Executive Functions and Behavior Problems in Children Exposed to Child Sexual Abuse: The Moderating Role of Attachment Security.

While executive functions are known predictors of behavior problems in normative samples, they remain understudied among sexually abused children. Little is known about potential moderators, such as attachment security, which may influence the association between executive functions and behavior problems. This study explored attachment security as a moderator in the association between executive functions and behavior problems in school-aged, sexually abused children in Quebec, Canada. The sample included 212 children aged six to twelve. Teachers completed questionnaires on behavior problems, and children completed tasks measuring inhibitory control and cognitive flexibility, along with an attachment security questionnaire. Results indicated that the effect of cognitive flexibility was specific only in children with high attachment security, showing that higher cognitive flexibility was associated with fewer internalizing behavior problems. For inhibitory control, we found an inverse effect depending on children's level of attachment security: among children with high attachment security, higher inhibitory control was associated with fewer internalizing behavior problems, whereas among children with low attachment security, higher inhibitory control was associated with more internalizing behavior problems. No significant results were found for externalizing behaviors. These findings suggest that the association between executive function and adaptive functioning may depend on attachment security. It may be that less securely attached children display more internalizing behavior problems due to over-control, while more securely attached children with more cognitive flexibility may better manage environmental demands, resulting in fewer internalizing behavior problems. Interventions focused on enhancing children's attachment security after child sexual abuse may thus support adaptive functioning.