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Neuropsychological Profile of Children, Adolescents and Adults Experiencing

Maltreatment: A Meta-analysis

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DOI: 10.1080/13854046.2015.1061057

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Neuropsychological Profile of Children,

Adolescents and Adults Experiencing
Maltreatment: A Meta-analysis
a b a
Marjolaine Masson , Eve-Line Bussières , Caroline East-Richard ,
a ab
Alexandra R-Mercier & Caroline Cellard
a
École de Psychologie, Pavillon Félix-Antoine-Savard, Université
Laval, Québec, QC, Canada
b
Centre Jeunesse Québec-Institut Universitaire, Québec, QC,
Canada
Published online: 26 Jun 2015.
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 The Clinical Neuropsychologist, 2015
http://dx.doi.org/10.1080/13854046.2015.1061057

Neuropsychological Profile of Children, Adolescents and

Adults Experiencing Maltreatment: A Meta-analysis

Marjolaine Masson1, Eve-Line Bussières2,

Caroline East-Richard1, Alexandra R-Mercier1, and
Caroline Cellard1,2
1
École de Psychologie, Pavillon Félix-Antoine-Savard, Université Laval, Québec, QC, Canada
2
Centre Jeunesse Québec-Institut Universitaire, Québec, QC, Canada

Objective: Few studies have attempted to describe the range of cognitive impairments affecting
Downloaded by [Marjolaine masson] at 09:34 26 June 2015

people who have experienced child maltreatment. The aim of this meta-analysis was to examine
the neuropsychological profile of these people and to determine the cognitive impacts of maltreat-
ment from childhood to adulthood. Method: Fifty-two publications from 1970 to 2013 were
included. Results: The affected cognitive domains were working memory (g = −.65), attention
(g = −.63), intelligence (g = −.56) and speed of processing (g = −.49). The impact of maltreatment
was greater in young children (g = −.71) and less pronounced in adults (g = −.26). Conclusions:
These results suggest that exposure to maltreatment has an impact on specific cognitive
processes, regardless of age.

Keywords: Neuropsychology; Maltreatment; Meta-analysis.

INTRODUCTION
The United States’ Child Abuse Prevention and Treatment Act (i.e., PL 93-247)
defines child maltreatment as “the physical and mental injury, sexual abuse, negligence
or maltreatment of the child, under the age of 18 by a person who is responsible for
child’s welfare, which indicates the child health and welfare is threatened thereby.”
Recently it has been shown that children and adolescents that have experienced
maltreatment suffer from more emotional problems than the general population
(Buckingham & Daniolos, 2013; McCrae, 2009). These young people also demonstrate
cognitive deficits relative to youth that have not been maltreated (Beers & De Bellis,
2002). Specific cognitive impairments at a specific time in development could
potentially shape the cognitive trajectory of young people and adversely affect their
mental health (Maziade et al., 2011). Cognitive deficits in victims of maltreatment may
result from chronic stress caused by abuse. Indeed, stress is perceived as an important
risk factor for the development of affective disorders (Keyes et al., 2012). However,
cognitive functioning may be preserved if stress acts as a protective factor by increasing
cognitive reserve (Vance, Roberson, McGuinness, & Fazeli, 2010). Cognitive
reserve refers to the ability to optimize or maximize performance through differential

Address correspondence to: Marjolaine Masson, École de psychologie, Pavillon Félix-Antoine-Savard,

Université Laval, 2325, rue des Bibliothèques, Québec, QC G1V 0A6, Canada. E-mail: marjolaine.
masson@gmail.com
(Received 6 November 2014; accepted 5 June 2015)

© 2015 Taylor & Francis

 2 MARJOLAINE MASSON ET AL.

recruitment of brain networks, which may reflect the use of alternate cognitive strategies
(Stern, 2002). Higher levels of intelligence and of educational and occupational attain-
ment can be used as outcome measures of cognitive reserve; these factors can predict
the level of brain damage necessary to produce functional deficits (Stern, 2002). There-
fore, stress could ultimately act as both a risk and protective factor that influences
cognitive and emotional development throughout the life span (childhood, adolescence
and adulthood) of people suffering from maltreatment.
To better understand the relationship between maltreatment and the development
of psychopathology, several researchers have investigated the neurobiological conse-
quences of maltreatment. People who have experienced maltreatment have previously
been shown to suffer from chronic stress. That stress can hinder the healthy develop-
ment of brain structures, neural circuits and different neurotransmitter mechanisms
involved in emotional regulation and response to stress (Lupien, McEwen, Gunnar, &
Heim, 2009; Van Voorhees & Scarpa, 2004). The three brain regions most likely to be
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affected—by a hyperactivation of the hypothalamic–pituitary–adrenal HPA axis—are

the hippocampus, the amygdala and the prefrontal cortex (Lupien et al., 2009). The
impact of stress on these three brain structures may explain cognitive impairments such
as memory deficits subsequent to hippocampal lesions (Scoville & Milner, 1957) or
executive function deficits consequent to alterations in development of the prefrontal
cortex (Harlow, 1868; Hart & Rubia, 2012). Stress can also lead to clinical disorders
such as emotional distress due to amygdala dysfunction, which could lead, for example,
to depression (Heim, Newport, Mletzko, Miller, & Nemeroff, 2008). Therefore, mal-
treatment may give rise to diverse cognitive, emotional and social disorders by way of
neurobiological modulations. What is not yet known is to what extent different domains
of cognition are affected by maltreatment and whether impairments vary at different
stages of the life span. To our knowledge, this is the first meta-analysis to evaluate the
impact of maltreatment on cognition from childhood to adulthood.

Current study
The present meta-analysis assesses the neuropsychological profile from childhood
to adulthood of people who have suffered from any kind of maltreatment across
development. The first objective was to determine whether or not maltreatment has a
negative impact on every cognitive domain of interest (intelligence, verbal episodic
memory, visual episodic memory, working memory, attention, executive functioning,
visuo-spatial/problem-solving, and processing speed), or if some are preserved/unaf-
fected. The second objective was to examine if the neuropsychological profile varies
across different stages of development and across people with different characteristics
(i.e., socioeconomic status—SES, type of maltreatment, place of recruitment).

