Psychiatry Research 207 (2013) 218–224

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Executive functioning deficits and childhood trauma in juvenile violent

offenders in China
Zhili Zou a,1, Huaqing Meng a,1, Zhongrui Ma a, Wei Deng b, Lian Du a, Hui Wang a,
Pinhong Chen c, Hua Hu a,n
a
Department of Psychiatry, The First Affiliated Hospital, Chongqing Medical University, Chongqing, 400016, China
b
Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
c
Department of Psychology, Beijing Normal University, Beijing, 100875, China

a r t i c l e i n f o a b s t r a c t

Article history: A large body of evidence indicates that violent offenders have executive functioning deficits. However,
Received 29 October 2011 previous studies have not considered childhood trauma, which is likely to influence the executive
Received in revised form functioning of violent offenders. The aim of the present study was to compare the difference of
8 September 2012
executive functioning among juvenile violent offenders, with non-violent offenders and normal
Accepted 9 September 2012
controls, and then to analyse whether executive functioning was affected independently of childhood
trauma. In addition to using a battery of tests assessing executive functioning including the Intra/
Keywords: Extradimensional Shift Test(IED), the Stockings of Cambridge Test (SOC), and the Spatial Working
Cambridge Automated Neuropsychological Memory Test (SWM) from the Cambridge Automated Neuropsychological Testing Battery (CANTAB),
Testing Battery (CANTAB)
the short form of the Chinese Revision of the Wechsler Adult Intelligence Scale (WAIS-RC) and
Executive function
Childhood Trauma Questionnaire-28 item Short Form (CTQ) were also used among 107 violent
Violence
Childhood trauma offenders, 107 non-violent offenders and 107 normal controls. Our results showed that both offender
groups obtained significantly lower estimated Intelligence Quotient (IQ) scores and experienced more
childhood trauma than did normal controls. Violent offenders showed impaired executive functioning
on tasks of attention set-shifting, working memory and planning. Finally, spatial working memory
(SWM) deficits, particularly SWM strategy scores, may be associated with childhood trauma.
& 2012 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Violence has been defined as the number of violent incidents
that occur over a specific period of time (Adams et al., 1990;
Hoptman et al., 2002). Violent behaviour has always been a part
of human existence, and violent crime has become a serious health
concern, especially in young males. Victims of violent crime lose
valuable possessions, their health, and all too often their lives,
making violence a fundamental issue of public health (WHO,
2002). Many researchers have demonstrated that an individual with
violent behaviour shows impairment on tests of executive function-
ing such as the Wisconsin Card-sorting Test (WCST), the Tower of
Hanoi Test and the Benton Word Fluency Test (Barkataki et al., 2005;
Naudts, Hodgins (2006); Hancock et al., 2010), but not all studies
(Lafayette et al., 2003; Silver et al., 2005) are in agreement.
‘Executive function’ is a broadly defined cognitive construct,
n
Correspondence author at: 1 You Yi Road, Department of Psychiatry, the First
Affiliated Hospital, Chongqing Medical University, Chongqing, 400016. P.R. China.
Tel.: þ86 23 89012866; fax: 86 23 89012959.
E-mail address: huhua6688@sina.com (H. Hu).
1
These authors equally contributed to this work.
originally used to describe the deficits associated with focal frontal
lobe lesions, including planning, inhibition, organisation, self-mon-
itoring, mental representation of tasks and goals, cognitive flexibility
and set-shifting (Ozonoff et al., 2004). These abilities play a vital role
in the successful completion of new and difficult tasks.
Relative to non-violent offenders, a series of studies has
demonstrated that violent offenders show executive functioning
deficits (Brower and Price, 2001; Lewis et al., 2004; Hanlon et al.,
2010). Structural and functional imaging techniques have consis-
tently shown individuals with antisocial and violent behaviour to
have abnormalities in the frontal lobes (Relkin et al 1996; Raine
et al., 1998, 2000; Soderstrom et al., 2000). However, a previous
study discovered that there was no significant difference in
executive functioning between violent offenders and non-
violent offenders (Hoaken et al., 2007).
Nonetheless, several factors may influence the executive func-
tioning in violent offenders, such as intelligence, education level,
childhood trauma and psychiatric co-morbidity. For example, Aas
et al. (2012) found that childhood trauma was associated with a
reduction in cognitive function across cognitive domains in patients
with schizophrenia spectrum and bipolar disorders, in particular
working memory and executive function. Majer et al. (2010) found
emotional abuse was associated with impaired spatial working

