Cognitive skills and mental health among child victims of armed conflicts and conditions of socioeconomic vulnerability in Colombia

Abstract

Internal armed conflicts dramatically affect vulnerable populations, especially children. Such traumatic events negative affect mentalhealth, including emotional, cognitive, and behavioral well-being. The present study sought to identify cognitive, emotional, and social cognition states and characteristics of a child population who were victims of forced displacement that was caused by the armed conflict in Colombia. The sample consisted of 140 children, including childvictims of displacement (47 girls and 58 boys) and a comparison group(36 participants; 14 girls, 21 boys) who attended school and lived in relocation zones. Comparative and correlational analyses were performed to examine child outcomes between groups. The results indicated that the victim group had a higher risk, as reflected by scores on clinical and adaptive scales, compared to the comparison group. However, significant differences in performance were observed between the groups in terms of executive functioning tasks and theory of mind. The group of children exposed to displacement processes within the context of the Colombian armedconf lict exhibited better performance in these domains compared to a population without this background, who resided in socially vulnerable areas. These findings provide evidence that children who have experienced displacement because of armed conflict exhibit significant cognitive impairments in tasks related to cognitive flexibility, inhibitory control, and social cognition. Importantly, these difficulties extend observed among individuals residing in socially vulnerable environments. In fact, the cognitive performance of children without a history of displacement is inferior.

Keywords:

• mental health
• executive function
• social cognition
• armed conflict
• socioeconomic vulnerability

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1. Introduction

Childhood is a sensitive period of development that is susceptible to environmental factors that can interfere with the proper function and structure of the nervous system immediately or in the future (Amores-Villalba & Mateos-Mateos, 2017). Exposure to stressful situations or violent contexts during childhood negatively affects neurophysiological and neurodevelopmental processes (Bonilla- Santos et al., 2017), leading to deficits in cognition, social skills, and emotion. Such negative effects influence the course of life and can negatively impact individual potential and capabilities (Bacchini & Esposito, 2020; Grantham McGregor et al., 2007; Mueller & Tronick, 2019).

In Colombia, forced displacement is a stressor to which many children are exposed. Displacement is a consequence of the armed conflict in the country that has been ongoing for over 60 years. It affects the health and well-being of the population when children and their families are forced to leave their homes in search for safety in other territories (Kadir et al., 2019), reported that armed conflicts are a negative social determinant in child health. Experiencing armed conflict as a child can alter brain architecture and neuroendocrine function, leading to alterations of learning, behavior, and physical and mental health and result in maladaptive behaviors. For children and their caregivers, direct or indirect exposure to armed conflict is a traumatic experience that negatively impacts their health and academic and work opportunities into adulthood.

When communities are forcibly displaced, children can be separated from their families, leaving them more vulnerable to illness, psychological trauma, and exploitation (Duque, 2017; Slone & Mann, 2016). Children’s ability to adapt to stressful events that are associated with conflict is influenced by both individual qualities and family characteristics (Piñeros-Ortiz et al., 2021). Each family is unique and different because of affective bonds that form among its members and the number of members that comprise it. Family members also engage in unique activities and assume unique roles. Overall, the family is considered a system in which specific events can influence the behavior and development of its members (González Hernández et al., 2020), including losses of important sources of social and emotional support.

(Sharkey et al., 2012) reported that close environmental violence was positively associated with high parental distress, which increased the probability of negative parenting practices and child maltreatment (Baker & Brooks-Gunn, 2019). Therefore, if violence is part of the context in which a family develops, then relationships between parents and children could be affected.

The consequences of armed conflict are mediated by such social factors as age, sex, socioeconomic resources, social support, and beliefs and the time and duration of exposure to conflict situations. Factors that are either destructive or protective determine the level of complexity and impact at the emotional and cognitive levels (Dimitry, 2012). Living in areas that have difficult socioeconomic characteristics is also a determining factor in the development of children’s cognitive, emotional, and social skills (Kara & Selcuk, 2021).

According to (Shultz et al., 2014), forced displacement has generally affected populations who live under vulnerable conditions in Colombia. Communities escape from violence in rural areas and subsequently relocate, either voluntarily or through relocation programs, to areas on the outskirts of cities. These areas are frequently marked by social exclusion and encompass vulnerable sectors where vital services, including sanitation, electricity, health, transportation, and education, are often lacking. Moreover, these contexts commonly face social problems, such as coerced or voluntary involvement in criminal activities, substance abuse, and gender-based violence.

