due to logistical restraints; however, all of the graduate research assistants
were previously trained clinicians who also received extensive training on the current protocol.
Additionally, the two graduate principal investigators either conducted or observed nearly three
quarters of the research interviews, thus intterater reliability for the PTSDSSI is presumed to be
within acceptable limits.

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Dissociative symptoms were assessed by maternal report on the Child Dissociative
Checklist (CDC; Putnam et al., 1993). The CDC is a 20-item measure of behaviors a child may
have exhibited in the past six months. Items were scored on a three-point scale from “Not True”
to “Very True.” Sample items include, “Child goes into a daze or trance-like state at times or
often appears ‘spaced-out’,” and “Child is unusually forgetful or confused about things that he or
she should know, e.g. may forget the names of friends, teachers or other important people, loses
possessions or gets easily lost.” A sum score of dissociative symptoms was used. The CDC has
demonstrated good internal consistency (.82) in a previous sample of preschool-age children
exposed to family violence (Macfie et al., 2001a). In the present sample, internal consistency
across all items was good (! = .78).
Child Lab-Administered Assessments
Attentional Control: The children’s AC was assessed with the Dimensional Change Card
Sort (DCCS; Frye et al., 1995), according to a recent updated protocol (Zelazo, 2006). The
DCCS used two target cards depicting a blue rabbit and a red rowboat. The children sorted an
additional 14 cards (2 practice cards, 12 trial cards), evenly dived into eight red rabbits and either
blue rowboats (i.e., the opposite color/shape combination from the target cards). Following two
learning trials, the DCCS required the children to sort six cards into two trays according to a
single rule (i.e., by color) and then sort six additional cards according to the second rule (i.e., by
shape). This task required substantial AC and cognitive flexibility. The total number of incorrect
trials was used in the present study (range 0 – 12), so a higher score indicated worse AC
performance. The DCCS has good reliability and is highly correlated with other measures of
executive functioning (Zelazo, 2006). In the present sample, internal consistency across all trials
was good (! = .79).

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Working Memory: Non-verbal and verbal working memory were assessed using Working
Memory Index tests from the Early Stanford-Binet, 5th edition (Early SB5) (Roid, 2003). Two
sub-tests assessed non-verbal working memory: (1) a delayed response task, where the child
watched the examiner hide an object and then waited before indicating where the hidden object
was located, and (2) a block span task that measured the children’s ability to observe and mimic
a motor-spatial sequence. Two sub-tests assessed the preschool-age children’s verbal working
memory. The first required the children to remember progressively longer sentences they heard
the examiner read out loud and then repeat the sentences back to the examiner verbatim. The
second sub-test of verbal working memory required the participants to listen to a sentence posed
as a question and repeat only the last word of the sentence back to the examiner. A WM Index
Score standard score was calculated using age-adjusted norms (Roid, 2003) and then reverse
coded, so a higher score equaled worse WM. The Working Memory Index from the Early SB5
has excellent reported validity and internal reliability (> .90) (Strauss et al., 2006). In the current
sample, the children completed widely different number of items based upon their performance
on the WM tasks (e.g., some children completed as few as 8 items and others completed more
than 20 items); therefore, alpha was unable to be calculated.
Inhibitory Control: Two tasks of IC were administered. First, a peg tapping task
(Diamond & Taylor, 1996), required the children to observe the examiner tapping a wooden peg
once or twice and then respond with the opposite action (e.g., if the examiner taped twice, the
child was told to tap once). After the initial learning trials, the children completed 16 PegTapping trials. The second measure of IC was a Stroop-like Day–Night measure developed by
Gerstadt et al. (1994). The Day/Night task used two illustrated cards: one black, depicting a
nighttime scene (moon and stars), and the other painted brightly, depicting daytime (blue-sky

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and clouds). When the children were shown the nighttime card, they were told to verbally
respond, “day” and vice versa when shown the opposite card. The Day/Night task measures
children’s ability to inhibit a pre-potent response in favor of a secondary, less automatic response
(Gerstadt et al., 1994). After the initial learning trials, the children completed 16 additional trials.
For both the Peg-Tapping task and the Day/Night task, the total number of incorrect trials for
each task was used in the analyses, so a higher score indicated worse IC. In the present sample,
internal consistency for the Peg Tapping Task (! = .93) and Day/Night Task (! = .92) was
excellent.

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CHAPTER 9
Results
A multi-step analytic plan was employed, including imputation for missing data, bivariate
analyses, principal components analysis, linear regressions, and structural equation modeling. As
the present study uses numerous variables in the analyses, an overall list of variable acronyms
and associated descriptions is provided in Table 2 below. Additionally, variables listed within
individual tables are defined in the table notes for quick reference.

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Table 2
Alphabetical List of Variables Used in Present Study’s Analyses
Variable

Description

CBCL
CBCL Ext.
CBCL Int.
CDC
CTS2
Day/Night
Day/Night sum score
DCCS
DCCS sum score
Dissociation
Early SB5
Hypervig.
IPV Mom
IPV Partner
LA EF
MR AC
MR EF
MR IC
MR WM
Peg-Tapping
Peg-Tapping sum score
PMSI-S
SB5 WM
TR AC
TR BRIEF-P
TR EF
TR IC
TR WM
TRF
TRF Ext.
TRF Int.

All CBCL items – used to examine pattern of missingness
CBCL Externalizing Problems t-score
CBCL Internalizing Problems t-score
All CDC items – used to examine pattern of missingness
All CTS2 items – used to examine pattern of missingness
Sum of Day/Night incorrect trials controlling for child’s age
Sum of Day/Night incorrect trials
Sum of DCCS incorrect trials controlling for child’s age
Sum of DCCS incorrect trials
Sum of CDC items
All Early SB5 items – used to examine pattern of missingness
Sum of PTSDSSI hypervigilance items
Sum of all mother perpetrated CTS2 and PMWI-S items
Sum of all partner perpetrated CTS2 and PMWI-S items
Component score of lab-assessed EF
Maternal reported shifting score on BRIEF-P
Component score of maternal reported EF
Maternal reported inhibition score on BRIEF-P
Maternal reported working memory score on BRIEF-P
Sum of Peg-Tapping incorrect trials controlling for child’s age
Sum of Peg-Tapping incorrect trials
All PMWI-S items – used to examine pattern of missingness
Lab-assessed Working Memory Index score from Early SB5
Teacher reported shifting score on BRIEF-P
All teacher report items on the BRIEF-P
Component score of teacher reported EF
Teacher reported inhibition score on BRIEF-P
Teacher reported working memory score on BRIEF-P
All TRF items – used to examine pattern of missingness
TRF Externalizing Problems t-score
TRF Internalizing Problems t-score

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Missing Data and Imputation
There were three sources of missing data in the current study: (1) during the lab-based
mother-child visits, some mothers failed to complete all of the items and some children declined
to complete all tasks, (2) five teachers declined to participate in the study; thus, for these
teachers, none of the TRF (Achenbach & Rescorla, 2000) and BRIEF-P (Gioia et al., 2003) data
were available, and (3) several teachers failed to complete all of the items in their returned
packets. Overall, the amount of missing data in the present study was very small (i.e., < 0.50 %
of all data points used in the current analyses). Despite the small percentage of missing data, a
careful imputation strategy was implemented in order to increase the power available for all
analyses, as case-wise deletion of all participants with any missing data would have likely biased
the findings and resulted in an unacceptably high number of discarded dyads.
Missing data was imputed for individual measures separately. This approach enabled a
more nuanced examination of the pattern of missingness for individual measures than imputing
all of the missing values at once. Across individual measures with any missing data, the percent
of data points estimated ranged from 0.035% for the CDC (Putnam et al., 1993) to 3.56% for the
TRF (Achenbach & Rescorla, 2000) and BRIEF-P Teacher Report forms (Gioia et al., 2003). For
applicable measures, correlations between items with missing values and complete items that
loaded onto the same subscale were examined. Complete items that correlated most highly were
selected as matching variables. Some cases were missing all items on a measure (i.e., for the five
cases with teachers who declined to participate). For these cases, subscale level scores were
imputed, rather than all raw items, using other subscale scores that correlated significantly.
All missing values were estimated using maximum likelihood procedures. Imputation for
most measures was conducted using STATA SE 11 (StataCorp, 2009). In some instances,

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matching variables with a small percentage of missing data were used (e.g., subscales within the
same measure) in order to use highly correlated and theoretically related matching variables. For
these cases, maximum likelihood estimation in LISREL 8.7 (Jöreskog & Sörbom, 2001) was
used, as STATA SE 11 (StataCorp, 2009) does not impute from variables with missing data.
Following imputation, all estimated values were examined to determine whether they fell within
the range of possible values for that specific item or subscale; all imputed values met this
criterion.
To determine whether the pattern of missingness within each measure occurred at
random, cases were dichotomously coded as having complete data or missing any data at either
the item or subscale level. Each measure with this dichotomous pattern of missingness was
correlated with all other measures for which data was imputed, as well as with key demographic
variables (age of mother, age of child, child’s gender, mother’s education, monthly family
income, and mother’s reported experience of IPV at intake). The pattern of missingness for three
measures (CTS2, Straus et al., 1996; PMWI-S, Tolman 1995; Day/Night Task, Gerstadt et al.,
1994) was not correlated with the pattern of missingness for any other imputed data, or the
demographic variables, thus these data are considered missing at random. See Table 3 below, for
correlations between the pattern of missingness for all imputed variables and key demographic
variables.
The patterns of missingness for eight measures significantly correlated with the patterns
of missingness for other imputed measures and demographic variables, suggesting non-random
missingness. Some of these correlations can be meaningfully interpreted. For instance, the
patterns of missingness for the TRF (Achenbach & Rescorla, 2000) and BRIEF-P Teacher
Report forms (Gioia et al., 2003) are naturally correlated (r = 0.410, p = .000), as teachers who

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failed to complete all items on one measure were also likely to fail to complete all items on the
other measure. Furthermore, for five children, teacher report data were not available, thus the
subscale scores for both measures were imputed for these children, increasing the strength of the
correlation. Age of the child was negatively correlated with the pattern of missingness on the
Early SB5 (Roid, 2003) (r = -0.228, p = .006). The Early SB5 was the last task of the lab-based
assessment, suggesting that younger children became tired or non-compliant by the end of the 2hour protocol. The patterns of missingness for the Peg-Tapping Task (Diamond & Taylor, 1996)
and the Early SB5 were correlated (r = 0.401, p = .000). As with the Early SB5, the Peg-Tapping
Task was completed near the end of the child assessment, suggesting the children became
fatigued. A similar age-associated pattern of missingness for younger children has been reported
in other samples of preschool-age children (e.g., Wiebe et al., 2008). The pattern of missingness
for the CDC (Putnam et al., 1993) was significantly correlated with maternal education (r = 0.171, p = .040). This may indicate that mothers with lower education had difficulty
understanding some of the items on CDC measure. The remaining correlations do not appear
conceptually explainable. In summary, although some of these data are missing systematically,
the number of significant correlations is small and the patterns of missingness are unlikely to
significantly bias the results of any hypothesis testing, given the minimal percentage of the
overall data that was estimated (< 0.05%).

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Table 3
Correlation Matrix of Pattern of Missingness for Imputed Measures and Key Demographic Variables
Variable

1

2

3

4

5

6

7

8

9

10

1. CBCL
2. CTS2
3. PMWI-S
4. CDC
5. DCCS
6. Peg-Tapping
7. Day/Night
8. Early SB5
9. TRF
10. TR BRIEF-P
11. Mother’s Age

--

-.020
--

-.020
-.007
--

-.020
-.007
-.007
--

.345*
-.007
-.007
-.007
--

.345*
-.007
-.007
-.007
-.007
--

-.029
-.010
-.010
-.010
-.010
-.010
--

.101
-.017
-.017
-.017
-.017
.401*
-.025
--

.023
-.027
-.027
-.027
-.027
.255*
-.039
.049
--

-.073
-.025
-.025
-.025
-.025
-.025
-.036
-.063
.410*
--

12. Child’s Age
13. Child’s Gender
14. IPV Reported at Intake
15. Mother’s Education
16. Family Monthly Income

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Table 3 (cont’d)
Variable
1. CBCL
2. CTS2
3. PMWI-S
4. CDC
5. DCCS
6. Peg-Tapping
7. Day/Night
8. Early SB5
9. TRF
10. TR BRIEF-P
11. Mother’s Age
12. Child’s Age
13. Child’s Gender
14. IPV Reported at Intake
15. Mother’s Education
16. Family Monthly Income

11

12

13

14

15

16

-.003
.023
-.005
-.138
.049
.018
-.019
.112
.087
-.071
--

-.089
.103
.047
-.104
.052
-.130
.003
-.228*
.030
.109
---

.057
.082
.082
-.085
.082
.082
-.002
-.003
.136
.147
----

.106
-.070
.100
.100
-.070
.100
.022
.038
.060
.106
--!
----

.019
.032
.032
-.171*
.167*
.032
.045
.080
.050
.095
------

-.103
.024
.054
.024
-.007
-.076
.108
.073
-.107
-.065
-------

Note. CBCL = Child Behavior Checklist; CTS2 = Revised Conflict Tactics Scales; PMWI-S = Psychological Maltreatment of Women
Inventory – Short Form; CDC = Child Dissociative Checklist; DCCS = Dimensional Change Card Sort; Early SB5 = Early StanfordBinet – 5th Edition; TRF = Child Behavior Checklist, Teacher Report Form; TR BRIEF-P = Behavior Rating Inventory of Executive
Functioning, Teacher Report version.
*p < .05.

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Basic Descriptives
Means, standard deviations, and ranges of values for all variables included in the
preliminary and hypotheses testing analyses are presented below, in Table 4.
Table 4
Means, Standard Deviations, and Ranges of Values for Variables in Preliminary and Hypotheses
Testing Analyses
Variable
CBCL Ext.
CBCL Int.
Day/Night
Day/Night sum score
DCCS
DCCS sum score
Dissociation
Hypervig.
IPV Mom
IPV Partner
LA EF
MR AC
MR EF
MR IC
MR WM
Peg-Tapping
Peg-Tapping sum score
SB5 WM
TR AC
TR EF
TR IC
TR WM
TRF Ext.
TRF Int.

M

SD

50.04
50.04
0.00
8.75
0.00
4.81
3.40
0.60
16.17
24.04
0.00
46.72
0.00
51.57
53.26
0.00
9.80
95.48
44.76
0.00
50.59
50.40
50.94
47.90

9.40
9.66
4.70
5.19
2.17
2.32
3.70
1.01
14.94
25.16
1.00
8.40
1.00
10.29
12.49
4.79
5.36
13.38
6.35
1.00
10.79
9.22
9.08
9.69

Possible
Values
28 – 100
29 – 100
-16 – 16
0 – 16
-12 – 12
0 – 12
0 – 40
0–6
0 – 234
0 – 234
-5 – 5
37 – 98
-5 – 5
34 – 104
36 – 110
-16 – 16
0 – 16
-152 – -48
40 – 100
-5 – 5
39 – 113
40 – 103
36 – 100
34 – 100

Observed
Values
28 – 77
29 – 75
-9.32 – 10.20
0 – 16
-5.62 – 4.24
0–9
0 – 16
0–5
0 – 63
0 – 103
-3.19 – 2.92
37 – 74
-1.58 – 2.78
34 – 78
36 – 98
-10.48 – 10.28
0 – 16
-123 – -54
40 – 79
-1.32 – 4.05
39 – 90
40 – 84
36 – 82
34 – 91

Relationship between Dissociative Symptoms and Hypervigilance
One of the aims of the present study was to explore the basic associative nature between
symptoms of dissociation and hypervigilance, in order to evaluate Perry et al.’s (1995) traumatic
stress theory that argues these two traumatic stress reactions occur on a continuum. As the

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present study did not offer specific hypotheses for this aim, the results are presented here, as
basic descriptives, before the preliminary analyses and hypotheses testing results. In the present
sample, dissociative and hypervigilant symptoms were moderately-highly correlated (r = .517),
consistent with Mertin and Mohr’s (2002) findings; however, a more nuanced understanding of
the relationship between the two symptoms is possible. Dissociative and hypervigilant symptoms
were categorized according to published clinical norms. According to Scheeringa et al.’s (1995)
alternative, developmentally sensitive PTSD criteria for preschool-age children, one or more
symptoms of hypervigilance identify children who develop clinically significant PTSD and thus
represent an acceptable clinical cut-off. For dissociative symptoms, Putnam et al. (1993)
suggested a clinical cutoff of 12 or more symptoms. The cross-tabulations for clinically
significant dissociation and hypervigilance are presented below, in Table 5.
Table 5
Co-morbidity between Dissociation and Hypervigilance
Hypervigilance
No Symptoms
Dissociation

No Symptoms
Sub-clinical Symptoms
Clinically Sig.
Symptoms
Column Count (%)

Clinically Sig.
Symptoms

Row Count (%)

21 (14.7%)
69 (48.3%)

7 (4.9%)
39 (27.3%)

28 (19.6%)
108 (75.5%)

0 (0%)

7 (4.9%)

7 (4.9%)

90 (62.9%)

53 (37.1%)

143 (100%)

As shown in the table, 62.9% (n = 90) of the sample had no reported lifetime symptoms
of hypervigilance, whereas 37.1% (n = 53) of the children in the present sample met Scheeringa
et al.’s suggested clinical cut-off for hypervigilance. For the 53 children with clinicallysignificant hypervigilance, 23.8% (n = 34) of the children had one reported symptom; 7.7% (n =

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11) had two reported symptoms, and 5.6% (n = 7) had 3 or more reported symptoms of
hypervigilance. For the 53 children with clinically significant hypervigilance, 13.2% of this subsample (n = 7) had no reported dissociative symptoms and only 13.2% (n = 7) had clinically
significant co-morbid dissociative symptoms. The remaining 73.6% (n = 39) of the children with
clinically significant hypervigilance exhibited varying levels of sub-clinical dissociative
symptoms.
Given the moderately high, positive correlation between dissociative and hypervigilant
symptoms in the present sample, the possibility of collinearity was examined in order to
determine whether the two traumatic stress reactions are best represented by a single indicator or
separate metrics. In the study’s regression models, the variance inflation factor, which formally
assesses the degree of collinearity was small in each model (i.e., < 1.5 for dissociative and
hypervigilant symptoms), suggesting that although the two constructs are correlated, they each
contribute unique variance to predicted outcomes and are not linear dependent. Therefore,
dissociation and hypervigilance were entered into all future analyses as separate
predictors/indicators.
Preliminary Analyses
Controlling for Effects of Child’s Age on Lab-Assessed EF Performance
EF performance is strongly, positively correlated with chronological age (e.g., Carlson,
2005; Diamond, 2002/2006). Thus, before any further analyses were conducted, the children’s
EF scores were age adjusted. The raw maternal and teacher report EF scores from the BRIEF-P
(Gioia et al., 2003) were converted to age-normed t-scores. Likewise, age-normed standard
scores were calculated for the WM Index from the Early SB5 manual (Roid, 2003). No ageadjusted norms are available for the other three lab-based EF tasks (i.e., DCCS, Peg-Tapping,

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and Day/Night). Therefore, three linear regression equations (see Figure 2) were estimated
regressing the children’s EF scores onto their age (in years). The residuals were saved, which
represent the remaining variance of the children’s EF performance not associated with age. See
Table 6 for the regression results. The three residual scores were used in all subsequent analyses.
Figure 2
Regression Equations for Controlling for Effects of Child’s Age on Lab-Assessed EF
DCCS sum score = !0 + !1Age + "
Day/Night sum score = !0 + !1Age + "
Peg-Tapping sum score = !0 + !1Age + "
Table 6
Predicting Lab-Assessed EF Scores by Child’s Chronological Age
a

DCCS sum score
B
SE B

Predictor
Age in Years
*

-1.255*
a 2

b 2

.278

b

Peg-Tapping sum score
B
SE B
-3.670*

.614

c

Day/Night sum score
B
SE B
-3.343*

.603

c 2

Note. p # .05; R = .13; R = .20; R = .18.
Examining the Underlying Structure of EF
A principal components analysis (PCA) was conducted to determine the number of
underlying components derivable from the six maternal and teacher reported BRIEF-P scores
(Gioia et al., 2003) and the four lab-based measures of EF. Based upon previous factor analytic
findings (e.g., Miyake et al., 2000), an a-priori assumption was that the PCA model would reveal
a three-component solution, with a single component representing each of the three sub-domains
of EF reviewed in the literature (i.e., AC, WM, and IC). These predicted components would thus

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represent the children’s EF performance on that EF sub-component across multiple environments
(i.e., home, school, and in the lab).
The ten EF scores were entered into a PCA model (see Table 7 below, for correlations)
and three components with eigenvalues > 1 emerged (Barlett’s Test of Sphericity = 386.575, p =
.000). The resulting components were rotated using the direct oblimin method, as the
components should theoretically correlate. Contrary to expectations, however, the three
components did not represent the three sub-domains of EF (AC, WM, and IC), but clearly
represented the children’s EF within each of the child’s environments (i.e., school, home, and
lab) (see Tables 8 and 9 below, for the pattern and structure matrices). The first component
explained the shared variance across the three teacher reported EF scores (26.03% of the total
variance across the 10 EF scores). The second component explained the shared variance across
the three maternal reported EF scores (19.50% of the total variance). The third component
explained the shared variance across the four lab-based EF assessments (13.83% of the total
variance). Together, the three components explained 59.36% of the total EF variance (see Table
10 below, for correlations between the three rotated component scores). For the lab-assessed EF
component, one variable had a relatively low component loading (DCCS = .485). Thus, an
alternative PCA model was estimated excluding this measure; however, an identical component
solution emerged. Therefore, the results from the first PCA model (with the DCCS score entered)
were retained in order to capture the partial variance of EF performance associated with the labassessed AC task. For each of the three components, a separate component score was estimated
and used for hypothesis testing. Note: higher values on the teacher reported EF and lab-assessed
EF components equaled greater executive dysfunction; however, higher scores on the second
component score, representing maternal reported EF, were associated with better EF

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performance. Thus, this component score was reverse-coded before any hypothesis testing, so
higher values across all three components equaled greater executive dysfunction.

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Table 7
Correlation Matrix of 10 EF Variables Entered Into the PCA Model
Variable

1

2

3

4

5

6

7

8

9

10

1. MR IC

--

.446*

.774*

.265*

.105

.184*

-.137

-.081

.035

.012

--

.526*

.081

.175*

.104

.042

-.011

-.020

-.063

--

.146*

.091

.188*

-.079

-.012

-.002

.022

--

.322*

.720*

-.006

.256*

.033

.063

--

.383*

-.022

.257*

.050

.006

--

-.042

.309*

.027

.065

--

.216*

.105

.093

--

.295*

.308*

--

.264*

2. MR AC
3. MR WM
4. TR IC
5. TR AC
6. TR WM
7. DCCS
8. Day/Night
9. Peg-Tapping
10. SB5 WM

--

Note. All EF scores were coded, so that a higher score equals worse performance; MR = Maternal Reported; TR = Teacher Reported;
IC = BRIEF-P Inhibition T-Score; AC = BRIEF-P Attention Shifting T-Score; WM = BRIEF-P Working Memory T-Score; DCCS =
Dimensional Change Card Sort Age-adjusted Residual Score; Peg-Tapping = Peg-Tapping Task Age-adjusted Residual Score; SB5
WM = Early Stanford-Binet V Reverse Scored Working Memory Index Score.
*p < .05.

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Table 8
Pattern Matrix for PCA Model
Component
Variable

1

2

3

1. MR IC

.065

-.876

-.027

2. MR AC

-.017

-.742

.025

3. MR WM

.004

-.913

.029

4. TR IC

.852

-.038

-.043

5. TR AC

.636

-.020

-.002

6. TR WM

.887

-.021

-.039

7. DCCS

-.091

.058

.485

8. Day/Night

.421

.117

.625

9. Peg-Tapping

-.043

-.087

.705

10. SB5 WM

-.003

-.053

.690

Note. Primary component loadings are bolded; MR = Maternal Reported; TR = Teacher
Reported; IC = BRIEF-P Inhibition T-Score; AC = BRIEF-P Attention Shifting T-Score; WM =
BRIEF-P Working Memory T-Score; DCCS = Dimensional Change Card Sort Age-adjusted
Residual Score; Peg-Tapping = Peg-Tapping Task Age-adjusted Residual Score; SB5 WM =
Early Stanford-Binet V Reverse Scored Working Memory Index Score.

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Table 9
Structure Matrix for PCA Model
Component
Variable

1

2

3

1. MR IC

.211

-.889

-.084

2. MR AC

.111

-.738

-.030

3. MR WM

.163

-.912

-.036

4. TR IC

.855

-.186

.033

5. TR AC

.639

-.128

.056

6. TR WM

.887

-.175

.042

7. DCCS

-.056

.108

.481

8. Day/Night

.459

.090

.672

9. Peg-Tapping

.037

-.030

.694

10. SB5 WM

.069

-.003

.685

Note. Primary component loadings are bolded; MR = Maternal Reported; TR = Teacher
Reported; IC = BRIEF-P Inhibition T-Score; AC = BRIEF-P Attention Shifting T-Score; WM =
BRIEF-P Working Memory T-Score; DCCS = Dimensional Change Card Sort Age-adjusted
Residual Score; Peg-Tapping = Peg-Tapping Task Age-adjusted Residual Score; SB5 WM =
Early Stanford-Binet V Reverse Scored Working Memory Index Score.

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Table 10
Correlations between Three Rotated EF Components
Components

1

2

3

1. TR EF

--

.170*

.092

--

-.071

2. MR EF
3. LA EF

--

Note. All scores coded, so that a higher score equals worse EF; TR EF = Teacher Reported EF
Component Score; MR EF = Maternal Reported EF Component Score; LA EF = Lab Assessed
EF Component Score.
*p < .05.
Confirmatory Factor Analyses: Evaluating Two Alternative EF Latent Models
Following the unexpected PCA results, which clearly indicated that a single underlying
EF component best explained the shared variance across the children’s EF scores within specific
contexts, two confirmatory factory analysis (CFA) models were estimated in LISREL 8.7
(Jöreskog & Sörbom, 2001). These two CFA models were estimated to empirically compare two
alternative theoretical models of EF structure in the present sample. The first CFA model tested
the original, hypothesized model that AC, WM, and IC latent factors would best describe the
shared variance across the EF tasks, whereas the second CFA model evaluated the PCA results
indicating that the children’s EF was contextually dependent. Whereas PCA makes no a priori
assumptions about the underlying latent structure of the data and thus is exploratory in nature,
CFA assesses whether observed data are consistent with a theorized latent structure. By using
CFA to test two alternative models following the PCA results, the current study is able to draw
stronger conclusions regarding the structure of preschool-age children’s EF.

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Both CFA models were specified using maximum likelihood estimation from covariance
matrices and all manifest and latent variables were placed on the x-side (see Table 11, below, for
a list of the modifications that were necessary for model convergence and optimal fit). For both
models, all three latent factors were allowed to correlate based on theoretical rationale. Five fit
indices were chosen a-priori to evaluate the adequacy of the models specified, according to Hu
and Bentler’s (1999) cut-off recommendations: the Chi-square test (Chi-square, p > .05), the
Root Mean Square Error of Approximation (RMSEA ! .06), Comparative Fit Index (CFI " .95),
the Goodness-of-Fit Index (GFI " .95), and the Standardized Root Mean-squared Residual
(SRMR ! .08). Following model specification, the estimated parameters for each model were
examined as a final plausibility check (e.g., ensuring variances and residuals were > 0).
Table 11
CFA Model Modifications Required
EF Latent Factors

Matrix

Estimation
Method

Modifications Required

Model #1

AC, WM, IC

Covariance

ML

Residuals for TR AC
and TR IC were not
estimated (residuals < 0)

Model #2

MR, TR, LA

Covariance

ML

None

Note. MR = Maternal Report; TR = Teacher Report; LA = Lab-assessed; ML = Maximum
Likelihood.