0165-1781/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.psychres.2012.09.013
 Z. Zou et al. / Psychiatry Research 207 (2013) 218–224
memory performance and physical neglect was correlated with
impaired spatial working memory and pattern recognition memory.
In particular, childhood trauma has been found to have detrimental
effects on performance on neurocognitive tasks (Beers and De Bellis,
2002; El-Hage et al., 2006; Navalta et al., 2006; Nolin., Ethier 2007 ),
and many violent offenders experience an unusual level of child-
hood trauma (Widom, 1989; Zagar et al., 2009). It is thus possible
that childhood trauma may be an important influence in the
development of the executive function deficits of juvenile violent
criminals. However, few studies have accounted for the relationship
between childhood trauma and the performance on neuropsycho-
logical tests in violent offenders.
The Cambridge Neuropsychological Test Automated Battery
(CANTAB) is a computerised test battery targeting multiple neuro-
psychological functions involving non-verbal information processing
(CANTABeclipse, 2006). It contains five main cognitive domains:
visual memory, executive function, attention, semantic/verbal mem-
ory and decision making/response control. Three CANTAB subtests,
the Intradimensional/Extradimensional Shift tasks (IED), the Stock-
ings of Cambridge (SOC) Test and the Spatial Working Memory
(SWM) Test, have been shown to be sensitive to frontal lobe
executive functioning (Owen et al., 1991; Tyson et al., 2004). The
CANTAB has been used to assess executive dysfunction in schizo-
phrenia (Tyson et al., 2004), major depression (Elliott et al., 1996),
bipolar disorders (Sweeney et al., 2000), dementia (Egerhazi et al.,
2007), antisocial personality disorder (Mitchell et al., 2002), autism
(Ozonoff et al., 2004), attention deficit hyperactivity disorder (Gau
and Shang, 2010), and childhood trauma (Majer et al., 2010). Few
studies have used the CANTAB to assess executive functioning in
violent offenders, and because most previous studies have been
conducted in Western populations, their results may not be general-
ised to other ethnic groups, such as the Chinese population. Hence, in
this study, we hypothesised that executive functioning deficits would
be more prevalent in juvenile violent offenders relative to non-
violent offenders and normal controls on set-shifting, planning, and
working memory as assessed by a relatively new battery of tests of
executive functioning, the CANTAB, and that some specific executive
functioning areas may be associated with childhood trauma.
2. Methods
2.1. Subjects
As defined in the official criminal record, 214 incarcerated male juvenile
offenders participated in this study, including 107 violent offenders and 107 non-
violent offenders. Classification of the violent offenders (e.g., assault, assault causing
bodily harm, wounding, attempted homicide, homicide, kidnapping, forced confine-
ment, armed robbery and all ‘hands-on’ sexual offences) was made based on a
definition of violent crime proposed by Harris et al. (Harris et al., 2002); non-violent
offenders were offenders for whom there was no demonstrable history of violence
(these offenders were incarcerated due to property or drug offences, non-violent
robberies and fraud). All participants in the offender groups were located and tested
at the Remand Home of Chongqing. The Structured Clinical Interview for the
Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV)
(SCID) was administered by a trained clinical psychiatrist to exclude diagnosis of
schizophrenia, conduct disorder, and so on. Subjects with neurological illness or
head trauma, a history of alcohol or drug abuse, colour blindness, or an estimated
Intelligence Quotient (IQ) below 80 were excluded from the study.
A group of 107 control participants was recruited from a vocational school
sample with no psychiatric background. The SCID was also administered by a
trained clinical psychiatrist to exclude schizophrenia, conduct disorder and so on.
Exclusion criteria for the controls included a history of violence and the presence
of a medical illness that might impair cognitive functioning.
The study protocol was approved by the Ethics Committee of the First
Affiliated Hospital, Chongqing Medical University. All subjects provided written
informed consent prior to the initiation of study procedures.
2.2. Childhood Trauma Questionnaire(CTQ)
The Childhood Trauma Questionnaire (CTQ) is a valid and reliable 28-item
retrospective self-report inventory (Bernstein et al., 1998, 2003; Paivio,
et al.,2004). Items are scored 1–5 on a Likert scale ranging from ‘never true’ to
219
‘very often true’. The CTQ yields scores for childhood emotional abuse, physical
abuse, sexual abuse, physical neglect and emotional neglect, as well as a weighted
total CTQ score, which is calculated by a formula that considers the score of each
subscale adjusted for the number of items included in the subscale. It was