Some environmental characteristics are considered risk factors for the development of depression, anxiety, and posttraumatic stress disorder, manifested by inattention, insecurity, fear, aggressiveness, cognitive distortions, and somatization, among others (Piñeros-Ortiz et al., 2021). A review by (Cervantes Duarte & Fernández-Cano, 2016) stated that when children are exposed to conflict, they can exhibit internalizing behaviors (e.g., anxious, depressive, and posttraumatic symptoms) and externalizing behaviors (e.g., behavioral problems and aggression) that interfere with social interaction. A study in Colombia found that 70% and 83% of children and adolescents, respectively, who lived in rural areas and were exposed to armed conflict presented internalized behaviors (e.g., depression and anxiety), and 56% of adolescents presented a clinical risk of posttraumatic stress (Hewitt Ramírez et al., 2014).

However, these are not the sole consequences experienced by children exposed to conflict or other adverse circumstances. Cognitive impairments related to both fundamental and higher-order processes have also been identified, significantly impacting academic performance, learning processes, and social competence (Kara & Selcuk, 2021), particularly regarding executive function (EF). EF encompasses the conscious regulation of thoughts, actions, and goal-directed behavior (David et al., 2017). In preschool and school-age children, executive function skills play a crucial role in facilitating knowledge acquisition, social interaction, and environmental adaptation. As children develop, executive functions enable the gradual formation of specific and precise perceptual abilities in response to environmental conditions, thereby promoting the development of enhanced social, emotional, and cognitive abilities (Lee et al., 2022). Neuropsychological studies indicate that executive functions exhibit different developmental trajectories; however, they primarily occur during childhood and adolescence, ranging from 4 to 15 years of age ((Best & Miller, 2010; Best et al., 2009; Huang et al., 2016; Rastikerdar et al., 2023)

Furthermore, cognitive difficulties are observed in Theory of Mind, a cognitive ability that encompasses understanding and inferring mental states, differentiating between one’s own mental states and those of others, interpreting situations from multiple perspectives, predicting and explaining others’ behaviors, and facilitating behavior modeling (Zai Ting et al., 2017). It is considered that children’s EF skills play a facilitative role in the development of social interaction abilities, including Theory of Mind (ToM), communicative behaviors, and moral skills (Moriguchi & Qu, 2014). Therefore, deficits in executive function can lead to challenges in behavior regulation, conceptual transitions, and inhibitions, resulting in an inadequate response to everyday life events. Consequently, acquiring executive function skills during early childhood is vital not only for preparing children for early school learning and academic achievement but also for fostering the development of coping strategies to address stressful situations (Lee et al., 2022). The accumulated evidence suggests a functional interdependence between the development of EF skills, social interaction, and learning (Moriguchi & Qu, 2014; Segundo-Marcos et al., 2022; Turunç & Kisbu, 2023).

As a result, experiencing adverse circumstances within areas affected by armed conflict and displacement constitutes negative risk factors for the cognitive abilities and mental health of children. The relationship between exposure to armed conflict, EF, Theory of Mind, and emotional states represents a broad research field that necessitates further investigation, given the significance of these skills for normative development and healthy psychological functioning. The present study aimed to identify the cognitive and emotional characteristics of a child population that experienced displacement due to armed conflict in Colombia, comparing them with a child population residing in the area where the displaced children were relocated. Our focus was on children aged 6 to 12 years, considering the critical developmental importance within this age range.

We formulated two hypotheses in the present study. First, the child population of victims of displacement would exhibit deficiencies in measures of EF and Theory of Mind, as well as more internalizing-type symptoms, compared to a child population without this history. Second, living in geographical areas characterized by socioeconomic adversity would lead to lower or similar performance as those who were victims of the armed conflict.

2. Methods

2.1. Participants

The data were collected from three public educational institutions located in socially vulnerable sectors of a city in southern Colombia. These institutions, due to their geographical positioning, serve as primary hubs for a significant number of students with a history of forced displacement. This circumstance provides a unique opportunity to identify and evaluate the population within a concentrated area.

The sample comprised 140 participants who were divided into two groups. The first group consisted of children who had experienced forced displacement within the context of the Colombian armed conflict, with a total of 105 participants (47 girls and 58 boys). The average age of this group was 9.46 years (SD = 1.6 years). The second group, serving as a comparison, included 35 participants (14 girls and 21 boys) with a mean age of 8.94 years (SD = 1.2 years). It was observed that children with a history of displacement were more likely to experience grade retention, with a prevalence rate of 32%. Within the study group, 74.7% of the child victims had witnessed the displacement event, while 25.3% were born to mothers who had experienced forced displacement during pregnancy.

The sampling method employed was non-probabilistic. The inclusion criteria for the study group were as follows: being between 6 and 12 years old, enrolled in one of the educational centers associated with the study, and being a victim of forced displacement, either directly or indirectly, as registered in the Single Registry of Victims (Decreto 1084de 2015 Sector de Inclusión Social y Reconciliación, 2015). The comparison group consisted of children of similar ages and educational backgrounds to those in the forced displacement group. Exclusion criteria for both groups encompassed a history of neurological injuries, psychiatric disorders, substance abuse, intellectual disability, brain injury, brain damage, hydrocephalus, epilepsy, a history of criminal behavior, or uncorrected visual or auditory impairments (see Figure 1).

