War-related exposure moderates the association between attachment-related characteristics and cognitive-limbic functional connectivity in children: an fMRI study.

Abstract

Background: Early-life exposure to chronic and unpredictable stress is a major risk factor for affective disorders, yet the neurodevelopmental mechanisms linking such exposure to emotional vulnerability remain unclear. War-related environments represent an extreme form of environmental unpredictability and may shape how children's attachment-related characteristics relate to the organization of cognitive-limbic brain systems. Here we test whether war-related exposure moderates this brain-behavior association, rather than producing uniform group-level differences.

Methods: Seventy-nine children (42 war-exposed; 37 non-exposed) underwent behavioral assessment and resting-state fMRI. Executive functions (EF) were assessed via parent report, attachment-related characteristics via the Experiences in Close Relationships questionnaire, and war exposure via a structured exposure index. Functional connectivity analyses focused on large-scale executive-control networks and limbic circuits.

Results: The war-exposed and non-exposed groups did not differ significantly in attachment-related characteristics, and group differences in parent-reported EF were no longer significant after adjustment for scan timing and nonverbal ability. At the neural level, the two groups showed divergent patterns of association between attachment-related characteristics and limbic connectivity. Critically, attachment-related difficulties were associated with distinct connectivity patterns depending on exposure status: in the war-exposed group, greater attachment-related anxiety and avoidance were associated with reduced cingulate-amygdala connectivity, whereas in the non-exposed group the same characteristics were associated with reduced amygdala-hippocampal connectivity. For large-scale networks, the direction of the attachment-connectivity association shifted across exposure levels, from negative at lower exposure to positive at higher exposure; these within-level simple slopes did not survive correction for multiple comparisons and are interpreted with caution.

Conclusions: War-related exposure was associated with distinct patterns of association between children's attachment-related characteristics and cognitive-limbic connectivity, rather than with uniform group-level differences in attachment or connectivity. These findings provide preliminary evidence that environmental adversity may moderate brain-behavior coupling in childhood; longitudinal studies with validated exposure and symptom measures are needed to clarify causal mechanisms.