Model 1, which evaluated whether preschool-age children’s EF is best described by three
sub-domains of EF (AC, WM, and IC), demonstrated poor fit across all five indices
recommended by Hu and Bentler (1999) (see Figure 3, below, for standardized coefficients and
fit information). In contrast, model 2, which evaluated whether EF is contextually based and best

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described by a single, global EF construct in each environment as suggested by the PCA results,
demonstrated excellent fit according to all five indices (see Figure 4). T-scores for parameter
estimates for both models are displayed in Figures 11 and 12 in Appendix I, as well as a
complete list of fit indices for both models (Tables 17 and 18). Taken together, these results
strongly suggest that preschool-age children’s EF is a unitary construct that is contextually
dependent and thus must be examined within individual environments.

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Figure 3
CFA Model #1: AC, WM, and IC Latent Factors

Note. Standardized coefficients reported; Chi-Square = 216.26 (df = 34), p = 0.000; RMSEA =
0.194 (90% C.I. = 0.17 – 0.22); CFI = 0.38; GFI = 0.77; SRMR = 0.16.
*p < .05.
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Figure 4
CFA Model #2: MR, TR, and LA Latent Factors

Note. Standardized coefficients reported; Chi-Square = 36.84 (df = 32), p = 0.255; RMSEA =
0.033 (90% C.I. = 0.00 – 0.07); CFI = 0.98; GFI = 0.95; SRMR = 0.05.
*p < .05.
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Hypotheses Testing
The results of the PCA – confirmed by the two comparative CFA models – indicated that
a single EF construct represented the children’s global EF within individual contexts (i.e., at
home, school, and in the lab). As a result, several of the hypotheses (i.e., 2.a. – 3.b.iii.) proposed
by the current study either no longer applied or required modification. In addition, the nonsignificant/small correlations between maternal and teacher reported behavior problems (see
Table 12, below) suggested that the preschool-age children’s behaviors were also context
dependent. In light of this new empirical information, a modified analytic strategy was
necessary.
First, two original hypotheses (i.e., 1.a.i. – 1.b.i.) concerning the relationship between
traumatic stress symptoms and behavior problems remained relevant and were tested, as planned.
The hypotheses (i.e., 2.a.i. – 2.c.i.) regarding the relationship between traumatic stress symptoms
and the three sub-domains of EF (AC, WM, and IC) no longer applied. Instead, a series of
exploratory analyses examined the relationships between traumatic stress symptoms and the
children’s EF in the three environments (i.e., at school, home, and in the lab). No specific
predictions were made regarding the nature of these relationships, based on the lack of previous
empirical evidence to guide hypothesis generation. Lastly, the original hypotheses (i.e., 3.a.i. –
3.b.iii.) positing that the three sub-domains of EF would partially mediate the relationship
between IPV exposure, traumatic stress symptoms, and behavior problems required
modification. Structural equation modeling was used to examine whether EF mediated the
relationship between IPV exposure, traumatic stress symptoms, and behavior problems within
and across environmental contexts (e.g., maternal reported EF and behavior problems; maternal
reported EF and teacher reported behavior problems). It was hypothesized that EF would mediate

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the relationship between IPV exposure, traumatic stress symptoms, and behavior problems
within single environmental contexts (e.g., teacher reported EF and behavior problems);
whereas, models that tested these relationships across multiple contexts (e.g., teacher reported EF
and maternal reported behavior problems) were not expected to demonstrate evidence for
mediation given the highly contextual nature of the children’s EF and behavior problems. No
specific hypotheses were offered regarding the possible mediational effects of the lab-assessed
EF and behavior problems at home or school.

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Table 12
Correlation Matrix of 11 Variables Used in Hypothesis Testing Analyses
Variable

1

2

3

4

5

6

7

8

9

10

11

1. IPV Mom

--

.759*

.114

.339*

.003

.312*

.076

.233*

.268*

-.053

.047

--

.251*

.293*

-.015

.320*

.056

.276*

.266*

-.051

-.001

--

.517*

.039

.350*

-.009

.331*

.320*

.087

.138

--

.145

.701*

-.085

.556*

.594*

.173*

.199*

--

.170*

.092

.028

.104

.626*

.750*

--

-.071

.700*

.707*

.174*

.204*

--

-.125

-.171*

.056

.069

--

.693*

.048

-.021

--

.162

.185*

--

.558*

2. IPV Partner
3. Hypervig.
4. Dissociation
5. TR EF
6. MR EF
7. LA EF
8. CBCL Int.
9. CBCL Ext.
10. TRF Int.
11. TRF Ext.

--

Note. All scores coded, so that a higher score equals worse outcomes/performance; IPV Mom = Sum of Mom Perpetrated IPV; IPV
Partner = Sum of Partner(s) Perpetrated IPV; Hypervig. = Sum of Hypervigilant Symptoms; Dissociation = Sum of Dissociative
Symptoms; TR EF = Teacher Reported EF Component Score; MR EF = Maternal Reported EF Component Score; LA EF = Lab
Assessed EF Component Score; CBCL Int. = Maternal Reported Internalizing Problems; CBCL Ext. = Maternal Reported
Externalizing Problems; TRF Int. = Teacher Reported Internalizing Problems; TRF Ext. = Teacher Reported Externalizing Problems.
*p < .05.

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Hypothesis 1.a.i: Dissociative symptoms will predict greater levels of internalizing
behavior problems, whereas hypervigilant symptoms will not.
Two hierarchical regression models were estimated predicting maternal and teacher
reported internalizing behavior problems separately. The variables were entered into the models
in the following order: hypervigilance (block 1) and then hypervigilance and dissociative
symptoms (block 2). This order was based on previous studies, which almost invariably have
assessed PTSD-related symptoms (e.g., hypervigilance), rather than dissociation. The ordering of
the blocks in the current hierarchical regression models allowed for an explicit test of whether
dissociation uniquely predicted internalizing behavior problems above and beyond the effects of
hypervigilance.
As shown in Table 13, below, the results from block 1 indicated that hypervigilance
significantly predicted maternal reported internalizing problems [F(1, 141) = 19.19, p < .01]
accounting for 12% of the variance. In contrast, hypervigilance did not predict teacher reported
internalizing problems [F(1, 141) = 1.67, p = .20]. Consistent with the hypothesis, when
dissociation was added to the model, hypervigilance no longer predicted maternal reported
internalizing problems, but dissociation emerged as the sole significant predictor [F(2, 140) =
30.38, p < .01] accounting for an additional 18.3% of the variance above and beyond
hypervigilance. However, neither hypervigilance nor dissociation emerged as significant
predictors for teacher reported internalizing problems [F(2, 140) = 1.50, p = .23]. Thus,
hypothesis 1.a.i. was partially supported (i.e., for maternal reported internalizing problems only).

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Table 13
Predicting Internalizing Behavior Problems by Traumatic Stress Symptoms
CBCL – Internalizing Problems
Predictor
Block 1
Hypervigilance
Block 2
Hypervigilance
Dissociation

2

B

SE B

.137*

!R
.120*

a

TRF – Internalizing Problems
2

.031

.183*

B

SE B

.043

!R
.012

.034

.023
.026

b

.038
.022

.009
.049
.113*

.031
.019

Note. All scores were LOG10 transformed to correct for non-normal distributions.
a 2
b 2
R Total = .30; R Total = .02.
*

p " .05.
Hypothesis 1.b.i: Hypervigilant symptoms will predict greater levels of externalizing

behavior problems, whereas dissociative symptoms will not.
Two hierarchical regression models were estimated predicting maternal and teacher
reported externalizing behavior problems separately. The variables were entered into the models
in the same order as the previous analyses (i.e., hypervigilance, then hypervigilance and
dissociative symptoms). As shown in Table 14, below, the results from block 1 indicated that
hypervigilance significantly predicted maternal reported externalizing problems [F(1, 141) =
17.86, p < .01] accounting for 11% of the variance. Similarly, hypervigilance predicted teacher
reported externalizing problems [F(1, 141) = 4.43, p < .05] accounting for 3% of the variance.
Contrary with the hypothesis, however, when dissociation was added to the model,
hypervigilance no longer predicted maternal reported externalizing problems, but dissociation
emerged as the sole significant predictor [F(2, 140) = 30.10, p < .01] accounting for an
additional 18.8% of the variance above and beyond hypervigilance. In the final model, neither

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hypervigilance nor dissociation emerged as significant predictors for teacher reported
internalizing problems [F(2, 140) = 2.42, p = .09]. Together, these results suggested that
hypervigilance was a significant predictor of maternal and teacher reported externalizing
problems, as predicted; however, when dissociative symptoms were also considered, dissociation
emerged as the sole predictor of maternal reported externalizing problems. When considered
simultaneously, neither hypervigilance nor dissociation significantly predicted teacher reported
behavior problems.
Table 14
Predicting Externalizing Behavior Problems by Traumatic Stress Symptoms
CBCL – Externalizing Problems
Predictor
Block 1
Hypervigilance
Block 2
Hypervigilance
Dissociation

2

B

SE B

.131*

!R
.112*

a

TRF – Externalizing Problems
2

.031

.188*

B

SE B

.064*

!R
.030*

.031

.054
.013

b

.034
.020

.003
.043
.113*

.031
.018

Note. All scores were LOG10 transformed to correct for non-normal distributions.
a 2
b 2
R Total = .30; R Total = .033.
*

p " .05.

Exploratory Analyses Predicting EF from Hypervigilance and Dissociative Symptoms
Three hierarchical regression models were estimated predicting maternal reported EF,
teacher reported EF, and lab-assessed EF separately. The traumatic stress variables were entered
into the models in the same order as the previous analyses (i.e., hypervigilance, then
hypervigilance and dissociative symptoms). As shown in Table 15, below, the results from block
1 indicated that hypervigilance significantly predicted worse maternal reported EF [F(1, 141) =

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22.42, p < .01] accounting for 13.7% of the variance. In contrast, hypervigilance did not predict
either teacher reported EF [F(1, 141) = 0.90, p = .35] or lab-assessed EF [F(1, 141) = 0.00, p =
.96]. When dissociation was added to the model, hypervigilance no longer predicted maternal
reported EF, but dissociation emerged as a significant predictor [F(2, 140) = 55.48, p < .01]
accounting for an additional 30.5% of the variance above and beyond hypervigilance. In the final
model, neither hypervigilance nor dissociation emerged as significant predictors for teacher
reported EF [F(2, 140) = 1.36, p = .26] or lab-assessed EF [F(2, 140) = 0.18, p = .84].

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Table 15
Predicting Executive Functioning by Traumatic Stress Symptoms
Maternal Reported EF
Predictor
Block 1
Hypervigilance
Block 2
Hypervigilance
Dissociation

2

a

B

SE B

.075*

!R
.137*

Teacher Reported EF
2

.016

.305*

B

SE B

.016

!R
.006
.013

.017
.075*

.014
.009

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2

c

B

SE B

-.001

!R
.000

.018

.005
-.007

.020
.012

.003
.004
.015

p " .05.

Lab Assessed EF

.016

Note. All scores were LOG10 transformed to correct for non-normal distributions.
a 2
b 2
c 2
R Total = .44; R Total = .02; R Total = .00.
*

b

.018
.011

Modified Hypotheses 3.a. – 3 b.: EF will mediate the relationship between IPV exposure,
traumatic stress symptoms, and behavior problems within single environmental contexts (e.g., at
home), but not across environments (e.g., teacher reported EF and maternal reported behavior
problems).
In order to test the modified hypotheses 3.a. – 3.b., a series of six structural equation
models (SEM) were estimated in LISREL 8.7 (Jöreskog & Sörbom, 2001). In SEM, one
approach to determine the minimum number of participants required for a specified model is to
multiply the number of manifest variables and latent constructs by 10 (von Eye, personal
communication, 2011). The six SEM models each specified a total of 11 indicators and latent
constructs and thus required a minimum sample size of 110 participants. The current study has
143 mother-child dyads and therefore has sufficient power to reveal any true effects in the
models.
In SEM, the strength of the relationship between the latent constructs, as well as from the
indicators to the constructs can be evaluated using standardized scores. All six models were
initially specified using maximum likelihood estimation from covariance matrices, with all
relevant parameters freed for estimation. In certain cases, modifications were necessary in order
for the models to converge and then demonstrate optimal fit (see Table 16, below, for a complete
list of all modifications required for the six models). Five fit indices were chosen a-priori to
evaluate the adequacy of the models specified, according to Hu and Bentler’s (1999) cut-off
recommendations: the Chi-square test (Chi-square, p > .05), the Root Mean Square Error of
Approximation (RMSEA ! .06), Comparative Fit Index (CFI " .95), the Goodness-of-Fit Index
(GFI " .95), and the Standardized Root Mean-squared Residual (SRMR ! .08). Following model

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specification, the estimated parameters for each model were examined as a final plausibility
check (e.g., ensuring variances and residuals were > 0).

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Table 16
SEM Specifications and Modifications
EF Source

Behavior Problem
Reporter

Matrix

Estimation
Method

Model #1:

Maternal Report

Mother

Covariance

ML

1. None

Model #2:

Teacher Report

Teacher

Covariance

ML

1. Residuals for Hyp. and Dissoc. set
equal (residual for Dissoc. < 0)

Modifications Required

2. Did not estimate variance for Beh.
Probs. factor (variance was < 0)
Model #3:

Maternal Report

Teacher

Covariance

ML

1. Residuals for Hyp. and Dissoc. set
equal (residual for Dissoc. < 0)

Model #4:

Teacher Report

Mother

Covariance

ML

1. Did not estimate variance for TR EF
factor (variance was < 0)

Model #5:

Lab Assessed

Mother

Correlation

ULS

1. Did not estimate variance for Beh.
Probs. factor (variance was < 0)

Model #6:

Lab Assessed

Teacher

Correlation

ML

1. Residuals for Hyp. and Dissoc. set
equal (residual for Dissoc. < 0)
2. Did not estimate variance for LA EF
factor (variance was < 0)

Note. ML = Maximum Likelihood; ULS = Unwieghted Least Squares; Hyp. = Hypervigilance; Dissoc. = Dissociation; TR EF =
Teacher Reported EF; LA EF = Lab Assessed EF; Beh. Probs. = Behavior Problems.

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Models #1 and # 2 (see Figures 5 and 6, below, for path diagrams of standardized
parameter estimates) tested whether EF mediated the relationship between IPV exposure,
traumatic stress symptoms, and behavior problems within a single environmental context (i.e.,
maternal and teacher reports, respectively). Both models demonstrated excellent fit, meeting or
exceeding the cut-offs suggested by Hu and Bentler (1999) for at least four out of the five fit
indices chosen a priori. Consistent with the modified hypotheses, an examination of the
standardized estimates indicated that in both contexts, the children’s EF fully mediated the
relationship between IPV exposure, traumatic stress symptoms, and behavior problems.
Specifically, IPV exposure predicted greater traumatic stress symptoms, which predicted worse
EF, which then predicted greater behavior problems. Within both contexts (i.e., at home and at
school), dissociation loaded most strongly onto the traumatic stress latent factor. The model
explained 83% of maternal reported behavior problems. The percent of teacher reported behavior
problems explained by the mediational model could not be estimated, as the variance for
behavior problems in Model #2 had to be fixed in order for the model to converge. Additional
information for both models is presented in Appendix J, including t-scores for estimated
parameters (see Figures 13 – 14) and a complete list of fit indices (Tables 19 – 20).
Importantly, two initial models without EF were specified in an attempted replication of
Milot et al.’s (2010) findings, which stated that traumatic stress symptoms alone mediated the
relationship between IPV exposure and behavior problems. Milot and colleagues only assessed
teacher reported traumatic stress symptoms and behavior problems, whereas the present study
assessed traumatic stress symptoms by a maternal semi-structured interview. The first replication
model examined teacher reported behavior problems, consistent with Milot et al.’s model;
however, the model’s chi-square was significant, indicating the model did not provide an

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acceptable fit to the observed data (see Figures 15 – 18 and Tables 21 – 22 in Appendix J, for
parameter estimates and fit indices information for the two replication models). Likewise, the
replication model with maternal reported behavior problems also had a significant chi-square,
indicating that the model did not provide an acceptable fit to the observed data. These two
replication failures, in contrast with the excellent fitting full mediation models proposed by the
present study, offer strong evidence in support of the present study’s assertion that EF is an
important inter-mediating variable.

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Figure 5
SEM #1: Maternal Reported EF and Behavior Problems

2

Note. Chi-Square = 14.81 (df = 9), p = 0.096; RMSEA = 0.067 (90% C.I. = 0.00 – 0.13); CFI = 0.99; GFI = 0.97; SRMR = 0.024; R
for Behavior Problems = 0.83.
†
*p < .05; significance test is not conducted.
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Figure 6
SEM #2: Teacher Reported EF and Behavior Problems

Note. Chi-Square = 17.10 (df = 11), p = 0.105; RMSEA = 0.063 (90% C.I. = 0.00 – 0.12); CFI = 0.98; GFI = 0.97; SRMR = 0.033; R
for Behavior Problems = 1.00 (variance for Behavior Problems was not estimated).
†
*p < .05; significance test is not conducted.
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2

Models #3 and #4 tested whether the children’s reported EF in one context (e.g., at home
or school) mediated the relationship between IPV exposure, traumatic stress symptoms, and
behavior problems reported in a separate context. Both of these models (see Figures 7 and 8,
below) demonstrated excellent fit to the data, satisfying all five of the fit indices’ cut-offs
suggested by Hu and Bentler (1999); however, the two models suggest contradictory
conclusions. Model #2 indicated that maternal reported EF fully mediated the relationship
between IPV exposure, traumatic stress symptoms, and teacher reported behavior problems,
suggesting that EF observed at home predicts behavior problems at school. This model explained
12% of teacher reported behavior problems. In contrast, mediation was not supported for teacher
reported EF and maternal reported behavior problems, consistent with the modified hypothesis
that predicted EF in one context would not mediate behavior problems in another. Additional
information for both models is presented in Appendix J, including t-scores for estimated
parameters (see Figures 19 – 20) and a complete list of fit indices (Tables 23 – 24).

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Figure 7
SEM #3: Maternal Reported EF and Teacher Reported Behavior Problems

2

Note. Chi-Square = 14.44 (df = 10), p = 0.154; RMSEA = 0.056 (90% C.I. = 0.00 – 0.11); CFI = 0.98; GFI = 0.97; SRMR = 0.028; R
for Behavior Problems = 0.12.
†
*p < .05; significance test is not conducted.
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Figure 8
SEM #4: Teacher Reported EF and Maternal Reported Behavior Problems

2

Note. Chi-Square = 14.73 (df = 10), p = 0.142; RMSEA = 0.058 (90% C.I. = 0.00 – 0.12); CFI = 0.99; GFI = 0.97; SRMR = 0.026; R
for Behavior Problems = 0.51.
†
*p < .05; significance test is not conducted.
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Models #5 and #6 (see Figures 9 and 10, below) tested whether lab-assessed EF mediated
the relationship between IPV exposure, traumatic stress symptoms, and behavior problems at
home and at school. Both models required more substantial changes in model specification and
estimation in order to converge and demonstrate acceptable fit values. For instance, both models
required estimation from correlation matrices, rather than covariance matrices. Traditional SEM
estimation methods use covariance matrices, rather than standardized variables, in order to
provide more stable estimates (Kline, 2011). Models #5 and #6, however, only converged when
correlation matrices were used, suggesting the models might not be scale invariant (Kline, 2011).
Additionally, model #5 required estimation using unweighted least squares, rather than
maximum likelihood in order to converge. Therefore, there is evidence to suggest that the
parameter estimates for the proposed mediational models using lab-assessed EF may not be as
reliable compared to the previous four models and should be replicated in another sample before
strong conclusions can be drawn. Both models either met or exceeded Hu and Bentler’s (1999)
suggested cut-offs for at least four out of the five fit indices, indicating that the models provided
an acceptable fit to the observed data. Neither model, however, supported the mediation
pathways proposed in the study. Model #5 (Figure 9) indicated IPV had a direct effect on the
three y-side variables, such that IPV exposure predicted greater traumatic stress symptoms,
worse lab-assessed EF, and maternal reported behavior problems. Interestingly, model #5 also
suggested that increased traumatic stress symptoms predicted better lab-assessed EF
performance in contrast to the findings of each of the previous models, which indicated that
traumatic stress symptoms were associated with worse EF. Possible reasons for this unexpected
finding are explored in the discussion. Additional information for both models is presented in

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Appendix J, including t-scores for estimated parameters (see Figures 21 – 22) and a complete list
of fit indices (Tables 25 – 26).
Lastly, alternative models were examined, addressing whether EF and behavior problems
simply measure different aspects of the same underlying construct. This alternative hypothesis
suggests that EF and behavior problems covary, but EF does not independently predict behavior
problems. Alternative models were therefore estimated to test whether behavior problems
mediated the relationship between IPV exposure, traumatic stress symptoms, and EF. If there
was support for the alternative hypothesis (i.e., that EF and behavior problems covary, but do not
have a directional relationship), these models should have demonstrated equally good fit as those
presented in this manuscript; however, the alternative models either failed to converge or
demonstrated poor fit.

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Figure 9
SEM #5: Lab Assessed EF and Maternal Reported Behavior Problems

2

Note. Chi-Square = 13.67 (df = 10), p = 0.189; RMSEA = 0.051 (90% C.I. = 0.00 – 0.11); CFI = 1.00; GFI = 1.00; SRMR = 0.023; R
for Behavior Problems = 1.00 (variance for Behavior Problems was not estimated).
†
*p < .05; significance test is not conducted.
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Figure 10
SEM #6: Lab Assessed EF and Teacher Reported Behavior Problems

2

Note. Chi-Square = 19.32 (df = 11), p = 0.056; RMSEA = 0.073 (90% C.I. = 0.00 – 0.13); CFI = 0.95; GFI = 0.96; SRMR = 0.044; R
for Behavior Problems = 0.10.
†
*p < .05; significance test is not conducted.
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CHAPTER 10
Discussion
The present study recruited a sample of at-risk mothers and their preschool-age children
through a local Head Start organization to empirically address three primary research questions:
(1) whether dissociative and/or hypervigilant responses to IPV exposure are differentially related
to behavior outcomes, (2) whether dissociative and/or hypervigilant responses are differentially
related to levels of AC, WM, and IC, and (3) if AC, WM, and/or IC functioning mediates the
relationship between IPV exposure, dissociative and/or hypervigilant traumatic stress responses,
and observed behavior problems. Contrary to expectations, however, exploratory and
confirmatory analyses offered strong evidence that the three EF sub-components loaded onto a
single, global EF factor within each environment assessed (i.e., at home, school, and in the lab).
Additionally, maternal and teacher reported behavior problems were minimally correlated,
suggesting that the children’s behavior problems were also context dependent. Therefore, the last
two research questions were modified as follows: (2) are dissociative and/or hypervigilant
responses differentially related to the children’s EF in the three environments, and (3) does EF
mediate the relationship between IPV exposure, traumatic stress responses, and behavior
problems at home and at school? The evidence for each of these research questions is examined
next, along with other relevant topics.
Relationship between Dissociation and Hypervigilance
In the present sample, dissociative and hypervigilant symptoms were moderately-highly
correlated, consistent with one of the few previously published findings (i.e., Mertin & Mohr,
2002). The current research represents the first substantive investigation into the co-morbidity
between dissociative and hypervigilant symptoms in preschool-age children exposed to chronic,

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interpersonal violence. Based on published clinical norms (i.e., Putnam et al., 1993; Scheeringa
et al., 1995) more than one third (37.1%) of the sample had clinically significant hypervigilance,
whereas less than five percent (4.9%) had clinically significant dissociative symptoms.
Importantly, however, each of the children with clinically significant dissociation also exhibited
clinically significant hypervigilance. In contrast, for the children with clinically significant
hypervigilance, 13.2% had no reported dissociative symptoms and only 13.2% had clinically
significant co-morbid dissociative symptoms. The remaining 73.6% of the children with
clinically significant hypervigilance exhibited varying levels of sub-clinical dissociative
symptoms, indicating that for most of the children in the sample, there was a high degree of
comorbidity between the two traumatic stress reactions.
The present study also evaluated the possibility of collinearity due to the high degree of
co-morbidity between dissociative and hypervigilant symptoms; however, variance inflation
factor metrics were non-significant, suggesting that although the two constructs are correlated,
they each contribute unique variance to predicted outcomes and are not linear dependent. The
implication is that dissociative and hypervigilant symptoms represent two different, but related,
traumatic stress reactions and should be assessed separately, rather than by a single indicator.
Based on animal studies and clinical reports of young children exposed to chronic forms
of interpersonal violence, Perry and colleagues (1995) argued that traumatic stress reactions
occur on a continuum anchored by dissociative experiences on one end and hypervigilance on
the other. Perry et al. speculated that some children experience alternating dissociative and
hypervigilant episodes; however, no previous empirical studies had investigated Perry et al.’s
theory. In part, this lack of empirical research was likely related to the course of history of
psychiatric nosology. The four most recent editions of the DSM (APA, 1983/1987/1994/2000)

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only included symptoms of hypervigilance in the PTSD criteria and not dissociation. The current
research argued that dissociative responses might be especially salient for young children
exposed to IPV due to the threat and betrayal of trust occurring within the caregiving system
(e.g., Freyd, 1996; Perry et al., 1995). In support of this argument, the few previous studies that
had examined dissociative symptoms following exposure to family violence, such as IPV,
indicated that young children are at an increased risk for developing dissociative symptoms (e.g.,
Macfie et al., 2001a; Ogawa et al., 1997) in addition to the more widely studied hypervigilant
symptoms (e.g., Levendosky et al., 2002; Zerk et al., 2009).
Contrary to expectations, however, in the present sample fewer than five percent of the
children (i.e., 4.9%) exhibited clinically significant dissociative symptoms. This surprising
finding suggests two possible interpretations. First, the limited number of preschool-age children
with clinically significant dissociative symptoms might indicate the need to update Perry et al.’s
(1995) theory. Perry et al. suggested that young children might be equally likely to dissociate in
response to a threat, as experience hypervigilance. If the current study’s results are replicated, the
findings would clearly indicate that preschool-age children exposed to IPV are considerably
more likely to become hypervigilant than to dissociate. Furthermore, the relatively few
preschool-age children who experience clinically significant dissociation might be particularly
likely to experience episodes of clinically significant hypervigilance, whereas the opposite may
not hold true (i.e., a child with clinically significant hypervigilance might not experience
clinically significant co-morbid dissociative episodes).
An alternative, compelling interpretation of the low rates of clinically significant
dissociative symptoms is that the mothers were not able to report on their children’s dissociative
symptoms as accurately as their hypervigilant symptoms. This would plausibly be due to

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dissociation reflecting a fragmented internal experience (e.g., DePrince & Freyd, 2007) rather
than externally manifested symptoms. A preschool-age child with significant dissociative
experiences might appear to be reserved and under-responsive to an observed, when if fact the
child might be experiencing significant internal distress in response to the repeated exposure to
the violence. Over 75% of the children in the current study had reported sub-clinically levels of
dissociative symptoms. These figures suggest that dissociative symptoms might be a common
response to chronic IPV, as Perry et al. (1995) argued, but that the rates found in the present
study might be an underestimate of the true number of children with clinically significant
dissociation.
Macfie et al. (2001a) anticipated the problem with maternal reported dissociative
symptoms and collected teacher reports of dissociation using the same measure administered in
the present study. The teachers frequently participated in research and were trained to carefully
observe the children. Using teacher reports, Macfie and colleagues found that 17% of maltreated
preschool-age children exhibited clinically significant dissociation. The present study recruited a
similar SES sample as Macfie et al.; however, the children in Macfie et al.’s study were referred
by social services, thus the children arguably might have had more severe forms of
psychopathology and higher rates of dissociation than would be expected in a community
sample. In summary, it is plausible that the current study’s findings underestimate the rates of
dissociation for preschool-age children exposed to chronic IPV. Future research should examine
these two alternative interpretations (i.e., that dissociation is not as common as hypervigilance
versus that the current study’s findings underestimated the true prevalence rates of dissociation)
by including multiple reporters of dissociative symptoms and/or careful observations by trained
clinicians.