METHOD
Literature search
MEDLINE (PubMed), PsycInfo and Embase databases were searched from 1970
to June 2013 to identify all studies with neuropsychological data of people who suf-
fered from maltreatment. A combination of the following Medical Subject Headings
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 3

(Mesh) and search terms was used: “child*” OR “adolescent*” OR “adult”—AND

“cognit*” OR “neuropsycho*” OR “memory” OR “executive function” OR “attention
deficit” OR “IQ” OR “cognitive disorders”—AND “maltreatment” OR “child* abuse*”
OR “child* neglect*” OR “sexual abuse” OR “physical abuse” OR “childhood trauma”.
The meta-analysis was done according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) standards, including evaluation of bias (con-
founding, overlapping data, publication bias) (Moher, Liberati, Tetzlaff, & Altman,
2009). Title and abstract screening of publications found in the databases was per-
formed by two independent investigators (CC and MM), and all data were verified by a
co-author (CER). In the event of disagreement or uncertainly, the full text was read and
discussed until conformity was achieved. After database extraction, the next phase of
the search strategy involved hand-searching for studies potentially overlooked or absent
from the databases by screening the references of all retrieved articles (reference list
searching). To ensure that all relevant peer-reviewed studies were included in the meta-
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analysis, 27 experts in the field of maltreatment and cognition were also contacted.

Inclusion/exclusion criteria
Inclusion criteria for the studies in the current meta-analysis were the following:
(1) peer-reviewed and published in English or French, (2) included participants less
than 60 years old, (3) had a group who suffered from maltreatment during childhood or
adolescence (sexual abuse, physical abuse, neglect or emotional/psychological abuse),
(4) had a control group without maltreatment, (5) reported an assessment of cognitive
functioning using standardized neuropsychological tests listed in A Compendium of
Neuropsychological Tests—3rd edition (Strauss, Sherman, & Spreen, 2006), and (6)
had sufficient statistical data to compute an effect size.
Exclusion criteria for the studies in the current meta-analysis were as follow: (1)
presence of a neurological disease (e.g., traumatic brain injury resulting from maltreat-
ment or another cause, stroke, neurodegenerative disease), (2) presence of a group
recruited in psychiatric hospital or with psychiatric disease, and (3) presence of any dis-
ease that could affect cognitive processes (e.g., HIV).

Neurocognitive domains
Two authors of the present study with expertise in neuropsychology (MM and
CC) independently categorized the neuropsychological measures examined in the
selected articles. Neuropsychological measures were defined as measures that objec-
tively assessed a cognitive domain. Consensus was achieved through discussion and by
referring to theoretical models (Strauss et al., 2006). Eight categories of cognitive
domains were identified: intelligence, verbal episodic memory, visual episodic memory,
working memory, attention, executive functioning, visuo-spatial/problem solving and
processing speed. Table 1 provides an overview of the eight cognitive domains and the
assigned individual neuropsychological tests.
Inventory, interview or achievement tests (e.g., WRAT), developmental tests (e.g.,
BSID), clinical scales and measures of retrospective or pre-morbid cognitive function-
ing (e.g., NART, assessment of autobiographical memory) and language tests were
 4 MARJOLAINE MASSON ET AL.

Table 1. Overview of the eight cognitive domains and the assigned neuropsychological tests for the included
studies

Cognitive
domains Neuropsychological tests Performance measure (dependant variables)

Intelligence WPPSI, WPPSI-R, WPPSI-R estimated FSIQ, VIQ, PIQ

WISC, WISC-R, WISC-R estimated,
WISC-III estimated, WISC-IV, WISC-
IV estimated
WAIS-R, WAIS-R estimated, WAIS-III
WASI (vocabulary and Matrix reasoning
abilities)
PPVT, PPVT-R, PPVT-III
Stanford–Binet Intelligence Scale
K-BIT
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FSIQ, VIQ, PIQ, WISC-III similarities, WISC-III
vocabulary, WISC-IV Verbal comprehension
index, WISC-IV perceptual reasoning index
FSIQ, VIQ, PIQ, WAIS-R vocabulary subscale,
WAIS-R similarities subscale
FSIQ, VIQ, PIQ
IQ
IQ
FSIQ, VIQ, PIQ

RPM IQ
TONI-3 IQ
Verbal CVLT Trial 1, trial 5, trial 1–5, SDFR, SDCR, LDFR,
episodic LDCR, recognition, total perseveration, total
memory intrusion, false positive
CVLT-C List B, trial 1–5, SDFR, LDFR, LDCR,
recognition, false positive total perseveration, total
intrusion, semantic group, order recall,
discriminability index
WMS-R, WMS-III WMSL-I, WMSL-D, WMSL-R, WMS-III
auditory immediate (subtests: logical memory I
recall, verbal paired associates I recall), WMS-III
auditory delayed (subtests: logical memory II
recall, verbal paired associates II recall)
CMS Verbal immediate, verbal delayed
NEPSY Narrative memory
Visual ROCF Immediate, delayed
episodic BVRT-F Index of immediate visual memory
memory WMS-R, WMS-III WMSF-I, WMSF-D, WMSF-R, WMS-III visual
immediate (subtests: faces I recognition, family
pictures I recall), WMS-III visual delayed
(subtests: faces II recognition, family pictures II
recall)
CMS Visual immediate, visual delayed
NEPSY Memory for faces, memory for names
CANTAB PAL (adjusted total errors), PRM (percent correct),
SRM (percent correct)
Working WISC-IV Working memory index
memory WISC-III Arithmetic
WMS-III WMS-III working memory (subtests: letter–
number sequencing, spatial span), letter/number
sequencing subtest
CANTAB SWM: total errors, between errors, strategy
WAIS, WISC-III DS total, DS backwards
Attention WAIS, WISC-III DS forwards
PASAT Trial 1 (2.4 s), trial 2 (2.0 s), trial 3 (1.6 s), trial 4
(1.2 s)

(continued)
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 5

Table 1. (Continued)

Cognitive
domains Neuropsychological tests Performance measure (dependant variables)

NEPSY Visual attention, auditory attention and response

set (Part A: selective auditory attention, Part B:
complex selective auditory attention)
CPT-II Omission errors, commission errors, correct
detection, variability
CANTAB RVP
Executive WCST Categories, perseverations, perseverative errors,
functions perseverative responses, non perseverative errors,
total errors, maintenance of set
TMT B Reaction time (in seconds)
NEPSY Verbal fluency, tower, knock and tap, statue
CANTAB DMS, IED, SOC, AGN
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D-KEFS Color–word interference test: inhibition (condition