translated into Chinese by Zhao XF (Zhao et al., 2005). The CTQ has good internal
consistency (Cronbach’s alpha) for the CTQ total score (0.77), and alpha coeffi-
cients for the five subscales range from 0.41 to 0.68 in juvenile samples of 794
individuals enrolled in China (Zhao et al., 2005). The CTQ is widely used in China,
as in recent studies of depressive disorder (Xu et al., 2007) and antisocial
personality (Li et al., 2011).
2.3. Neuropsychological assessment
2.3.1. Short form of the Chinese version of the Wechsler Adult Intelligence Scale-
Revised (WAIS-RC) (Gong, 1986)
It is a Chinese version of the WAIS-Revised (Wechsler, 1981). Two subtests
(Vocabulary and Block Design) from the Chinese version of the WAIS-R (Wechsler,
1981) were administered to estimate the current intellectual level. The correlation
between estimated IQ according to the short form of the WAIS-RC and IQ
according to the full-length WAIS-RC has been reported to be 0.9, which is fairly
high (Gong and Dai, 1984).
2.3.2. IED
The IED subtest is a computer touch-screen adaptation of the WCST that was used
to assess flexibility, or set-shifting. The task is graded in difficulty, beginning with a
simple visual discrimination task, and then gradually increasing the degree of
complexity. Two stimuli (one correct, one incorrect) in the form of shapes and lines
are presented in four possible locations on the computer screen. First, the subject has to
maintain attention to different examples of stimuli within the same dimension
(shapes), while distracting stimuli of a different dimension are present (lines):
intradimensional shifts (IDSs). Second, the subject has to shift attention to the
previously irrelevant dimension (lines) and ignore the previously relevant dimension
(shapes): extradimensional shifts (EDSs). The IDS only requires perceptual flexibility, or
shifting from one exemplar to another exemplar within the same cognitive set; the EDS
requires conceptual flexibility. The task involves nine stages, the subject progresses to a
subsequent stage by making six consecutive correct responses within 50 trials at a
particular stage. Alternatively, termination of the task follows failure to reach criterion.
The following measures were derived from this test: Pre-ED errors (errors
made prior to the EDS of the task, which are defined as instances when the subject
fails to select the stimulus that is compatible with the current rule), EDS errors
(errors at the extradimensional shift), total errors (a measure of the subject’s
efficiency in performing the test) and number of stages completed (the number of
reaching the final stages, which indicates the ability to engage in executive set-
shifting and reversal).
2.3.3. SOC
This task was derived from the Tower of Hanoi task, which assesses planning
ability. Participants must move three coloured circles in the lower half of the screen
to match a given pattern in the upper half of the screen. Problems can be solved in a
certain ‘Minimum Number of Moves’ (two, three, four or five moves). ‘Initial
Thinking Times’ during trials are recorded to provide estimates of cognitive speed
during the preparatory and execution phases of task performance. For each trial, an
estimate of cognitive deliberation/planning time in the test conditions was recorded
for a subject. For example, some impulsive subjects may have recorded very brief
initial thinking time latencies, but they fail to solve any of the presented problems.
The key measures were derived from this test: Problems Solved in the
Minimum Number of Moves (which is a succinct expression of overall planning
accuracy in SOC), Mean Moves for 2-, 3-, 4- and 5-move problems, and Initial
Thinking Time for 2-, 3-, 4- and 5-move problems (subjects are encouraged to plan
their moves before actually enacting the solution to the problems).
2.3.4. SWM task
It measures subjects’ ability to retain spatial information and to manipulate
remembered items in working memory. This test is a sensitive measure for ‘executive’
dysfunction of the frontal lobe. Subjects are required to ‘search through’ boxes on a
screen to find a blue token. They are instructed that once they find a token under a
particular box they will not find another token under that box on a particular trial.
‘Between search errors’ occur when subjects open a box in which they have already
found a blue token. ‘Strategy’ is measured by the extent to which a repetitive search
pattern is used and can be estimated from adding together the number of search
sequences starting with the same box. A high score represents poor use of this
strategy and a low score equates to effective use (Owen et al., 1990). The following key
measures were derived from this test: Between search errors and Strategy score.
More detailed explanations and illustrations of these CANTAB tests can be
found on the Cambridge Cognition website (http://www.cantab.com).
220 Z. Zou et al. / Psychiatry Research 207 (2013) 218–224