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Differential Relationships between Two Traumatic Stress Reactions and Behavior Problems
Consistent with expectations, the present study’s findings indicated that dissociative
symptoms were predictive of maternal reported internalizing problems above and beyond the
effects of hypervigilance; however, neither traumatic stress symptoms predicted teacher reported
internalizing problems. Also consistent with the study’s hypotheses, hypervigilance predicted
both maternal and teacher reported externalizing problems; however, when dissociation and
hypervigilance were considered together, dissociation unexpectedly predicted maternal reported
externalizing behavior problems, as well.
The present study’s findings suggest that dissociation might be associated with global
affective and physiological dysregulation, rather than only processes related to internalizing
behavior problems (e.g., anxiety and depression). In support of this explanation, as previously
detailed, every child with clinically significant dissociative symptoms also exhibited clinically
significant hypervigilance. If these children experienced vacillating traumatic stress reactions, it
is reasonable to assume that they also experienced more global affective dysregulation. Very
limited empirical data is available to evaluate this claim. Shields and Cicchetti (1998) found that
maltreated children’s sub-clinical dissociation predicted worse emotion regulation, above and
beyond controlling for maltreatment status and other cognitive variables (e.g., attention and
verbal abilities). Only one previous study has examined the relationship between dissociative
symptoms and broadband behavior problems. In a sample of maltreated preschool-age children,
dissociation was moderately-highly associated with both internalizing and externalizing
problems (Macfie et al., 2001a).
Alternatively, the results also suggest a possible “halo effect” for maternal reported
symptoms. In other words, mothers who perceived their child as “bad” may have been more

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likely to endorse several items on measures of traumatic stress symptoms, as well as on other
measures of problematic behaviors with high face validity (e.g., behavior problem questionnaire
and the EF maternal report measure). If true, the halo effect might have masked a more nuanced
differential relationship between the traumatic stress symptoms and internalizing and
externalizing behavior problems. Importantly, a relationship between these two constructs
emerged across reporters (e.g., maternal reported traumatic stress symptoms and teacher reported
behavior problems), suggesting that the possible halo effect was not the sole driver behind the
relationship.
Overall, these findings also highlight the importance of assessing for both dissociation
and hypervigilance. Had the current study only assessed PTSD-related symptoms, consistent
with previous studies (e.g., Jouriles et al., 2008), hypervigilance would have emerged as the sole
predictor of maternal reported behavior problems and teacher reported externalizing problems.
Yet, with the addition of dissociative symptoms, a more nuanced picture was obtained.
Underlying Structure of Preschool-age Children’s Executive Functioning
The current study conducted the first empirical examination of the structure underlying
preschool-age children’s EF after assessing multiple sub-components of EF, including AC, WM,
and IC. Contrary to expectations, however, the exploratory and confirmatory analyses revealed
that preschool-age children’s EF is not comprised by dissociable subcomponents, but are best
represented by a single, global EF within each context (i.e., at home, school, and in the lab).
Exploratory analyses elucidated the natural latent structure inherent in the data, whereas two
alternative models of EF structure were subsequently tested through confirmatory methods.
Importantly, even exploratory models with EF variables obtained within a single context (e.g.,

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maternal report, teacher report, or lab-based scores) did not result in the predicted three
component structure and offered additional evidence for a single, global EF component.
The current findings of a single, global EF factor within individual contexts offers the
strongest evidence to-date of the underlying structure for preschool-age children’s EF. Although
previous factor analytic studies (e.g., Hughes & Ensor, 2008; Shing et al., 2010; Wiebe et al.,
2008/2011) with preschool-age children suggested a single EF factor, each of these studies only
examined two sub-components of EF (i.e., WM and IC) using fairly complex EF tasks, which
increased the likelihood of obtaining a single factor (e.g., Garon et al., 2008). In contrast to these
previous studies, the current research used simple EF tasks that minimized recruitment of more
than one EF domain at a time. Even with these more targeted EF tasks, a single EF factor
emerged suggesting that the previous studies’ (e.g., Shing et al., 2010) results were not solely
attributable to the authors’ choice of measures. The single EF factor found in the current study
contrasted sharply with the three latent factors reported in samples with older children (Lehto et
al., 2003) and adolescents (Miyake et al., 2000). The divergent findings across these factor
analytic studies suggests a developmental trajectory of EF structure with increasingly
differentiated abilities with age.
The second novel contribution of the present study’s factor analytic results was the
finding that the children’s EF was context dependent, with relatively independent EF abilities
reported at home, school, and in the lab. Specifically, the children’s EF was only minimally
correlated across maternal and teacher reports, with no association found between either of these
reports and lab-assessed abilities. These results suggest that preschool-age children’s EF may be
dependent on contextual cues. From a developmental perspective, this novel finding makes
theoretical sense. EF is an important cognitive regulatory system (e.g., Eisenberg et al., 2009;

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Rueda et al., 2010) with strong structural and functional associations with other regulatory
systems (e.g., the limbic system) (e.g., Lezak, 1995). During their early years, children are
unable to fully regulate their own affect or behaviors, relying on caregivers and contextual cues
(e.g., social demands) to play an important role as external regulators (e.g., Bernier, Carlson, &
Whipple, 2010). Within typical development, as children age, they increasingly strengthen their
internal capacity for self-regulation and rely less on external regulators (Kochanska, Coy, &
Murray, 2001; Morris et al., 2011). For instance, in a sample of preschool-age through early
elementary school children, Morris and colleagues (2011) reported that mothers were
successfully able to help the preschool-age children regulate their negative affect after negative
affect was induced using a lab paradigm. In contrast, elementary age children did not rely on
maternal regulatory attempts.
Preschool-age children may therefore be sensitive to regulatory differences in external
regulators. This could explain the unexpected pattern of findings that both EF and behavior
problems were contextually dependent in the present study. For instance, for most of the children
included in the study it is plausible that their home environment is less restrictive than the
classroom, which is arguably a more structured, restrictive environment. The lab arguably
presented the children with the most structured and restrictive environment with relatively
austere furnishings, one-on-one attention with a research assistant, and highly structured tasks.
Given that EF is a regulatory system (e.g., Eisenberg et al., 2009; Rueda et al., 2010), the
children might have demonstrated different EF in each of these three environments in response to
the different contextual cues (e.g., levels of restrictiveness, caregiver attention, and task
demands). Before these findings are generalized, however, they need to be replicated in
additional samples. If replicated, one obvious implication of the findings is that researchers

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should be cautious in presuming that associations between EF and outcome variables of interest
measured in one environment (e.g., in the lab) generalize to other contexts (e.g., at home or
school).
Relationship between Traumatic Stress and Executive Functioning
Neither dissociative or hypervigilant symptoms predicted either teacher reported EF or
lab-assessed EF, regardless of whether the symptoms were considered individually or together.
Thus, traumatic stress and EF within these two contexts did not reveal a direct relationship, in
contrast to the findings from the structural equation models reviewed in the next section.
Hypervigilance initially predicted greater maternal reported executive dysfunction, until
dissociative symptoms were considered simultaneously, at which point only dissociation
emerged as a significant predictor. Together, hypervigilance and dissociation accounted for a
considerable portion of variance in the children’s EF (44%).
This pattern of findings suggests two possible explanations. The simplest explanation is
that in light of the highly context dependent nature of EF and behavior problems in the current
sample, traumatic stress symptoms assessed in one context (e.g., by maternal report) may not be
directly related to EF assessed in other contexts (e.g., at school or in the lab). This possibility
necessitates that traumatic stress symptoms were also highly context dependent, which the
current study did not assess, but seems plausible given the underlying role physiological
dysregulation may play in both traumatic stress symptoms and behavior problems (e.g., Cook et
al., 2005; De Bellis et al., 1999a/1999b; Milot et al., 2010). If preschool-age children partially
rely on external sources of regulation (e.g., caregivers), which are contextually dependent (i.e.,
mother at home, teacher at school), then traumatic stress symptoms may differentially manifest
in separate environments.

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Although previous empirical studies have not rigorously examined whether traumatic
stress symptoms differentially manifest in various environments, evidence from GrahamBermann et al.’s (2008) study of preschool-age children’s traumatic stress following exposure to
IPV appears to support this possibility. Graham-Bermann and colleagues collected maternal and
teacher reports of the children’s PTSD symptoms using developmentally appropriate, modified
criteria. They did not report formal statistics on the interrater agreement between maternal and
teacher reports; however, the authors provided a table of how many children in their sample
exhibited each symptom according to both reports. According to Graham-Bermann et al.’s
figures, mothers and teachers only shared three out of the five most commonly endorsed
symptoms. Furthermore, for these three symptoms, mothers appeared considerably more likely to
endorse the PTSD symptoms (ranging from 29 – 54.1% greater endorsement for each symptom)
(Graham-Bermann et al., 2008). Assuming the mothers and teachers in the study were reliably
reporting on the children’s observable behavior in each context, these figures indicate that
preschool-age children’s traumatic stress symptoms may be highly context dependent, similarly
to EF and behavior problems.
An alternative, related interpretation is that a direct relationship between traumatic stress
symptoms and EF only occurs within single contexts (i.e., at home or school) and not when
functioning is assessed across contexts. In the current study, the regression models that examined
direct effects of dissociative and hypervigilant symptoms on EF found support for this direct
relationship within single contexts; however, across contexts the relationship between traumatic
stress symptoms and EF may be indirect and undetectable without another mediating variable
(such as EF, as proposed in the current study) or additional related variables (e.g., IPV). If this
explanation has empirical support, then a structural model including the related variables of

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interest and EF should demonstrate acceptable fit to the data. The evidence from the structural
models do, in fact, offer support for this alternative explanation and are reviewed next.
Executive Functioning as a Mediating Mechanism between IPV Exposure, Traumatic Stress, and
Preschool-age Children’s Behavior Problems
The current study’s findings strongly indicated that EF is a mediating variable between
IPV exposure, traumatic stress symptoms, and behavior problems, with a couple of important
exceptions. Within single environments (i.e., at home or school), EF fully mediated the
relationship between IPV exposure, traumatic stress symptoms, and reported behavior problems
in the expected directions. For instance, IPV exposure predicted greater traumatic stress
symptoms, which in turn predicted worse EF. Worse EF then predicted greater behavior
problems. These effects were robust and the mediational models demonstrated excellent fit to the
observed data.
Models examining the mediational pathways across environments (e.g., maternal reported
EF and teacher reported behavior problems) suggested somewhat conflicting results. Maternal
reported EF fully mediated the relationship between IPV exposure, traumatic stress, and teacher
reported behavior problems; however, no such mediation occurred for teacher reported EF and
maternal reported behavior problems. No specific hypotheses were specified regarding the
relationships between lab-assessed EF and maternal/teacher reported behavior problems due to
the lack of previous empirical work to guide hypothesis generation. Notably, the models which
included lab-assessed EF required greater modifications in order for the models to converge and
demonstrate acceptable fit. Therefore, the findings should be interpreted with caution, as the
results are likely less reliable than the models assessing maternal and teacher reported EF. Labassessed EF did not mediate the relationships between IPV exposure, traumatic stress symptoms,

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and either maternal or teacher reported behavior problems. Furthermore, the model which
included maternal reported behavior problems suggested that greater levels of traumatic stress
were associated with better lab-assessed EF, presumably due to increased levels of arousal
associated with being in a novel environment.
Only one previous study has examined preschool-age children’s cognitive functioning
following IPV exposure and thus the present study’s results must be replicated before strong
conclusions can be drawn. As reviewed in the introduction, Jouriles et al. (2008) tested whether
hypervigilance mediated the relationship between IPV exposure and explicit memory
performance assessed with lab-based tasks and did not find any support for the mediating
pathway. The findings from the present study are somewhat consistent with Jouriles et al., in that
the structural models with lab-assessed EF and teacher reported behavior problems did not
indicate traumatic stress symptoms mediate the relationship between IPV exposure and EF. In
contrast, the model with maternal reported behavior problems and lab-assessed EF suggested that
traumatic stress symptoms mediated the relationship between IPV exposure and EF.
Comparisons with Jouriles et al.’s (2008) findings should be approached cautiously,
however, as SEM parameter estimates are very sensitive to changes in the model and the present
analyses included a latent factor for behavior problems, which Jouriles et al. did not assess.
Additionally, the authors assessed explicit memory, which is a different form of memory than
WM. The present study also examined EF as a global construct, in response to the exploratory
and confirmatory analyses, which further differentiates the two studies and makes cross-study
comparisons difficult.
Notably, the current study also failed to replicate two modified versions of Milot et al.’s
(2010) mediational model that posited traumatic stress symptoms alone (i.e., not in conjunction

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with EF) mediate the relationship between exposure to chronic, family violence (maltreatment in
their sample) and preschool-age children’s behavior problems. It is possible that methodological
differences between the two studies may have contributed to the replication failures. Milot et al.
relied on a single reporter (teacher) for their assessments, whereas the present study assessed
both maternal and teacher reported behavior problems. The authors also used a global measure of
PTSD-related symptoms and did not breakdown the results according to PTSD symptom
clusters. As others have extensively documented (e.g., Scheeringa et al., 1995; Scheeringa et al,
2003; van der Kolk et al., 2009), PTSD demonstrates poor construct validity for preschool-age
children exposed to chronic, interpersonal forms of violence, such as maltreatment or IPV. The
current research used Perry et al.’s (1995) traumatic stress theory, which posits that
psychological traumatic stress symptoms fall on a continuum anchored by dissociative symptoms
on one end and hypervigilance on the other. Unfortunately, Milot et al. neither assessed
dissociated symptoms nor reported specific fit information for the three PTSD symptom clusters;
thus, no information is available regarding the unique role of hypervigilance relative to reexperiencing or avoidance/numbing symptom clusters.
More important than the methodological differences between the present research and
Milot et al.’s (2010) study, the current research refined the theoretical argument advanced by the
authors to explain why children exposed to chronic, interpersonal violence develop such
pernicious behavior problems. As Milot et al. noted, physiological dysregulation associated with
chronic psychological stress and subsequent chronic activation of the HPA axis (e.g., Cicchetti &
Rogosh, 2001; Heim et al., 2000; Heim et al., 2003) is thought to result in broad dysregulation.
However, Milot and colleagues only assessed traumatic stress symptoms as a mediated variable
between exposure to chronic, interpersonal violence and behavior problems; yet, traumatic stress

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symptoms alone do not inherently indicate behavior problems. In other words, even if the present
study had successfully replicated Milot et al.’s findings, an additional mediating mechanism is
theoretically necessary. The current research integrated Perry et al.’s (1995) traumatic stress
theory, De Bellis et al.’s (1999a/1999b) developmental trauma theory, and Blair’s (2010)
contextual stress and EF theory to argue that exposure to IPV alters structural and functional
neural networks associated with EF. The current study’s models that included EF as a mediating
variable demonstrated excellent fit to the observed data and explained a large portion of the
variance in the children’s behavior problems for both maternal and teacher reports. The study’s
results offered strong empirical evidence that executive dysfunction plays an important role in
the development of preschool-age children’s behavior problems following exposure to IPV.
The present study’s findings also revealed important information regarding preschool-age
children’s behavior problems. In contrast to the original hypotheses, structural models that
examined broadband maternal and teacher reported internalizing and externalizing symptoms
separately either failed to converge or demonstrated poor fit, suggesting the need to examine
total behavior problems within contexts (i.e., at home or school) rather than by separate
broadband behaviors. Although contrary to the theoretical pathways posited in the introduction,
the context dependent behavior problems were unsurprising in light of the minimal correlations
between maternal and teacher reports of behavior problems. Furthermore, this pattern of findings
is consistent with the exploratory and confirmatory EF analyses that also demonstrated context
dependent behavior. A similar theoretical rationale as that offered for EF also makes sense for
the context dependent behavior problems (i.e., preschool-age children may be responding to
differential contextual cues to regulate their behavior). Additionally, previous studies indicate
that EF concurrently and longitudinally predicts children’s behavior problems (e.g., Eisenberg et

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al., 2010; Hughes & Ensor, 2008; Rueda et al., 2010) and therefore context dependent EF should
also theoretically be related to context specific behavior problems.
Although the present study was cross-sectional and directional effects could not be
established, alternative models that examined whether behavior problems mediated the
relationship between traumatic stress symptoms and EF either failed to converge or demonstrated
poor fit. This pattern of findings is important and suggests that the relationship between EF
impairment and behavior problems is not equivocally bidirectional, but unidirectional in nature
(i.e., executive dysfunction predicts behavior problems).
Strengths of the Present Study
The study benefited from several methodological strengths. The mother-child dyads were
carefully recruited from a local Head Start organization to closely match the broader, low-SES
population in the area. The present study was able to naturally control for the effects, stressors,
such as poverty, might have had on traumatic stress symptoms, EF, and behavior problems, by
recruiting a relatively homogenous SES sample. Although the present study was not
experimental, the natural controls associated with recruiting families with similar SES increase
the reliability of the findings associated with the effects due to IPV exposure and minimizes
potential confounding effects associated with environmental factors.
In contrast to a previous, particularly noteworthy study (i.e., DePrince et al., 2009) of EF
and exposure to family violence, the present study assessed children during a critical
developmental period for emerging EF (Carlson, 2005; Diamond, 2002) and when children are
also most likely to have IPV exposure (e.g., Fantuzzo et al., 1997). Other methodological
strengths include the assessment of unidirectional and bidirectional IPV, which better captures
the total violence preschool-age children are exposed to within the caregiving environment. The

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present study also assessed EF across three environments (at home by maternal report, at school
by teacher report, and in the lab). EF studies with preschool-age children typically assess EF
with lab-based tasks (e.g., DePrince et al., 2009; Jouriles et al., 2008; Wiebe et al., 2008/2011);
however, the present study demonstrated the importance of assessing preschool-age children’s
EF within single contexts due to their cognitive and behavioral sensitivity to contextual cues.
Likewise, behavior problems were assessed by maternal and teacher reports, which showed a
similar context dependent pattern as EF.
Limitations of the Present Study
Even though the present study makes several theoretical and empirical contributions to
several distinct fields of study (e.g., effects of early childhood IPV exposure; preschool-age
children’s EF), the study is also limited by four important constraints. First, the cross-sectional
nature of the study prevents strong conclusions from being drawn regarding the relationship
between the timing of the IPV exposure, subsequent traumatic stress reactions, EF impairment,
and the behavior problems reported at home and in school. This is not a trivial limitation. For
example, it is possible that young children with greater executive dysfunction are more prone to
experiencing either dissociative or hypervigilant responses following IPV exposure in contrast to
the direction of effect posited by the current research. This empirical question can only be
answered with a longitudinal study that carefully assesses exposure to traumatic events,
traumatic stress, and EF with serial measurement.
Second, although the children’s EF and behavior problems were assessed with maternal
and teacher reports (and EF was also assessed with lab tasks), traumatic stress symptoms were
only assessed by maternal report using a well-validated, semi-structured clinical interview and a
questionnaire. The study presumed that maternal reported traumatic stress symptoms would

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represent the children’s global symptoms; however, the present study found strong evidence that
the children’s EF and behavior problems were highly context dependent. Additionally,
regression and structural models that evaluated the relationship between traumatic stress
symptoms, EF, and behavior problems across reporters offered mixed evidence. In light of these
findings, future studies evaluating children’s functioning across multiple environments, should
assess traumatic stress symptoms within each environment of interest (e.g., maternal reported
symptoms at home and teacher reported symptoms at school).
Third, due to logistical constraints, all research interviews were conducted in either the
late afternoon or evening so the dyads could attend the visits after the school day. Some of the
children were tired during the visits (especially the younger preschool-age children), which may
have resulted in less than optimal performances on the EF tasks than if the visits had been
conducted at an earlier time of the day. The research assistants were provided extensive training
regarding strategies for helping the children remain engaged in the activities and to give their
best performances on the tasks; despite the research assistants exceptional attempts, however,
some of the children were naturally less motivated on the tasks than others. Statistically, some of
the variance associated with the younger children being tired during the visits was likely
partialled out in the regression models that controlled for the effects of the children’s age on their
EF performance for lab-based EF tasks. Not all of the variance was presumably removed,
though, and the lab-assessed EF tasks demonstrated lower internal consistency than the maternal
or teacher reported EF scores and should therefore be interpreted with greater caution.
Lastly, the current sample was purposefully recruited from the local Head Start schools in
order to provide a relatively homogenous, at-risk population; however, this also naturally limits
the generalizability of the findings beyond low-income, at-risk families, such as those eligible for

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Head Start services. The reported findings are expected to remain significant in other samples
(e.g., with middle-class families) due to the proposed psychological and physiological
mechanisms thought to be invariant across samples; however, this remains an empirical question
contingent on future replications.
Clinical Implications of the Present Study’s Findings
The current study’s findings suggest two primary clinical implications, both involving the
need for more careful assessment when children are exposed to IPV. First, the present study
demonstrated the importance of assessing for dissociative symptoms in addition to PTSD-related
symptoms, such as hypervigilance. Although the study’s results did not fully support the
proposed differential pathways for dissociative and hypervigilant symptoms and broadband
internalizing and externalizing problems, dissociation emerged as a significant predictor for
maternal reported behavior problems and worse EF. Additionally, in the structural models,
dissociative symptoms had a higher factor loading on the traumatic stress latent factor than
hypervigilance, offering converging evidence that dissociative symptoms play an important role
in the pathways predicting greater executive dysfunction and behavior problems both at home
and in the classroom.
Mental health professionals who solely rely on the DSM-IV-TR (APA, 2000) to guide
their clinical conceptualization of a child’s traumatic stress reactions following exposed to family
violence are likely to miss important clinical information, as dissociative symptoms are not
included in the PTSD criteria. The pattern of findings from the current study offers strong
empirical support for Perry et al.’s (1995) traumatic stress theory, which posits that traumatic
stress reactions occur on a spectrum of dissociative and hypervigilant experiences. For clinicians
with limited material resources or requiring a quick dissociation screening measure, the Child

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Dissociative Checklist (Putnam et al., 1993) used in the current study is an excellent option. The
measure has good psychometric properties (Putnam et al. 1993), is free, and requires little time to
complete (3 – 4 minutes).
The second important clinical implication of the current study’s findings concerns the
need for mental health professionals to carefully assess a child’s EF following IPV exposure.
Within single contexts (i.e., at home or at school), EF fully mediated the relationship between
IPV exposure, traumatic stress symptoms, and preschool-age children’s behavior problems.
Furthermore, the failed attempts to replicate Milot et al.’s (2010) mediation model, suggest that
considering traumatic stress symptoms alone is not sufficient for explaining the relationship
between IPV exposure and behavior problems. If replicated in other samples, this pattern of
findings has significant implications for establishing best clinical practices. For instance, if a
contemporary clinician is following best clinical practices and he/she suspects a child has been
exposed to IPV, he or she will likely assess for traumatic stress symptoms, most notably PTSD.
In addition to supporting the need for assessing dissociative symptoms, the current study’s
results also indicate that the clinician should conduct an assessment for potential EF problems, in
order to more fully understand the nature of the child’s behavior problems. As with dissociative
symptoms, there are well-validated parent and teacher report measures of preschool-age
children’s EF, including the Behavior Rating Inventory of Executive Functioning (Gioia et al.,
2003) used in the current study.
Future Directions
The findings from the present study suggest several important future directions for
research. For instance, which children are most likely to develop primarily hypervigilant versus
dissociative responses to chronic forms of interpersonal violence, such as IPV? Additionally,

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initial reports (e.g., Macfie et al., 2001a; Putnam et al., 1997) indicate that levels of dissociation
decline with age; however, no research to-date examines whether this decline is simultaneously
accompanied by an increase in hypervigilant symptoms for traumatized children. The
consequence of this paucity of research is that there is little empirical evidence to evaluate
whether Perry et al.’s (1995) traumatic stress theory is invariant across developmental periods.
Future longitudinal studies, complete with serial assessment, should investigate the relationship
between dissociative and hypervigilant responses to interpersonal violence across time.
An unresolved research question is whether dissociation and hypervigilance have a
differential relationship with broadband behavior problems. The present study attempted to
empirically resolve this question; however, the evidence was mixed and contingent on which
reporter (i.e., mother or teacher) reported the behavior problems. The study’s findings suggested
highly context dependent EF and behavior problems. Based upon initial evidence from previous
studies (e.g., Graham-Bermann et al., 2008), it is also likely that preschool-age children’s
traumatic stress symptoms are context dependent; however, the present study did not anticipate
this possibility and only assessed maternal reported traumatic stress symptoms. Future studies
would benefit from assessing both parent and teacher reported traumatic stress symptoms. With
multi-informant reports of dissociation and hypervigilance, it is possible the theorized
differential relationships between these two traumatic stress responses and internalizing and
externalizing behavior problems within single contexts (i.e., at home or school) will emerge.
The present study used careful analytic methods to determine the natural structure of
preschool-age children’s EF. The present study determined that a single, global EF factor
represented the underlying structure of preschool-age children’s EF. Previous studies (e.g., Shing
et al., 2010; Wiebe et al., 2008; Wiebe et al., 2011) have also reported a single EF factor for

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preschool-age children; however, these studies only examined two highly related sub-domains of
EF, WM and IC, (Garon et al., 2008) and did not include AC. Thus, there is converging evidence
for a single, global EF factor during the preschool period, but additional evidence from studies
that assess multiple domains of EF is required before this question is fully resolved.
Based on the divergent findings of EF factor structure from samples with preschool-age
children (e.g., the present study’s findings, as well as Hughes & Ensor, 2008; Shing et al., 2010;
Wiebe et al., 2008/2011) compared to older children and adolescents (e.g., Lehto et al., 2003;
Miyake et al., 200) future longitudinal research should explicitly examine whether EF factor
structure changes with development. For instance, a single EF factor might best describe
preschool-age children’s functioning; however, as the children develop and their cognitive
abilities mature and differentiate, a more complex EF structure might emerge, presumably due to
increasingly differentiated and complex neural networks.
Another line of future research concerns the unexpected findings that the preschool-age
children’s behavior problems and EF were strongly context dependent. As argued in this
discussion, this pattern of findings might be related to preschool-age children’s reliance on
external regulators, such as their mothers and teachers (e.g., Bernier et al., 2010; Kochanska,
Coy, & Murray, 2001; Morris et al., 2011), who naturally vary in their regulatory abilities.
Further longitudinal investigations should examine whether children’s behavior problems and EF
become less context dependent with age, as children internalize regulatory abilities (Kochanska
et al., 2001) that are presumably less variant across environments than when children rely on
external regulators.
Lastly, the present study’s main series of findings indicated that EF fully mediates the
relationship between IPV exposure, traumatic stress symptoms, and behavior problems within

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single contexts (i.e., at home or school) requires. If this mediating relationship is successfully
replicated in future samples, then future studies should also empirically test whether EF mediates
these relationships for children only exposed to a single-incident, non-interpersonal traumatic
event in contrast to chronic, interpersonal violence. If the mediation pathways are specific to
chronic, interpersonal violence, this contrast would suggest possible greater resilience in the face
of a single-incident traumatic event. Additionally, if the mediation pathways are only supported
for chronic, interpersonal violence, this would be further evidence for altered
neurodevelopmental trajectories in areas associated with EF (e.g., PFC) (e.g., Blair, 2010) due to
chronic exposure to traumatic stress (e.g., De Bellis et al., 1999; Perry et al., 1995). Future
longitudinal, imaging studies should examine this possibility by exploring the precise timing and
course of the developmental pathology.