3), inhibition/switching (condition 4)
Stroop color–word task, Stroop Interference trial (in seconds)
Verbal fluency-FAS test Letter fluency (letter: F, A, S)
Visuo-spatial/ WISC-III Picture completion, block design
problem WAIS-R Picture completion
solving ROCF Copy
Processing TMT A Reaction time (in seconds)
speed D-KEFS Color–word interference test: color naming
(condition 1), word reading (condition 2)
Stroop Word trial, color trial
WAIS-R Digit symbol substitution subscale
SDMT Oral, written
CANTAB RTI
WISC-IV Processing speed index

Notes: BVRT-F = Benton Visual Retention Task-Form; CANTAB = Cambridge Neuropsychological

Testing Automated Battery, AGN = Affective Go-No-Go, DMS = Delayed Matching to Sample, IED =
Intra-Extra Dimensional Set Shifting, PAL = Paired Associates Learning, PRM = Pattern Recognition Mem-
ory, RTI = Reaction Time Task, SOC = Stockings of Cambridge, SRM = Spatial Recognition Memory;
CMS = Child Memory Scale; CPT-II = Conners’ Continuous Performance Test-II; CVLT, CVLT-C =
California Verbal Learning Test, — for Children, SDFR = Short Delay Free Recall, SDCR = Short Delay
Cued Recall, LDFR = Long Delay Free Recall, LDCR = Long Delay Cued Recall; D-KEFS = Delis-Kaplan
Executive Function System; K-BIT = Kaufman Brief Intelligence Test; NEPSY = A developmental
neuropsychological assessment; PASAT = Paced Auditory Serial Addition Test; PPVT, PPVT-R or
PPVT-III = Peabody Picture Vocabulary Test, — Revised, — third edition; ROCF: Rey–Osterrieth Com-
plex Figure; RPM = Raven’s Progressive Matrices; SDMT = Symbol Digit Modalities Test; Stanford–Binet
Intelligence Scale (Form L-M); Stroop color–word task, Stroop; TMT = Trail Making Test; TONI-3 = Test
of Nonverbal Intelligence—third edition; Verbal fluency-FAS test; WAIS-R, WAIS-III = Wechsler Adult
Intelligence Scale — Revised, —third edition, —FSIQ = Full Scale Intelligence Quotient, —VIQ = Verbal
Intelligence Quotient, —PIQ = Performance Intelligence Quotient, —DS = Digit Span; WASI = Wechsler
Abbreviated Scales of Intelligence; WCST = Wisconsin Card Sorting Test; WISC, WISC-R, WISC-III or
WISC-IV = Wechsler Intelligence Scale for Children, — Revised, — third edition, — fourth edition;
WMS-R, WMS-III: Wechsler Memory Scale — Revised, — third edition, WMSF-I = Figural memory
Immediate, WMSF-D = Figural memory Delayed, WMSF-R = Figural memory percentage of Retention,
WMSL-I = Logical memory Immediate, WMSL-D = Logical memory Delayed, WMSL-R = Logical memory
percentage of Retention; WPPSI or WPPSI-R = Wechsler Preschool and Primary Scale of Intelligence, —
Revised (cf. Strauss et al., 2006).
 6 MARJOLAINE MASSON ET AL.

excluded because there are beyond the scope of the current meta-analysis to assess neu-
ropsychological functioning, even though these tests are reported in the compendium.
We focused on domains that are evaluated in the context of neuropsychological evalua-
tion. Language is more closely related to the field of speech therapy, and was therefore
not considered in this meta-analysis. However, the Peabody Picture Vocabulary Test
(PPVT) was included because it is defined in the compendium (Strauss et al., 2006,
p. 941) as “[…] serving several purposes, its primary goals are to serve as an achieve-
ment test of receptive vocabulary and it is also considered a screening test of intellec-
tual functioning (Dunn & Dunn, 1997).” Moreover, the PPVT-III correlates highly with
IQ (Strauss et al., 2006, p. 942).

Statistical analysis
All analyses were performed using the Comprehensive Meta-analysis software
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package (Borenstein, Hedges, Higgens, & Rothstein, 2000). It is recommended that

Cohen’s d or Hedge’s g be used when original studies have compared two groups and
the differences between their means are available (Borenstein, Hedges, Higgins, &
Rothstein, 2009). Hedge’s g was used as a measure of effect size (Hedges, 1981). We
calculated the mean difference between maltreatment and healthy control groups’ per-
formance divided by the pooled standard deviation. Hedges’s g was appropriated for
the current meta-analysis because it further allowed us to correct for the small sample
size bias (Hedges & Olkin, 1985). Negative effect sizes indicate poorer performance by
the maltreatment group. Interpretation of effect sizes was done according to Cohen’s
(Cohen, 1988) guidelines (d = .20 is small; d = .50 is moderate; d = .80 is large).

Effect size calculation

Effect sizes were computed for each cognitive domain. Within each cognitive
domain, mean effect size, standard error, 95% confidence interval and corresponding
z-value and significance level were reported. All calculations were performed under the
assumptions of a conservative random effect model. In addition, the Q-statistic was
computed to evaluate the homogeneity of the study results within each domain (fixed
model). No covariation for IQ was done because deficits in other cognitive domains can
cause slight decreases in IQ. Indeed, IQ scores comprise various cognitive indices, as
demonstrated by factor analysis of WAIS-IV (Wechsler, 2008): speed of information
processing, verbal comprehension, working memory, and perceptual organization. These
factors are correlated with global IQ, which complicates the use of IQ scores to control
for general impairments.

RESULTS
Search
Literature search and reasons for exclusion are showed in a diagram flow-chart
according to PRISMA guidelines (Figure 1). After the initial screening procedures, 1,154
articles were excluded because of the following reasons: case study, no maltreatment
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 7
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Figure 1. Flowchart literature search and data extraction according to the PRISMA guidelines.

(e.g., an absence of maltreatment in the entire group or just for some people in the group),
no population of interest (e.g., people older than 65 years, patients with neurological
disease, assessment of parent abuser, etc.), no cognition (e.g., study without neuropsy-
chological assessment or study which use experimental assessment or tests not listed in
the compendium), no control group or prevalence study. A total of 107 full texts were
 8 MARJOLAINE MASSON ET AL.

evaluated in the eligibility step. In the case of missing data or possible overlap, the
authors were contacted. Since no additional information could be obtained or if the over-
lapping was confirmed by authors, these articles (Choi, Jeong, Rohan, Polcari, & Teicher,
2009; DePrince, Chu, & Combs, 2008; Stein, Koverola, Hanna, Torchia, & McClarty,
1997; Sullivan, Bennett, Carpenter, & Lewis, 2008; Toth, Cicchetti, Macfie, Rogosch, &
Maughan, 2000) were excluded from further analysis. Overall, 52 samples (k = 52) from
50 studies were included in the present meta-analysis (see supplemental materials for the
list of these 50 references).