Table 1
The comparisons of demographic characteristics and childhood trauma among violent, non-violent, and control subjects.

Violent (N ¼ 107) Non-violent (N ¼ 107) Control (N¼ 107) F-value p-value

Mean 7S.D. Mean7 S.D. Mean7 S.D.

Age (years) 16.5 70.6 16.6 7 0.6 16.5 7 0.6 1.307 0.272
Education (years) 6.3 71.2 a,e 6.47 1.5 a,e
9.3 7 0.5 245.51 0.000
Verbal IQ (VIQ) 99.6 76.6 a,e 99.4 7 6.1 a,e
107.2 7 7.2 47.48 0.000
Performance IQ (PIQ) 97.1 75.7 a,c 97.5 7 4.7 99.0 7 6.3 3.13 0.045
Estimated IQ 98.3 75.1 a,e 98.3 7 4.3 a,e
103.8 7 5.5 43.94 0.000
Emotional abuse 9.1 73.6 a,e 8.47 3.7 b,c
7.4 7 2.9 7.00 0.001
Physical abuse 8.9 74.0 a,e, b,d 7.57 3.3 a,e
5.9 7 1.7 23.21 0.000
Sexual abuse 6.7 71.7 6.57 2.0 6.1 7 1.7 2.79 0.063
Emotional neglect 13.1 74.7a,e,b,c 11.9 7 4.6 11.0 7 4.5 5.83 0.003
Physical neglect 11.1 74.2 a,e 10.27 2.9 a,c
9.2 7 3.0 7.92 0.000
CTQ Total score 48.9 712.9 a,e,b,e 44.5 7 9.1 a,e
39.7 7 8.9 20.56 0.000

a
¼ vs. controls;
b
¼vs. non-violent;
C
p r 0.05;
d
pr 0.01;
e
p r 0.001.

2.4. Statistical analysis
The data were analysed using the Statistical Package for the Social Sciences
(SPSS) version 12 for Windows. Analysis of variance (ANOVA) was performed to
compare demographic and neuropsychological variables. Analyses of covariance
(ANCOVAs) were also conducted to investigate the relationship between violent
crime and executive functioning deficits in juvenile offenders (years of education,
estimated IQ and childhood trauma total scores as covariates). For those tests with
different levels of difficulties (SWM and SOC), we further adjusted the repeated
measures ANOVA and repeated measures ANCOVA (years of education, estimated IQ
and CTQ total scores as covariates) within the same subjects while we examined the
interaction between groups and the difficulty levels of task. Statistical tests were
two-tailed and an alpha level of 0.05 was used to define statistical significance.
3. Results
3.1. Demographic and childhood trauma variables
As shown in Table 1, it can be concluded that the three groups did
not significantly differ in age; however, both offender groups had
significantly fewer years of education and lower estimated IQ scores,
and experienced more childhood trauma than did normal controls,
except sexual abuse. Meanwhile, violent offenders also had experi-
enced more physical abues and had higher CTQ total scores than non-
violent offenders.
3.2. Executive function tasks
3.2.1. IED
We found significant group differences in pre-ED errors, total
errors and Number of Stages Completed [F(2,318)¼8.90, Po0.001;
F(2,318)¼4.32, po0.05; F(2,318)¼4.62, po0.05] on the IED test,
and no significant group differences in the ED errors
[F(2,318)¼0.05, P40.05]. Post hoc analyses indicated that juvenile
violent offenders had significantly more total and pre-ED errors
than did non-violent offenders and normal controls (all P’so0.05),
and fewer Number of Stages Completed than did non-violent
offenders and normal controls on the IED test (all P’so0.01).
However, there was no significant difference between non-violent
offenders and normal controls on the IED test (all P’s40.05). It
implies that non-violent offenders and normal controls did not
show any significant differences while both groups showed better
performance than violent offenders (Table 2).
3.2.2. SOC
Violent offenders were impaired on the SOC planning task. A
significant group difference was observed in the key measure of
Number of Problems Solved in the Minimum Number of Move
Solutions [F(2,318) ¼5.11, Po0.001]. This reflected fewer pro-
blems solved by violent offenders in comparison to the normal
controls (P o 0.001). There was no significant difference between
non-violent offenders and normal controls on the SOC test
(P4 0.05) (Table 2).
A repeated-measures ANOVA revealed group differences in the
mean moves made across levels of difficulty with a main effect of
group [F(2,318) ¼ 5.20, Po0.001]. Both violent offenders and
non-violent offenders made more moves across the levels than
the normal controls (all P’so0.05). Post hoc follow-up ANOVAs
were conducted at each level (2-, 3-, 4- and 5-move problems)
and revealed no group differences at the 2- and 4-move stage (all
P’s 40.05). A significant group difference at the 3-move stage
[F(2,318)¼ 4.63, Po0.01] and the 5-move stage [F(2,318)¼ 3.05,
Po0.05] reflected more moves taken by the violent offenders
than the normal controls, and no differences between the non-
violent offenders and the normal controls (Fig. 1). No significant
interaction was also observed between mean moves at each level
(2-, 3-, 4- and 5-move problems) and groups [F (6,954)¼1.81,
P40.05].
That repeated measures ANOVA that was conducted on Initial
Thinking Times revealed a significant main effect of group
[F(2,318) ¼ 12.22, P o 0.001]. Both violent offenders and non-
violent offenders made fewer Initial Thinking Times than did the
normal controls (all P’s o0.001). A significant interaction was also
observed between group and difficulty level [F(6,954)¼3.85,
Po0.001]. Post hoc follow–up ANOVAs were conducted at each
level (2-, 3-, 4- and 5-move problems) and revealed no significant
group differences at the 2- and the 3-move stages (all P’s40.05).
A significant group difference at the 4- and the 5-move stage
[F(2,318)¼ 3.76, Po0.05; F(2,318)¼9.74, P o0.01] reflected the
fact that both violent offenders and non-violent offenders made
fewer Initial Thinking Times (4 and 5 move) in comparison to the
normal controls (all P’so0.05) (Fig. 2).
3.2.3. SWM
The repeated measures ANOVA conducted on the level of diffi-
culty of the key measure of Between Search Errors (4, 6 and 8 box)
revealed a non-significant main effect of group [F(2,318)¼2.08,
P40.05], as well as a non-significant interaction between group
and task difficulty [F(3,474)¼1.95, P40.05].
We also found significant group differences in the SWM
Strategy score [F(2,318)¼3.06, Po0.05]. Post hoc analyses indi-
cated that juvenile violent offenders exhibited a significantly
 Z. Zou et al. / Psychiatry Research 207 (2013) 218–224 221