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APPENDICES

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APPENDIX A
COPY OF RECRUITMENT FLYER

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148
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APPENDIX B
TELEPHONE SCREENING INTERVIEW

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ID #: ________
Date: _________
Interviewer’s Initials: _________
Healthy Moms – Healthy Kids
Telephone Screening Protocol
“Thank you for your interest in the Healthy Moms – Healthy Kids Study! Before we begin, we
need to tell you about the study and your rights as a potential research participant.
This research study is about stress, parenting, the mother-child relationship, and child
development. If you are eligible, the information you provide will be used as part of this study.
The information you provide during this brief screening, regardless of your eligibility, will be
stored in a locked file cabinet in the Healthy Moms - Healthy Kids Study office. If you decide at
any point now or in the future that you would like us to destroy and not use your information, we
will do so. The possible risks of participating in this study are small and include possible
discomfort from discussing sensitive topics. Do you have any questions or concerns about this?”
“Okay, I’d like to find out a little information from you to see if you are eligible to participate in
the study. Are you able to answer a few questions right now? (Wait for participant to say yes or
no. If no, thank the participant for calling and ask her to call back at a more convenient time.)
The questions are about your age, education, and racial background. We also ask about your
experiences with your romantic partner, including types of conflict that you may have
experienced. It should only take about 15 minutes. You can choose not to answer any of the
questions or you can choose to end the telephone conversation whenever you want. Even after
you answer all the questions, you can still choose to participate or not in the study. Any of these
decisions will not affect your relationship with any agencies or Michigan State University. Do
you have any questions?”
“If you have any questions as we go along, please ask me. If at any time you have concerns or
questions about this study please contact Dr. Alytia Levendosky at (517) 432-1447. If you have
questions or concerns about your role and rights as a research participant, would like to obtain
information or offer input, or would like to register a complaint about this study you may
anonymously contact the Michigan State University’s Human Research Protection Program at
517-355-2180.”
“Finally, there are no right or wrong answers to these questions. We want women in our study
who have lots of different life experiences.”
Demographics & Identifying Information
“Please spell your first and last name for me”
Name : _________________________________________
Phonetic spelling/pronunciation key:___________________________________

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“What is your birth date?” (mm/dd/yyyy) ___________________
“How old are you right now?” Age:_________ ! If younger than 18 or older than 40
years discontinue interview
Interviewer completes (circle one): 18-21

22-25

26-29

30-34

35-40

“What is your racial or ethnic group?” (Read options and circle one)
1 = Native American
2 = Asian American/Pacific Islander
3 = Black, African American
4 = Latino, Hispanic, Chicano
5 = Multiracial (multiracial means having parents of different races)
6 = Caucasian, White
Interviewer completes (circle one): White

Non-white

“Please spell your child’s name who attends Head Start”
Name: ________________________________
Phonetic spelling/pronunciation: ____________________________
“What is your child’s gender”? Male

Female

“What is your child’s birth date?” (mm/dd/yyyy) _____________________
“How old is your child right now?”
Age: ____________ ! If younger than 3 years OR older than 5 years,
discontinue
“What is your child’s racial or ethnic group?” (Read options and circle one)
1 = Native American
2 = Asian American/Pacific Islander
3 = Black, African American
4 = Latino, Hispanic, Chicano
5 = Multiracial (multiracial means having parents of different races)
6 = Caucasian, White
“Let me go ahead and get some contact information from you, in case we need to get in touch
with you or get disconnected from you during the intake screening process.”

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Contact information
Address:
___________________________________________________________________
Street number and name and apartment #
___________________________________________________________________
City, State, ZIP
Telephone #:______________________ h/c/w, ________________________h/c/w (Always get
a second telephone number. If the mother does not have a second personal number, ask her for
the number of a friend or family member that she would feel comfortable with us contacting to
get in touch with her.)
1. Is it OK to contact you on the phone numbers you have provided?

YES

NO

If NO, is this because you think it may be hard to reach you directly?______
OR because you would rather not to have people in your household know about your
participation in our study? ______ (check only one option)
2. When we call, do you have any preferences for any of the following? (read a through d and
check all that apply)
_________a) block caller ID when calling
_________b) do not leave a message on answering machine
_________c) only call during the day; indicate specific preferred times:
________________________________________
________________________________________
_________d) only call during the evening; indicate specific preferred times:
________________________________________
________________________________________
_________e) no preference
Do you have an email address? _____________________________________
If YES, Is it OK to contact you at the e-mail address you have provided? YES

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NO

INTERVIEWER, please transfer ID number here from previous pages ! ID #: ________
Date: _________
Sensitive Information – TO BE STORED SEPARATELY!
1. “What Head Start location does your child attend?”
Head Start School: ______________________________ !if child does not attend a
Head Start
school, discontinue the intake1
2. “Is English your first language?”

YES

If NO, “Can you read and understand English?”
3. “Are you the biological mother of this child?” YES

NO

YES NO ! If NO, discontinue
NO ! if NO, discontinue

4. “In the past year, have you always lived with your child?” YES NO ! if NO,
discontinue
5. “Was your child born premature?” YES NO
If YES, how many weeks premature? ________ ! If below 37 weeks, discontinue
6. “Does your child have any of the following:” ! If child has any of these, discontinue
Birth defects? Describe: ____________________________________________
________________________________________________________________
Serious medical conditions? Describe: _________________________________
________________________________________________________________
Significant developmental delays? Describe: ____________________________
________________________________________________________________
7. “Do you have legal custody of your child?” YES NO ! If NO, discontinue
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
"!Anytime the interviewer discontinues the interview, s/he says “Thank you for calling us today.
Unfortunately you are not eligible for our study. We have specific requirements in terms of
(age/health status/relationship status) because we are looking at stress hormones and the
effects of experiencing life stress on those hormones. We really appreciate the time you took
calling our project and answering our questions! Thank you so much!”

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8. “Are you currently breastfeeding any infants or young children?”

YES NO

If YES, “if you are eligible to participate, would you be willing to not breastfeed
for 2 hours prior to the in person interview?” YES NO ! If NO, discontinue
9. “Are you currently pregnant?” YES NO ! If YES, complete item below
9a. When is your due date?: _____________________________
10. “Do you currently have any of the following health problems?” (read list) ! If YES,
discontinue
Cushings
Addisons Disease
Cancer

YES
YES
YES

NO
NO
NO

11. “Are you currently receiving cancer treatment?” YES

NO ! If YES discontinue

“Now I’d like to ask you some yes/no questions about your relationships with any romantic
partners you may have had during your child’s entire lifetime. Note that this also includes
partners who may not be your child’s biological father. Are you by yourself or, if not, are you
able to answer these questions at this time?” (Wait for participant to say yes or no. If no, ask the
participant to call back at a more convenient time.)
Domestic Violence Screening
CTS Postnatal
“No matter how well a couple gets along, there are times when they disagree on major decisions,
get annoyed about something the other person does, or just have spats or fights because they’re
in a bad mood, they are tired, or for some other reason. They also use many different ways of
trying to settle their differences. I’m going to read a list of things that you and any of your
partners might have done when you had a dispute. Think about each one of the items on the list
as I read them to you. At the end, I will ask you if any of these things have happened to you with
ANY of your romantic partners since your child’s birth.”
5. Threatened to hit or throw something at you
6. Threw or smashed or hit or kicked something
7. Threw something at you
8. Pushed, grabbed, or shoved you
9. Slapped you
10. Kicked, bit, or hit you with a fist
11. Hit or tried to hit you with something
12. Beat you up
13. Threatened you with a knife or gun
14. Used a knife or gun on you

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Did any of these things happened to you since your child’s birth? YES

NO

If NO, did anything else happen that I did not list here since your child’s birth?
Describe: ___________________________________
“Thank you for sharing this information with us. The study manager will go over your
information and a scheduler will call you back within the next week or so to let you know if you
are eligible for our study.”
“Let me tell you something about the bigger research study. This research study is about stress,
parenting, the mother-child relationship, and child cognitive, social and emotional development.
One of the stressors we will ask you about is domestic violence. We hope to learn about the
strengths that you bring to your situation, your feelings and perceptions of your child, and your
child’s behaviors both at home and at school. We hope to use this information to help plan better
programs for families experiencing domestic violence.
If you decide to take part in the study, you and your child will come to the campus of Michigan
State University to participate. We will ask you questions about how you have been feeling
recently, events that have happened to you including during your pregnancy, your feelings about
your child, and the health and behavior of your child. We will also be asking you for 3 saliva
samples (drool) from you and your child during the interview. This just involves spitting in a
tube. Spitting in the tubes is easy to do, and it is not painful or dangerous. We use the saliva to
measure the levels of a stress hormone (cortisol). After we measure the cortisol, we will destroy
the samples immediately. We will not run any other biological tests on these samples.
One of these saliva samples will be taken after your child engages in a challenging task. For this
we will have your child walk across a balance beam. This activity is safe and voluntary. We will
also ask your child to engage in a series of fun, interactive assessments to learn how children
think. Your child can take a break and visit with you at any time.
The entire interview will take about 2 hours to complete. You will be paid $75 at the end of this
interview to thank you for your participation.
“Do you have any questions?”
“Would you like to participate?” YES

NO

If YES ! “Let me go ahead and schedule you for an interview. All of our interviews start
at either 4 or 6:30 pm. Which day would work best for you?”
“We offer care for one additional child on some interviews, will you need to bring another child
to your interview?” YES NO
If YES: How many children and how old are them? _______________________
“We provide parking during the interview, will you be driving to our project office?”
YES NO

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If YES: What is the model and color of the car you will be driving? A research assistant
will be waiting for you by the parking lot, and this information will help her recognize
you.
_________________________________
_________________________________
There are a few things we need you to avoid before your interview (Read list of things to avoid).
We’ll provide a snack and water for your child, but he/she will not be able to eat during about the
first hour to the interview. Feel free to bring other food/drinks or sippy cup if s/he needs one.
AFTER COMPLETION OF THE INTAKE SCREENING INTERVIEW GIVE THE
INTAKE TO A PROJECT INVESTIGATOR (AUDIE OR LIA) TO BE REVIEWED
BEFORE THE SENSITIVE INFORMATION IS DETACHED AND FILED
SEPARATELY FROM THE REST OF THE INTAKE INTERVIEW!

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APPENDIX C
VERBAL INTRODUCTION TO STUDY AND CONSENT PROCESS

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Introduce the interview protocol to the participant:
“Thank you for coming in for our interview. This afternoon we will be completing a
number of activities, including an interview, filling out questionnaires and collecting saliva
samples from you and your child. Your child will also be working with another interviewer (state
the child interviewer’s name) to complete a balance beam task, as well as some interactive
assessments. We are interested in learning more about you and your child’s physical and
psychological health, your parenting style, as well as domestic violence and other stressful life
events you may have experienced.
During the balance beam task, your child will be asked to walk forward, backward
sideways and over some cones on a balance beam that is approximately 2 and half feet (30
inches) off the ground. Your child will perform these tasks for a total of five minutes while you
watch from another room. However, if your child becomes very upset at any point or cries we
will stop the procedure. You can also ask us to stop this procedure at any time if you feel
uncomfortable. We will be videotaping this so that later we can code your child’s emotional and
behavioral responses to this situation. We will also be collecting 3 saliva samples from you and
3 saliva samples from your child, which will be used only to study the activity of a stress
hormone called cortisol that is present in the saliva.
All the information gathered today is strictly confidential and will not be linked to any
identifying information after the end of our interview. However, if you indicate that child abuse
is occurring or has occurred in your household, we are required to make a report to Child
Protective Services.
When the interview is complete, you will be paid $75. If for any reason we are not able to
complete the interview today, we can schedule another time to finish and will pay you at the
completion of that follow-up interview. If you decide to withdraw from participating in the study
at any point or your child does not want to participate, we will stop the interview immediately
and not use any of your data. In this case, we will pay you $30 for coming to the interview. This
decision would not impact your relationship with MSU, Head Start, or the study.
I would like for you to read over this consent form, which includes more detailed
information. I will be back in a few minutes to answer any questions you may have.”

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APPENDIX D
MOTHER’S CONSENT FORM

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!

Thank you for your participation in The Healthy Moms – Healthy Kids Study! We
appreciate your time and the effort you made to come in today. This research study is about
stress, parenting, the mother-child relationship, and child development. One of the stressors we
will ask you about is domestic violence. We hope to learn about the strengths that you bring to
your situation, your feelings and views of your child, and your child’s behaviors both at home
and at school. We hope to use this information to help plan better programs for families
experiencing domestic violence. Participation in all or part of this study is completely voluntary.
You can choose not to answer any questions/questionnaires, or discontinue your participation at
any time. If you or your child choose to stop the interview at any time you will paid $30 for your
participation. If you and your child complete the entire interview, you will be paid $75 as a way
for us to say ‘thank you’ for your time. Either way, your child will receive a prize and a snack,
with your permission.
What will I do as part of the research study today?
If you decide to take part in the study, you will be asked questions about romantic
relationships and conflict you may have had in those relationships, events that have happened to
you recently, your feelings about your child, your parenting style, and your child’s behaviors at
home. We will also be asking your permission to have your child’s Head Start teacher fill out 2
brief questionnaires about your child’s behavior at school (see the separate form “Mother’s
Permission for Teacher”). Additionally, we will ask you for 4 saliva samples (drool) from you
and 4 from your child during the interview. This involves spitting in a tube—it is very easy to do
and it is not painful or dangerous in any way. We will show you how to do this. Three of these
saliva samples will be taken after your child does a mild stress task. For this your child will be
asked to walk across a balance beam, with soft padding underneath it. You will be able to watch
your child during this task but will not be able to help them walk across the beam. A research
assistant will be there in case your child needs help with the task. The task is safe as the research
assistant will nearby in case your child begins to fall and because there is ample padding
underneath the beam. Additionally, the beam is wide enough for most children to walk across
without trouble. However, you or your child can stop the task at any time if either of you feel
uncomfortable.
How long will this interview last today?
The interview lasts approximately 90 minutes. You and your child may take breaks at any
time. If you child finishes their portion of the interview early, we have lots of fun games and
puzzles for them to play while you complete your interview.
How will you protect my confidentiality?
" Question: Will my information/answers be shared with anyone at Head Start?
" Answer: While Head Start is helping the Healthy Moms – Healthy Kids Study find
families to participate in our research, none of the information you share during the research
interview will be given to any person at Head Start. This includes information you share with us
about yourself, your family and your child.
" Question: Who will get to see the results of my child’s questionnaires?
" Answer: To protect your child’s confidentiality, we will not be sharing their answers
from the interview with you, or anyone at Head Start, with 3 exceptions: 1) If your child tells us

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they are being hurt, 2) If your child tells us they are going to hurt someone else, or 3) If your
child tells us they are hurting or plan to hurt themselves. In any of these instances we would let
you know.
Also, while we will be asking you for permission to have your child’s teacher fill out
behavior rating forms, personally identifiable information will not be shared with you, your
child’s teacher or anyone else at Head Start. Your child’s teacher will not be interviewed for the
study – they will only be answering questions on a paper-and-pencil questionnaire about your
child’s behavior at school. When the study is done, we will summarize information from all
study participants and will not report information about individuals. This anonymous
summarized information will be presented to Head Start so that they can provide better services
to families.
" Question: How else will you keep my information/answers confidential?
" Answer: All information will be kept strictly confidential to the fullest level according to
law. When you signed up for the study during the intake interview, we put your name, child’s
name, basic demographic information and contact information on a piece of paper along with a
unique identification number. This paper is stored under lock and key and is kept separate from
all other sensitive information you provided us during the intake screening interview. It will also
be kept separate from the information you will provide today. Following the intake interview,
this information can only be accessed by the project investigators and research assistants
responsible for scheduling interviews. Your name, unique identification number, and contact
information is also stored in a digital file that is password protected and stored in a locked office
on a computer that is not connected to the internet. Only the project investigators and the
research assistants who schedule visits have access to this digital file.
" All of the questionnaires you fill out today will have your identification number on them,
so the information you provide today cannot be easily linked with your identity. Your full name
will not be on any questionnaires or pieces of paper with your answers to our interview
questions. All of the information you provide us today will be kept in locked file cabinets in a
locked office at Michigan State University. All saliva samples will have the same identification
number and they will be stored in a locked freezer and destroyed after analysis. Your identity
will not be revealed in any reports written about this study. We will summarize information
from all study participants and will not report information about individuals. The only exception
is in the case of child abuse. If you indicate that child abuse is occurring or has occurred in your
household, we must make a report to Protective Services. If a report to Protective Services is
required, Head Start will not be told about this.
Why do you need saliva samples?
We use the saliva to measure levels of a stress hormone in the body called cortisol. After
we test the levels of cortisol, we will destroy the samples right away. We will not run any other
tests on these samples.
Are there any risks or direct benefits of participating for me and my child?
While you may not directly benefit from your participation in this study, your
participation will help us to better understanding of the effects of domestic violence on women
and young children. You may experience some benefits in telling your history and having
someone who can help you find resources.

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The possible risks of participating in this study are small and include possible upset or
discomfort from discussing topics such as domestic violence. We will provide a list of resources
for counseling and other services at the end of the interview.
Can I or my child stop participating if we want?
Yes, absolutely. You can participate in all parts of the study or just some parts. For
example, you may want to answer the questions but you may not want your child to do the mild
stress task. You have the right to withdraw from this study at any point during the interview and
receive $30 for your participation. Your decision about whether to participate or not will not
affect your relationship with Head Start, Michigan State University, or any other agencies.
Will you videotape any parts of this interview?
We would like to videotape mild stress task that the research assistant will conduct with
you and your child. This videotape will be used to make sure that the interviewer is conducting
the task properly. The videotape may be coded by trained research assistants for your child’s
response to the task at the end of the study. The videotape will not have your or your child’s
name on it; an identification number will be put on it. We will keep this videotape in a locked
file cabinet in a locked office at Michigan State University. When we are finished with all
interviews and analysis using these data, we will destroy the videotapes (after approximately 24
months).
Videotaping of the mild stress task is completely voluntary. If you do not want to be
videotaped, you can still do all of the parts of the interview and will not be penalized in any way.
You and your child will receive the full payment for this interview, regardless of your decision
about videotaping.
Who will have access to the videotape?
Only two groups of people will see the videotapes: the Healthy Moms – Healthy Kids
study staff and, in the case of a research audit, the Michigan State University Institutional
Review Board staff.
What if I have questions now or later?
If you have any questions now, please feel free to ask us at any time. If at any time you
have concerns or questions about this study, such as scientific issues, how to do any part of it, or
to report an injury, please contact Dr. Alytia Levendosky at (517) 432-1447.
If you:
" have questions or concerns about your role and rights as a research participant
" would like to obtain information or offer input
" would like to register a complaint about this study
you may anonymously contact the Michigan State University’s Human Research Protection
Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at 202
Olds Hall, MSU, East Lansing, MI 48824.

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I have read this consent form and voluntarily agree that my child and I will participate in this
research study.

_______________________
Signature of Participant

______________________
Print Name

______________
Date

I have read this consent form and voluntarily agree to have the mild stress task videotaped for
training and reliability purposes.

_______________________
Signature of Participant

______________________
Print Name

______________
Date

_______________________
Signature of Witness

_______________________
Print Name

_____________
Date

Alytia Levendosky, Ph.D.
107C Psychology Building
Michigan State University
Department of Psychology
East Lansing, MI 48824
!

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APPENDIX E
TEACHER RELEASE FORM SIGNED BY MOTHER

164
!

We would like your permission to have your child’s teacher answer some questions about his
/her observations of your child’s behavior, feelings, and academic performance. Your child’s
teacher will be told that you are participating in a study of child development by Michigan State
University, but nothing else about the study. No information that you give us will be shared with
the child’s teacher. If you agree to let us contact your child’s teacher, please complete the
release form below.
-----------------------------------------------------------------------------------------------------------As a parent of, _________________________, I give my permission for my child’s teacher,
Name of Child
________________________, to answer questions about my child’s behavior, feelings,
Name of Teacher
and academic performance for a study of child development that I am participating in at
Michigan State University.

Parent Name (Print) ____________________________________________
Parent Signature _______________________________________________
Date _____________________
!

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APPENDIX F
TEACHER CONSENT FORM

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Dear Teacher:
The parent or guardian of your student ________________________has provided consented for
us to contact you as part of their participation in the Healthy Moms – Healthy Kids Study. This
research study is about the child cognitive, social and emotional development. We hope to use
the information you share to help plan better strategies and interventions for parents and for
teachers who work with young children. We are asking that you complete 2 questionnaires
regarding this student’s emotions, behavior, and academic performance. The questionnaires
should take approximately 20-30 minutes to complete, and you will be paid $10 to thank you for
your time. We would like to thank you in advance for your willingness to participate, and for the
time and effort you are taking to help us. Your participation in this study is completely
voluntary. We will provide you with a copy of the release of information from the student’s
mother.
How will you protect my confidentiality?
All information that you give us will be kept strictly confidential among the project staff. None
of the information you provide will be shared with the student, his/her parent, or anyone else at
Head Start. Neither your name nor the student’s name will appear on any questionnaires. An
identification number will be put on them instead. Everything you give us today will be kept in
locked file cabinets in a locked office on the campus of Michigan State University. Your
identity will not be revealed in any reports written about this study. When the study is
completed, we will summarize information from all study participants and will not report
information about individuals. This anonymous summarized information will be presented to
Head Start so that they can provide better services to families.
Your privacy will be protected to the maximum extent allowable by law. The only exception to
full confidentiality is in the case of ongoing child abuse or neglect. If you indicate that child
abuse or neglect may be occurring in the child’s household, we are required to make a report to
Child Protective Services.
How will you protect the confidentiality of the student for whom I completing these
questionnaires?
As part of their participation in this study, families are ensured confidentiality of all information
shared regarding their child. This means that you will not have access to any of the information
shared by parents regarding their child during their interview. This also means that the results of
the questionnaires that you complete about the child will not be shared with you, the child’s
family, or anyone else at Head Start.
What if I do not want to answer all or part of the questionnaires?
You have the right to refuse to answer any questions at any point during the interview without
penalty or negative consequences. Your decision about whether to participate or not will not
affect your relationship with Head Start, Michigan State University, or any other agencies or
Michigan State University.
What if I have questions now or later?
If at any time you have concerns or questions about this study, such as scientific issues,
how to do any part of it, or to report an injury, please contact Dr. Alytia Levendosky at (517)
432-1447.

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If you:
" have questions or concerns about your role and rights as a research participant
" would like to obtain information or offer input
" would like to register a complaint about this study
you may anonymously contact the Michigan State University’s Human Research Protection
Program at 517-355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at 202
Olds Hall, MSU, East Lansing, MI 48824.

I have read this form and voluntarily agree to participate in this research study.

_______________________
Signature of Teacher

______________________
Print Name

______________
Date

_______________________
Signature of Research Staff

_______________________
Print Name

_____________
Date

Alytia Levendosky, Ph.D.
107C Psychology Building
Michigan State University
Department of Psychology
East Lansing, MI 48824
!

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APPENDIX G
CHILD ASSENT FORM

169
!

“If it’s okay with you today, we will ask you to do some fun activities, like playing games,
solving puzzles, and gym activities. We want to learn about kids like you! For some of these
things we are going to use a camera to videotape you. Most kids think this stuff is really fun! If
you don’t want to do any of the activities it is okay. No one will be mad or upset. Just tell me. We
will take lots of breaks and if you want to see your mom at any time, you can. When we are
finished I have a gift for you so say “thank you” for helping us to learn about kids.
Does this sound okay to you – do you want to do the activities today? Yes or no?
(Interviewer circle one based on child’s verbal response):
!
!

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YES

NO

APPENDIX H
COPIES OF MEASURES

171
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Demographics Questionnaire
Subject # _____________
Date of Interview _____________
Name of Interviewer ______________________
Interviewer: “Please rate how anxious or nervous you feel RIGHT NOW:”

1
Not at all nervous

2

3

4

5

6
Extremely nervous

_____________________________________________________________________________
1.

First name of child:
assignment sheet prior to interview)

2.

Confirm Child’s birthdate:

3.

Are you currently pregnant? YES NO
! If yes, due date: _____/_____ (mm/yy)
Interviewer discontinue interview. If due date is before Nov. 1,
2011 ask the mom if we can reschedule for Dec. If due date is after
Nov. 1 or mom does not want to reschedule, provide full payment
(and child prize) and inform mom that she is not eligible to
complete remainder of study.

4.

How many biological children do you currently have? ___________

5.

How many people, including yourself, live in your household? _________
(If participant is living in a shelter, question refers to household
composition before moving into shelter.)

6.

Choose the one that best describes your current marital/relationship status
(choose only one):
(1)
single, never married

/

(Interviewer: fill in from

/_____

(2)

married

(a) For how long? _______ (in months)

(3)

separated

(b) For how long? _______ (in months)

(4)

divorced

(c) For how long? _______ (in months)

(5)

widowed

(d) For how long? _______ (in months)

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7.

How would you describe your relationship status with the biological father
of your child? (Read all choices and circle one)
(1)
I am still in a relationship with him.
(2)
(3)

We have been together off and on and are currently not
together.

(4)

I have not had a relationship with him since the child was
born.

(5)
8.

We have been together off and on and are currently
together.

Is deceased.

What is your current relationship with the father of your child? (circle one)
1 = spouse
2 = ex-spouse
3 = partner/fiancé
4 = ex-partner
5 = friend
6 = acquaintance
7 = stranger
8 = other Please specify: _____________________________

9.

Is the child’s father involved with the child?

YES

NO

10.

Does the child’s father live with the child?

YES

NO

11.

Do you currently have custody of your child?
YES
! IF NO, discontinue interview, provide full payment but do not
reschedule (mom cannot provide legal consent).

NO

11a.

IF YES, is it full or joint?
FULL
(Joint custody is ONLY selected if custody arrangement was
decided in a court of law, otherwise code as full custody)

JOINT

11b.

IF JOINT, who do you share custody with? __________________
(Give name and relationship to child)

11c.

IF JOINT, how many days per month does your child live with
you? _______

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12.

What is your occupation status? Chose one of the following:
1.
2.
3.
4.
5.

13.

What is the highest level of education you have completed? (Circle one)
1.
2.
3.
4.
5.
6.

14.

16.

Some High School
High School Diploma
GED
Some college, trade school (e.g., Cosmetology, Nursing,
Technical/Vocational), or AA degree
BA/BS
Some grad school or graduate degree

Do you currently receive services from . . . ?
a.
b.
c.
d.
e.
f.
g.

15.

Unemployed
SSI Disability
Full-time employee
Part-time employee
Contract worker / per diem

WIC
TANF (formerly AFDC)
Protective Services
Food Stamps
Medicaid
SSI (Disability)
FIA cash assistance/grant

YES
YES
YES
YES
YES
YES
YES

What is your total family income per month (estimate)?___________
! Note: Must be a value over $0 – include all forms of income,
including, but not limited to, unemployment, disability, child
support, food stamps, Medicaid, etc. PROBE EXTENSIVELY.
Are you currently residing in a shelter for battered women?
(a)

YES

(b)
17.

NO
NO
NO
NO
NO
NO
NO

NO/888

If YES, # days? ________

Have you ever stayed in a shelter for battered women?
(a)

YES

NO/888

(b)

If YES, # days? ________

174
!

Revised Conflicts Tactics Scales (Straus et al., 1996)
No matter how well a couple gets along, there are times when they disagree, get annoyed with
the other person, want different things from each other, or just have spats or fights because they
are in a bad mood, are tired, or for some other reason. Couples also have many different ways of
trying to settle their differences. This is a list of things that might happen when you have
differences. Please circle how many times you did each of these things since your child was
born, and how many times your partner(s) did them since your child was born. If you or your
partner(s) did not do one of these things since your child was born, circle “N/A”.
HOW OFTEN DID THE FOLLOWING HAPPEN SINCE YOUR CHILD WAS BORN:
A = ONCE
B = TWICE
C = 3 – 5 TIMES
D = 6 – 10 TIMES
E = 11 – 20 TIMES
F = MORE THAN 20 TIMES
N/A = THIS NEVER HAPPENED
1. I showed my partner(s) I cared even though we disagreed.