Demographics
The complete data-set covered 3,919 participants of which 1965 (50.1%) had
been maltreated while the remaining 1954 (49.9%) had not (see Table 1S in the supple-
mental materials for demographic characteristics). Of the 52 samples, 51 reported the
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mean ages of both patients and controls. The sample weighted mean age for the mal-
treated group was 11.86 ± 8.62 years (range of study means: 3.85–35.20) years, com-
pared to 11.77 ± 8.49 years for controls (range: 4.06–37.80 years). In all studies
reporting participant sex, 50.0% of the maltreated group and 48.6% of control partici-
pants were males. The sample-weighted average of years of education across the 12
studies that provided this information was 10.41 ± 5.51 years for the maltreated group
(range: 2.30–17) and 10.86 ± 5.63 for controls (range: 2.5–17). A systematic analysis
(see Table 2S in the supplemental material) revealed that the maltreated group did not
differ from the control group on major demographic variables (age, gender, SES, race,
and education). In fact, all of the included studies controlled demographic differences
with a methodological control (by matching groups) and/or a statistical control (a pos-
teriori between-groups analysis). In fact, of the 52 samples, 41 matched on at least one
variable, 23 matched on at least 2 variables, 15 matched on at least 3 variables, 11
matched on at least 4 variables, and 5 samples matched on all major demographic vari-
ables. In addition, when samples that demonstrated no a posteriori statistical differences
between groups are included, the number of controlled studies highly increases. Indeed,
all of the 52 samples in the current study included methodological and/or statistical con-
trol of at least 2 variables, 43 controlled at least 3 variables, 33 controlled at least 4
variables, and 11 controlled at least 5 demographic variables. Finally, the demographic
variables most frequently matched were SES (k = 28), gender (k = 24), and age (k = 23);
the demographic variables with no significant differences between groups were age
(k = 27) and gender (k = 24).

Main meta-analysis
Table 2 displays the results of the meta-analysis of maltreated and comparison
group differences on general cognitive performance (see Figure 1S in the supplemental
materials for the forest plot). Negative effect sizes indicate impairment in the maltreated
group relative to healthy controls, with a grand mean weighted effect size of g = −.50
(k = 52, 95% CI = −.60 to −.41). A significant Q statistic (Q51 = 291.93, p < .001)
indicated heterogeneity among the studies beyond what would be expected on the basis
of sampling variation.
 Downloaded by [Marjolaine masson] at 09:34 26 June 2015

Table 2. Meta-analytic results based on cognitive domains or age (K = 52)

Heterogeneity test

Number of Total sample Effect size Standard 95% confidence p- Q- Df p-

Cognitive domains/age studies (k) size (N) (g) error Variance interval Z-value Value statistic (Q) Value

Global g 52 3,919 −.502 .048 .002 −.596 to −.407 −10.410 .000 291.928 51 .000
Adjusted g (publication 52 3,919 −.440 −.536 to −.344 341.249
bias)
Cognitive domains
Intelligence 72 4,746 −.557 .051 .003 −.657 to −.458 −10.994 .000 182.075 71 .000
Verbal episodic 50 2,901 −.250 .051 .003 −.349 to −.151 −4.944 .000 73.152 49 .014
memory
Visual episodic 16 607 −.105 .131 .017 −.361 to .151 −.806 .420 35.692 15 .002
memory
Working memory 12 569 −.653 .088 .008 −.825 to −.481 −7.457 .000 7.496 11 .758
Attention 23 1,345 −.628 .100 .010 −.825 to −.431 −6.247 .000 64.667 22 .000
Executive functions 37 2,295 −.437 .061 .004 −.557 to −.317 −7.129 .000 67.666 36 .001
Visuo-spatial/problem 5 340 −.193 .109 .012 −.406 to .020 −1.774 .076 2.348 4 .672
solving
Processing speed 10 369 −.493 .105 .011 −.699 to −.286 −4.677 .000 4.885 9 .844
Total between 40.614 7 .000
Age
0–5 years 13 803 −.713 .140 .020 −.988 to −.438 −5.076 .000 46.195 12 .000
6–12 years 27 2,191 −.512 .062 .004 −.634 to −.389 −8.199 .000 165.502 26 .000
NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT

13–17 years 3 131 −.564 .184 .034 −.924 to .204 −3.071 .002 3.873 2 .144
18 years and older 9 340 −.261 .083 .007 −.425 to .097 −3.127 .002 35.482 8 .000
Total between 9.934 3 .019
9
 10 MARJOLAINE MASSON ET AL.

Publication bias
Publication bias can be examined graphically with a funnel plot (Egger, Davey
Smith, Schneider, & Minder, 1997). Funnel plots show studies distributed symmetri-
cally about the mean effect size if there is no publication bias (Borenstein et al., 2009).
However, in the current study, the funnel plot (Figure 2) shows symmetry at the top
and asymmetry at the bottom with studies missing at the right. This led us to assume
that there was a publication bias (although publication bias is not the only possible
cause of asymmetry in funnel plots). In order to control for this bias, a “Trim-and-Fill”
procedure was used (Duval & Tweedie, 2000) yielding an unbiased estimate of the
effect size. This procedure allowed us to create a funnel plot that included both the
observed studies and the imputed studies. Thus, the adjusted effect size was reported
in Table 2. The effect sizes are similar and are of moderate effect (g = .44, k = 52,
95% CI = −.54 to −.34).
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Results by cognitive domain OR age

The results of the meta-analysis of maltreated and comparison group differences
in eight cognitive domains are shown in Table 2. Cognitive performance was signifi-
cantly impaired in the maltreated group across all domains. Moderate effect sizes were
observed for working memory (g = −.65, 95% CI = −.83 to −.48), attention (g = −.63,
95% CI = −.83 to −.43), intelligence (g = −.56, 95% CI = −.66 to −.45) and also for
processing speed (g = −.49) and executive functioning (g = −.44). There was a signifi-
cant effect of cognitive domain (Qbetween = 39.91, p < .0001). Pairwise comparisons
mainly showed (see Table 3S in the supplemental materials for more statistical details)
that working memory, attention and intelligence differ significantly from effect sizes for
verbal episodic memory (g = −.25), visuo-spatial/problem solving (g = −.19) and visual
episodic memory (g = −.11).