Figure 1. Identification and selection of groups

Read the detailed description of this figure

Two flowcharts with 3 sections each explaining the process of enrolling the population included in the study group and the comparison group. The first flowchart corresponds to the process of identifying children who are victims of forced displacement due to armed conflict in three educational institutions (Section 1). The exclusion criteria were then applied, resulting in a sample of 107 enrolled children (Section 2). However, only 104 children completed the evaluation protocol (Section 3). The second flowchart illustrates the formation of the comparison group, which was identified in a public educational institution with 145 students (Section 1). The exclusion criteria were applied, resulting in a sample of 54 children (Section 2), and finally, data from 36 children were analyzed, as the evaluation process was interrupted due to the COVID-19 pandemic.

These children attended schools within the same geographical area, characterized by high crime rates. The communities to which they belonged were classified under socioeconomic strata 0, 1, and 2, indicating a prevalence of precarious infrastructures and inadequate access roads. Their academic levels spanned from the first grade of primary school to the sixth grade of secondary school.

Regarding the participants’ ages, 33% were between 6 and 8 years old, 60% were between 9 and 11 years old, and 7% were 12 years old. In terms of family configuration, the nuclear family typology predominated, accounting for 44.8% in the study group and 33.3% in the comparison group. Single-parent families accounted for 37% in the forced displacement group, while the comparison group consisted of reconstituted families (29.6%). The average household size was four individuals, with maternal grandmothers often residing in the same household but outside the nuclear family structure.

These families originated from rural areas, which impose limitations on access to education. Educational disparities between urban and rural areas in Colombia are well-documented (Parra Triana et al., 2019). The average education level of mothers in the victim group was 8.27 years (SD = 3.3 years), while fathers had an average education level of 6.59 years (SD = 3.4 years). The illiteracy rates were 3.7% for fathers and 4.2% for mothers in the victim group. In the comparison group, fathers had an average education level of 8.57 years (SD = 3.3 years), and mothers had an average education level of 9.50 years (SD = 2.2 years), with no cases of illiteracy. Among the entire sample, only two parents held university degrees, while eight were classified as technicians or technologists.

In terms of parental occupations, the majority of mothers worked as housekeepers, while some were employed in informal positions as cleaning staff. Fathers, on the other hand, engaged in occupations such as construction labor, driving, security staff, and others. Being employed in informal jobs or being unemployed leads parents and their children to enroll in the subsidized regime in Colombia. This system provides health services to vulnerable populations who lack the financial means, with sponsorship offered by the General System of Social Security in Health and funded by taxpayers. Approximately 75.5% and 76.9% of families in the victim group and comparison group, respectively, were enrolled in the subsidized regime.

Considering the impact of the armed conflict on emotional regulation, mothers were assessed in this domain. Mothers typically bear the responsibility for caregiving and educational tasks within the household, and their mental well-being significantly influences children’s socioemotional and cognitive development. The Difficulties in Emotional Regulation Scale revealed that 45.3% of caregivers exhibited average emotional adjustment. In contrast, approximately 52% of mothers demonstrated difficulties in emotional regulation, as evidenced by low and very low scores in this domain.

Table 1 provides a comparison of demographic variables in both groups. As can be observed, the groups are homogeneous in terms of education level, age, gender, and parental education.

Table 1. Demographic data of both groups

Demographic data	Study group(n = 105)		Comparison group(n = 35)		P value *
	Me	IQR	Me	IQR
Age	9	2	9	2	0.558
Educational level	3	3	4	2	0.266
Mother’s education level	9	6	11	3	0.974
Father’s education level	8	4	9	6	0.169
Gender	n (%)		n (%)		X^2
Female	47 (44,8)		14 (40)		0,695
Masculine	58 (55,2)		21(60)

Me: Median

IRQ: Interquartile range

*Mann Whitney U statistic, significance level of < 0,05.

2.2. Ethical considerations

The present study was approved by the ethics committee of the Faculty of Health of the Universidad Surcolombiana, following the standards of good clinical practice of the Declaration of Helsinki (Helsinki De, 2008), international ethical guidelines for biomedical experimentation on humans, and national regulations. The objectives, methodology, and potential impact of the study results were clearly and precisely explained in common language to the parents who signed an informed consent form, and agreement was subsequently requested and obtained from each participant.

2.3. Procedures

After obtaining approval from the ethics committee, data were collected at one point in time at four educational institutions. The data were collected by professional research assistants in psychology, who completed training in neuropsychological assessment.