A

B

C D

E F

N/A

2. My partner(s) showed care for me even though we disagreed. A

B

C D

E F

N/A

3. I explained my side of a disagreement to my partner(s).

A

B

C D

E F

N/A

4. My partner(s) explained his/her side of a disagreement to me. A

B

C D

E F

N/A

5. I insulted or swore at my partner(s).

A

B

C D

E F

N/A

6. My partner(s) did this to me.

A

B

C D

E F

N/A

7. I threw something at my partner(s) that could hurt.

A

B

C D

E F

N/A

8. My partner(s) did this to me.

A

B

C D

E F

N/A

9. I twisted my partner(s) arm or hair.

A

B

C D

E F

N/A

10. My partner(s) did this to me.

A

B

C D

E F

N/A

11. I had a sprain, bruise, or small cut because of a fight with my A
partner(s).

B

C D

E F

N/A

12. My partner(s) had a sprain, bruise, or small cut because of a
fight with me.

B

C D

E F

N/A

175
!

A

13. I showed respect for my partners’ feelings about an issue.

A

B

C D

E F

N/A

14. My partner(s) showed respect for my feelings about an issue. A

B

C D

E F

N/A

15. I made my partner(s) have sex without a condom.

A

B

C D

E F

N/A

16. My partner(s) did this to me.

A

B

C D

E F

N/A

17. I pushed or shoved my partner(s).

A

B

C D

E F

N/A

18. My partner(s) did this to me.

A

B

C D

E F

N/A

19. I used force (like hitting, holding down, or using a weapon)
to make my partner(s) have oral or anal sex.

A

B

C D

E F

N/A

20. My partner(s) did this to me.

A

B

C D

E F

N/A

21. I used a knife or gun on my partner(s).

A

B

C D

E F

N/A

22. My partner(s) did this to me.

A

B

C D

E F

N/A

23. I passed out from being hit on the head by my partner(s) in a
fight with me.

A

B

C D

E F

N/A

24. My partner(s) passed out from being hit on the head in a
fight with me.

A

B

C D

E F

N/A

25. I called my partner(s) fat or ugly.

A

B

C D

E F

N/A

26. My partner(s) called me fat or ugly.

A

B

C D

E F

N/A

27. I punched or hit my partner(s) with something that could hurt. A

B

C D

E F

N/A

28. My partner(s) did this to me.

A

B

C D

E F

N/A

29. I destroyed something belonging to my partner(s).

A

B

C D

E F

N/A

30. My partner(s) did this to me.

A

B

C D

E F

N/A

31. I went to a doctor because of a fight with my partner(s).

A

B

C D

E F

N/A

32. My partner(s) went to a doctor because of a fight with me.

A

B

C D

E F

N/A

33. I choked my partner(s).

A

B

C D

E F

N/A

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34. My partner(s) did this to me.

A

B

C D

E F

N/A

35. I shouted or yelled at my partner(s).

A

B

C D

E F

N/A

36. My partner(s) did this to me.

A

B

C D

E F

N/A

37. I slammed my partner(s) against a wall.

A

B

C D

E F

N/A

38. My partner(s) did this to me.

A

B

C D

E F

N/A

39. I said I was sure we could work out a problem.

A

B

C D

E F

N/A

40. My partner(s) were sure we could work it out.

A

B

C D

E F

N/A

41. I needed to see a doctor because of a fight with my partner(s), A
but I didn’t.

B

C D

E F

N/A

42. My partner(s) needed to see a doctor because of a fight with
me, but I didn’t.

A

B

C D

E F

N/A

43. I beat up my partner(s).

A

B

C D

E F

N/A

44. My partner(s) did this to me.

A

B

C D

E F

N/A

45. I grabbed my partner(s).

A

B

C D

E F

N/A

46. My partner(s) did this to me.

A

B

C D

E F

N/A

47. I used force (like hitting, holding down, or using a weapon)
to make my partner have sex.

A

B

C D

E F

N/A

48. My partner(s) did this to me.

A

B

C D

E F

N/A

49. I stomped out of the room or house or yard during a
disagreement.

A

B

C D

E F

N/A

50. My partner(s) did this to me.

A

B

C D

E F

N/A

51. I insisted on sex when my partner(s) did not want to (but
did not use physical force).

A

B

C D

E F

N/A

52. My partner(s) did this to me.

A

B

C D

E F

N/A

53. I slapped my partner(s).

A

B

C D

E F

N/A

54. My partner(s) did this to me.

A

B

C D

E F

N/A

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55. I had a broken bone from a fight with my partner(s).

A

B

C D

E F

N/A

56. My partner(s) had a broken bone from a fight with me.

A

B

C D

E F

N/A

57. I used threats to make my partner(s) have oral or anal sex.

A

B

C D

E F

N/A

58. My partner(s) did this to me.

A

B

C D

E F

N/A

59. I suggested a compromise to a disagreement.

A

B

C D

E F

N/A

60. My partner(s) did this to me.

A

B

C D

E F

N/A

61. I burned or scalded my partner(s) on purpose.

A

B

C D

E F

N/A

62. My partner(s) did this to me.

A

B

C D

E F

N/A

63. I insisted my partner(s) have oral or anal sex (but did not
use force).

A

B

C D

E F

N/A

64. My partner(s) did this to me.

A

B

C D

E F

N/A

65. I accused my partner(s) of being a lousy lover.

A

B

C D

E F

N/A

66. My partner(s) did this to me.

A

B

C D

E F

N/A

67. I did something to spite my partner(s).

A

B

C D

E F

N/A

68. My partner(s) did this to me.

A

B

C D

E F

N/A

69. I threatened to hit or throw something at my partner(s).

A

B

C D

E F

N/A

70. My partner(s) did this to me.

A

B

C D

E F

N/A

71. I felt physical pain that still hurt the next day, because of
a fight with partner(s).

A

B

C D

E F

N/A

72. My partner(s) felt physical pain the next day, because of a
fight we had.

A

B

C D

E F

N/A

73. I kicked my partner(s).

A

B

C D

E F

N/A

74. My partner(s) did this to me.

A

B

C D

E F

N/A

75. I used threats to make my partner(s) have sex.

A

B

C D

E F

N/A

178
!

76. My partner(s) did this to me.

A

B

C D

E F

N/A

77. I agreed to try a solution to a disagreement my partner(s)
suggested.

A

B

C D

E F

N/A

78. My partner(s) tried a solution I suggested.

A

B

C D

E F

N/A

179
!

Psychological Maltreatment of Women Inventory – Short Version
(Tolman, 1995)
The questionnaire asks about actions you and your partner(s) may have experienced in any of
your relationships since your child was born. Answer each item as carefully as you can by
circling a number next to each statement according to the following scale:
1 = NEVER
2 = RARELY
3 = OCCASIONALLY
4 = FREQUENTLY
5 = VERY FREQUENTLY
SINCE YOUR CHILD WAS BORN:
10a. My partner(s) called me names.

1

2

3

4

5

10b. I called my partner(s) names.

1

2

3

4

5

11a. My partner(s) swore at me.

1

2

3

4

5

11b. I swore at my partner(s).

1

2

3

4

5

12a. My partner(s) yelled and screamed at me.

1

2

3

4

5

12b. I screamed and yelled at my partner(s).

1

2

3

4

5

13a. My partner(s) treated me like an inferior.

1

2

3

4

5

13b. I treated my partner(s) like an inferior.

1

2

3

4

5

26a. My partner(s) monitored my time and made me
account for my whereabouts

1

2

3

4

5

26b. I monitored my partner(s) time and made him
account for his whereabouts

1

2

3

4

5

30a. My partner(s) used our money or made important
financial decisions without talking to me about it.

1

2

3

4

5

30b. I used our money or made important financial
1
decisions without talking to my partner(s) about it.

2

3

4

5

32a. My partner(s) was jealous or suspicious of my
friends.

2

3

4

5

180
!

1

32b. I was jealous or suspicious of my partner(s)
friends.

1

2

3

4

5

36a. My partner(s) accused me of having an affair with
another man.

1

2

3

4

5

36b. I accused my partner(s) of having an affair with
another woman.

1

2

3

4

5

39a. My partner(s) interfered in my relationship with
other family members.

1

2

3

4

5

39b. I interfered in my partner(s)’ relationship with
other family members.

1

2

3

4

5

40a. My partner(s) tried to keep me from doing things
to help myself.

1

2

3

4

5

40b. I tried to keep my partner(s) from doing things
to help himself.

1

2

3

4

5

42a. My partner(s) restricted my use of the telephone.

1

2

3

4

5

42b. I restricted my partner(s) use of the telephone.

1

2

3

4

5

45a. My partner(s) told me my feelings were irrational
or crazy.

1

2

3

4

5

45a. I told my partner(s) his feelings were irrational
or crazy.

1

2

3

4

5

46a. My partner(s) blamed me for his problems.

1

2

3

4

5

46b. I blamed my partner(s) for my problems.

1

2

3

4

5

49a. My partner(s) tried to make me feel crazy.

1

2

3

4

5

49b. I tried to make my partner(s) feel crazy.

1

2

3

4

5

181
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Behavior Rating Inventory of Executive Functioning – Preschool
(Gioia et al., 2003) *Note: for both Parent and Teacher Report
During the past 6 months, please rate how often the following behaviors have been a problem for
your child (if you are the teacher, ‘your student’).
N = NEVER
S = SOMETIMES
O = OFTEN
1.

Overreacts to small problems.

N

S

O

2.

When given two things to do, remembers only the first or last.

N

S

O

3.

Is unaware of how his/her behavior affects or bothers others.

N

S

O

4.

When instructed to clean up, puts things away in a disorganized,
random way.

N

S

O

5.

Becomes upset with new situations.

N

S

O

6.

Has explosive, angry outbursts.

N

S

O

7.

Has trouble carrying out the actions needed to complete tasks
(such as trying one puzzle piece at a time, cleaning up to earn
a reward).

N

S

O

8.

Does not stop laughing at funny things or events when others stop.

N

S

O

9.

Needs to be told to begin a task even when willing to do it.

N

S

O

10. Has trouble adjusting to new people (such as babysitter, teacher,
friend, or day care worker).

N

S

O

11. Becomes upset too easily.

N

S

O

12. Has trouble concentrating on games, puzzles, or play activities.

N

S

O

13. Has to be more closely supervised than similar playmates.

N

S

O

14. When sent to get something, forgets what he/she is supposed to get. N

S

O

15. Is upset by a change in plans or routine (for example, order of daily
activities, adding last minute errands to schedule, change in
driving to the store).

S

O

182
!

N

16. Has outbursts for little reason.

N

S

O

17. Repeats the same mistakes over and over even after help is given.

N

S

O

18. Acts wilder or sillier than other in groups (such as birthday parties,
play group).

N

S

O

19. Cannot find clothes, shoes, toys, or books even when he/she has
been given specific instructions.

N

S

O

20. Takes a long time to feel comfortable in new places or situations
(such as visiting distant relatives or new friends).

N

S

O

21. Mood changes frequently.

N

S

O

22. Makes silly mistakes on things he/she can do.

N

S

O

23. Is fidgety, restless, or squirmy.

N

S

O

24. Has trouble following established routines for sleeping, eating, or
play activities.

N

S

O

25. Is bothered by loud noises, bright lights, or certain smells.

N

S

O

26. Small events trigger big reactions.

N

S

O

27. Has trouble with activities or tasks that have more than one step.

N

S

O

28. Is impulsive.

N

S

O

29. Has trouble thinking of a different way to solve a problem or
complete an activity when stuck.

N

S

O

30. Is disturbed by changes in the environment (such as new furniture,
things in room moved around, or new clothes).

N

S

O

31. Angry or tearful outbursts are intense but end suddenly.

N

S

O

32. Needs help from adult to stay on task.

N

S

O

33. Does not notice when his/her behavior causes negative reactions.

N

S

O

34. Leaves messes that others have to clean up even after instruction.

N

S

O

35. Has trouble changing activities.

N

S

O

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!

36. Reacts more strongly to situations than other children.

N

S

O

37. Forgets what he/she is doing in the middle of an activity.

N

S

O

38. Does not realize that certain actions bothers others.

N

S

O

39. Gets caught up in the small details of a task or situation and
misses the main idea.

N

S

O

40. Has trouble “joining in” at unfamiliar social events (such as
birthday parties, picnics, holiday gatherings).

N

S

O

41. Is easily overwhelmed or overstimulated by typical daily activities.

N

S

O

42. Has trouble finishing tasks (such as games, puzzles, pretend play
activities).

N

S

O

43. Gets out of control more than playmates.

N

S

O

44. Cannot find things in room or play area even when given specific
instructions.

N

S

O

45. Resists change of routine, foods, places, etc.

N

S

O

46. After having a problem, will stay disappointed for a long time.

N

S

O

47. Cannot stay on the same topic when talking.

N

S

O

48. Talks or plays too loudly.

N

S

O

49. Does not complete tasks even after given directions.

N

S

O

50. Acts overwhelmed or overstimulated in crowded, busy situations
(such as lots of noise, activity, or people).

N

S

O

51. Has trouble getting started on activities or tasks even after instructed. N

S

O

52. Acts too wild or out of control.

N

S

O

53. Does not try as hard as his/her abilities on activities.

N

S

O

54. Has trouble putting the brakes on his/her actions even after being
asked.

N

S

O

55. Unable to finish describing an event, person, or story.

N

S

O

184
!

56. Completes tasks or activities too quickly.

N

S

O

57. Is unaware when he/she does well and not well.

N

S

O

58. Gets easily sidetracked during activities.

N

S

O

59. Has trouble remembering something, even after a brief period of
time.

N

S

O

60. Becomes too silly.

N

S

O

61. Has a short attention span.

N

S

O

62. Plays carelessly or recklessly in situations where he/she could be
hurt (such as playground, swimming pool).

N

S

O

63. Is unaware when he/she performs a task right or wrong.

N

S

O

185
!

Child Behavior Checklist – 1 ! - 5 (Achenbach & Rescorla, 2000)
Below is a list of items that describe children. For each item that describes the now or within the
past 2 months, please circle the 2 if the item is very true or often true of the child. Circle the 1 if
the item is somewhat or sometimes true of the child. If the item is not true of the child, circle
the 0. Please answer all items as well as you can, even if some do not seem to apply to the child.
0 = Not True (as far as you know)
1 = Somewhat or Sometimes True
2 = Very True or Often True

1. Aches or pains (without medical cause; do not include stomach or headaches) 0

1

2

2. Acts too young for age

0

1

2

3. Afraid to try new things

0

1

2

4. Avoids looking others in the eye

0

1

2

5. Can’t concentrate, can’t pay attention for long

0

1

2

6. Can’t sit still, restless or hyperactive

0

1

2

7. Can’t stand having things out of place

0

1

2

8. Can’t stand waiting; wants everything now

0

1

2

9. Chews on things that aren’t edible

0

1

2

10. Clings to adults or too dependent

0

1

2

11. Constantly seeks help

0

1

2

12. Constipated, doesn’t move bowels (when not sick)

0

1

2

13. Cries a lot

0

1

2

14. Cruel to animals

0

1

2

15. Defiant

0

1

2

16. Demands must be met immediately

0

1

2

17. Destroys his/her own things

0

1

2

18. Destroys things belonging to his/her family or other children

0

1

2

19. Diarrhea or loose bowels (when not sick)

0

1

2

20. Disobedient

0

1

2

21. Disturbed by any change in routine

0

1

2

22. Doesn’t want to sleep alone

0

1

2

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!

23. Doesn’t answer when people talk to him/her

0

1

2

24. Doesn’t eat well

0

1

2

25. Doesn’t get along with other children

0

1

2

26. Doesn’t know how to have fun; acts like a little adult

0

1

2

27. Doesn’t seem to feel guilty after misbehaving

0

1

2

28. Doesn’t want to go out of home

0

1

2

29. Easily frustrated

0

1

2

30. Easily jealous

0

1

2

31. Eats or drinks things that are not food – don’t include sweets

0

1

2

32. Fears certain animals, situations, or places

0

1

2

33. Feelings are easily hurt

0

1

2

34. Gets hurt a lot, accident-prone

0

1

2

35. Gets in many fights

0

1

2

36. Gets into everything

0

1

2

37. Gets too upset when separated from parents

0

1

2

38. Has trouble getting to sleep

0

1

2

39. Headaches (without medical cause)

0

1

2

40. Hits others

0

1

2

41. Holds his/her breath

0

1

2

42. Hurts animals or people without meaning to

0

1

2

43. Looks unhappy without good reason

0

1

2

44. Angry moods

0

1

2

45. Nausea, feels sick (without medical cause)

0

1

2

46. Nervous movements or twitching

0

1

2

47. Nervous, highstrung, or tense

0

1

2

48. Nightmares

0

1

2

49. Overeating

0

1

2

50. Overtired

0

1

2

51. Shows panic for no good reason

0

1

2

52. Painful bowel movements (without medical cause)

0

1

2

53. Physically attacks people

0

1

2

187
!

54. Picks nose, skin, or other parts of body

0

1

2

55. Plays with own sex parts too much

0

1

2

56. Poorly coordinated or clumsy

0

1

2

57. Problems with eyes (without medical cause)

0

1

2

58. Punishment doesn’t change his/her behavior

0

1

2

59. Quickly shifts from one activity to another

0

1

2

60. Rashes or other skin problems (without medical cause)

0

1

2

61. Refuses to eat

0

1

2

62. Refuses to play active games

0

1

2

63. Repeatedly rocks head or body

0

1

2

64. Resists going to bed at night

0

1

2

65. Resists toilet training

0

1

2

66. Screams a lot

0

1

2

67. Seems unresponsive to affection

0

1

2

68. Self-conscious or easily embarrassed

0

1

2

69. Selfish or won’t share

0

1

2

70. Shows little affection toward people

0

1

2

71. Shows little interest in things around him/her

0

1

2

72. Shows too little fear of getting hurt

0

1

2

73. Too shy or timid

0

1

2

74. Sleeps less than most children during the day and/or night

0

1

2

75. Smears or plays with bowel movements

0

1

2

76. Speech problem

0

1

2

77. Stares into space or seems preoccupied

0

1

2

78. Stomachaches or cramps (without medical cause)

0

1

2

79. Rapid shifts between sadness and excitement

0

1

2

80. Strange behavior

0

1

2

81. Stubborn, sullen, or irritable

0

1

2

82. Sudden changes in mood or feelings

0

1

2

83. Sulks a lot

0

1

2

84. Talks or cries out in sleep

0

1

2

188
!

85. Temper tantrums or hot temper

0

1

2

86. Too concerned with neatness or cleanliness

0

1

2

87. Too fearful or anxious

0

1

2

88. Uncooperative

0

1

2

89. Underactive, slow moving, or lacks energy

0

1

2

90. Unhappy, sad, or depressed

0

1

2

91. Unusually loud

0

1

2

92. Upset by new people or situations

0

1

2

93. Vomiting, throwing up (without medical cause)

0

1

2

94. Wakes up often at night

0

1

2

95. Wanders away

0

1

2

96. Wants a lot of attention

0

1

2

97. Whining

0

1

2

98. Withdrawn, doesn’t get involved with others

0

1

2

99. Worries

0

1

2

100.

0

1

2

Please write in any problems the child has that were not listed above:

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

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Child Behavior Checklist – Teacher Report Form
(Achenbach & Rescorla, 2000)
I.

For how many months have you known this child? ________ months.

II.

How well do you know him/her? (circle one):
a. Not well
b. Moderately well
c. Very well

III.

Has he/she ever been referred for a special education program or special services? (circle
one):
a. No
b. Yes
c. Don’t know

Below is a list of items that describe children. For each item that describes the child now or
within the past 2 months, please circle the 2 if the is very true or often true of the child. Circle
the 1 if the item is somewhat or sometimes true of the child. If the item is not true of the child,
circle the 0. Please answer all the items as well as you can, even if some do not seem to apply to
the child.
0 = Not True (as far as you know)
1 = Somewhat or Sometimes True
2 = Very True or Often True

1. Aches or pains (without medical cause; do not include stomach or headaches) 0

1

2

2. Acts too young for age

0

1

2

3. Afraid to try new things

0

1

2

4. Avoids looking others in the eye

0

1

2

5. Can’t concentrate, can’t pay attention for long

0

1

2

6. Can’t sit still, restless or hyperactive

0

1

2

7. Can’t stand having things out of place

0

1

2

8. Can’t stand waiting; wants everything now

0

1

2

9. Chews on things that aren’t edible

0

1

2

10. Clings to adults or too dependent

0

1

2

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11. Constantly seeks help

0

1

2

12. Apathetic or unmotivated

0

1

2

13. Cries a lot

0

1

2

14. Cruel to animals

0

1

2

15. Defiant

0

1

2

16. Demands must be met immediately

0

1

2

17. Destroys his/her own things

0

1

2

18. Destroys things belonging to others

0

1

2

19. Daydreams or gets lost in his/her thoughts

0

1

2

20. Disobedient

0

1

2

21. Disturbed by any change in routine

0

1

2

22. Cruelty, bullying, or meanness to others

0

1

2

23. Doesn’t answer when people talk to him/her

0

1

2

24. Difficulty following directions

0

1

2

25. Doesn’t get along with other children

0

1

2

26. Doesn’t know how to have fun; acts like a little adult

0

1

2

27. Doesn’t seem to feel guilty after misbehaving

0

1

2

28. Disturbs other children

0

1

2

29. Easily frustrated

0

1

2

30. Easily jealous

0

1

2

31. Eats or drinks things that are not food – don’t include sweets

0

1

2

32. Fears certain animals, situations, or places other than daycare or school

0

1

2

33. Feelings are easily hurt

0

1

2

34. Gets hurt a lot, accident-prone

0

1

2

35. Gets in many fights

0

1

2

36. Gets into everything

0

1

2

37. Gets too upset when separated from parents

0

1

2

38. Explosive and unpredictable behavior

0

1

2

39. Headaches (without medical cause)

0

1

2

40. Hits others

0

1

2

41. Holds his/her breath

0

1

2

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42. Hurts animals or people without meaning to

0

1

2

43. Looks unhappy without good reason

0

1

2

44. Angry moods

0

1

2

45. Nausea, feels sick (without medical cause)

0

1

2

46. Nervous movements or twitching

0

1

2

47. Nervous, highstrung, or tense

0

1

2

48. Fails to carry out assigned tasks

0

1

2

49. Fears daycare or school

0

1

2

50. Overtired

0

1

2

51. Fidgets

0

1

2

52. Gets teased by other children

0

1

2

53. Physically attacks people

0

1

2

54. Picks nose, skin, or other parts of body

0

1

2

55. Plays with own sex parts too much

0

1

2

56. Poorly coordinated or clumsy

0

1

2

57. Problems with eyes (without medical cause)

0

1

2

58. Punishment doesn’t change his/her behavior

0

1

2

59. Quickly shifts from one activity to another

0

1

2

60. Rashes or other skin problems (without medical cause)

0

1

2

61. Refuses to eat

0

1

2

62. Refuses to play active games

0

1

2

63. Repeatedly rocks head or body

0

1

2

64. Inattentive, easily distracted

0

1

2

65. Lying or cheating

0

1

2

66. Screams a lot

0

1

2

67. Seems unresponsive to affection

0

1

2

68. Self-conscious or easily embarrassed

0

1

2

69. Selfish or won’t share

0

1

2

70. Shows little affection toward people

0

1

2

71. Shows little interest in things around him/her

0

1

2

72. Shows too little fear of getting hurt

0

1

2

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73. Too shy or timid

0

1

2

74. Not liked by other children

0

1

2

75. Overactive

0

1

2

76. Speech problem

0

1

2

77. Stares into space or seems preoccupied

0

1

2

78. Stomachaches or cramps (without medical cause)

0

1

2

79. Overconforms to rules

0

1

2

80. Strange behavior

0

1

2

81. Stubborn, sullen, or irritable

0

1

2

82. Sudden changes in mood or feelings

0

1

2

83. Sulks a lot

0

1

2

84. Teases a lot

0

1

2

85. Temper tantrums or hot temper

0

1

2

86. Too concerned with neatness or cleanliness

0

1

2

87. Too fearful or anxious

0

1

2

88. Uncooperative

0

1

2

89. Underactive, slow moving, or lacks energy

0

1

2

90. Unhappy, sad, or depressed

0

1

2

91. Unusually loud

0

1

2

92. Upset by new people or situations

0

1

2

93. Vomiting, throwing up (without medical cause)

0

1

2

94. Unclean personal appearance

0

1

2

95. Wanders away

0

1

2

96. Wants a lot of attention

0

1

2

97. Whining

0

1

2

98. Withdrawn, doesn’t get involved with others

0

1

2

99. Worries

0

1

2

0

1

2

100.

Please write in any problems the child has that were not listed above:

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

193
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Posttraumatic Stress Disorder Semi-Structured Interview
and Observational Record (Scheeringa et al., 2005)
“Now I am going to ask about upsetting events that may have occurred at any time in your
child’s life.”
“Has your child ever experienced, witnessed, or learned about a loved one experiencing…”
1. An accident or crash with automobile, plane, or boat.

Date of event: __________

2. Attacked by an animal.

Date of event: __________

3. Man-made disasters (crashes, fires, war)

Date of event: __________

4. Natural disasters (hurricane, tornado, flood)

Date of event: __________

5. Has your child ever witnessed another person being
beaten, raped, threatened with serious harm, shot at,
seriously wounded, or killed (not including IPV)

Date of event: __________

6. Has your child ever experienced physical abuse

Date of event: __________

7. Has your child ever experienced sexual abuse,
been sexually assault, or raped

Date of event: __________

“Has your child experienced, witnessed, or heard about…”
8. Accidental burn
Date of event: __________
9. Near drowning

Date of event: __________

10. Hospitalization, emergency room visit, and/or
invasive medical procedures

Date of event: __________

11. Kidnapped

Date of event: __________

12. Any item endorsed on the post-natal violence questionnaires or items 10, 11, or 12 on PMWI
(interviewer show the post-natal CTS2 and PMWI
Y
N
! If YES, worst violent event the child was in the house during (qualitative description):
_______________________________________________________________________
Date of worst CTS2 or PMWI event: __________
13. Other (Specify): __________________

Date of event: __________

194
!

NOTE: IF NO EVENTS ARE ENDORSED, CHECK HERE _________ AND skip to item
#P45 ! Ask items P45 – P50 and then end PTSDSSI interview.
IF MORE THAN ONE EVENT, ASK:
“Which of these do you think caused the most emotional or behavior problems for your child?”
WRITE THE EVENT NUMBER 1-13 ________
IF CHILD EXPERIENCED MORE THAN ONE EVENT, ASK THE QUESTIONS ON THIS
PAGE ONLY ABOUT THE WORST EVENT.
“For (worst event), I’m going to ask you a list of reactions that s/he might have had in the
seconds or minutes right after the event occurred”
P14. “Was s/he afraid or scared?”

“For how long?” ________ MIN.

P15. “Worried?”

“For how long?” ________ MIN.

P16. “Helpless?”

“For how long?” ________ MIN.

P17. “Angry?”

“For how long?” ________ MIN.

P18. “Sad?”

“For how long?” ________ MIN.

P19. “Surprised?”

“For how long?” ________ MIN.

P20. “Numb?”

“For how long?” ________ MIN.

P21. “Did s/he cry?”

“For how long?” ________ MIN.

P22. “Scream?”

“For how long?” ________ MIN.

P23. “Become agitated?”

“For how long?” ________ MIN.

P24. “Act aggressive?”

“For how long?” ________ MIN.

P25. “Look confused?”

“For how long?” ________ MIN.