Table 2
Comparisons of executive functioning among violent, non-violent, and control subjects.

Violent (N ¼107) Non-violent (N¼ 107) Control (N ¼ 107) F-value p-value

Mean7 S.D. Mean7 S.D. Mean7 S.D.

IED (Pre-ED errors) 11.5 7 8.5 a,e,b,e 8.5 7 4.4 8.5 7 4.1 8.90 0.000
IED (ED errors) 14.2 7 10.9 14.1 7 10.2 13.8 7 10.5 0.05 0.952
IED (Stages completed) 7.1 7 1.9 a,e,b,d 8.3 7 1.0 8.2 7 0.9 4.62 0.011
IED (Total errors) 31.4 7 13.1 a,c,b,e 27.9 7 12.5 26.4 7 12.2 4.32 0.014
SOC (minimum moves) 7.5 7 2.1 a,e 7.1 7 2.0 6.6 7 2.1 5.11 0.007
SWM (Between errors) 26.2 7 18.6 b,e 19.2 7 18.4 21.7 7 18.8 3.81 0.023
SWM (Strategy score) 33.7 7 4.4 a,c 33.3 7 4.6 32.2 7 5.2 3.06 0.048

a
¼vs. controls;
b
¼ vs. non-violent;
c
pr 0.05;
d
pr 0.01;
e
p r 0.001.

Mean Moves Table 3

Executive functioning measurements among violent, non-violent, and control
10 A*
Violent subjects after controlling education, estimated IQ and CTQ level (separately)
Non-Violent
8 F-value a P a F-value b P b F-value c P c
Control
Mean Moves

6 IED (Pre-ED errors) 7.82 0.000 8.12 0.000 10.14 0.000

IED (ED errors) 0.02 0.977 0.06 0.940 0.00 0.997
A** IED (Stages completed) 3.50 0.031 3.91 0.021 3.27 0.039
4 IED (Total errors) 2.44 0.089 3.83 0.023 3.85 0.022
SOC (minimum moves) 4.80 0.009 2.83 0.061 5.31 0.005
2 SWM (Between errors) 3.69 0.026 3.70 0.026 3.36 0.036
SWM (Strategy score) 1.04 0.356 3.11 0.046 2.81 0.062
0
a
2 3 4 5 b
Results of ANCOVA with years of education as covariate
Results of ANCOVA with estimated IQ as covariate;
n-Choice Problems c
Results of ANCOVA with CTQ Total score as covariate.
Fig. 1. Mean Moves in the Stockings of Cambridge (SOC) task among violent, non-
violent, and control subjects. A¼vs. controls; nP r 0.05; nnPr 0.01.
Times still revealed a significant main effect of group [F(2,317) ¼
Mean Initial Thinking Time 5.81, Po0.001], and a significant interaction between group and
difficulty level [F(6,951) ¼2.40, Po0.05]. Post hoc analyses
15000
Violent revealed that both violent offenders and non-violent offenders
Non-Violent still made fewer Initial Thinking Times than did the normal
Control controls (all P’so0.01). No significant main effect and interaction
10000
Time (ms)