Funnel Plot of Standard Error by Hedges's g

0,0

0,1
Standard Error

0,2

0,3

0,4

0,5

0,6
-2,0 -1,5 -1,0 -0,5 0,0 0,5 1,0 1,5 2,0
Hedges's g

Figure 2. Funnel plot of effect size against standard error for the meta-analysis of the impact of maltreatment
on cognition in 52 samples comparing maltreated group with control group.
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 11

The data were also analyzed according to age. The participants from each study
were classified within one of four age strata (0–5, 6–12, 13–17, 18 and older). The
operative factor is age at testing because most of the studies did not report the time of
maltreatment. Table 2 shows a significantly different impact of age on the effect size
(Qbetween = 9.93, p = .019), with a greater effect size for children between the ages of
0–5 (g = −.66, 95% CI = −.97 to −.35) compared to adults aged 18 or more (g = −.56,
CI = −.92 to −.20).

Results by cognitive domain AND age

After analyzing variations in cognitive performance for cognitive domain and age
separately, we then examined effect sizes for each cognitive domain by age strata
(Table 3). Results showed that cognitive domains were differentially affected according
to age.
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For children below the age of 6, only intelligence was assessed resulting in a strong
effect size (g = −.78). Regarding older children (6–12 years), all of cognitive domains
were significantly impaired except visuo-spatial/problem solving domain. A strong effect
size was observed for working memory (g = −.80) whereas moderate effect sizes were
observed for attention (g = −.63), processing speed (g = −.62), intelligence (g = −.59),
visual episodic memory (g = −.52) and executive functioning (g = −.47). There was a sig-
nificant difference between cognitive domains (Qbetween = 23.48, p = .001). Pairwise com-
parisons mainly showed (see Table 3S in the supplemental materials for more statistical
details) smaller effect size in visuo-spatial/problem solving domain (g = −.20) compared
to the intelligence (p = .004) and working memory domains (p = .000); and smaller effect
size in verbal episodic memory domain (g = −.30) compared to the intelligence (p = .003)
and working memory domains (p = .000).
For the adolescents (13–17 years), only intelligence was assessed resulting in a
moderate effect (g = −.59, 95% CI = −.84 to −.34). Finally, for adults (age 18 or over),
moderate effect sizes were reported for attention (g = −.62) and working memory
(g = −.47). Small effect sizes were reported for executive functioning (g = −.40), pro-
cessing speed (g = −.40), and verbal episodic memory (g = −.19). It is important to high-
light that no significant differences were observed for intelligence, visuo-spatial/
problem-solving, and visual episodic memory domains, that is, these domains were not
affected. Moreover, the effect size of visual episodic memory is the only one that had a
positive value (g = .14); that is, the M + PD group had better results than control group.
A significant difference between all cognitive domains was observed (Qbetween = 19.44,
p = .007). Pairwise comparisons mainly showed (see Table 3S in the supplemental
materials for more statistical details) smaller effect size for visual episodic memory, com-
pared to almost all others cognitive domains and especially attention (p = .002), execu-
tive functioning (p = .002), working memory (p = .006) and processing speed (p = .009).

Moderator variable analyses

Regarding the current analysis, significant Q-values in Table 2 (Q51 = 291.93,
p < .001) signify great variation in cognitive performance from study to study.
Therefore, a series of analyses was performed to examine the influence of moderator
 Downloaded by [Marjolaine masson] at 09:34 26 June 2015

12

Table 3. Meta-analytic results based on cognitive domain by age

Heterogeneity test

Number of Total sample size Effect size Standard 95% confidence Z- p- Q- Df p-

Cognitive domain studies (k) (N) (g) error Variance interval value Value statistic (Q) Value

0–5 years
Intelligence 16 983 −.778 .125 .016 −1.024 to −.533 −6.204 .000 47.861 15 .000
6–12 years
Intelligence 36 3,042 −.592 .066 .004 −.720 to −.463 −9.018 .000 96.032 35 .000
Verbal episodic memory 23 2050 −.301 .075 .006 −.449 to −.154 −4.001 .000 48.981 22 .001
Visual episodic memory 5 298 −.522 .117 .014 −.752 to −.293 −4.456 .000 3.756 4 .440
Working memory 5 318 −.802 .118 .014 −1.034 to −.570 −6.782 .000 1.964 4 .742
Attention 16 1,124 −.625 .120 .014 −.860 to −.391 −5.225 .000 54.597 15 .000
Executive function 20 1,309 −.465 .084 .007 −.629 to −.301 −5.555 .000 39.557 19 .004
Visuo-spatial/Problem 3 278 −.198 .121 .015 −.435 to .039 −1.635 .102 1.343 2 .511
solving
Processing speed 3 161 −.615 .159 .025 −.927 to −.302 −3.857 .000 .228 2 .892
Total between 23.476 7 .001
13–17 years
Intelligence 6 255 −.587 .128 .016 −.838 to −.336 −4.585 .000 5.057 5 .409
18 years and older
MARJOLAINE MASSON ET AL.

Intelligence 14 466 −.150 .092 .009 −.331 to .032 −1.617 .106 9.647 13 .723
Verbal episodic memory 27 851 −.186 .068 .005 −.320 to −.052 −2.727 .006 24.048 26 .573
Visual episodic memory 11 309 .137 .147 .022 −.152 to .426 .927 .354 .997 1 .318
Working memory 7 251 −.472 .130 .017 −.728 to −.217 −3.623 .000 2.016 6 .918
Attention 7 221 −.615 .188 .035 −.983 to −.247 −3.274 .001 9.627 6 .141
Executive function 17 986 −.401 .093 .009 −.583 to −.219 −4.327 .000 27.956 16 .032
Visuo-spatial/problem 2 62 −.173 .249 .062 −.661 to .315 −.693 .488 .997 1 .318
solving
Processing speed 7 208 −.398 .140 .020 −.673 to −.123 −2.835 .005 3.615 6 .729
Total between 19.444 7 .007
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 13

variables (type of maltreatment, place of recruitment, SES and age) on effect size
variability within the total sample.
Concerning the type of maltreatment, five categories were established in order to
see if the impact on cognition was the same: maltreatment (includes all type of abuse),
abuse (includes sexual and physical abuse), physical abuse, sexual abuse and neglect.
For the place of recruitment, categories were created: “confirmed case” when place of
recruitment were child welfare or protective agencies and “not confirmed case” when
people were recruited from the community through an advertisement or local newspa-
per. SES was classified as low or middle/upper using the Hollingshead Index of
Socioeconomic Status (Hollingshead, 1975). Studies reporting SES had measured it at
the time of neuropsychological assessment, not at the time of maltreatment. Finally, age
was examined as continuous variable.
Concerning non-continuous variables (type of maltreatment, place of recruitment
and SES), a g was computed. Results showed that there were no factors influencing the
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effect size (Table 4). Meta-regressions were also computed for continuous variable (age).
Results showed that age had an impact on the effect size because the meta-
regression coefficient for slope is significant and positive (slope = .009, SE = .002,
p < .00001). The more age increases, the more g value increases. It is important to note
here that the g scale is negative, that is to say that when the g value increases in the scale
it moves closer to a value of 0. Then, the effect size decreases when the age increases.
This result is congruent with the previous analysis of age by strata where lower effect
sizes were observed in adults whereas higher effect sizes were observed in children.
Consequently, the high variability of ages could explain the heterogeneity among studies.