P26. “Look out of touch like s/he was in a daze?”
“For how long?” ________ MIN.
P27. “Seem physically sick, like sick to her stomach?”
“For how long?” ________ MIN.
“Now I’m going to ask you a bunch of questions about any symptoms your child might have
developed since the event(s) you mentioned, such as (list all endorsed on previous page). For
195
!

something to be a symptom it must be abnormal. I’ll be repeating that a behavior needs to be
“more than the average child his/her age.” We know that sometimes this is obvious and
sometimes it’s hard to figure out.” “Most symptoms that people show after traumas start right
away. Some of them go away and some of them stick around. I only need to mark it if it is still
around in the last 4 weeks.”
IF A CHILD HAS EXPERIENCED MORE THAN ONE TRAUMATIC EVENT, ASK THE
REMAINDER OF THE PTSD QUESTIONS FOR THE TOTALITY OF ALL EVENTS. THAT
IS, SYMPTOMS CAN BE ENDORSED FOR ANY OF THE EVENTS.
FREQUENCY = NUMBER OF TIMES IT OCCURRED DURING THE LAST 4 WEEKS.
P28. INTRUSIVE RECOLLECTIONS
“Does s/he have intrusive memories of the event(s)?”
“Does s/he bring it up on his/her own?”
IF YES, EXAMPLE:

Y
Y

N
N

_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P29

Note: Only ask if P28 is YES !P28a. AFFECT WHEN TALKING ABOUT IT
“Does s/he look distressed or not distressed when s/he brings it up?”

Y

N

P29. PLAY REENACTMENT OF THE TRAUMA
“Does X reenact the event in her play with dolls or toys? This would be scenes that look just like
the trauma?” “Does s/he act it out by him/herself or with other kids?”
Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P30

P30. NON-PLAY REENACTMENT OF LIFE EVENT
“What about other times? Does s/he act it out at the grocery or mealtime?”

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!

Y

N

IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P31

P31. NIGHTMARES: ABOUT TRAUMA
“Has s/he had any nightmares or bad dreams about the trauma that wake him/her up?”
Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P32

P32. NIGHTMARES: INCREASED/ NOT ABOUT TRAUMA
“Is X having more nightmares than s/he used to have but you don’t know if they are about the
trauma or not?”
Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P33
Frequency? _______
Onset? ___/_____
P33. FLASHBACKS
“Since the event, has s/he felt as though the “life event” was happening to him/her again, even
when it wasn’t? This is where a child is acting like they are back in the traumatic event and
aren’t in touch with reality. This is a pretty obvious thing when it happens.”
Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________

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IT DID NOT HAVE TO HAPPEN IN THE PAST 4 WEEKS ONLY. THIS ITEM IS AN
EXCEPTION TO THE 4 WEEK RULE.
Frequency? _______ FREQUENCY = TOTAL OCCURRENCES SINCE LIFE EVENT.
Duration? _______MIN
Onset? ___/_____
P34. DISSOCIATION
“Since (the event) has s/he had episodes when s/he seems to freeze? We call this dissociation
where you try to snap him/her out of it but s/he was unresponsive.” Y N
IF YES, EXAMPLE:
_____________________________________________________________
_______________________________________________________________
IF YES, ask: “One of the best ways to tell if this was dissociation is if you wave your hand in
front of their face and they don’t even blink. Did you try that?
__________________________________________________________________
If further clarification needed, ask: “Did you try touching him/her on the shoulder to snap
him/her out of it?
__________________________________________________________________
IT DID NOT HAVE TO HAPPEN IN THE PAST 4 WEEKS ONLY. THIS ITEM IS AN
EXCEPTION TO THE 4 WEEK RULE.
Frequency? _______ FREQUENCY = TOTAL OCCURRENCES SINCE LIFE EVENT.
Duration? _______MIN
Onset? ___/_____
P35. PSYCHOLOGICAL DISTRESS AT REMINDERS
“Does s/he get upset when exposed to reminders of the event(s)?”
Y
N
PROBE WITH EXAMPLES THAT ARE SPECIFIC TO THIS CHILD’S EVENT(S). ASK
ABOUT AS MANY SPECIFIC EXAMPLES AS YOU CAN THINK OF UNTIL YOU GET
AN ENDORSEMENT OR RUN OUT OF EXAMPLES.
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y N ! IF NO, SKIP TO P36
RECORD AVOIDANCE AND DISTRESS ITEMS EVEN IF THERE HAVE NOT BEEN ANY
REMINDERS IN THE LAST 4 WEEKS BUT THE MOTHER BELIEVES THE SYMPTOM
WOULD HAVE OCCURRED IF THERE HAD BEEN REMINDERS.
Frequency? _______
Duration? _______MIN
Onset? ___/_____

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P36. PHYSIOLOGICAL DISTRESS AT REMINDERS
“Does s/he get physically distressed when confronted by reminders? Like heart racing, shaking
hands, sweaty, short of breath, or sick to his/her stomach?”
Y
N
PROBE WITH EXAMPLES THAT ARE SPECIFIC TO THIS CHILD’S EVENT(S). ASK
ABOUT AS MANY SPECIFIC EXAMPLES AS YOU CAN THINK OF UNTIL YOU GET
AN ENDORSEMENT OR RUN OUT OF EXAMPLES.
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P37
RECORD AVOIDANCE AND DISTRESS ITEMS EVEN IF THERE HAVE NOT BEEN ANY
REMINDERS IN THE LAST 4 WEEKS BUT THE MOTHER BELIEVES THE SYMPTOM
WOULD HAVE OCCURRED IF THERE HAD BEEN REMINDERS.
Frequency? _______
Duration? _______MIN
Onset? ___/_____
P37. AVOIDANCE OF THOUGHTS, FEELINGS, OR CONVERSATIONS
“Does s/he try to avoid conversations that might remind him/her of the trauma?” “Does s/he try
to avoid private thoughts or feelings that might remind him/her of the trauma?” Y
N
PROBE WITH EXAMPLES THAT ARE SPECIFIC TO THIS CHILD’S EVENT(S).
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P38
RECORD AVOIDANCE AND DISTRESS ITEMS EVEN IF THERE HAVE NOT BEEN ANY
REMINDERS IN THE LAST 4 WEEKS BUT THE MOTHER BELIEVES THE SYMPTOM
WOULD HAVE OCCURRED IF THERE HAD BEEN REMINDERS.
Frequency? _______
Duration? _______MIN
Onset? ___/_____
P38. AVOIDANCE OF PEOPLE, PLACES OR THINGS
“Does s/he try to avoid any things or places that might remind him/her of the trauma? I mean,
can you tell that s/he is trying to avoid a reminder before s/he becomes upset?” Y
N
PROBE WITH EXAMPLES THAT ARE SPECIFIC TO THIS CHILD’S EVENT(S). ASK
ABOUT AS MANY SPECIFIC EXAMPLES AS YOU CAN THINK OF UNTIL YOU GET
AN ENDORSEMENT OR RUN OUT OF EXAMPLES.

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!

IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P40
RECORD AVOIDANCE AND DISTRESS ITEMS EVEN IF THERE HAVE NOT BEEN ANY
REMINDERS IN THE LAST 4 WEEKS BUT THE MOTHER BELIEVES THE SYMPTOM
WOULD HAVE OCCURRED IF THERE HAD BEEN REMINDERS.
Frequency? _______
Duration? _______MIN
Onset? ___/_____
P39. INABILITY TO RECALL AN IMPORTANT ASPECT OF THE EVENT
“Does s/he have difficulty remembering the incident?” “Has s/he seemed to have forgotten the
entire event?” Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
IF YES !“And this was present in the last 4 weeks?” Y

N

P40. LOSS OF INTEREST IN USUAL ACTIVITIES
“Has s/he lost interest in doing things that s/he used to like to do since the trauma?”
IF NO, ASK: “Would you say s/he was not interested in much before the trauma but it’s become
substantially worse since then?”
Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” 0
Frequency? _______
Onset? ___/_____

1 IF NO, SKIP TO P41

P41. RESTRICTED RANGE OF AFFECT: LOSS OF POSITIVE AFFECT
“Since the trauma, s/he doesn’t show as many happy emotions – like smiles or laughs - on
his/her face, or doesn’t show them as strongly as s/he used to?”
Y
N

200
!

IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____

N ! IF NO, SKIP TO P42

P42. RESTRICTED RANGE OF AFFECT: LOSS OF NEGATIVE AFFECT
“And how about as many negative emotions – like sad, mad, or upset?”
Y
IF YES, EXAMPLE:

N

_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P43
Onset? ___/_____
P43. SENSE OF FORESHORTENED FUTURE
“This may seem like an odd question, but has _____ seemed to lose hope for the future. I mean,
she/he said that she/he won’t live long enough to be a big kid or she’ll/he’ll never be able to get
married or get a job.” Y
N
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____

N ! IF NO, SKIP TO P44

P44. DETACHMENT/ SOCIAL WITHDRAWAL
“Since the trauma has s/he become more distant from family members and friends? I mean, s/he
doesn’t want to show affection or maybe even be around people?” Y
N
IF NO, ASK: “Would you say s/he was distant before the trauma but it’s become substantially
worse since then?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____

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!

N ! IF NO, SKIP TO P45

P45. DIFFICULTY INITIATING SLEEP
“Has s/he had a hard time falling asleep since the trauma?”
Y
N
IF NO, ASK: “Did s/he have trouble falling asleep before the trauma but it’s become more
difficult since then?”
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he had difficulty
falling asleep? Did this happen more nights than not during this period of time? Did anything
significant happen in his/her life around the same time that could have affected his/her sleep?”
IF YES to any of the above questions, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Duration? ______MIN
Onset? ___/_____

N ! IF NO, SKIP TO P46

P46. NIGHT WAKING
“Has your child had trouble staying asleep during the night since the trauma?” Y
N
IF CHILD WAKES UP BECAUSE OF NIGHTMARES, CODE NIGHTMARES, NOT NIGHT
WAKING. NIGHT TERRORS DO NOT COUNT AS NIGHT WAKING.
IF NO, ASK: “Did s/he have trouble staying asleep before the trauma but it’s become more
difficult since then?
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he had trouble
staying asleep? Did this happen more nights than not during this period of time? Did anything
significant happen in his/her life around the same time that could have affected his/her sleep?”
IF CHILD WAKES UP BECAUSE OF NIGHTMARES, DO NOT CODE. NIGHT TERRORS
ALSO DO NOT COUNT AS NIGHT WAKING.
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Duration? ______MIN
Onset? ___/_____

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!

N ! IF NO, SKIP TO P46

P47. IRRITABILITY/ ANGER/ TANTRUMS
“Has s/he been more irritable, or had outbursts of anger, or developed extreme temper tantrums
since the trauma?”
Y
N
IF NO, ASK: “Would you say s/he was unusually irritable before the trauma but it’s become
substantially worse since then?”
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he has been very
irritable, or had outbursts of anger, or developed extreme temper tantrums? Was this different
than how your child normally feels or acts?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Duration? ______MIN
Onset? ___/_____

N ! IF NO, SKIP TO P48

P48. DECREASED CONCENTRATION
“Has X had more trouble concentrating since (the event)?”
Y
N
IF NO, ASK: “Did s/he have trouble concentrating before the trauma but it’s become more
difficult since then?”
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he has had trouble
concentrating? Was this different than how your child normally is able to concentrate? Has your
child been diagnosed with ADD or ADHD?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P49

P49. HYPERVIGILANCE
“Has s/he been more “on the alert” for bad things happening than before the trauma? I mean,
does s/he look over her shoulder, looking out for danger?”
Y
N

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!

IF NO, ASK: “Would you say s/he was hypervigilant before the trauma but it’s become
substantially worse since then?”
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he has been “on the
alert” for bad things happenings, like looking over his/her shoulder for danger? Was this
different than how your child normally acts?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____

N ! IF NO, SKIP TO P50

P50. EXAGGERATED STARTLE RESPONSE
“Has ______ startled more easily than before the trauma? I mean, if there’s a loud noise or
someone sneaks up behind him/her, does s/he jump and seem startled more than the average
child that age?”
Y
N
INTERVIEWER OUGHT TO DEMONSTRATE STARTLE RESPONSE
IF NO, ASK: “Would you say s/he was easily startled before the trauma but it’s become
substantially worse since then?”
IF NO TRAUMATIC EVENT(S) ENDORSED, USE FOLLOWING PROBE:
“Has there ever been a time for a period of 4 weeks or longer, that s/he has startled
easily? I mean, if there’s a loud noise or someone sneaks up behind him/her, does s/he jump and
seem startled more than the average child that age? Was this different than how your child
normally acts?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
N ! IF NO, SKIP TO P51
Frequency? _______
Onset? ___/_____
P51. AGGRESSION
“Has your child been more physically aggressive since the trauma? Like hitting, kicking, biting,
or breaking things.”
Y
N
IF NO, ASK: “Would you say s/he was aggressive before the trauma but it’s become
substantially worse since then?”

204
!

IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Onset? ___/_____

N ! IF NO, SKIP TO P52

P52. SEPARATION ANXIETY
“Has s/he developed separation anxiety, that is, become more clingy to you since the trauma?”
Y
N
IF NO, ASK: “Would you say s/he was too clingy before the trauma but it’s become
substantially worse since then?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Duration? ______MIN
Onset? ___/_____

N ! IF NO, SKIP TO P53

P53. NIGHT TERRORS
“Does s/he ever have what we call night terrors? This is where a person screams out like they’re
having a bad dream, but they don’t wake up, and they don’t remember it the next day.”
Y
N
USUALLY OCCUR IN FIRST 60 MINUTES OF SLEEP. NIGHTMARES USUALLY
OCCUR AFTER THE FIRST 90 MINUTES OF SLEEP.
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Frequency? _______
Duration? ______MIN
Onset? ___/_____

N ! IF NO, SKIP TO P54

P54. REGRESSION IN DEVELOPMENTAL SKILLS
“Since the life event, has X gone backward in his/her development?”
Y
“Are there things that s/he could do before the trauma that s/he no longer does?”

205
!

N

ONLY IF CHILD HAD SKILL BEFORE AND LOST IT AFTER LIFE EVENT. E.G.,
TOILETING, LANGUAGE, MOTOR SKILLS.
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____

N ! IF NO, SKIP TO P55

P55. NEW FEARS NOT OBVIOUSLY TRAUMA-RELATED
“Since the trauma, has X developed any new fears about things that don’t seem related to the
trauma?”
Y
N
“What about going to the bathroom alone?” “Afraid of the dark now?” “Other?”
If NO, ask: “Would you say s/he had any of these fears before the trauma but it’s become
substantially worse since then?”
IF YES, EXAMPLE:
_______________________________________________________________
_______________________________________________________________
IF YES, “And this was present in the last 4 weeks?” Y
Onset? ___/_____
!
!!

!

206
!

N ! IF NO, SKIP TO P55

Child Dissociative Checklist (Putnam, 1997)
Below is a list of behaviors that describe children. For each item that describes your child NOW
or WITHIN THE PAST 12 MONTHS, please circle one of the following:
NT = NOT TRUE
ST = SOMEWHAT OR SOMETIMES TRUE
VT = VERY TRUE
1.

Child does not remember or denies traumatic or painful experiences
that are known to have occurred.

NT

ST

VT

2.

Child goes into a daze or trance-like state at times or often appears
“spaced-out.” Teachers may report that he or she “daydreams”
frequently in school.

NT

ST

VT

3.

Child shows rapid changes in personality. He or she may go from
being shy to being outgoing, from feminine to masculine, from
timid to aggressive.

NT

ST

VT

4.

Child is unusually forgetful or confused about things that he or she
should know, e.g. may forget the names of friends, teachers, or
other important people, loses possessions or gets easily lost.

NT

ST

VT

5.

Child has a very poor sense of time. He or she loses track of time
may think that it is morning when it is actually afternoon, gets
confused about what day it is, or becomes confused about when
something has happened.

NT

ST

VT

6.

Child shows marked day-to-day or even hour-to-hour variations
in his or her skills, knowledge, food preferences, athletic
abilities, e.g. changes in handwriting, memory for previously
learned information such as multiplication tables, spelling, use
of tools or artistic ability.

NT

ST

VT

7.

Child shows rapid regressions in age-level behavior, e.g. a 12
year-old starts to use baby-talk, sucks thumb, or draws like
a 4 year-old.

NT

ST

VT

8. Child has a difficult time learning from experience, e.g.,
explanations, normal discipline or punishment do not change
his or her behavior.

NT

ST

VT

9.

NT

ST

VT

Child continues to lie or deny misbehavior even when the evidence
is obvious.

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!

10. Child refers to himself or herself in third person (e.g., as she or her) NT
when talking about self, or at times insists on being called by a
different name. He or she may also claim that things that he or
she did actually happened to another person.

ST

VT

11. Child has rapidly changing physical complaints such as a headache
or upset stomach. For example, he or she may complain of a
headache one minute and seem to forget about it the next.

NT

ST

VT

12. Child is unusually sexually precocious and may attempt
age-inappropriate sexual behavior with older children or adults.

NT

ST

VT

13. Child suffers from unexplained injuries or may even deliberately
injure self at times.

NT

ST

VT

14. Child reports hearing voices that talk to him or her. The voices may NT
be friendly or angry and may come from “imaginary friends” or
sound like the voices of parents, friends, or teachers.

ST

VT

15. Child has a vivid imaginary companion(s). Child may insist that the NT
imaginary companion(s) is responsible for things that he or she
has done.

ST

VT

16. Child has intense outbursts of anger, often without apparent cause
NT
and may display unusual physical strength during these episodes.

ST

VT

17. Child sleepwalks frequently.

NT

ST

VT

18. Child has unusual nighttime experiences, e.g. may report seeing
“ghosts” or that things happen at night that he or she can’t
account for (e.g., broken toys, unexplained injuries).

NT

ST

VT

19. Child frequently talks to him or herself, may use a difference voice
or argue with self at times.

NT

ST

VT

20. Child has two or more distinct and separate personalities that take
control over the child’s behavior.
!

NT

ST

VT

208
!

Stanford-Binet Intelligence Scales for Early Childhood* (Roid, 2003)
Materials: Early SB5 testing kit, including answer response sheets and stimulus presentation
books.
Both non-verbal and verbal working memory will be assessed using the tasks from the Working
Memory Index on the Early SB5 (Roid, 2003). Two sub-tests will assess non-verbal working
memory, including a delayed response task, where the child must watch the examiner hide an
object and then wait before indicating where the hidden object is located, and a block span task
that measures children’s ability to observe and mimic a motor-spatial sequence (the examiner
touching a series of blocks in a predetermined order, which gets progressively more difficult as
the number of blocks included in each trial is increased). Likewise, two sub-tests will assess the
preschoolers’ verbal working memory. The first is a task that requires the children to remember
progressively longer sentences they hear the examiner read and then are required to repeat the
sentences back to the examiner verbatim. A second sub-test of verbal working memory requires
the participants to listen to a sentence posed as a question and repeat only the last word of the
sentence back to the examiner. The Working Memory Index from the Early SB5 has excellent
reported validity and reliability (Strauss et al., 2006).
*Note. The Stanford-Binet is an assessment battery that cannot be fully reproduced here, as each
of the subtests require stimulus materials. Thus, a brief description of this well-validated measure
follows.

209
!

Dimensional Change Card Sort* (Frye et al., 1995)
(Protocol based on Zelazo, 2006)
Materials:

Two sorting trays approximately 11.5 cm long, 9.5 cm wide, and 2 cm deep.
Two vertical pieces of foamcore board with velcro attached (to display affixed
target cards behind sorting trays).
Two laminated target cards: each card is 10.5 cm x 7 cm with velcro attached to
back. One card depicts of blue rabbit and the other depicts a red row boat.
Twelve test cards (same dimensions as target cards). Half (n = 6) depict a red
rabit, while the other half depict a blue row boat.

INTERVIEWER: Place two trays on table, in front of child, and within the child’s reach. Affix
the two target cards to the vertical foam core boards (one per board) and place one board behind
each tray.
“Here’s a blue rabbit and here’s a red boat. Now we are going to play a card game. This is the
color game. In the color game, all the blue ones go here [pointing to the tray with the blue
rabbit], and all of the red ones go here [pointing to the tray with the red boat].”
DEMONSTRATION:
“See, here’s a blue one. So it goes here [place the card face down in the appropriate tray]. If it’s
blue, it goes here [point to tray], but if it’s red it goes there [point to tray].”
“Now here’s a red one. Where does this one go?”
Demonstration Correct?
Y
N
If PRE-TRIAL IS CORRECT, say “Very good! You know how to play the color
game.”
If child POINTS, say “Can you help me put this red one down?”
If NO, say “No, this one’s red, so it has to go over here in the color game. Can
you help me put this red one down?”
NOTE: The cards must be placed face down in the trays. If the child places the card face up, turn
the card over before handing the child another card to sort.
PRE-SWITCH TRIALS:
“Now it’s your turn. So remember, if it’s blue it goes here, but if it’s red it goes there.”
-Select first test card and label it by the relevent dimension only (e.g., say
“Here’s a blue one. Where does it go?”)
-If the child point to a tray, sort the cards for him or her. Ensure that whomever
sorts the cards, that the cards are placed face down in the sorting trays.
-For each new randomly presented card, use one of the following prompts:
“Here’s a blue one, where does this one go?”
“Here’s a red one, where does this one go?”

210
!

“Let’s do another one.”
“Let’s do it again.”
“How about another one?”
-Do not say “Okay” or let the child know if they sorted the cards correctly.
Trial #
1 - Boat
2 – Rabbit
3 – Boat
4 – Rabbit
5 – Rabbit
6 - Boat

Relevant Dimension
Blue
Red
Blue
Red
Red
Blue

Correct Sort?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

POST-SWITCH TRIALS:
“Now we’re going to play a new game. We’re not going to play the color game anymore. We’re
going to play the shape game. In the shape game, all the rabbits go here [pointing to the correct
tray], and all the boats go there [point to the correct tray]. Remember, if it’s a rabbit, put it here
[point], but if it’s a boat put it there [point]. Okay?”
Hand the child the seventh card.
“Where does this one go?” Regardless of the child’s performance, say “Let’s do another one.”
Proceed to administer all six trials in the same manner as the pre-switch trials. Do not indicate
whether the sorts are correct.
Trial #
7 – Rabbit
8 – Boat
9 – Rabbit
10 – Boat
11 – Boat
12 - Rabbit

Relevant Dimension
Rabbit
Boat
Rabbit
Boat
Boat
Rabbit

211
!

Correct Sort?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

Peg Tapping Task (Diamond & Taylor, 1996)
“When I tap one time like this (Experimenter taps once), I want you to tap two times like this
(Experimenter taps twice). Let’s try that.”
Rule #1: “When I tap one time (Experimenter taps once), you tap…(Experimenter holds the
dowel for the child to tap).”
Demonstration Trial #1 Correct?
Y
N
If CORRECT, provide significant praise.
If NO, re-explain and demonstrate the rule again.
“Now, when I tap two times like this (Experimenter taps twice), I want you to tap one time like
this (Experimenter taps once). Let’s try that.”
Rule #2: “When I tap two times (Experimenter taps twice), you tap… (Experimenter holds the
dowel for the child to tap).”
Demonstration Trial #2 Correct?
Y
N
If CORRECT, provide significant praise ! see note below.
If NO, re-explain and demonstrate the rule again.
REGARDLESS OF PERFORMANCE, DO NOT GIVE ANY FEEDBACK ON THE
FOLLOWING TRIALS:
Trial #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

# of Experimenter Taps
1
2
2
1
2
2
1
1
1
2
1
2
2
1
1
2

# of Child Taps

212
!

Trial Correct?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

Day-Night Task (Gerstadt et al., 1994)
Materials: Two stimulus cards – one painted with brightly with a blue sky and a yellow sun and
another painted black with stars and a white moon.
Rule #1: SHOW CHILD ‘NIGHT’ CARD: “When you see this card, I want you to say ‘day’.”
! IF NECESSESARY, PROMPT WITH “What do you say for this one?”
Demonstration Trial #1 Correct?
Y
N
If CORRECT, provide significant praise.
If NO, re-explain and demonstrate the rule again.
Rule #2: SHOW CHILD ‘DAY’ CARD: “When you see this card, I want you to say ‘night’.”
! IF NECESSESARY, PROMPT WITH “What do you say for this one?”
Demonstration Trial #2 Correct?
Y
N
If CORRECT, provide significant praise.
If NO, re-explain and demonstrate the rule again.
REGARDLESS OF PERFORMANCE, DO NOT GIVE ANY FEEDBACK ON THE
FOLLOWING TRIALS:
Trial #

CORRECT
Response

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
!

Card
Moon
Sun
Sun
Moon
Sun
Moon
Moon
Sun
Sun
Moon
Sun
Moon
Moon
Sun
Moon
Sun

Child’s
Response
(D or N)

“Day”
“Night”
“Night”
“Day”
“Night”
“Day”
“Day”
“Night”
“Night”
“Day”
“Night”
“Day”
“Day”
“Night”
“Day”
“Night”

Trial Correct?
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y

!

213
!

N
N
N
N
N
N
N
N
N
N
N
N
N
N
N
N

APPENDIX I
ADDITIONAL CFA FIGURES AND TABLES NOT INCLUDED IN TEXT

214
!

Figure 11
T-scores of Parameter Estimates for CFA Model #1: AC, WM, and IC Latent Factors

Note. Chi-Square = 216.26 (df = 34), p = 0.000; RMSEA = 0.194 (90% C.I. = 0.17 – 0.22);
CFI = 0.38; GFI = 0.77; SRMR = 0.16.
215
!

Table 17
Fit Indices for CFA Model #1: AC, WM, and IC Latent Factors
Degrees of Freedom = 34
Minimum Fit Function Chi-Square = 240.63 (P = 0.0)
Normal Theory Weighted Least Squares Chi-Square = 216.24 (P = 0.0)
Estimated Non-centrality Parameter (NCP) = 182.24
90 Percent Confidence Interval for NCP = (139.50 ; 232.48)
Minimum Fit Function Value = 1.69
Population Discrepancy Function Value (F0) = 1.28
90 Percent Confidence Interval for F0 = (0.98 ; 1.64)
Root Mean Square Error of Approximation (RMSEA) = 0.19
90 Percent Confidence Interval for RMSEA = (0.17 ; 0.22)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.00
Expected Cross-Validation Index (ECVI) = 1.82
90 Percent Confidence Interval for ECVI = (1.52 ; 2.17)
ECVI for Saturated Model = 0.77
ECVI for Independence Model = 2.81
Chi-Square for Independence Model with 45 Degrees of Freedom = 379.48
Independence AIC = 399.48
Model AIC = 258.24
Saturated AIC = 110.00
Independence CAIC = 439.10
Model CAIC = 341.46
Saturated CAIC = 327.96
Normed Fit Index (NFI) = 0.37
Non-Normed Fit Index (NNFI) = 0.18
Parsimony Normed Fit Index (PNFI) = 0.28
Comparative Fit Index (CFI) = 0.38
Incremental Fit Index (IFI) = 0.40
Relative Fit Index (RFI) = 0.16
Critical N (CN) = 34.08
Root Mean Square Residual (RMR) = 16.00
Standardized RMR = 0.16
Goodness of Fit Index (GFI) = 0.77
Adjusted Goodness of Fit Index (AGFI) = 0.62
Parsimony Goodness of Fit Index (PGFI) = 0.47

216
!

Figure 12
T-scores of Parameter Estimates for CFA Model #2: MR, TR, and LA Latent Factors

Note. Chi-Square = 36.84 (df = 32), p = 0.255; RMSEA = 0.033 (90% C.I. = 0.00 – 0.07);
CFI = 0.98; GFI = 0.95; SRMR = 0.05.
217
!