between ‘Between Search Errors’ (4, 6, 8 box) and group were

A** A* A** found when years of education was designated as the covariate
A*** (all P’s 40.05). A repeated-measures ANCOVA also revealed there
5000
were no group differences in the mean moves made across levels
of difficulty with a main effect of group [F(2,317)¼1.82, P40.05]
after controlling for estimated IQ.
0 The ANCOVA with years of education as the covariate showed
2 3 4 5
that the IED total errors was no longer significantly different
n-Choice Problems [F(2,317) ¼2.44, P40.05] and neither was Strategy score
Fig. 2. Mean Initial Thinking in the Stockings of Cambridge (SOC) task Times
[F(2,317) ¼1.04, P40.05]. When estimated IQ was designated as
among violent, non-violent, and control subjects. A ¼ vs. Controls; nP r 0.05; the covariate, SOC Problems Solved in Minimum Moves was no
nn
P r 0.01; nnnPr 0.001 longer significantly different [F(2,317) ¼2.83, P40.05]. When
the CTQ Total score was designated as the covariate, the SWM
higher Strategy score than did normal controls (Po0.05), which Strategy score became non-significant difference [F(2,317)¼2.81,
reflected a higher use of strategy (as indicated by lower Strategy P40.05]. Finally, no statistically significant changes were found
score) in normal controls in comparison to the violent for the other executive functioning indexes when the years of
offenders. The non-violent offenders did not differ significantly education, estimated IQ and CTQ total score were separately
from the violent offenders and normal controls group (all entered as the covariates (Table 3).
P’s40.05) (Table 2).

