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Original Investigation
July 26, 2021

Associations of Early-Life Threat and Deprivation With Executive Functioning in Childhood and Adolescence: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
  • 3Department of Psychology, Harvard University, Boston, Massachusetts
JAMA Pediatr. Published online July 26, 2021. doi:10.1001/jamapediatrics.2021.2511
Key Points

Question  Is the association of executive functioning with early-life experiences of threat different from its association with early-life experiences of deprivation in children and adolescents?

Findings  In this systematic review and meta-analysis of 91 studies, early-life deprivation had a stronger association with the domains of inhibitory control and working memory than early-life threat. No differences in the association of threat and deprivation with cognitive flexibility were observed.

Meaning  Early-life adversity was associated with reduced executive functioning among children and adolescents, and those who were exposed to deprivation may be at an increased risk for executive functioning difficulties compared with those who were exposed to threat.


Importance  Many studies have demonstrated an association between early-life adversity (ELA) and executive functioning in children and adolescents. However, the aggregate magnitude of this association is unknown in the context of threat and deprivation types of adversity and various executive functioning domains.

Objective  To test the hypothesis that experiences of deprivation are more strongly associated with reduced executive functioning compared with experiences of threat during childhood and adolescence.

Data Sources  Embase, ERIC, MEDLINE, and PsycInfo databases were searched from inception to December 31, 2020. Both forward and reverse snowball citation searches were performed to identify additional articles.

Study Selection  Articles were selected for inclusion if they (1) had a child and/or adolescent sample, (2) included measures of ELA, (3) measured executive functioning, (4) evaluated the association between adversity and executive functioning, (5) were published in a peer-reviewed journal, and (6) were published in the English language. No temporal or geographic limits were set. A 2-reviewer, blinded screening process was conducted.

Data Extraction and Synthesis  PRISMA guidelines were used to guide data extraction and article diagnostics (for heterogeneity, small study bias, and p-hacking). Article quality was assessed, and data extraction was performed by multiple independent observers. A 3-level meta-analytic model with a restricted maximum likelihood method was used. Moderator analyses were conducted to explore heterogeneity.

Main Outcomes and Measures  Primary outcomes included measures of the 3 domains of executive functioning: cognitive flexibility, inhibitory control, and working memory.

Results  A total of 91 articles were included, representing 82 unique cohorts and 31 188 unique individuals. Deprivation, compared with threat, was associated with significantly lower inhibitory control (F1,90 = 5.69; P = .02) and working memory (F1,54 = 5.78; P = .02). No significant difference was observed for cognitive flexibility (F1,36 = 2.38; P = .12). The pooled effect size of the association of inhibitory control with deprivation was stronger (Hedges g = −0.43; 95% CI, −0.57 to −0.29) compared with threat (Hedges g = −0.27; 95% CI, −0.46 to −0.08). The pooled effect size of the association of working memory with deprivation was stronger (Hedges g = −0.54; 95% CI, −0.75 to −0.33) compared with threat (Hedges g = −0.28; 95% CI, −0.51 to −0.05).

Conclusions and Relevance  Experiences of both threat and deprivation in childhood and adolescence were associated with reduced executive functioning, but the association was stronger for exposure to deprivation. Efforts to address the consequences of ELA for development should consider the associations between specific dimensions of adversity and specific developmental outcomes.

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    1 Comment for this article
    Childhood Survival Amidst the Anthropocene Era
    Paul Nelson, MS, MD | Family Health Care, PC retired
    One can only imagine the collaborative commitment that must have occurred among the leading and contributing authors to achieve the analytic detail of this sentinel report. No doubt that this report will be cited in 5 or 10 years by subsequent systematic reviews of childhood maltreatment. I would hope that any subsequent review would then be able to acknowledge the existence of a unified Epistemology for "Population Health" and its "Healthcare." An established and well-excepted basis for integrating the cosmological, biological, and anthropological realms of knowledge will eventually be necessary to prevent, mitigate, and ameliorate the epigenetic as well as social-legal-economic antecedents of childhood maltreatment.