The mothers were informed about the voluntary nature of their children’s participation in the study, emphasizing their right to decline to answer any questions or withdraw from the study at any time. After obtaining consent, questionnaires were administered to collect background medical information and document the children’s age at the time of displacement. In situations where a mother provided information regarding multiple children, distinct forms and scales were utilized for each child, with clear instructions for the mothers to respond while considering the individual experiences of each child. Additionally, the children themselves were actively involved in the decision-making process and their consent was sought. Furthermore, the teacher version of the BASC was administered by the researchers in the school counseling room to clarify any doubts for the teacher and to ensure that the reports were fully scored.

Regarding the process of administering neuropsychological tests and self-report measures to the children involved in the project, both paper-and-pencil and computer-based tasks were administered in a quiet environment. The computer tasks were presented on a 14-inch screen. The tasks were implemented in a specific sequence: initially, clinical, and behavioral scales were administered, followed by tasks assessing the executive component, and finally, tasks evaluating Theory of Mind. The administration of these instruments required four sessions, each lasting 45 minutes. It should be noted that the self-report measures of the BASC and the CDI were not administered to children under 8 years of age, as per the age ranges specified in the instruments’ administration guidelines.

2.4. Questionnaires

2.4.1. Clinical aspects

2.4.1.1. Clinical history interview

The clinical history corresponds to the battery of child neuropsychological assessment. This tool enables the identification of both pathological and non-pathological backgrounds of the child, as well as the characteristics of their current condition (Rosselli-Cock et al., 2004).

Multidimensional Behavior Scale. The standardized and validated version in Colombia was used (Pineda et al., 1999). The multidimensional Behavior Assessment System for Children (BASC) was designed to facilitate the diagnosis of the pedagogical classification of various emotional and behavioral disorders and measure behavioral and personality aspects, including positive (adaptive) and negative (clinical) dimensions. In the range of dimensions that were assessed, this instrument establishes a differential diagnosis according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised. The instrument assesses the perspectives of teachers and parents and self-reports. These are administered depending on the age of the child. Thus, there are scales for preschool children, school children, and adolescents between 12 and 18 years of age. Its components have high internal consistency and reliability and are easy to manage and qualify. The components of this instrument offer several types of validity that allow clinicians to measure veracity and consistency of the informants. A percentile scores higher than 75 on clinical scales or negative dimensions indicates a clinical risk. In other words, the higher the score, the greater the risk. On the other hand, for adaptive scales, a percentile scores below 25 indicates a higher risk.

2.4.1.2. Childhood Depression Questionnaire (CDI) (Kovacs, 1992)

The objective of the CDI is to evaluate depressive symptomatology in the child population. It consists of 27 items, each stated in three sentences that reflect the intensity or frequency of its presence in the child or adolescent. It has a general scale with two subscales: dysphoria (depressed mood, sadness, worry) and negative self-esteem (judgments of ineffectiveness, ugliness, badness). The psychometric data in the Spanish-adapted version (Del Barrio, 2004) show internal validity and external validity.

2.4.1.3. Difficulties in Emotion Regulation Scale (DERS)

The adaptation of the DERS by (Hervás & Jódar, 2008) has a high reliability index (α = 0.90). The scale consists of 36 items that are grouped into six factors: (a) non-acceptance of emotional responses (non-acceptance), (b) difficulties in goal-directed behaviors when upset (goals), (c) difficulties in controlling impulsive behaviors when upset (impulsivity)), (d) limited access to emotional regulation strategies perceived as effective (strategies), (e) lack of emotional awareness (awareness), and (f) lack of emotional clarity (clarity). The original analysis of the DERS revealed good internal consistency (α = 0.88) and construct and predictive validity.

2.4.2. Social cognition domain

2.4.2.1. Test of false beliefs of first and second orders (Test of Sally and Anne)

This instrument evaluates the ability to infer the state of knowledge or beliefs of another person, regardless of whether it agrees with one’s own. These are “first-order” tasks because the child only needs to represent the (false) belief that a person has. The “second-order” tasks imply a higher level of complexity and measure the child’s ability to represent and understand that someone may have a false belief about someone else’s belief.

2.4.2.2. Faux pas test. This test was developed by (Baron-Cohen et al., 1997)

The present study used the Argentinian Spanish translation. This test measures the ability to detect when someone says something inappropriate but without a bad intention because it was or could have been hurtful to another person. It consists of 20 stories. Half the stories contain a social faux pas, and the other half are control stories that contain a minor conflict that does not constitute a faux pas. The score is 0 when the answer is incorrect and 1 when the answer is correct.

2.4.2.3. Emotional recognition in eyes (Test of Eyes). This test was designed by (Baron-Cohen et al., 2001)

It measures the ability to recognize the mental state of a person through the expression of their gaze, emphasizing the visual perceptual aspect and minimizing the demand for memory, executive, and contextual functions. The test consists of presenting the participant with sheets that contain images of the gaze of different people. The participant must choose between four words that correspond to the expression of the gaze.