Systematic and qualitative analysis of emotional/psychosocial

functioning
Population with psychiatric diagnosis was excluded of the current meta-analysis
when participants were recruited on that specific criterion (recruited in a psychiatric
hospital, psychiatric clinic, on the basis of a psychiatric diagnosis). Some people who
suffer from maltreatment, however, had clinical mental health symptoms highlighted by
clinical scales—they were recruited on the basis of maltreatment. Therefore, clinical
symptoms were considered and qualitatively analyzed as a moderator variable.
Of the 52 studies included in the meta-analysis, 35 used clinical measures to
assess emotional/psychosocial functioning in participants who had suffered from mal-
treatment (see Table 4S in the supplemental materials). That is, 17/52 studies did not
include clinical measures or did not mention having done so. Of the 35 studies using
clinical measures, 9/35 did not report the results; overall, 26/35 studies used clinical
measures and reported the results. Of the 26 studies, 21/26 found at least one significant
difference between groups (maltreated/control) in emotional/psychosocial functioning
and 5/26 found no significant difference between groups on clinical measures. In sum-
mary, among the studies that reported results on clinical measures, the majority (21/26)
reported that the maltreated group had poorer emotional/psychosocial functioning than
did the control group. The most common clinical symptoms in individuals who suffered
from maltreatment were depression (k = 11), anxiety (k = 5), aggressive behavior (k = 4),
and internalizing/externalizing behaviors (k = 4).
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14

Table 4. Moderator variables analyses

Heterogeneity test

Number of Total sample size Effect size Standard 95% confidence Z- p- Q- Df p-

Moderator variables studies (k) (N) (g) error Variance interval value Value statistic (Q) Value

Type of maltreatment
Maltreatment (abuse + 28 2,360 −.440 .063 .004 −.554 to −.316 −6.955 .000 153.781 27 .000
neglect)
Abuse (physical + 7 718 −.529 .195 .038 −.911 to −.147 −2.714 .007 59.651 6 .000
sexual)
Physical abuse 6 289 −.783 .208 .043 −1.191 to −.374 −3.756 .000 21.076 5 .001
Sexual abuse 4 170 −.473 .171 .029 −.808 to −.138 −2.768 .006 14.945 3 .002
Neglect 7 382 −.566 .063 .004 −.689 to −.442 −8.989 .000 9.542 6 .145
Total between 3.757 4 .440
Place of recruitment
Welfare 38 3,266 −.510 .056 .003 −.620 to −.400 −9.068 .000 191.194 37 .000
Others 14 653 −.485 .096 .009 −.674 to −.296 −5.030 .000 95.025 13 .000
MARJOLAINE MASSON ET AL.

Total between .048 1 .826

SES
Low 31 2,557 −.481 .061 .004 −.602 to −.361 −7.834 .000 168.710 30 .000
Middle-upper 7 292 −.472 .126 .016 −.718 to −.225 −3.753 .000 41.675 6 .000
No data 14 1,070 −.570 .117 .014 −.799 to −.341 −4.880 .000 81.371 13 .000
Total between .496 2 .780

Note: SES = Socioeconomic status.

 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 15

DISCUSSION
The objectives of the current meta-analysis were to examine the neuropsychologi-
cal profiles of individuals who had experienced maltreatment, and to determine whether
or not profiles varied across different age groups. Overall, 3,919 participants in 50 stud-
ies on 52 independent samples published from 1970 to 2013 were included. The meta-
analysis found that children, adolescents, and adults who had suffered from maltreat-
ment had worse global cognitive performances than did individuals of similar ages in
the general population (moderate effect size, g = −.50). This result remained constant
after controlling for publication bias. Furthermore, the systematic review of primary
demographic variables (age, gender, SES, race and education) demonstrated that all
studies used a methodological control (matching) and/or a statistical control on at least
two demographic variables (mainly age, gender or SES). That methodological strength
supports the probability that the observed cognitive difference between groups were
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probably not moderated or mediated by demographic variables, but were attributable to

maltreatment.
Regardless of age, victims of maltreatment demonstrated deficits in each cognitive
domain in comparison to a non-maltreated control group. Moderate effect sizes were
observed in working memory, attention and intelligence. Concerning global cognitive
performance by age, maltreatment had a negative impact across development. However,
the impact was more pronounced for young children (0–5 years) and less pronounced
for young adults (18 years and more). It is important to note that the operative factor is
age at time of testing, not at time of maltreatment, and that the cognitive profiles estab-
lished in this study reflect a variable period of time after maltreatment It is reasonable
to assume that time between maltreatment onset and adults’ assessment is longer than
was the period between maltreatment onset and children/adolescents’ assessment. The
second objective of this meta-analysis was to evaluate whether or not cognitive domains
were affected in the same way across individuals of different ages. First, it is difficult to
compare cognitive domains across all age strata because children aged 0–5 years and
adolescents aged 13–17 years were only assessed on the intelligence domain. Where
the two remaining age strata (6–12 and 18+) are concerned, a completed neuropsycho-
logical assessment of all eight cognitive domains of interest was conducted. With
respect to the intelligence domain, the impact of maltreatment varied significantly
across age groups. The effect size was large for young children (under 6 years), moder-
ate for children aged 6–12 years and adolescents aged 13–17; intelligence was not sig-
nificantly affected in adults over 18 years. The impact of maltreatment on intelligence
seems to decrease as age increases. Even when time since cessation of maltreatment is
unknown, it is theoretically higher for adults than for children/adolescents; that is, the
cognitive profiles of adults reflect long-term consequences of maltreatment. Therefore,
we can postulate that individuals who experienced maltreatment may compensate as
they age. Longitudinal designs represent the ideal method of observing the evolution of
cognitive impairments over time. In this study, however, age groups were compared
using a cross-sectional design.
Working memory and attention were the two most strongly affected domains in
both the 6–12 and the 18+ age strata. Working memory is strongly impaired in older
children and moderately impaired in adults; attention is moderately affected in both
older children and adults. Visuo-spatial/problem solving was unaffected in both groups.
 16 MARJOLAINE MASSON ET AL.

