Diatheses and stressors in borderline pathology of childhood: The role of neuropsychological risk and trauma

Objective: To determine the relative contributions of neuropsychological deficits and psychosocial stressors to the presence of borderline pathology in children. Method: The subjects were 86 school-age children (75 males, 11 females) referred for psychiatric day treatment. Thirty-five of the children met criteria for borderline pathology. Data on psychosocial risk factors were obtained for each child from a questionnaire completed by members of the child's clinical team and were based on interviews with parents and children, as well as reports from schools and social agencies. Neuropsychological measures included computerized versions of the Wisconsin Card Sorting Test and the Continuous Performance Test. Results: Both deficits in executive function and psychological trauma made significant and independent contributions to the variance in borderline pathology. Inclusion of both sets of risk factors produced a model that explained 48% of the variance in borderline diagnosis. Conclusions: Both environmental risks and neurobiological vulnerability should be taken into account to understand the etiology of borderline pathology in children.