2.4.2.4. Emotional recognition in faces

This instrument was designed by Baron-Cohen et al. (1997). It measures the ability to recognize a person’s mental state through facial expressions. The test consists of 20 photographs of the full face of the same actress (10 photographs express basic emotional states, and the other 10 photographs express complex emotional states). Each photograph is followed by two words that describe emotional states. For classification, one point is awarded for each correct answer. The maximum score is 20.

2.4.2.5. Strange stories of Happé

This instrument evaluates the ability to attribute intentions to people from non-literal communicative expressions. The protocol in the present study included stories with irony, lies, white lies, simulation, metaphor, and persuasion. In each of the stories, a character says something that should not be taken literally. The participant is asked to explain why the character said that. The correct solution involves precisely identifying the intention behind the character’s expression. Responses are coded from 0 to 2: 0 (does not justify or provides meaningless justification), 1 (makes a realistic mistake, gives a justification related to the literal meaning of what the character said and its figurative meaning), and 2 (adequately justifies the non-literal meaning).

2.4.3. Executive component

2.4.3.1. Stroop Color and Word Test (SCWT)

This instrument evaluates the ability to inhibit cognitive interference, which occurs when the processing of one characteristic of a stimulus affects the simultaneous processing of another attribute of the same stimulus (Golden C.J., 2020). It consists of three different sheets. Two sheets represent the congruent condition, in which the participant is required to read the names of the colors as presented in the lists. The third sheet presents the incongruent condition, in which the participant must perform a less automated task while inhibiting interference that arises from a more automated task. The literature reports the application of the SCWT to measure other cognitive functions, such as attention, processing speed, cognitive flexibility, and working memory.

2.4.3.2. Trail Making Test (TMT)

This instrument evaluates such cognitive processes as visual search, visual planning, visuomotor control, attention, and memory. The TMT has two parts (A and B), each involving linking a total of 15 items that are randomly placed in ascending order. Part A (TMT-A) involves matching numbers. Part B (TMT-B) involves matching numbers that alternate with letters. Standardized protocols require the participant to complete the TMT as quickly as possible without lifting the pen from the paper.

2.4.3.3. Rey’s Complex Figure

This instrument consists of two phases: copy figure and evocation. It involves the reproduction of a complex geometric design from memory and is commonly used to assess cognitive functioning, particularly in areas related to visual perception, memory, planning, and problem-solving (Arango Lasprilla et al., 2017).

2.4.3.4. FAS test

This is a short phonological fluency test that is widely used to neuropsychologically evaluate verbal abilities and executive dysfunction. Verbal production is usually assessed with the phonemes F, A, and S. In Spanish-speaking countries, the letters “P” M, R, Pare used (Arango Lasprilla et al., 2017).

2.4.3.5. Semantic categories

This instrument assesses semantic memory. It consists of requesting the participant to generate a list of words that belong to a specific category within a given time (usually 1 minute). When evaluating children, the number of categories or letters can be reduced to two (Arango Lasprilla et al., 2017).

2.4.3.6. Verbal fluency

(Flores et al., 2012). This instrument estimates the ability to produce the largest number of verbs fluently and within a short time.

2.4.3.7. Token test

(Olabarrieta Landa et al., 2017). This instrument assesses language comprehension based on the recognition of nouns, verbs, and prepositions that include instructions. The test includes 36 items that are organized into six parts that refer to verbal commands that the participant must understand and complete. If the participant answers incorrectly after each element of parts 1–5, then the examiner returns the tiles to their original order and repeats the element. One point is scored for correct performance in the first presentation, and 0.5 points are scored if performance is correct for repeated items. The last part gives only one chance to answer, with 1 point for correct and 0 points for incorrect (e.g., “Touch the circle”). The test consists of 20 tiles, 10 circles, and 10 squares that are colored black, white, red, yellow, and green.

2.4.3.8. Card game

(Flores et al., 2012).This instrument estimates the ability to detect and avoid risky choices and identify and maintain profit selections. It is an adaptation of the suggested version for children of the “Iowa” card task. It assesses the ability to operate under uncertain conditions and learn risk-benefit relationships, to make selections (based on calculated risks) that are as advantageous as possible for the subject. The objective of the task is to achieve the highest possible gains, with minimal instructions given to the subject to create an uncertain scenario.

2.5. Statistical analysis

The analysis proceeded in three stages. First, descriptive statistics were performed for sociodemographic data. The results of the clinical dimensions, executive function tasks, and social cognition were compared between the two groups. Associations between children’s outcomes (i.e., clinical, adaptive, and executive function and Theory of Mind scales) and possible family factors that influenced the children’s performance were examined. Spearman’s Rho was calculated between the study variables. The data were analyzed using SPSS 27.0 software (IBM Corp., 2020).

