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