3.3. Relationships among education, estimated IQ, childhood trauma 4. Discussion

and executive functioning
The repeated measures ANCOVA after controlling for years of
education showed no significant main effect and interaction
between SOC mean moves at each level (2-, 3-, 4- and 5-move
problems) and group (all P’s 4 0.05). However, Initial Thinking
In comparison with normal controls, the finding showed that
violent and non-violent offenders had significantly fewer years of
education than controls. Similarly, the current study found that IQ
in offenders was reduced in comparison to normal samples, which
is consistent with the results of previous studies (Lopez-Leon and
222 Z. Zou et al. / Psychiatry Research 207 (2013) 218–224
Rosner, 2010). It is possible that juvenile offenders are not inter-
ested in learning, or they cannot receive education due to family
economic conditions, while normal controls have completed 9 years
of compulsory education. Hence, the low IQ scores among offenders
may partly reflect years of education. Matarazzo and Herman
(1984) showed the positive correlation between years of schooling
and IQ. Hodgins et al. (2011) found offenders, compared with non-
offenders, were characterized by significantly lower IQ scores and
poorer performance in the working memory and executive func-
tions test. These results suggest that the low intellectual level might
be associated with crime.
The finding that both violent offenders and non-violent offen-
ders experienced more childhood trauma than did normal con-
trols is consistent with the results of previous studies. For
example, Dutton and Hart (1992) reported that 415 of 601
offenders had childhood trauma. It can be observed that negative
childhood experiences have been linked to criminal behaviour in
adolescence from those results. Our results also showed violent
offenders experienced more physical abuse and childhood trauma
than non-violent offenders. Sarchiapone et al. (2009) found that
male prisoners who reported high levels of childhood trauma had
significantly higher lifetime aggression scores. They also reported
a significant positive correlation between total CTQ scores and
Brown–Goodwin Assessment of Lifetime History of Aggression
(BGHA) scores. It might be speculated that the higher lifetime
level of aggression was linked to violent crime. Dodge et al. (1990)
thought abused children tended to acquire deviant patterns of
processing social information, and these may mediate the devel-
opment of aggressive behaviour. However, our study failed to find
a significant difference in sexual abuse, which is inconsistent with
the study results from Western countries. For example, Weeks
and Widom (1998) reported that two-thirds among 301 male
offenders had experienced sexual abuse. The different results of
these studies might be partly attributable to the differences of
Chinese and Western cultures, because Chinese people are rela-
tively conservative culturally. Juveniles in China may be ashamed
to reveal sex-related experiences.
In the present study, the performance of violent offenders was
inferior to those of non-violent offenders and controls on Number
of Stages Completed, total errors and pre-ED errors. Nevertheless,
no differences emerged between non-violent offenders and con-
trols on the IED test, indicating that violent offenders had more
errors and fewer Numbers of Stage Completed. The IED test
occurs at the ED shift stage of the test, which is considered
equivalent to the category shift in the WCST, and the number of
errors made at this stage is viewed as the key determinant of
attentional set-shifting ability (Fray et al., 1996). Hence, they had
difficulties in shifting and flexibility of attention, which is con-
sistent with the results of previous studies. For example, Bergvall
et al. (2001) found that adult violent offenders committed a
significantly greater number of errors than did normal controls
on the IED test.
Our study also found that violent offenders showed an increase
in the number of Problems Solved in the Minimum Number of
Moves and in the Mean Number of Moves and a decrease in the
Initial Thinking Time in the SOC task. When the task was relatively
easy (2-move), all the subjects showed relatively ‘intact’ perfor-
mance in the Mean Number of Moves and the Initial Thinking Time.
As task difficulty increased the pattern of performance changed (for
moves 3, 4 or 5). At these more complex stages, violent offenders
exhibited more Mean Number of Moves in comparison to normal
controls. Interestingly, normal controls showed longer Initial Think-
ing Time in comparison to violent offenders and non-violent
offenders. Previous research reported that male juvenile offenders
showed higher level of impulse in comparison to healthy controls.
Owing to impulsivity, juvenile offenders may record very brief
latencies of Initial Thinking Time, but fail to solve any of the
presented problems.
At the same time, we found violent offenders had poorer strategy
use and made more between search errors on the test of SWM in the
current study. A high strategy score represents poor use of this
strategy and a low score equates to effective use. This finding
suggests that violent offenders cannot adopt a spatial search strategy
to be beneficial to their performance. Previously, Cauffman et al.
(2005) reported that juvenile offenders showed poorer performance
on tasks that activate cognitive functions mediated by the prefrontal
cortex, especially those measuring spatial working memory.
Because previous research found that violent offenders have
executive functioning deficits and most juvenile offenders meet
criteria for conduct disorder (Wasserman et al., 2002), and a
series of studies also had demonstrated that conduct disorder
showed executive functioning deficits (Kim et al., 2001; Narhi
et al., 2010; Hobson et al., 2011), this study intentionally excluded
juvenile offenders with a co-morbidity of conduct disorder.
Namely, the study subjects were only participants without co-
morbid conduct disorder so as to better to explore the relation-
ship between executive functioning deficits and violent crime in
juvenile offenders. Our results suggest that violent offenders
showed impairments on frontal-lobe-related executive tasks of
attention set-shifting, working memory and planning. This find-
ing is consistent with the results in violent offenders and in
schizophrenic patients with violent behaviour from studies con-
ducted in Western countries. Hanlon et al. (2010) found that
individuals who committed a single murder were characterised
by executive dysfunction. Violent individuals with schizophrenia
demonstrated poorer performance than their non-violent schizo-
phrenia peers on a measure of executive function (Barkataki et al.,
2005). Imaging studies also indicated that individuals with anti-
social and violent behaviour showed smaller brain tissue and
decreased activity in the frontal lobes (Brower and Price, 2001;
Hoptman, 2003; Pridmore, 2005; Anckarsater, 2006). Although no
brain activity was measured in the current study, one might
speculate that the observed executive functioning deficits are
linked to altered structure and/or function of brain regions. Our
study results suggest that violent offenders have executive func-