3. Results

The results of the scales assessing clinical and adaptive dimensions from the parents’ perspective indicated a higher clinical risk in children who experienced forced displacement compared to children without this history, as reported by their parents (Mann-Whitney test, p < 0.05). Specifically, the victim group exhibited higher scores on scales measuring aggression, depression, atypicality, hyperactivity, isolation, attention problems, and somatization. Conversely, the comparison group obtained lower scores on the companionship and social skills scale, reflecting fewer positive dimensions (see Table 2). Regarding self-reports, a significant difference was found between the groups on the “relationship with parents” scale, with the study group showing a higher clinical risk (Mann-Whitney test, p < 0.05).

Table 2. Clinical and adaptive results from the perspective of parents, teacher, and self-report

Dimension/Informant		Measure	Study group			Comparison group			P value
			Me	IRQ	% Risk	Me	IRQ	% Risk
Negatives Dimensions (Clinicals)	Parents	Behavioral difficulties	45	45	19,6	25	45	3,7	0,011*
		Aggression	55	55	26,1	20	40	3,7	0,025*
		Depression	40	30	11	25	31	7,4	0,008*
		Atypicality	40	54	16,3	25	15	-	005*
		Hyperactivity	40	54	16,3	20	21	-	0,004*
		Isolation	48	49	26,1	30	45	18,5	0,022*
		Anxiety	40	44	18,5	25	35	7,4	0,177
		Attentional difficulties	48	49	19,6	45	30	7,4	0,385
		Somatization	35	45	18,5	20	15		0,007*
	Self-report	Attitude towards school	65	50	30,9	68	20	35,7	0,778
		Attitude towards teachers	70	25	35,8	55	59	28,6	0,328
		Depression	60	55	37	60	34	42,9	0,549
		Control locus	45	40	12,3	30	35	14,3	0,397
		Anxiety	50	60	29,6	55	53	35,7	0,316
		Feeling of Inadequacy	65	50	42,5	45	55	34,3	0,066
		Atypicality	30	60	20	63	69	35,7	0,105
		Social stress	55	40	23,5	58	44	21,4	0,641
	Teacher	Behavioral difficulties	60	41	33,7	40	25	-	0,058
		Aggression	55	65	31,4	55	30	10,7	0,414
		Depression	55	41	24,4	30	55	10,7	0,031*
		Atypicality	40	40	15	40	46	10,7	0,56
		Hyperactivity	45	51	25,6	43	45	21,4	0,724
		Isolation	25	45	10,5	45	48	21,4	0,048*
		Anxiety	40	34	20,9	45	40	7,1	0,843
		Attentional difficulties	63	56	36	48	39	14,3	0,281
		Somatization	35	45	7	25	20	7,1	0,487
		Learning difficulties	50	57	36	15	55	21,4	0,26*
Positives dimensions (Adaptative)	Parents	Fellowship	40	45	28,3	35	30	37	0,108
		Social Skills	60	55	22,8	45	55	33,3	0,188
		Adaptability	50	50	29,3	55	74	29,6	0,595
	Self-report	Self-confidence	45	35	43,2	45	59	28,6	0,111
		Self-esteem	50	65	34,6	50	50	21,4	0,861
		Relationship with parents	50	82	38,3	60	49	17,9	0,040*
		Relationship	55	43	28,4	55	50	32,1	0,672
	Teacher	Fellowship	30	43	40	30	30	42,9	0,679
		Social skills	40	40	44,2	45	45	37,9	0,769
		Adaptability	60	60	32,6	60	50	24,1	0,876
		Study Skills	33	51	40,7	50	49	32,1	0,6

Me: Median

IRQ: Interquartile range

*Mann Whitney U statistic, significance level of < 0,05.

Moreover, teachers reported significant differences in the scales of learning problems and depression, with these symptoms being more prevalent among children in the victim group. Additionally, teachers reported a higher tendency toward isolation among children in the comparison group. The results of the CDI indicated that the comparison group had higher scores on the negative self-esteem scale (victim group: M = 50; comparison group: M = 62; p = 0.144), higher dysphoria scores (Study group: M = 60; comparison group: Me = 70; p = 0.273), and higher total scores (Study group: Me = 70; Comparison group: Me = 70; p = 0.085) compared to the study group. However, these differences were not statistically significant.

Performance on tasks assessing executive function domains, including inhibitory control, working memory, phonological fluency (i.e., F, A, S), comprehensive language, and processing speed, was found to be below the reference scores on standardized tests for children in the Colombian population in both groups. Specifically, their scores fell below the 50th percentile (Arango-Lasprilla & Rivera, 2015; see Table 3).

