The study was approved by the University of Chicago Medicine and Biological Sciences Division Institutional Review Board (IRB). Review of the procedures underwent significant consideration by the IRB, given the sensitivity and specificity of the study aims and the population being assessed. Approval from the University’s IRB was based on assurances that our team made, in conjunction with the staff of the shelters, for the protection of the participants in this study.
After informed consent was obtained, and following discussion with each youth regarding the sensitivity of the questions being asked and their ongoing right to maintain privacy and to minimize potential re-traumatization, each participant completed a psychosocial interview and was administered a full neurocognitive battery, over the course of two sessions. All testing was completed by trained research staff, who had a minimum of an undergraduate education and who achieved appropriate levels of administration skill consistent with the Department’s psychometrician staff. All interviews were conducted with the youth were administered by trained graduate students in clinical psychology or medicine, who were supervised by a licensed clinical psychologist and a board-certified child and adolescent psychiatrist, both of whom specialize in working with youth and families who have experienced trauma and adversity. Participants were provided with a $10 gift card as compensation for their time after the first session and a $20 gift card following completion of the second session.
For all participants in the homeless youth study, the first session, lasting approximately 1.5 h, included administration of the following measures: a detailed demographic interview administered by a trained research assistant that allowed for the collection of information addressing multiple areas of the participant’s early life, their upbringing, and their adolescence, and included questions regarding their experiences of homelessness, foster care, and education; the Adult Temperament Questionnaire (ATQ), a self-report model of temperament [21
]; the Behavior Rating Inventory of Executive Function (BRIEF) [22
], a well-standardized and normed self-report measure that assesses a range of everyday examples of executive functioning abilities, including inhibition, set-shifting, emotional control, task initiation, working memory, planning/organizing, self-organization of materials, and self-monitoring providing three composite scores, the Metacognition Index (MI), Behavior Rating Index (BRI), and Global Executive Composite (GEC) Index, which were examined with this study; the Mini International Neuropsychiatric Interview, Sixth edition (MINI), a semi-structured interview allowing for assessment of DSM-IV-TR based diagnoses and substance use disorders [23
]; an adapted version of the 2011 Youth Risk Behavior Survey (YRBS), a standardized, self-report multiple-choice questionnaire that assesses recent and lifetime participation in common risky behaviors that has been used in previous research with homeless youth [25
]; and lastly, the Wechsler Abbreviated Scale of Intelligence (WASI) [27
], a measure of academic achievement which provides a full scale IQ score based on completion of four subtests addressing verbal and nonverbal problem solving.
The second session, lasting approximately 2.5 h, included administration of a number of neuropsychological tests, including the California Verbal Learning Test, Second Edition (CVLT-II) [28
], an evaluation of multi-trial learning and long term recall of verbal information; the Delis-Kaplan Executive Functioning System (D-KEFS) [29
], a well standardized objective assessment of executive functioning, including both verbal and nonverbal tasks; the Iowa Gambling Task (IGT) [30
], a test of behavioral decision-making that addresses aspects of risk-taking and executive development; the Nelson-Denny Reading Test [31
], a standardized and normed measure of vocabulary development, reading comprehension, and reading rate; the Drexel version of the Tower of London (TOL), an executive assessment measuring higher order problem solving [32
]; the Weinberger Adjustment Inventory (WAI) [33
], a self-report assessment of social-emotional adjustment in the context of external constraints; two subtests from the Wide Range Assessment of Memory and Learning, Second Edition (WRAML2) [34
], assessing both immediate and delayed memory for verbal and nonverbal information; and the Wide Range Achievement Test, Fourth Edition (WRAT4) [35
], a standardized and well-normed assessment of basic academic skills, including spelling, word reading, and basic calculations.
For this analysis and the questions posed with this study, we specifically focused on the demographic and semi-structured interview questions regarding current behavioral and adaptive functioning, and their relationship to profile responses to the BRIEF. The MINI was used to identify youths who met DSM-IV-TR criteria for alcohol dependence and abuse through a series of questions regarding their alcohol consumption [23
]. The YBRS was used to identify the regularity and level of each study participant’s engagement in several common risky behaviors including experiences with alcohol, marijuana, other drugs, and their engagement in sex with multiple partners. The three core BRIEF composite scores where used to assess self-reported executive functioning. As mentioned above, these include the BRI, which measures the ability to modulate emotions via inhibitory control; the MI, which measures the ability to plan and sustain future oriented problem solving; and the GEC, which measures overall executive function [22