tion deficits in tasks that involve the frontal lobes. However,
group differences between those non-violent offenders and the
normal controls did not reach the level of significance in the
current study. However, some other researchers have reported
that those non-violent offenders remained more impaired than
normal controls in terms of their performance on tests of execu-
tive functioning. For instance, Hoaken et al. (2007) found both
violent offenders and non-violent offenders performed signifi-
cantly more poorly on measures of executive function relative to
controls (60 adults males participated in this study, consisting of
20 incarcerated violent offenders, 20 incarcerated non-violent
offenders and 20 university undergraduate and community con-
trols) as assessed by the Conditioned Non-spatial-Association Test
and the Concrete Subject Ordered Working Memory Test.
Lafayette et al. (2003) found no significant differences in mean
scores on a battery of neuropsychological tests between patients
with schizophrenia who had a history of violent arrest, those who
had a history of non-violent arrest and those who had no history
of arrest. The mixed results of studies might be partly attributable
to different sample characteristics or the use of different neurop-
sychological measurements. For example, some neuropsychologi-
cal measurements are related to language and culture.
Neuropsychological results in groups of different language and
cultural background show poor comparability. In addition, heri-
table factors may confer risk for executive dysfunction. Further,
Antila et al. (2007) found executive functioning had high herit-
ability in bipolar disorder. In the future, it may be necessary to
 Z. Zou et al. / Psychiatry Research 207 (2013) 218–224
further research the association between heritable factors and
executive functioning deficits in juvenile violent offenders.
In this study, with the exception of SWM Strategy score, we also
found that there were remained significant group differences in
total errors, pre-ED errors and Number of Stages Completed on the
IED test, Problems Solved in Minimum Moves on the SOC test and
Between errors on the SWM test even after controlling for level of
CTQ. In other words, childhood trauma may be associated with
impaired spatial working memory performance in juvenile violent
offenders. Previously, Majer et al. (2010) reported that the number
of Double errors in the SWM test was related to self-reported
physical neglect and emotional abuse (using the CTQ); Similar to
our study, they also reported that there were no significant
associations between the CTQ subscales and the IED or SOC task
in 47 healthy adults. Previous research found that childhood trauma
had a complex, long-term influence both on basal cortisol levels and
the hypothalamic–pituitary–adrenal (HPA) axis responsivity to
psychological stressors (Cicchetti and Rogosch, 2001; Alink et al.,
2012). Sapolsky (1996) indicated a significant correlation between
sustained stress, excess cortisol and damage to the hippocampus in
humans, and the hippocampus is integrally concerned with mem-
ory (Squire, 1992). It might be partly explained why childhood
trauma was related to memory impairments. In addition, childhood
trauma might interact with brain development causing long-lasting
changes in brain development and functioning during this period.
Executive functioning deficits may be related to direct brain
damage caused by different types of abuse and neglect. Indeed,
imaging studies further proved that exposure to various forms of
childhood trauma, including physical abuse, sexual abuse and
neglect, have been associated with alterations in brain structure
(Bremner et al., 1997; Teicher et al., 2004; De Bellis et al., 2002,
2006; Richert et al., 2006; Andersen et al., 2008). Hence, the current
study shows that juvenile violent offenders have impaired spatial
working memory, and it may be associated to childhood trauma.
The mechanisms are however not fully clear.
The study also found that group differences on the IED test and
the SWM test remained significant even after controlling for IQ,
which indicated these poor performances were independent of IQ.
However, Problems Solved in Minimum Moves and mean moves
became non-significant in the SOC task after controlling for IQ.
Because the SOC task mainly reflects subjects’ planning ability,
successful performance requires them to think carefully about
strategy, an ability that may be compromised by low intellectual
level. In addition, after controlling for years of education, total
errors on the IED test and Strategy score on the SWM test became
insignificant. Using the WCST, after covarying for the educational
level, Stratta et al. (2001) found schizophrenia and healthy controls
were no longer showed significant group differences for executive
functions, and the authors thought that the onset of the illness
could limit further achievement, thus contaminating the measure of
educational level. In our study, the three groups differed in terms of
years of education. Incarceration might be similar to the onset of
schizophrenia; the incarceration may interfere with progress in
education for juvenile offenders, thus affecting the measure of
educational level.
In conclusion, we found evidence that differences in executive
functioning exist between juvenile offenders and normal controls,
whereas violent offenders demonstrated a broader range of execu-
tive impairments, and childhood trauma may be associated with
impaired spatial working memory performance. However, the
results of our study should be considered in light of the following
limitations: (1) Because the given sample was purely male, it is
difficult to extend the present findings to a mixed or pure female
population. The contribution of gender differences to these should
be studied in future. (2) Although excluding participants with a
diagnosis of conduct disorder was beneficial to explore the
223
relationship between executive functioning and violent crime in
juvenile offenders in this study, there is really a limitation of the
generalisability for all juvenile offenders. In the future, we will
further compare the difference of executive functioning of juvenile
offenders with and without conduct disorder, and then explore how
childhood trauma plays a role in the relationship between executive
functioning and violent crime. (3) The current study provides
evidence of frontal-lobe-related-to-executive-function impairment
in violent offenders, and further studies should involve other
cognitive deficits, such as cognitive deficits related to the hippo-
campus. (4) Neuroimaging studies should be particularly informa-
tive in identifying the brain areas associated with such dysfunction.
Moreover, future studies should examine the neuropsychological
functioning in a larger sample.
Acknowledgements
This study was supported by grants from the Chongqing Associa-
tion for Science and Technology [(2011 Document, No. 14)] and the
Chongqing Medical University Graduate Student Fund. The authors
thank Mr. Huaping Liang and Ms. Chunyan Zhong for their help in
participant recruitment. We thank the participants in this study.
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