Table 3. Descriptive results of neuropsychological tests and comparisons between groups

Measure	Study group (n = 105)		Comparison group (n = 35)		P Value
	Me	IRQ	Me	IRQ
Stroop Word	30	40	40	45	0,261
Stroop Color	30	45	30	48	0,769
Stroop Word-Color	20	35	30	35	0,484
Stroop interference	30	45	40	41	0,88
Complex figure of Rey (reproduction)	49	66	30	65	0,227
Complex figure of Rey (evocation)	30	45	25	50	0,235
TMT- A	20	40	10	22	0,012*
TMT- B	30	45	10	35	0,108
Token test	30	50	15	45	0,416
F	30	35	30	40	0,6
A	30	40	30	35	0,956
S	40	40	40	30	0,247
P	40	40	45	40	0,575
M	40	40	40	48	0,805
R	30	38	40	55	0,314
Semantics Categories -Animals	30	40	30	20	0,347
Semantics Categories—Fruits	40	40	35	38	0,305
Verbal Fluency (hits)	4	4	4	4	0,951
Verbal fluency (Perseverations)	10	0	10	0	0,462
Card Game (Hits)	11	8	11	7	0,868

*Mann Whitney U statistic, significance level of < 0,05.

Of note, the Trail Making Test Part A (TMT-A) was the only task that displayed a statistically significant difference between the groups. Children in the study group obtained higher scores compared to the comparison group (Study group: Me = 20 Comparison group: Me = 10 p = 0.012). Performance on tasks assessing perceptual organization and risk-benefit analysis was within the normal range for both groups.

For tasks that assessed domains of social cognition (Table 4), the study group obtained a statistically significant score in identifying errors (Test Faux Paus) compared with the comparison group (p = 0.048). The recognition of emotions through the face and eyes and the identification of communicative intent were similar between groups. Children in the study group had a lower percentage of successfully identifying second-order false beliefs. In both groups, limitations were identified in effectively detecting social errors that were committed accidentally.

Table 4. Descriptive results of the tests that assess the domain of social cognition and comparisons between groups

Domain	Measures	Study group. (n = 105)		Comparison group(n = 35)		P Value
		Me	IRQ	Me	IRQ
Emotion recognition	Emotional recognition in faces (Score máx. 20)	15	3	14	3	0,096
	The Eyes Test (Score max. 20)	15	6	14	7	0,388
Communicative intention	Test Faux Pas (Score máx.10)	3	4	2	4	0,048*
	Happe’s Strange Stories Test (Score max. 24)	14	8	13	8	0,132
		% Hits		% Hits		X^2
Belief identification	False-belief task (First order)	76		53		0,011**
	False-belief task (Second order)	43		57		0,087

*Mann Whitney U statistic, significance level of < 0,05.

**Chi-square statistic, significance level of < 0,05.

Correlation coefficients were also analyzed to determine whether executive function measures were associated with performance on Theory of Mind tests. Moderate and low positive correlations were found between performance on phonological fluency tasks and communicative intent comprehension tasks and the recognition of emotions through the face and gaze (Table 5).

Table 5. Correlation between tasks associated with executive functioning and performance in ToM tasks

Measure		Compressive language	Perceptual Organization	Phonological Fluency						Verbal Fluency	Semantics Categories
		1	2	3	4	5	6	7	8	9	10	11
Grupo Comparación	Faux Pass Test
	Happe’s Strange Stories Test	388*
	The Eyes Test				435*
	Emotional recognition in faces
Grupo Estudio	Faux Pass	420**			275**	241*	306**	328**	264*		298**
	Happe’s Strange Stories Test	414**			365**		266*		248*		301**
	The Eyes Test	220*		209*	286**	338**	305**	268*	332**	237*	303**	267*
	Emotional recognition in faces	210*	249*	258*	343**	251*	235*	281**	419**		302**

Note: 1. Token Test. 2. Complex figure of Rey (reprodution). 3. F 4.A 5. S 6.P 7.M 8.R 9. Verbal Fluency (hits) 10. Semantics categories—animals 11. Semantics categories—Fruits.

*The correlation is significant at the 0.05 level (bilateral).

**The correlation is significant at the 0.01 level (bilateral).

To identify relationships between performance in executive function, social cognition, and family characteristics, significant (low) relationships were found between the education level of mothers and performance on comprehensive language tasks (r = 0.21), and phonological fluency (r = 0.22). Higher levels of education of parents were associated with higher performance among children in tasks that assessed verbal production and the comprehension of instructions.

4. Discussion

The literature reports that executive function and Theory of Mind are important skills for cognitive development, social and emotional competence, and the acquisition and maintenance of adaptive social behaviors. Exposure to traumatic events during childhood can interfere with normal development. The present study sought to identify cognitive, emotional, and social cognition characteristics of children who were subjected to conditions of displacement that was caused by the Colombian armed conflict. We hypothesized that child victims of displacement would present deficits in executive function and Theory of Mind and more internalizing-type symptoms compared with a child population without this background. We also hypothesized that living in geographical areas that are characterized by socioeconomic adversities would lead to lower or similar performance among children as the performance of children who were victims of the Colombian armed conflict.