Table 18
Fit Indices for CFA Model #2: MR, TR, and LA Latent Factors
Degrees of Freedom = 32
Minimum Fit Function Chi-Square = 37.74 (P = 0.22)
Normal Theory Weighted Least Squares Chi-Square = 36.84 (P = 0.25)
Estimated Non-centrality Parameter (NCP) = 4.84
90 Percent Confidence Interval for NCP = (0.0 ; 24.08)
Minimum Fit Function Value = 0.27
Population Discrepancy Function Value (F0) = 0.034
90 Percent Confidence Interval for F0 = (0.0 ; 0.17)
Root Mean Square Error of Approximation (RMSEA) = 0.033
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.073)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.72
Expected Cross-Validation Index (ECVI) = 0.58
90 Percent Confidence Interval for ECVI = (0.55 ; 0.72)
ECVI for Saturated Model = 0.77
ECVI for Independence Model = 2.81
Chi-Square for Independence Model with 45 Degrees of Freedom = 379.48
Independence AIC = 399.48
Model AIC = 82.84
Saturated AIC = 110.00
Independence CAIC = 439.10
Model CAIC = 173.98
Saturated CAIC = 327.96
Normed Fit Index (NFI) = 0.90
Non-Normed Fit Index (NNFI) = 0.98
Parsimony Normed Fit Index (PNFI) = 0.64
Comparative Fit Index (CFI) = 0.98
Incremental Fit Index (IFI) = 0.98
Relative Fit Index (RFI) = 0.86
Critical N (CN) = 202.25
Root Mean Square Residual (RMR) = 3.06
Standardized RMR = 0.050
Goodness of Fit Index (GFI) = 0.95
Adjusted Goodness of Fit Index (AGFI) = 0.92
Parsimony Goodness of Fit Index (PGFI) = 0.55

218
!

APPENDIX J
ADDITIONAL SEM FIGURES AND TABLES NOT INCLUDED IN TEXT

219
!

Figure 13
T-scores for SEM #1: Maternal Reported EF and Behavior Problems

2

Note. Chi-Square = 14.81 (df = 9), p = 0.096; RMSEA = 0.067 (90% C.I. = 0.00 – 0.13); CFI = 0.99; GFI = 0.97; SRMR = 0.024; R
for Behavior Problems = 0.83.

220
!

Table 19
Fit Indices for SEM #1: Maternal Reported EF and Behavior Problems
Degrees of Freedom = 9
Minimum Fit Function Chi-Square = 14.96 (P = 0.092)
Normal Theory Weighted Least Squares Chi-Square = 14.81 (P = 0.096)
Estimated Non-centrality Parameter (NCP) = 5.81
90 Percent Confidence Interval for NCP = (0.0 ; 20.49)
Minimum Fit Function Value = 0.11
Population Discrepancy Function Value (F0) = 0.041
90 Percent Confidence Interval for F0 = (0.0 ; 0.14)
Root Mean Square Error of Approximation (RMSEA) = 0.067
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.13)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.28
Expected Cross-Validation Index (ECVI) = 0.37
90 Percent Confidence Interval for ECVI = (0.33 ; 0.48)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 4.65
Chi-Square for Independence Model with 21 Degrees of Freedom = 646.13
Independence AIC = 660.13
Model AIC = 52.81
Saturated AIC = 56.00
Independence CAIC = 687.87
Model CAIC = 128.10
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 0.98
Non-Normed Fit Index (NNFI) = 0.98
Parsimony Normed Fit Index (PNFI) = 0.42
Comparative Fit Index (CFI) = 0.99
Incremental Fit Index (IFI) = 0.99
Relative Fit Index (RFI) = 0.95
Critical N (CN) = 206.68
Root Mean Square Residual (RMR) = 1.66
Standardized RMR = 0.024
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.91
Parsimony Goodness of Fit Index (PGFI) = 0.31

221
!

Figure 14
T-scores for SEM #2: Teacher Reported EF and Behavior Problems

Note. Chi-Square = 17.10 (df = 11), p = 0.105; RMSEA = 0.063 (90% C.I. = 0.00 – 0.12); CFI = 0.98; GFI = 0.97; SRMR = 0.033; R
for Behavior Problems = 1.00 (variance for Behavior Problems was not estimated).

222
!

2

Table 20
Fit Indices for SEM #2: Teacher Reported EF and Behavior Problems
Degrees of Freedom = 11
Minimum Fit Function Chi-Square = 18.32 (P = 0.074)
Normal Theory Weighted Least Squares Chi-Square = 17.10 (P = 0.10)
Estimated Non-centrality Parameter (NCP) = 6.10
90 Percent Confidence Interval for NCP = (0.0 ; 21.44)
Minimum Fit Function Value = 0.13
Population Discrepancy Function Value (F0) = 0.043
90 Percent Confidence Interval for F0 = (0.0 ; 0.15)
Root Mean Square Error of Approximation (RMSEA) = 0.063
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.12)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.32
Expected Cross-Validation Index (ECVI) = 0.36
90 Percent Confidence Interval for ECVI = (0.32 ; 0.47)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 2.61
Chi-Square for Independence Model with 21 Degrees of Freedom = 356.76
Independence AIC = 370.76
Model AIC = 51.10
Saturated AIC = 56.00
Independence CAIC = 398.50
Model CAIC = 118.47
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 0.95
Non-Normed Fit Index (NNFI) = 0.96
Parsimony Normed Fit Index (PNFI) = 0.50
Comparative Fit Index (CFI) = 0.98
Incremental Fit Index (IFI) = 0.98
Relative Fit Index (RFI) = 0.90
Critical N (CN) = 192.64
Root Mean Square Residual (RMR) = 3.28
Standardized RMR = 0.033
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.92
Parsimony Goodness of Fit Index (PGFI) = 0.38

223
!

Figure 15
Standardized Estimates for Attempted SEM Replication of Milot et al.’s (2010) Findings: Teacher Reported Behavior Problems

Note. Chi-Square = 14.26 (df = 7), p = 0.047; RMSEA = 0.085 (90% C.I. = 0.01 – 0.15); CFI = 0.96; GFI = 0.97; SRMR = 0.031.
†
* p < .05; significance test is not conducted.

224
!

Figure 16
T-scores for Attempted SEM Replication of Milot et al.’s (2010) Findings: Teacher Reported Behavior Problems

Note: Chi-Square = 14.26 (df = 7), p = 0.047; RMSEA = 0.085 (90% C.I. = 0.01 – 0.15); CFI = 0.96; GFI = 0.97; SRMR = 0.031.

225
!

Table 21
Fit Indices for Attempted SEM Replication of Milot et al.’s (2010) Findings: Teacher Reported
Behavior Problems
Degrees of Freedom = 7
Minimum Fit Function Chi-Square = 15.19 (P = 0.034)
Normal Theory Weighted Least Squares Chi-Square = 14.26 (P = 0.047)
Estimated Non-centrality Parameter (NCP) = 7.26
90 Percent Confidence Interval for NCP = (0.094 ; 22.12)
Minimum Fit Function Value = 0.11
Population Discrepancy Function Value (F0) = 0.051
90 Percent Confidence Interval for F0 = (0.00066 ; 0.16)
Root Mean Square Error of Approximation (RMSEA) = 0.085
90 Percent Confidence Interval for RMSEA = (0.0097 ; 0.15)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.16
Expected Cross-Validation Index (ECVI) = 0.30
90 Percent Confidence Interval for ECVI = (0.25 ; 0.40)
ECVI for Saturated Model = 0.30
ECVI for Independence Model = 1.62
Chi-Square for Independence Model with 15 Degrees of Freedom = 217.90
Independence AIC = 229.90
Model AIC = 42.26
Saturated AIC = 42.00
Independence CAIC = 253.68
Model CAIC = 97.73
Saturated CAIC = 125.22
Normed Fit Index (NFI) = 0.93
Non-Normed Fit Index (NNFI) = 0.91
Parsimony Normed Fit Index (PNFI) = 0.43
Comparative Fit Index (CFI) = 0.96
Incremental Fit Index (IFI) = 0.96
Relative Fit Index (RFI) = 0.85
Critical N (CN) = 173.69
Root Mean Square Residual (RMR) = 3.10
Standardized RMR = 0.031
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.90
Parsimony Goodness of Fit Index (PGFI) = 0.32

226
!

Figure 17
Standardized Estimates for Attempted SEM Replication of Milot et al.’s (2010) Findings: Maternal Reported Behavior Problems

Note. Chi-Square = 14.32 (df = 7), p = 0.046; RMSEA = 0.086 (90% C.I. = 0.01 – 0.15); CFI = 0.98; GFI = 0.97; SRMR = 0.025.
†
* p < .05; significance test is not conducted.

227
!

Figure 18
T-scores for Attempted SEM Replication of Milot et al.’s (2010) Findings: Maternal Reported Behavior Problems

Note. Chi-Square = 14.32 (df = 7), p = 0.046; RMSEA = 0.086 (90% C.I. = 0.01 – 0.15); CFI = 0.98; GFI = 0.97; SRMR = 0.025.

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Table 22
Fit Indices for Attempted SEM Replication of Milot et al.’s (2010) Findings: Maternal Reported
Behavior Problems
Degrees of Freedom = 7
Minimum Fit Function Chi-Square = 14.59 (P = 0.042)
Normal Theory Weighted Least Squares Chi-Square = 14.32 (P = 0.046)
Estimated Non-centrality Parameter (NCP) = 7.32
90 Percent Confidence Interval for NCP = (0.13 ; 22.22)
Minimum Fit Function Value = 0.10
Population Discrepancy Function Value (F0) = 0.052
90 Percent Confidence Interval for F0 = (0.00091 ; 0.16)
Root Mean Square Error of Approximation (RMSEA) = 0.086
90 Percent Confidence Interval for RMSEA = (0.011 ; 0.15)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.15
Expected Cross-Validation Index (ECVI) = 0.30
90 Percent Confidence Interval for ECVI = (0.25 ; 0.40)
ECVI for Saturated Model = 0.30
ECVI for Independence Model = 2.83
Chi-Square for Independence Model with 15 Degrees of Freedom = 389.98
Independence AIC = 401.98
Model AIC = 42.32
Saturated AIC = 42.00
Independence CAIC = 425.76
Model CAIC = 97.80
Saturated CAIC = 125.22
Normed Fit Index (NFI) = 0.96
Non-Normed Fit Index (NNFI) = 0.96
Parsimony Normed Fit Index (PNFI) = 0.45
Comparative Fit Index (CFI) = 0.98
Incremental Fit Index (IFI) = 0.98
Relative Fit Index (RFI) = 0.92
Critical N (CN) = 180.83
Root Mean Square Residual (RMR) = 1.60
Standardized RMR = 0.025
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.90
Parsimony Goodness of Fit Index (PGFI) = 0.32

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Figure 19
T-scores for SEM #3: Maternal Reported EF and Teacher Reported Behavior Problems

2

Note. Chi-Square = 14.44 (df = 10), p = 0.154; RMSEA = 0.056 (90% C.I. = 0.00 – 0.11); CFI = 0.98; GFI = 0.97; SRMR = 0.028; R
for Behavior Problems = 0.12.

230
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Table 23
Fit Indices for SEM #3: Maternal Reported EF and Teacher Reported Behavior Problems
Degrees of Freedom = 10
Minimum Fit Function Chi-Square = 15.86 (P = 0.10)
Normal Theory Weighted Least Squares Chi-Square = 14.44 (P = 0.15)
Estimated Non-centrality Parameter (NCP) = 4.44
90 Percent Confidence Interval for NCP = (0.0 ; 18.72)
Minimum Fit Function Value = 0.11
Population Discrepancy Function Value (F0) = 0.031
90 Percent Confidence Interval for F0 = (0.0 ; 0.13)
Root Mean Square Error of Approximation (RMSEA) = 0.056
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.11)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.39
Expected Cross-Validation Index (ECVI) = 0.36
90 Percent Confidence Interval for ECVI = (0.32 ; 0.46)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 2.52
Chi-Square for Independence Model with 21 Degrees of Freedom = 343.73
Independence AIC = 357.73
Model AIC = 50.44
Saturated AIC = 56.00
Independence CAIC = 385.47
Model CAIC = 121.78
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 0.95
Non-Normed Fit Index (NNFI) = 0.96
Parsimony Normed Fit Index (PNFI) = 0.45
Comparative Fit Index (CFI) = 0.98
Incremental Fit Index (IFI) = 0.98
Relative Fit Index (RFI) = 0.90
Critical N (CN) = 208.82
Root Mean Square Residual (RMR) = 2.65
Standardized RMR = 0.028
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.92
Parsimony Goodness of Fit Index (PGFI) = 0.35

231
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Figure 20
T-scores for SEM #4: Teacher Reported EF and Maternal Reported Behavior Problems

2

Note. Chi-Square = 14.73 (df = 10), p = 0.142; RMSEA = 0.058 (90% C.I. = 0.00 – 0.12); CFI = 0.99; GFI = 0.97; SRMR = 0.026; R
for Behavior Problems = 0.51.

232
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Table 24
Fit Indices for SEM #4: Teacher Reported EF and Maternal Reported Behavior Problems
Degrees of Freedom = 10
Minimum Fit Function Chi-Square = 14.78 (P = 0.14)
Normal Theory Weighted Least Squares Chi-Square = 14.73 (P = 0.14)
Estimated Non-centrality Parameter (NCP) = 4.73
90 Percent Confidence Interval for NCP = (0.0 ; 19.15)
Minimum Fit Function Value = 0.10
Population Discrepancy Function Value (F0) = 0.033
90 Percent Confidence Interval for F0 = (0.0 ; 0.13)
Root Mean Square Error of Approximation (RMSEA) = 0.058
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.12)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.37
Expected Cross-Validation Index (ECVI) = 0.36
90 Percent Confidence Interval for ECVI = (0.32 ; 0.46)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 2.88
Chi-Square for Independence Model with 21 Degrees of Freedom = 394.84
Independence AIC = 408.84
Model AIC = 50.73
Saturated AIC = 56.00
Independence CAIC = 436.58
Model CAIC = 122.06
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 0.96
Non-Normed Fit Index (NNFI) = 0.97
Parsimony Normed Fit Index (PNFI) = 0.46
Comparative Fit Index (CFI) = 0.99
Incremental Fit Index (IFI) = 0.99
Relative Fit Index (RFI) = 0.92
Critical N (CN) = 224.05
Root Mean Square Residual (RMR) = 1.81
Standardized RMR = 0.026
Goodness of Fit Index (GFI) = 0.97
Adjusted Goodness of Fit Index (AGFI) = 0.92
Parsimony Goodness of Fit Index (PGFI) = 0.35

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Figure 21
T-scores for SEM #5: Lab Assessed EF and Maternal Reported Behavior Problems

2

Note. Chi-Square = 13.67 (df = 10), p = 0.189; RMSEA = 0.051 (90% C.I. = 0.00 – 0.11); CFI = 1.00; GFI = 1.00; SRMR = 0.023; R
for Behavior Problems = 1.00 (variance for Behavior Problems was not estimated).

234
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Table 25
Fit Indices for SEM #5: Lab Assessed EF and Maternal Reported Behavior Problems
Degrees of Freedom = 10
Normal Theory Weighted Least Squares Chi-Square = 13.67 (P = 0.19)
Estimated Non-centrality Parameter (NCP) = 3.67
90 Percent Confidence Interval for NCP = (0.0 ; 17.55)
Minimum Fit Function Value = 0.014
Population Discrepancy Function Value (F0) = 0.026
90 Percent Confidence Interval for F0 = (0.0 ; 0.12)
Root Mean Square Error of Approximation (RMSEA) = 0.051
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.11)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.44
Expected Cross-Validation Index (ECVI) = 0.35
90 Percent Confidence Interval for ECVI = (0.32 ; 0.45)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 2.91
Chi-Square for Independence Model with 21 Degrees of Freedom = 398.65
Independence AIC = 412.65
Model AIC = 49.67
Saturated AIC = 56.00
Independence CAIC = 440.39
Model CAIC = 121.00
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 1.00
Non-Normed Fit Index (NNFI) = 1.06
Parsimony Normed Fit Index (PNFI) = 0.48
Comparative Fit Index (CFI) = 1.00
Incremental Fit Index (IFI) = 1.03
Relative Fit Index (RFI) = 1.00
Root Mean Square Residual (RMR) = 0.023
Standardized RMR = 0.023
Goodness of Fit Index (GFI) = 1.00
Adjusted Goodness of Fit Index (AGFI) = 0.99
Parsimony Goodness of Fit Index (PGFI) = 0.36

235
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Figure 22
T-scores for SEM #6: Lab Assessed EF and Teacher Reported Behavior Problems

2

Note. Chi-Square = 19.32 (df = 11), p = 0.056; RMSEA = 0.073 (90% C.I. = 0.00 – 0.13); CFI = 0.95; GFI = 0.96; SRMR = 0.044; R
for Behavior Problems = 0.10.

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Table 26
Fit Indices for SEM #6: Lab Assessed EF and Teacher Reported Behavior Problems
Degrees of Freedom = 11
Minimum Fit Function Chi-Square = 21.05 (P = 0.033)
Normal Theory Weighted Least Squares Chi-Square = 19.32 (P = 0.056)
Estimated Non-centrality Parameter (NCP) = 8.32
90 Percent Confidence Interval for NCP = (0.0 ; 24.63)
Minimum Fit Function Value = 0.15
Population Discrepancy Function Value (F0) = 0.059
90 Percent Confidence Interval for F0 = (0.0 ; 0.17)
Root Mean Square Error of Approximation (RMSEA) = 0.073
90 Percent Confidence Interval for RMSEA = (0.0 ; 0.13)
P-Value for Test of Close Fit (RMSEA < 0.05) = 0.22
Expected Cross-Validation Index (ECVI) = 0.38
90 Percent Confidence Interval for ECVI = (0.32 ; 0.49)
ECVI for Saturated Model = 0.39
ECVI for Independence Model = 1.66
Chi-Square for Independence Model with 21 Degrees of Freedom = 221.34
Independence AIC = 235.34
Model AIC = 53.32
Saturated AIC = 56.00
Independence CAIC = 263.08
Model CAIC = 120.69
Saturated CAIC = 166.96
Normed Fit Index (NFI) = 0.90
Non-Normed Fit Index (NNFI) = 0.90
Parsimony Normed Fit Index (PNFI) = 0.47
Comparative Fit Index (CFI) = 0.95
Incremental Fit Index (IFI) = 0.95
Relative Fit Index (RFI) = 0.82
Critical N (CN) = 167.83
Root Mean Square Residual (RMR) = 0.044
Standardized RMR = 0.044
Goodness of Fit Index (GFI) = 0.96
Adjusted Goodness of Fit Index (AGFI) = 0.90
Parsimony Goodness of Fit Index (PGFI) = 0.38

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REFERENCES

238
!

REFERENCES
Achenbach, T., & Rescorla, L. (2000). Manual for the ASEBA Preschool Forms and Profiles.
Burlington: University of Vermont, Research Center for Children, Youth, and Families.
American Psychiatric Association. (1983). Diagnostic and statistical manual of mental disorders
(3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders
(Revised 3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(Revised 4th ed.). Washington, DC: Author
Anderson, P. (2002). Assessment and development of executive function (EF) during childhood.
Child Neuropsychology, 8(2), 71 – 82.
Anderson, S. W., Damasio, H., Tranel, D., & Damasio, A. R. (2000). Long-term sequealae of
prefrontal cortex damage acquired in early childhood. Developmental Neuropsychology,
18(3), 281-296.
Anderson, V. (1998). Assessing executive functions in children: Biological, psychological, and
developmental considerations. Neuropsychological Rehabilitation, 8(3), 319 – 349.
Baddeley, A. D. (2000). The episodic buffer: A new component of working memory? Trends in
Cognitive Sciences, 4(11), 417 – 423.
Baddeley, A. D. (2003). Working memory: Looking back and looking forward. Nature Reviews
Neuroscience, 4(10), 829 – 839.
Baddeley, A. D., & Hitch, G. (1974). Working memory. In G. A. Bower (Ed.), Recent advances
in learning and motivation. Vol. 8. New York: Academic Press.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions:
Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65 – 94.
Barkley, R. A. (2001). The executive functions and self-regulation: An evolutionary
neuropsychological perspective. Neuropsychology Review, 11(1), 1-29.
Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with
maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry,
159(3), 483-486.

239
!

Blair, C. (2010). Stress and the development of self-regulation in context. Child Development
Perspectives, 4(3), 181 – 188.
Blair, C., & Peters, R. (2003). Physiological and neurocognitive correlates of adaptive behavior
in preschool among children in Head Start. Developmental Neuropsychology, 24(1), 479
– 497.
Breiding, M. J., Black, M. C., & Ryan, G. W. (2008) Prevalence and risk factors of intimate
partner violence in eighteen U.S. states/territories, 2005. American Journal of
Preventative Medicine, 34(2), 112 – 118. doi:10.1016/j.amepre.2007.10.001
Bremner, J. D. (1999). Acute and chronic responses to psychological trauma: Where do we go
from here? American Journal of Psychiatry, 156(3), 349 – 351.
Briggs-Gowan, M. J., Carter, A. S., Clark, R., Augustyn, M., McCarthy, K. J., & Ford, J. D.
(2010). Exposure to potentially traumatic events in early childhood: Differential links to
emergent psychopathology. The Journal of Child Psychology and Psychiatry, 51(10),
1132 – 1140. doi:10.1111/j.1469-7610.2010.02256.x
Brewin, C. R. (2008). What is it that a neurobiological model of PTSD must explain? In E. R.
DeKloet & E. Vermetten (Eds.), Stress Hormones and Post Traumatic Stress Disorder:
Basic Studies and Clinical Perspectives (Vol. 167, pp. 217-228). Amsterdam: Elsevier
Science.
Brewin, C. R., Kleiner, J. S., Vasterling, J. J., & Field, A. P. (2007). Memory for emotionally
neutral information in posttraumatic stress disorder: A meta-analytic investigation.
Journal of Abnormal Psychology, 116, 448 – 463.
Brocki, K. C., Nyberg, L., Thorell, L. B., & Bohlin, G. (2007). Early concurrent and longitudinal
symptoms of ADHD and ODD: Relations to different types of inhibitory control and
working memory. Journal of Child Psychology and Psychiatry, 48(10), 1033 – 1041.
doi:10.1111/j.1469-7610.2007.01811.x
Bruce, J., Fisher, P. A., Pears, K. C., & Levine, S. (2009). Morning cortisol levels in preschoolaged foster children: Differential effects of maltreatment type. Developmental
Psychobiology, 51, 14 – 23. doi:10.1002/dev.20333
Caetano, R., Field, C. A., Ramisetty-Mikler, S., & McGrath, C. (2005). The 5-year course of
intimate partner violence among white, black, and Hispanic couples in the United States.
Journal of Interpersonal Violence, 20(9), 1039 – 1057. doi:10.1177/0886260505277783
Caetano, R., Vaeth, P. A., & Ramisetty-Mikler, S. (2008). Intimate partner violence victim and
perpetrator characteristics among couples in the United States. Journal of Family
Violence, 23, 507 – 518. doi:10.1007/s10896-008-9178-3

240
!

Camille, G., Vargas, S., Ryan, S., & Barnett, W. S. (2010). Meta-analysis of the effects of early
education interventions on cognitive and social development. Teachers College Record,
112(3), 579 – 620.
Carlson, S. M. (2005). Developmentally sensitive measures of executive functioning in
preschool children. Developmental Neuropsychology, 28(2), 595 – 616.
Carlson, S. M., & Moses, L. J. (2001). Individual differences in inhibitory control and children's
theory of mind. Child Development, 72(4), 1032-1053.
Carrion, V. G., Garrett, A., Menon, V., Weems, C. F., & Reiss, A. L. (2008). Posttraumatic stress
symptoms and brain function during a response-inhibition task: An fMRI study in youth.
Depression and Anxiety, 25(6), 514 – 526. doi:10.1002/da.20346
Carver, C. S. & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective
responses to impending reward and punishment: The BIS/BAS scales. Journal of
Personality and Social Psychology, 67(2), 319 – 333.
Ciairano, S., Visu-Petra, L., & Settanni, M. (2007). Executive inhibitory control and cooperative
behavior during early school years: A follow-up study. Journal of Abnormal Child
Psychology, 35, 335 – 345. doi:10.1007/s10802-006-9094-z
Cicchetti, D., & Rogosh, F. A. (2001). The impact of child maltreatment and psychopathology
on neuroendocrine functioning. Development and Psychopathology, 13, 783 – 804.
Cook, A., Spinazzola, P., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., … van der Kolk, B.
(2005). Complex trauma in children and adolescents. Psychiatric Annals, 35(5), 390-398.
Crone, E. A., Vendel, I., & van der Molen. (2003). Decision-making in disinhibited adolescents
and adults: Insensitivity to future consequences or driven by immediate reward?
Personality and Individual Differences, 35, 1625 – 1641. doi:10.1016/S01918869(02)00386-0
Davidson, M. C., Amso, D., Anderson, L. C., & Diamond, A. (2006). Development of cognitive
control and executive functions from 4 to 13 years: Evidence from manipulations of
memory, inhibition, and task switching. Neuropsychologia, 44(11), 2037 – 2078.
Davis, A. S., Pierson, E. E., & Finch, W. H. (2011). A canonical correlation analysis of
intelligence and executive functioning. Applied Neuropsychology, 18(1), 61 – 68.
doi:10.1080/09084282.2010.523392
De Bellis, M D. (2001). Developmental traumatology: The psychobiological development of
maltreated children and its implications for research, treatment, and policy. Development
and Psychopathology, 13, 539 – 564.
De Bellis, M. D., Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H. Boring, A. M., …

241
!

