Department of Mental Health and Wellbeing, University of Glasgow, Level 1, Administration Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G120XH, United Kingdom.
Department of Education, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M139PL, United Kingdom.
Child Abuse Negl. 2020 Sep;107:104603. doi: 10.1016/j.chiabu.2020.104603. Epub 2020 Jun 26.
Cognitive impairment (i.e. lower IQ/cognitive development) in individuals who have experienced childhood maltreatment is well documented in the literature. It is not yet clear whether maltreatment itself causes cognitive impairment, or whether reduced cognitive functioning pre-dates maltreatment exposure and places children at risk of maltreatment.
This systematic review critically evaluated the evidence for a causal association between child maltreatment and impaired cognition in children under 12 years.
Following PRISMA guidelines, databases were searched and articles extracted according to inclusion criteria. Quality rating of articles was conducted independently by two reviewers and the evidence for a causal association was evaluated using guidelines based on the Hill criteria for causation in epidemiological and public health research.
31 articles were included in the review, with results that suggested lower IQ/cognitive development in maltreated children compared to controls, and a dose-response relationship between timing and duration of maltreatment and impaired cognition. Assessment of causality indicated strong evidence for a causal association between maltreatment and reduced overall cognitive performance in institutionalised children. Findings were less robust for non-institutionalised samples. Evidence regarding specific cognitive functions was mixed.
Extreme maltreatment may lead to reduced cognitive functioning in children under 12 years. More research is required to determine the impact of the nature and timing of maltreatment, as well as additional heritable and social factors, on specific profiles of cognition in this population.
在有儿童期虐待经历的个体中，认知障碍（即较低的智商/认知发育）在文献中已有充分记载。目前尚不清楚虐待本身是否会导致认知障碍，还是认知功能下降先于虐待暴露，并使儿童面临虐待风险。
本系统评价批判性地评估了儿童虐待与 12 岁以下儿童认知障碍之间的因果关系的证据。
根据 PRISMA 指南，对数据库进行了搜索，并根据纳入标准提取了文章。两位评审员独立对文章进行了质量评估，并根据流行病学和公共卫生研究中因果关系的希尔标准指南，评估了因果关系的证据。
本综述纳入了 31 篇文章，结果表明受虐待的儿童的智商/认知发育低于对照组，且虐待的时间和持续时间与认知障碍之间存在剂量反应关系。因果关系的评估表明，在被机构收容的儿童中，虐待与整体认知表现下降之间存在很强的因果关系。对于非机构化样本，结果则不太可靠。关于特定认知功能的证据则存在差异。
极端的虐待可能导致 12 岁以下儿童的认知功能下降。需要进一步研究以确定虐待的性质和时间以及其他遗传和社会因素对该人群特定认知模式的影响。