Where executive functioning was concerned, the effect size was similar (moderate)
across groups, although its rank of importance varied by age group (sixth for children
and third for adults). Moreover, in older children, processing speed, intelligence, and
visual episodic memory had even larger effect sizes than those observed for executive
functioning. Finally, in adulthood, three cognitive domains—intelligence, visual episo-
dic memory and visuo-spatial domains—were unaffected by maltreatment. Moreover,
one of these cognitive domains—visual episodic memory—had positive value, reveal-
ing better results in the maltreatment group than in the control group. Visual episodic
memory was also highlighting by the results because it is the only one that differs sig-
nificantly from nearly all others cognitive domains in adult population.
It has been suggested that some cognitive domains could be preserved by the pro-
tective factor of cognitive reserve. If this is the case, when cognitive reserve is activated
in order to cope with maltreatment, it may even increase some cognitive skills. Nolin
and Ethier (2007) demonstrated that maltreated samples can have better cognitive
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results than control samples who did not experience maltreatment. The authors demon-
strated that their sample of neglected children had an increased capacity for problem-
solving, and for abstraction and planning, i.e., increased executive functioning. In the
current meta-analysis, there were no differences between groups in intelligence, visual
episodic memory, and visuo-spatial domains; these cognitive skills were equal in the
maltreated group and the control group, but were not superior in the maltreated group,
as in Nolin & Ethier’s study. Greater levels of intelligence and of educational and
occupational attainment predict a greater capacity to sustain brain damage before
demonstrating functional deficit (Stern, 2002). The level of education is relevant in the
current meta-analysis. Nevertheless, education could be used as an index of cognitive
reserve only for the nine studies about adults because for the other studies (below than
18 years old) the level referred to the parents’ education. The level of education of the
8/9 studies which reported the data was high (14.3 ± 1.2 years) and similar to the con-
trols. As a consequence, in the current meta-analysis, higher level of educational attain-
ment may have been a protective factor against maltreatment and consequent cognitive
impairments. The high level of education observed in adults who suffered from mal-
treatment was characterized by preservation of other cognitive processes, such as visual
episodic memory and visuo-spatial/problem-solving skill.

Impact of moderator variables

Given the finding that sexual abuse has been demonstrated to produce greater
cognitive impairment than does other forms of abuse or neglect (Nolin & Ethier, 2007),
different types of maltreatment were assessed separately. However, no significant differ-
ences in cognitive domains were observed across the five categories of type of maltreat-
ment (maltreatment, abuse, sexual abuse, physical abuse and neglect). Each type was
associated with moderate or large deficits in cognitive performance. The majority of
studies in the present meta-analysis were designed to evaluate one kind of maltreatment
only (i.e., “pure” types). In the minority of studies where this was not the case, partici-
pants were classified in the “maltreatment” category, which included individuals who
reported several types of maltreatment (i.e., no “pure” types) or in the “abuse” category,
which included individuals who reported various types of abuse (e.g., sexual, physical).
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 17

Therefore, although conclusions concerning the impact of various types of maltreatment

must be made cautiously, it seems clear that all forms of maltreatment have a significant
impact on victims’ cognitive functioning. Degree of stress and trauma subsequent to
maltreatment creates should also be taken into consideration. Clinical variables such as
diagnosis, stress, and subjective complaints may be essential variables in the evaluation
of the impact of maltreatment.
Recruitment was examined as a moderator variable (i.e., child welfare agencies or
other avenues, such as advertisement in newspapers). Participants recruited from child
welfare agencies were considered to be confirmed cases of maltreatment. No impact of
confirmed versus self-reported cases on cognition was observed. Maltreatment had a
considerable impact on cognition even when it was self-reported, allowing us to con-
clude there were few false positive statements.
Finally, contrary to expectations, the difference between cognitive performance in
the maltreatment group and the control group was not greater in sub-samples with lower
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SES. That is, maltreatment affects cognition in individuals with high SES as much as it
does in individuals with low SES. However, this result should be interpreted with cau-
tion as far fewer studies have been conducted using high SES groups (k = 7, 13%), as
compared to studies with low SES groups (k = 31, 60%); furthermore, data on SES was
missing for 14 studies (27%). Moreover, SES was assessed at the time of neuropsycho-
logical assessment and not at the time of maltreatment. Time of assessment may have
had a significant impact on the findings, particularly in adults, where SES may have
changed since childhood.

Impact of emotional/psychosocial functioning

The current meta-analysis highlights a recurrent limitation in the maltreatment
research literature: the lack of control for co-morbid clinical symptoms. In fact, even if
studies with populations with psychiatric diagnosis were excluded, a large number of
the studies included in the meta-analysis had samples with co-morbid symptoms.
Indeed, of the 26 studies that assessed emotional/psychosocial functioning, 21 found
that the maltreated group had significantly worse functioning than did the control group
on at least one clinical measure. Moreover, the 17/52 studies that did not include clini-
cal measures could be considered to be “false negatives” since potential clinical impair-
ments were not assessed. The reported differences between groups in cognitive test
performance may have been moderated or mediated by psychiatric problems. This
makes it difficult to disentangle which of the cognitive effects are attributable to mal-
treatment, which are attributable to the associated emotional/psychosocial functioning,
and which are attributable to an interaction. In the meta-analysis, the clinical symptoms
most commonly observed in concomitance with maltreatment were depression, anxiety,
aggressive behavior, and internalizing/externalizing behaviors. Psychiatric disorders are
associated with clinical symptoms and cognitive impairments. Indeed, cognitive deficits
are a core feature of several disorders, including schizophrenia (Schaefer, Giangrande,
Weinberger, & Dickinson, 2013), bipolar disorder (Mann-Wrobel, Carreno, &
Dickinson, 2011), major depressive disorder (Rock, Roiser, Riedel, & Blackwell,
2013), and several anxiety disorders (Castaneda, Tuulio-Henriksson, Marttunen,
Suvisaari, & Lonnqvist, 2008). Each of these psychiatric disorders can create a wide
 18 MARJOLAINE MASSON ET AL.

range of cognitive impairments. Many studies have examined the impact of either
maltreatment or psychiatric diagnosis on cognition, but few have assessed the relation-
ships between cognitive deficits, maltreatment, and the development of psychiatric
disorders. Given that both maltreatment and psychiatric disorders negatively impact
cognition, it is hypothesized that their combination would produce even greater
cognitive deficits. To verify this hypothesis, control groups could be compared with
groups of maltreated individuals with diagnosed psychopathology.