The results indicated that the children in the study group presented a higher clinical risk of clinical scales (behavioral difficulties, depression, isolation) compared to the comparison group from the perspective of parents and teachers. However, no significant differences were found at the level of clinical scales in the self-reports. Significant differences were identified in executive function and Theory of Mind tasks, evidencing that the study group obtained better than the comparison group. These findings confirmed our hypotheses, evidencing deficiencies in the executive and emotional component.

Previous studies reported that experiencing armed conflict significantly exacerbates cognitive and emotional alterations among child populations, even more than living under adverse socioeconomic conditions (Kara & Selcuk, 2021). Situations of armed conflict often impede healthy child development by altering family dynamics and exposing children to stressful situations where their rights are violated by restricting their access to food, health, education, and adequate housing (Betancourt & Khan, 2008).

The present results indicated significant differences between groups, but performance on tasks that assessed executive function and social cognition were mostly below reference scores. This implies that generally vulnerable conditions that are caused by political or structural violence hinder children’s normative development of cognitive skills and mental well-being. Thus, executive function, Theory of Mind, and emotion are all influenced by adverse childhood experiences that are associated with violence and social vulnerability (Hewitt Ramírez et al., 2014; Kadir et al., 2019; Kara & Selcuk, 2021).

Previous studies revealed that conditions of social inequity are predictors of language performance, an ability that regulates behavior and enhances executive function and social competence (Amso & Lynn, 2017). Thus, living under conditions of social and economic vulnerability while nested in conflict situations limits opportunities for cognitive stimulation compared with children who are not exposed to such adverse situations at an early age and who have relatively better social status and more effective caregivers who have a higher level of education, greater lexical capacity, better education, and a higher quality of learning experiences (McLaughlin et al., 2017). Therefore, children who live under adverse social conditions have a higher risk of being exposed to stressors that negatively affect their mental health and a low probability of intergenerational mobility when considering their limited access to opportunities.

4.1. Limitations

The present findings should be interpreted with caution. The data corresponds to a cross-sectional study, providing information on the emotional and cognitive states of children at a single time point. There was a significant time gap between the occurrence of the stressful experience of forced displacement and the assessments being conducted. Additionally, the participants were volunteers, which may introduce sampling bias. Moreover, the sample size is small, and the number of children included in the comparison group was lower than the number of children in the study group. This discrepancy resulted from social isolation during the public health emergency, which limited the inclusion of additional children in the study. For future studies examining the effects of armed conflict on social vulnerability, it is recommended to employ longitudinal designs to contextualize the impacts more conclusively on children and adolescents.

5. Conclusion

The present study reports on the performance of executive function and social cognition in the Colombian child population with and without a history of displacement within the framework of the internal armed conflict. Forced displacement can lead families to relocate to vulnerable areas that are not conducive to strengthening or recovering cognitive abilities, considering that the performance of children already residing in these areas also exhibited difficulties. Research on child development and the long-term effects of exposure to armed conflicts is a priority for identifying protective factors and mitigating the harmful effects of conflicts on children. Our findings can be valuable for future development of intervention programs and public health policies aimed at promoting cognitive, emotional, and social development in children.

Correction

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (https://doi.org/10.1080/23311908.2023.2262239).

Acknowledgements

We thank the staff, families, and children who were involved in the project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data generated within the framework of the current studies are available upon reasonable request to the corresponding author.

Additional information

Funding

This research was funded by MINCIENCIAS- Universidad Surcolombiana (Grant No. 777-2017), and Universidad Cooperativa de Colombia (CONADI 2830).

Notes on contributors

Alfredis González Hernández

Alfredis González Hernández, a research professor at the Surcolombiana University, is currently the director of the Neurocognition and Psychophysiology Laboratory ”Piedad Gooding Londoño.” He holds a Ph.D. in Cognitive Neuroscience from the University of Maimonedes. His research work has focused on processes of neuroaging, including the identification of preclinical markers in Alzheimer's disease.

Jasmin Bonilla Santos

Jasmin Bonilla Santos is a professor in the Department of Psychology at the Cooperative University of Colombia. She holds a Ph.D. in Cognitive Neuroscience from the University of Maimonedes - Buenos Aires. Her most recent writing has focused on aspects related to vulnerability conditions, school bullying, and neurodevelopmental disorders.

Tatiana Padilla-García

Leidy Tatiana Padilla-García, a psychologist graduated from the Surcolombiana University, is a candidate for a master's degree in public health from the University of Rosario. Currently, she is a student specializing in Research Methods and Techniques in the Social Sciences (CLACSO). Her research work has focused on neurodevelopment processes and health indicators.