Ryan, N. D. (1999a). Developmental traumatology Part I: Biological Stress Systems.
Biological Psychiatry, 45, 1259 – 1270.
De Bellis, M D., Hooper, S. R., Spratt, E. G., & Woolley, D. P. (2010a). Neuropsychological
findings in childhood neglect and their relationships to pediatric PTSD. Journal of the
International Neuropsychological Society, 15, 868 – 878.
doi:10.1017/S1355617709990464
De Bellis, M. D., Hooper, S. R., Woolley, D. P., & Shenk, C. E. (2010b). Demographic,
maltreatment, and neurobiological correlates of PTSD symptoms in children and
adolescents. Journal of Pediatric Psychology, 35(5), 570 – 577.
doi:10.1093/jpepsy/jsp116
De Bellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., …
Ryan, N. D. (1999b). Developmental traumatology Part II: Brain development.
Biological Psychiatry, 45, 1271 – 1284.
De Bellis, M. D., Keshavan, M. S., Shifflett, H., Iyengar, S. R., Beers, J. H., & Moritz, G.
(2002). Brain structures in pediatric maltreatment-related posttraumatic stress disorder: A
sociodemographically matched study. Biological Psychiatry, 52, 1066 – 1078.
De Luca, C. R., Wood, S. J., Anderson, V., Buchanan, J., Proffitt, T. M., Mahony, K., &
Pantelis, C. (2003). Normative data from the Cantab I: Development of executive
function over the lifespan. Journal of Clinical and Experimental Neuropsychology, 25(2),
242 – 254. doi:10.1076/jcen.25.2.242.13639
Dennis, T. A., & Brotman, L. M. (2003). Effortful control, attention, and aggressive behavior in
preschoolers at risk for conduct problems. Annual New York Academy of Science, 1008,
252 – 255. doi:10.1196/annals.1301.026
DePrince, A.P., & Freyd, J.J. (2001). Memory and dissociative tendencies: The roles of
attentional context and word meaning. Journal of Trauma and Dissociation, 2, 67-82.
DePrince, A. P., & Freyd, J. J. (2007). Trauma-induced dissociation. In M. J. Friedman, T.M.
Keane, & P. A. Resick (Eds.) Handbook of PTSD: Science and Practice (pp. 135 – 150).
New York: Guilford Press.
DePrince, A. P., Weinzierl, K. M., & Combs, M. D. (2009). Executive function performance and
trauma exposure in a community sample of children. Child Abuse & Neglect, 33(6), 353361. doi:10.1016/j.chiabu.2008.08.002
Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by
attentional control. Journal of Abnormal Psychology, 11(2), 225 – 236.
doi:10.1037//0021-843X.111.2.225
Derryberry, D., & Rothbart, M. K. (1997). Reactive and effortful processes in the organization of

242
!

temperament. Development and Psychopathology, 9, 633–652.
Diamond, A. (2002). Normal development of prefrontal cortex from birth to young adulthood:
Cognitive Functions, anatomy, and biochemistry. In D. Stuss & R. Knight (Eds.)
Principles of Front Lobe Function (pp. 466 – 503). Oxford University Press: New York.
Diamond, A. (2006). The early development of executive functions. In E. Bialystok & F. I. Craik
(Eds.) Lifespan Cognition: Mechanisms of Change (pp. 70 – 95). Oxford University
Press: New York.
Diamond, A., & Taylor, C. (1996). Development of an aspect of executive control: Development
of the abilities to remember what I said and to “do as I say, not as I do.” Developmental
Psychobiology, 29(4), 315 – 334.
Duncan, G. J., Claessens, A., Huston, A. C., Pagani, L. S., Engel, M., Sexton, H., … Duckworth,
K. (2007). School readiness and later achievement. Developmental Psychology, 43(6),
1428 – 1446. doi:10.1037/0012-1649.43.6.1428
Edleson, J. L. (1999). Children’s witnessing of adult domestic violence. Journal of Interpersonal
Violence, 14(8), 839 – 870.
Eisenberg, N., Spinrad, T. L., Eggum, N. D., Silva, K. M., Reiser, M., Hofer, C., … Michalik, N.
(2010). Relations among maternal socialization, effortful control, and maladjustment in
early childhood. Development and Psychopathology, 22, 507 – 525.
doi:10.1017/S0954579410000246
Eisenberg, N., Valiente, C., Spinrad, T. L., Cumberland, A., Liew, J., Reiser, M, … Losoya, S.
H. (2009). Longitudinal relations of children’s effortful control, impulsivity, and negative
emotionality to their externalizing, internalizing, and co-occurring behavior problems.
Developmental Psychology, 45(4), 988 – 1008. doi:10.1037/a0016213
Evans, S. E., Davies, C., & DiLillo, D. (2008). Exposure to domestic violence: A meta-analysis
of child and adolescent outcomes. Aggression and Violent Behavior, 13, 131 – 140.
doi:10.1016/j.avb.2008.02.005
Fantuzzo, J., Boruch, R., Beriama, A., Atkins, M., & Marcus, S. (1997). Domestic violence and
children: Prevalence and risk in five major U.S. cities. Journal of the American Academy
of Child and Adolescent Psychiatry, 36(1), 116 – 122.
Fantuzzo, J. W., Fusco, R. A., Mohr, W. K., & Perry, M. A. (2007). Domestic violence and
children’s presence: A population-based study of law enforcement surveillance of
domestic violence. Journal of Family Violence, 22, 331 – 340. doi:10.1007/s10896-0079080-4
Fantuzzo, J. W., & Mohr, W. K. (1999). Prevalence and effects of child exposure to domestic
violence. The Future of Children, 9(3), 21 – 32.

243
!

Field, A. (2009). Discovering statistics using SPSS. London: Sage Publications, Ltd.
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Poly-victimization: A neglected
component in child victimization. Child Abuse & Neglect, 31, 7 – 26.
doi:10.1016/j.chiabu.2006.06.008
Freyd, J. J. (1996). Betrayal trauma theory: The logic of forgetting childhood abuse. Cambridge,
MA: Harvard University Press.
Fry, D. Zelazo, P. D., & Palfai, T. (1995). Theory of mind and rule-based reasoning. Cognitive
Development, 10, 483 – 527.
Fusco, R. A., & Fantuzzo, J. W. (2009). Domestic violence crimes and children: A populationsbased investigation of direct sensory exposure and the nature of involvement. Children
and Youth Services Review, 31, 249 – 256. doi:10.1016/j.childyouth.2008.07.017
Garon, N., Bryson, S. E., & Smith, I. M. (2008). Executive function in preschoolers: A review
using an integrative framework. Psychological Bulletin, 134(1), 31 – 60.
doi:10.1037/0033-2909.134.1.31
Gathercole, S. E. (1998). The development of memory. Journal of Child Psychology and
Psychiatry, 39(1), 3-27.
Gazzinga, M. S., Ivy, R. B., & Mangun, G. R. (2009). Cognitive Neuroscience: The Biology of
the Mind. New York: W. W. Norton & Company.
Gerstadt, C. L., Hong, Y. J., & Diamond, A. (1994). The relationship between cognition and
action: Performance of children 3.5 – 7 years old on a Stroop-like day-night test.
Cognition, 53, 129 - 153.
Gioia, G., Espy, K. A., & Isquith, P. (2003). Behavior Rating Inventory of Executive Function –
Preschool Version (BRIEF-P). Lutz, FL: Psychological Assessment Resources.
Gioia, G., Isquith, P., & Guy, S. (2001). Assessment of executive functions in children with
neurological impairment. In R. Simeonsson & S. Rosenthal (Eds.) Psychological and
developmental assessment: Children with disabilities and chronic conditions (pp. 317 –
356). New York: The Guildford Press.
Golier, J., & Yehuda, R. (2002). Neuropsychological processes in post-traumatic stress disorder.
Psychiatric Clinics of North America, 25(2), 295-315.
Goodlin, W. E., & Dunn, C. S. (2010). Three patterns of domestic violence in households: Single
victimization, repeat victimization, and co-occurring victimization. Journal of Family
Violence, 25, 107 – 122. doi:10.1007/s10896-009-9274-z

244
!

Graham-Bermann, S. A., Howell, K., Habarth, J., Krishnan, S., Loree, A., & Bermann, E. A.
(2008). Toward assessing traumatic events and stress symptoms in preschool children
from low-income families. American Journal of Orthopsychiatry, 78(2), 220 – 228.
doi:10.1037/a0013977
Graham-Bermann, S. A., & Levendosky, A. A. (1998). Traumatic stress symptoms in children of
battered women. Journal of Interpersonal Violence, 13, 111 – 127.
doi:10.1177/088626098013001007
Graham-Bermann, S. A., & Seng, J. (2005). Violence exposure and traumatic stress symptoms as
additional predictors of health problems in high-risk children. The Journal of Pediatrics,
146(3), 349 – 354. doi:10.1016/j.jpeds.2004.10.065
Geurts, H. M., van der Oord, S., & Crone, E. A. (2006). Hot and cool aspects of cognitive
control in children with ADHD: Decision-making and inhibition. Journal of Abnormal
Child Psychology, 34, 813 – 824. doi:10.1007/s10802-006-9059-2
Hamby, S., Finkelhor, D., Turner, H., & Ormrod, R. (2010). The overlap of witnessing partner
violence with child maltreatment and other victimizations in a nationally representative
survey of youth. Child Abuse & Neglect, 34, 734 – 741.
doi:10.1016/j.chiabu.2010.03.001
Hanania, R., & Smith, L. B. (2010). Selective attention and attention switching: Towards a
unified developmental approach. Developmental Science, 13(4), 622 – 635.
doi:10.1111/j.1467-7687.2009.00921.x
Hankin, B. L., Badanes, L. S., Abela, J. R., & Watamura, S. W. (2010). Hypothalamic-PituitaryAdrenal Axis Dysregulation in Dysphoric Children and Adolescents: Cortisol Reactivity
to Psychosocial Stress from Preschool Through Middle Adolescence. Biological
Psychiatry, 68, 484 – 490. doi:10.1016/j.biopsych.2010.04.004
Heim, C., Ehlert, U., & Hellhammer, D. H. (2000). The potential role of hypocortisolism in the
pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25(1), 135.
Heim, C., Meinlschmidt, G., & Nemeroff, C. (2003). Neurobiology of early-life stress.
Psychiatric Annals, 33(1), 18 – 26.
Holmes, A., & Wellman, C.L. (2009). Stress-induced prefrontal reorganization and executive
dysfunction in rodents. Neuroscience and Biobehavioral Reviews, 33, 773 – 783.
Hrabok, M., Kerns, K. A., & Muller, U. (2007). The vigilance, orienting, and executive attention
networks in 4-year old children. Child Neuropsychology, 13, 408 – 421.
doi:10.1080/13825580600977224

245
!

Hu, L. & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis:
Conventional criteria versus new alternatives. Structural Equation Modeling – A
Multidisciplinary Journal, 6(1), 1 – 55.
Huang, C. C., Wang, L. R., & Warrener, C. (2010). Effects of domestic violence on behavior
problems of preschool-age children: Do maternal mental health and parenting mediate the
effects? Children and Youth Services Review, 32, 1317 – 1323.
Hughes, C., & Ensor, R. (2008). Does executive function matter for preschoolers’ problem
behaviors? Journal of Abnormal Child Psychology, 36, 1 – 14. doi:10.1007/s10802-0079107-6
Jackowski, A. P., de Araujo, C. M., de Lacerda, A. L. T., Mari, J. D., & Kaufman, J. (2009).
Neurostructural imaging findings in children with post-traumatic stress disorder: Brief
review. Psychiatry and Clinical Neurosciences, 63(1), 1 - 8. doi:10.1111/j.14401819.2008.01906.x
Jester, J. M., Nigg, J. T., Puttler, L. I., Long, J. C., Fitzgerald, H. E., & Zucker, R. A. (2009).
Intergenerational transmission of neuropsychological executive functioning. Brain and
Cognition, 70(1), 145 - 153.
Jouriles, E. N., Brown, A. S., McDonald, R., Rosenfield, D., Leahy, M. M., & Silver, C. (2008).
Intimate partner violence and preschoolers’ explicit memory functioning. Journal of
Family Psychology, 22(3), 420 – 428. doi:10.1037/0893-3200.22.3.420
Kagan, J., Reznick, S. J., Clarke, C., Snidman, N., & Garcia-Coll, C. (1984). Behavioral
inhibition toward the unfamiliar. Child Development, 55, 2212 - 2225.
Karl, A., Schaefer, M., Malta, L. S., Dorfel, D., Rohleder, N., & Werner, A. (2006). A metaanalysis of structural brain abnormalities in PTSD. Neuroscience and Biobehavioral
Reviews, 30(7), 1004 -1031. doi:10.1016/j.neubiorev.2006.03.004
Kline, R. B. (2011). Principles and Practice of Structural Equation Modeling (3rd edition). New
York: The Guilford Press.
Kochanska, G., Coy, K. C., & Murray, K. T. (2001). The development of self-regulation in the
first four years of life. Child Development, 72(4), 1091 – 1111.
Konrad, K., Neufang, S., Thiel, C. M., Specht, K., Hanisch, C., Fan, J., Herpertz-Dahlmann, B.,
& Fink, G. R. (2005). Development of attentional networks: An fMRI study with children
and adults. NeuroImage, 28, 429 – 439.
Kusche, C. A., Cook, E. T., & Greenberg, M. T. (1993). Neuropsychological and cognitivefunctioning in children with anxiety, externalizing, and comorbid psychopathology.
Journal of Clinical Child Psychology, 22(2), 172 – 195.

246
!

Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., &
Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence
for a dissociative subtype. American Journal of Psychiatry, 167, 640 – 647.
Lansford, J. E., Dodge, K. A., Pettit, G. S., Bates, J. E., Crozier, J., & Kaplow, J. (2002). A 12year prospective study of the long-term effects of early child physical maltreatment on
psychological, behavioral, and academic problems in adolescence. Archives of Pediatrics
and Adolescent Medicine, 156(8), 824 – 830.
!
Lehto, J., Juujarvi, P., Kooistra, L., & Pulkkinen, L. (2003). Dimensions of executive
functioning: Evidence from children. British Journal of Developmental Psychology, 21,
59–80.
Levendosky, A. A., Bogat, G. A., & Martinez-Torteya, C. (2011). PTSD symptoms in young
children exposed to intimate partner violence. Manuscript submitted for publication.
Levendosky, A. A., Huth-Bocks, A. C., Semel, M. A., & Shapiro, D. L. (2002). Trauma
symptoms in preschool-age children exposed to domestic violence. Journal of
Interpersonal Violence, 17(2), 150 – 164. doi:10.1177/0886260502017002003
Lezak, M. D. (1995). Neuropsychological Assessment. New York: Oxford University Press.
Liebermann, D., Giesbrecht, G. F., & Muller, U. (2007). Cognitive and emotional aspects of selfregulation in preschoolers. Cognitive Development, 22, 511 – 529.
doi:10.1016/j.cogdev.2007.08.005
Lieberman, A. F., van Horn, P., & Ozer, E. J. (2005). Preschooler witnesses of marital violence:
Predictors and mediators of child behavior problems. Development and Psychopathology,
17, 385 – 396. doi:10.10170S0954579405050182
Litrownik, A. J., Newton, R., Hunter, W. M., English, D., & Everson, M D. (2003). Exposure to
family violence in young at-risk children: A longitudinal look at the effects of
victimization and witnessed physical and psychological aggression. Journal of Family
Violence, 18(1), 59 – 73.
Luethi, M., Meier, B., & Sandi, C. (2011). Stress effects on working memory, explicit memory,
and implicit memory for neutral and emotional stimuli in healthy men. Frontiers in
Behavioral Neuroscience, 2(5), 1 – 9. doi: 10.3389/neuro.08.005.2008
Macfie, J., Cicchetti, D., & Toth, S. L. (2001a). Dissociation in maltreated versus nonmaltreated
preschool-aged children. Child Abuse & Neglect, 25(9), 1253 – 1267.
Macfie, J., Cicchetti, D., & Toth, S. L. (2001b). The development of dissociation in maltreated
preschool-aged children. Development and Psychopathology, 13, 233 – 254.
MacMillan, H. L., Fleming, J. E., Streiner, D. L., Lin, E., Boyle, M., Jamieson, E., Duku, E. K.,

247
!

Walsh, C. A., Wong, M. Y., & Beardslee, W. R. (2001). Childhood abuse and lifetime
psychopathology in a community sample. American Journal of Psychiatry, 158(11), 1878
– 1883.
MacMillan, H. L., Georgiades, K., Duku, E. K., Shea, A., Steiner, M., Niec, A., et al. (2009).
Cortisol Response to Stress in Female Youths Exposed to Childhood Maltreatment:
Results of the Youth Mood Project. Biological Psychiatry, 66(1), 62-68.
Marcovitch, S., Boseovski, J. J., & Knapp, R. J. (2007). Use it or lose it: Examining
preschoolers’ difficulty in maintaining and executing a goal. Developmental Science,
10(5), 559 – 564.
Marcovitch, S., Boseovski, J. J., Knapp, R. J., & Kane, M. J. (2010). Goal neglect and working
memory capacity in 4- to 6- year-old children. Child Development, 81(6), 1687 – 1695.
Margolin, G., & Gordis, E. B. (2000). The effects of family and community violence on children.
Annual Review of Psychology, 51, 445 – 479.
Margolin, G., & Vickerman, K. A. (2008). Posttraumatic stress in children and adolescents
exposed to family violence: I. Overview and Issues. Professional Psychology: Research
and Practice, 38(6), 613 – 619. doi:10.1037/0735-7028.38.6.613
Marshall, L. L. (1992). Development of the Severity of Violence Against Women Scales.
Journal of Family Violence, 7(2), 103-121.
McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, P., & Green, C. E. (2006).
Estimating the number of American children living in partner-violent families. Journal of
Family Psychology, 20(1), 137 – 142. doi:10.1037/0893-3200.20.1.137
Metcalfe, J., & Mischel, W. (1999). A hot/cool-system analysis of delay of gratification:
Dynamics of willpower. Psychological Review, 106(1), 3 – 19.
Miller, E. K., & Cohen, J. D. (2001). An integrative theory of prefrontal cortex function, Annual
Review of Neuroscience, 24, 167 – 202.
Milot, T., Ethier, L. S., St-Laurent, D., & Provost, M. A. (2010). The role of trauma symptoms in
the development of behavioral problems in maltreated preschoolers. Child Abuse &
Neglect, 34, 225 – 234.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., & Howerter, A. (2000). The unity
and diversity of executive functions and their contributions to complex “frontal lob”
tasks: A latent variable analysis. Cognitive Psychology, 41, 49 – 100.
doi:10.1006/cogp.1999.0734
Morris, A. S., Silk, J. S., Morris, M. D., Steinberg, L., Aucoin, K. J., & Keyes, A. W. (2011).
The influence of mother-child emotion regulation strategies on children’s expression of

248
!

anger and sadness. Developmental Psychology, 47(1), 213 – 225. doi:10.1037/a0021021
Muris, P., de Jong, P. J., & Engelen, S. (2004). Relationships between neuroticism, attentional
control, and anxiety disorders symptoms in non-clinical children. Personality and
Individual Differences, 37, 789 – 797. doi:10.1016/j.paid.2003.10.007
Olson, S. L., Lopez-Duran, N., Lunkenheimer, E. S., Chang, H., & Sameroff, A. J. (2011).
Individual differences in the development of early peer aggression: Integrating
contributions of self-regulation, theory of mind, and parenting. Development and
Psychopathology, 23, 253 - 266. doi:10.1017/S0954579410000775
Palmer, S. (2000). Working memory: A developmental study of phonological recoding. Memory,
8(3), 179-193.
Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation. Child and
Adolescent Psychiatry Clinics of North America, 7(1), 33 – 51.
Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. I., & Vigilante, D. (1995). Childhood
trauma, the neurobiology of adaptation, and “use-dependent” development of the brain:
How “states” become “traits.” Infant Mental Health Journal, 16(4), 271 – 291.
Pickering, S. J. (2001). The development of visuo-spatial working memory. Memory, 9(4-6),
423-432.
Pine, D. S., Mogg, K., Bradley, B. P., Montgomery, L., Monk, C. S., McClure, E., Kaufman, J.
(2005). Attention bias to threat in maltreated children: Implications for vulnerability to
stress-related psychopathology. American Journal of Psychiatry, 162(2), 291-296.
Pollak, S. D., & Tolley-Schell, S. A. (2003). Selective attention to facial emotion in physically
abused children. Journal of Abnormal Psychology, 112(3), 323 – 338. doi:10.1037/0021843X.112.3.323
Pollak, S. D., Vardi, S., Bechner, A. M. P., & Curtin, J. J. (2005). Physically abused children's
regulation of attention in response to hostility. Child Development, 76(5), 968-977.
Posner, M. I., & Petersen, S. E. (1990). The attention system of the human brain. Annual Review
of Neuroscience, 13, 25 – 42.
Posner, M., & Rothbart, M. (1998). Attention, self-regulation and consciousness. Philosophical
Transactions of the Royal Society of London, 353, 1915–1927.
Putnam, F. W. (1991). Dissociative disorders in children and adolescents. Psychiatry Clinics of
North America, 14(3), 519 – 531.
Putnam, F. W., Helmers, K., & Trickett, P. K. (1993). Development, reliability, and validity of a
child dissociation scale. Child Abuse & Neglect, 17, 731–741.

249
!

Raaijmakers, M. A., Smidts, D. P., Sergeant, J. A., Maassen, G. H., Posthumus, J. A., van
Engeland, H., & Matthys, W. (2008). Executive functions in preschool children with
aggressive behavior: Impairments in inhibitory control. Journal of Abnormal Child
Psychology, 36, 1097 – 1107. doi:10.1007/s10802-008-9235-7
Roid, G. H. (2003). Stanford-Binet Intelligence Scales for Early Childhood, Fifth Edition. Itasca,
IL: Riverside Publishing.
Romine, C. B., & Reynolds, C. R. (2005). A model of the development of frontal lobe
functioning: Findings from a meta-analysis. Applied Neuropsychology, 12(4), 190 – 201.
Rossman, B. B., Bingham, R. D., & Emde, R. (1997). Symptomatology and adaptive functioning
for children exposed to normative stressors, dog attack, and parental violence. Journal of
American Academy of Child and Adolescent Psychiatry, 36(8), 1089 – 1097.
Roth, R. M., Isquith, P. K., & Gioia, G. A. (2005). Behavioral Rating Inventory of Executive
Function—Adult version. Lutz, FL: Psychological Assessment Resources, Inc.
Rothbart, M. K. (1989). Temperament in childhood: A framework. In G. A. Kohnstamm, J. A.
Bates, & M. K. Rothbart (Eds.), Temperament in childhood (pp. 59-73). New York:
Wiley.
Rothbart, M. K., Ahadi, S. A., Hersey, K. L., & Fisher, P. (2001). Investigations of temperament
at three to seven years: The Children’s Behavior Questionnaire. Child Development, 72,
1394–1408.
Rothbart, M., & Posner, M. (2001). Mechanism and variation in the development of attentional
networks. In C. Nelson & M. Luciana (Eds.), Handbook of developmental cognitive
neuroscience (pp. 353–363). Cambridge, MA: MIT Press.
Rueda, M. R., Checa, P., & Rothbart, M. K. (2010). Contributions of attentional control to
socioemotional and academic development. Early Education and Development, 21(5),
744 – 764. doi:10.1080/10409289.2010.510055
Rugg, M. D., Mark, R. E., Walla, P., Schloerscheidt, A. M., Birch, C. S., Allan, K. (1998).
Dissociation of the neural correlates of implicit and explicit memory. Nature, 392, 595 –
598.
Samuelson, K. W., Krueger, C. E., Burnett, C., & Wilson, C. K. (2010). Neuropsychological
functioning in children with posttraumatic stress disorder. Child Neuropsychology, 16,
119 – 133. doi:10.1080/09297040903190782
Scheeringa, M. S. (2008). Developmental considerations for diagnosing PTSD and Acute Stress
Disorder in preschool and school-age children. American Journal of Psychiatry, 165(10),
1237 – 1239. doi:10.1176/appi.ajp.2008.08070974

250
!

Scheeringa, M. S., Zeanah, C. H., Myers, L. & Putnam, F. W. (2003). New findings on
alternative criteria for PTSD in preschool children. Journal of the American Academy of
Child and Adolescent Psychiatry, 42(5), 561 – 570.
doi:10.1097/01.CHI.0000046822.95464.14
Scheeringa, M. S., Zeanah, C. H., Drell, M. J., & Larrieu, J. A. (1995). Two approaches to the
diagnosis of Posttraumatic Stress Disorder in Infancy and Early Childhood. Journal of
American Academy of Child and Adolescent Psychiatry, 34(2), 191 – 200.
Schore, A. N. (2002). Dysregulation of the right brain: a fundamental mechanism of traumatic
attachment and the psychopathogenesis of posttraumatic stress disorder. Australian and
New Zealand Journal of Psychiatry, 36(1), 9-30.
Semrud-Clikeman, M., & Ellison, P. A. (2009). Child Neuropsychology – 2nd Edition. New
York: Springer.
Shields, A., & Cicchetti, D. (1998). Reactive aggression among maltreated children: The
contributions of attention and emotion dysregulation. Journal of Clinical Child
Psychology, 27(4), 381 – 395.
Shing, Y. L., Lindenberger, U., Diamond, A., Li, S. C., & Davidson, M. C. (2010). Memory
maintenance and inhibitory control differential from early childhood to adolescence.
Developmental Neuropsychology, 35(6), 679 – 697. doi:10.1080/87565641.2010.508546
Simeon, D., Knutelska, M., Yehuda, R., Putnam, F., Schmeidler, J., & Smith, L.M. (2007).
Hypothalamic-pituitary-adrenal axis function in dissociative disorders, post-traumatic
stress disorder, and healthy volunteers. Biological Psychiatry, 61, 966 – 973.
doi:10.1016/j.biopsych.2006.07.030
Simeon, D., Yehuda, R., Knutelska, M., & Schmeidler, J. (2008). Dissociation versus
posttraumatic stress: Cortisol and physiological correlates in adults highly exposed to the
World Trade Center attack on 9/11. Psychiatry Research, 161, 325 – 329.
doi:10.1016/j.psychres.2008.04.021
Spinazzola, J., Ford, J. D., Zucker, M., van der Kolk, B. A., Silva, S., Smith, S. S., & Blaustein,
M. (2005). Survey evaluates complex trauma exposure, outcome, and intervention among
children and adolescents. Psychiatric Annals, 35(5), 433 – 439.
Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The revised conflict
tactics scales (CTS2). Journal of Family Issues, 17(3), 283 – 316.
Strauss, E., Sherman, E. M., & Spreen, O. (2006). A compendium of neuropsychological tests:
Administration, norms, and commentary. New York: Oxford University Press, USA.
Struss, D. T., & Alexander, M. P. (2000). Executive functions and the frontal lobes: a conceptual

251
!

view. Psychological Research-Psychologische Forschung, 63(3-4), 289-298.
Teicher, M. H., Andersen, S. L., Polcari, A., Anderson, C. M., & Navalta, C. P. (2002).
Developmental neurobiology of childhood stress and trauma. Psychiatric Clinics of North
America, 25(2), 397-426.
Thorell, L. B., Bohlin, G., & Rydell, A. M. (2004). Two types of inhibitory control: predictive
relations to social functioning. International Journal of Behavioral Development, 28(3),
193 – 203. doi:10.1080/01650250344000389
Tjaden, P., & Thoennes, N. (2000). Full report of the prevalence, incidence, and consequences
of violence against women. Findings from the National Violence Against Women Survey:
U.S. Department of Justice, National Institute of Justice. NCJ 183781.
Tolman, R. M. (1995). Psychological Maltreatment of Women Inventory – Short Version.
downloaded from
http://sitemaker.umich.edu/pmwi/downloadable_versions_of_the_pmwi
Tolman, R. M. (1999). The validation of the psychological maltreatment of women inventory.
Violence and Victims, 14(1), 25-35.
van der Kolk, B. A. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401-408.
van der Kolk, B. A., Pynoos, R. S., Cicchetti, D., Cloitre, M., D’Andrea, W., Ford, J., D.,
Lieberman, A. F., Putnam, F. W., Saxe, G., Spinazzola, J., Stolbach, B. C., & Teicher, M.
(2009). Proposal to Include a Developmental Trauma Disorder Diagnosis for Children
and Adolescents in DSM-V, retrieved October 30, 2009 from
www.traumacenter.org/.../DTD_NCTSN_official_submission_to_DSM_V_Final_Versio
n.pdf
Weber, D. A., & Reynolds, C. R. (2004). Clinical perspectives on neurobiological effects of
psychological trauma. Neuropsychology Review, 14(2), 115 – 129.
Weiss, S. J. (2007). Neurobiological alterations associated with traumatic stress. Perspectives in
Psychiatric Care, 43(3), 114 – 122.
Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G. (2003). The effects of
children’s exposure to domestic violence: A meta-analysis and critique. Clinical Child
and Family Psychology Review, 6(3), 171 – 187.
Wolter, G., & Raffone, A. (2008). Coherence and recurrency: Maintenance, control and
integration in working memory. Cognitive Processing, 9, 1 – 17. doi:10.1007/s10339007-0185-8
Yasik, A. E., Saigh, P. A., Oberfield, R. A., & Halamandaris, P. V. (2007). Posttraumatic stress
disorder: Memory and learning performance in children and adolescents. Biological

252
!

Psychiatry, 61(3), 382-388.
Ybarra, G. J., Wilkens, S. L., & Lieberman, A. F. (2007). The influence of domestic violence on
preschooler behavior and functioning. Journal of Family Violence, 22, 33 – 42.
doi:10.1007/s10896-006-9054-y
Zelazo, P. D. (2006). The dimensional change card sort (DCCS): A method of assessing
executive function in children. Nature Protocols, 1(1), 297 – 301.
doi:10.1038/nprot.2006.46
Zerk, D. M., Mertin, P. G., & Proeve, M. (2009). Domestic violence and maternal reports of
young children’s functioning. Journal of Family Violence, 24, 423 – 432.
doi:10.1007/s10896-009-9237-4
Zhou, Q., Hofer, C., Eisenberg, N., Reiser, M., Spinrad, T. L., & Fabes, R. A. (2007). The
developmental trajectories of attention focusing, attentional behavioral persistence, and
externalizing problems during school-age years. Developmental Psychology, 43(2), 369 –
385. doi:10.1037/0012-1649.43.2.369

253
!