Research implications and limitations

To our knowledge, the present study constitutes the first meta-analysis of the
impact of maltreatment on cognition across development. Our analysis highlights a lack
in data on potentially crucial moderator variables: age of onset, duration of maltreat-
ment, and time since cessation of maltreatment. Unfortunately, this information was
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only reported in only 12/52 studies and was heterogeneous across studies. Despite
heterogeneity, four studies provided the precise the age of onset; maltreatment began
between 3.9 and 10 years old. The meta-analysis revealed that maltreatment always
begins during early childhood (0–6 years) or childhood (7–13 years), and may continue
or not continue during adolescence. Age of onset is a crucial moderator variable
because maltreatment may have a differential impact according to developmental per-
iod. Individuals who have experienced maltreatment suffer from chronic stress, which
leads to a hyperactivation of the HPA axis and disturbances in the hippocampus, amyg-
dala, and prefrontal cortex (Lupien et al., 2009). Yet, in normal development, these
three regions of the brain do not develop at the same time. Thus, the temporal window
during which maltreatment occurred is a key variable (Erickson, Egeland, & Pianta,
1989). For example, a child who suffered from maltreatment before the age of four
years may experience memory impairments; memory functions are assigned to the hip-
pocampus (Eliez & Schaer, 2009) which develops primarily during the first four years
of life (Giedd et al., 1996).
Moreover, our analysis highlights the lack of studies examining the impact of
maltreatment in certain age groups. The demographical data revealed that few studies
had explored the impact of maltreatment in adolescents aged 13–17 years (k = 3; 6%) or
in adults aged 18 years or over (k = 9; 17%). Moreover, studies on adolescents only
examined one cognitive domain of interest: intelligence. Clearly, more research on the
impact of maltreatment on cognition in adolescents is needed. Interestingly, despite the
limited research targeting maltreated adults, most of the studies on adults assessed all
cognitive domains. Finally, in young children (6 years or less), intelligence was also the
sole cognitive domain assessed. However, this practice is less problematic in studies
children rather than of adolescents because it is quite challenging to assess complex
cognitive processes (i.e., executive functioning) in young children (Zesiger, 2009). Sig-
nificant differences in sample sizes were observed for comparisons on observed cogni-
tive measures, because two age groups (0–6 and 13–17 years) were assessed solely on
the intelligence domain. This discrepancy may decrease in future research because (1)
the field of neuropsychology is recent, and older articles on maltreatment and cognition
focused solely on the intelligence domain; and (2) research on maltreatment initially
 NEUROPSYCHOLOGICAL PROFILE AND MALTREATMENT 19

focused on exclusively on repercussions during childhood, but interest in adolescent

and adults populations is growing.
Finally, the results from this meta-analysis demonstrate differences in neuropsy-
chological profile according to age of victims of maltreatment. However, there is very
little work that assesses cognitive development across the life span in individuals who
have suffered maltreatment. Rather, cognitive profiles are generally evaluated at a speci-
fic period of child development, but not assessed at later periods. Long-term psycho-
logical and social consequences of maltreatment are not observed. Moreover, data from
children were often combined with data collected from adolescents. This practice pre-
vented us from pinpointing the impact of maltreatment on specific age groups (Connor,
Doerfler, Volungis, Steingard, & Melloni, 2003; Einbender & Friedrich, 1989; Hanson
et al., 2013). These methodological problems limit the conclusions that can be drawn
from the present meta-analysis. Another limitation is that age strata were calculated
from an average. As a result, it is possible that a child aged 13 years could be classified
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in the 6–12 years stratum if the average age of his or her group were 11 years. This
methodological problem prevents us from separating the effects of age and development
from the effects of maltreatment. It is therefore essential to conduct longitudinal studies
designed to observe trajectories of cognitive impairment, and the possible development
of a cognitive reserve. Indeed, considering that the brains of children and adolescents
are in development, and that each cognitive function develops in a separate temporal
window, it is important to follow the evolution of cognitive functioning over time.

Clinical implications
Children who suffered from maltreatment often receive psychological therapy
to address clinical symptoms such as anxiety, behavior problems, and post-traumatic
stress disorder, among others. (Cicchetti & Toth, 2005). Children who have been
maltreated are more likely to develop developmental problems and psychopathology
(Cicchetti & Toth, 1995). The current meta-analysis demonstrates that individuals
with a history of maltreatment also demonstrate significant neuropsychological
impairments in a range of cognitive domains. Therefore, practitioners who treat indi-
viduals affected by maltreatment should take into account both cognitive functioning
and clinical symptoms. Victims of maltreatment may benefit from cognitive remedia-
tion to help with daily activities. Cognitive remediation is a treatment that promotes
improved cognitive functioning and the development of new strategies in order to
compensate for impairments (Franck, 2012). The objective of cognitive remediation
is to reduce cognitive impairments and promote independent living. Cognitive
remediation can complement psychotherapy in victims of maltreatment. Children and
adolescents victims of maltreatment who demonstrate neuropsychological deficits are
worthy of further study by researchers and further efforts by clinicians to restore
neuropsychological functioning.

CONCLUSION
The first objective of this meta-analysis was to determine whether or not maltreat-
ment has a negative impact on each cognitive domain of interest. The results indicate
 20 MARJOLAINE MASSON ET AL.

that maltreatment affects each cognitive domain explored, with variation in impact
across domains. The most strongly impaired cognitive domains are working memory,
attention, and intelligence. The second objective was to examine neuropsychological
profile across development age. We found that cognitive deficits are more pronounced
in children than in adults who suffered from maltreatment, and that they decrease in
adulthood. Finally, this meta-analysis demonstrated that, regardless of type of maltreat-
ment, recruitment source, and socioeconomic status, maltreatment has a significant
negative impact on cognitive processes. Clinicians may wish to take these findings into
consideration when providing care to victims of maltreatment.

DISCLOSURE STATEMENT
No potential conflict of interest was reported by the authors.
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FUNDING
This work was supported by the “Chaire Richelieu de recherche sur la jeunesse, l’enfance
et la famille”; the “Centre Jeunesse de Québec – Institut Universitaire”.

SUPPLEMENTAL DATA
Supplemental data for this article can be accessed here. [http://dx.doi.org/10.1080/
13854046.2015.1061057]

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