War and Prolonged Early-Life Stressors: Cross-Sectional Comparison of Children's Functional Cognition as Measured With the BRIEF.

Importance: Early-life stressors related to war have been linked to disruptions in children’s functional cognition, underscoring the need for occupational therapy practitioners to identify and address these difficulties. Objective: To compare functional cognition between cohorts of children before a global crisis and during a prolonged war and to test whether cohort differences vary by educational needs (typical vs. special). Design: Repeated cross-sectional design. Setting: Community-based data collection. Participants: Mothers of two cohorts of second- and third-grade children: Cohort 1 (precrisis, 2016–2017; n 5 129) and Cohort 2 (during war, 2024–2025; n 5 190). Outcomes and Measures: Functional cognition was assessed with the Behavior Rating Inventory of Executive Function (BRIEF) Parent Questionnaire. The BRIEF Global Executive Composite, Behavioral Regulation Index (BRI), and Metacognition Index (MI) were analyzed. Results: After controlling for gender, age, socioeconomic status, and educational needs, children in the Cohort 2 demonstrated significantly lower functional cognition than children in Cohort 1. Multivariate analysis with cohort and educational needs as independent variables and BRI and MI as dependent variables revealed that children exposed to war and those with special educational needs had functional cognition deficits. A significant interaction between cohort and educational needs indicated that exposure to early-life stressors disproportionately affected children with special educational needs. Conclusions and Relevance: War-related early-life stressors are associated with reduced functional cognition, particularly among children with special educational needs. The BRIEF Parent Questionnaire may serve as a practical screening measure to identify functional cognition challenges and guide pediatric occupational therapy interventions during and after crises. Plain-Language Summary: Functional cognition supports children’s ability to meet the demands of their daily tasks in real-world environments, such as managing daily routines, playing, and participating in school tasks. This study examined how prolonged war-related stress affects children’s functional cognition. The study compared children assessed before a global crisis with children assessed during a prolonged war, all from low socioeconomic backgrounds. Mothers reported on their children’s everyday functional performance with the Behavior Rating Inventory of Executive Function Parent Questionnaire. The findings showed that children exposed to ongoing war-related stress demonstrated lower functional cognition than children assessed before the war. Children with special educational needs were affected most. These findings highlight the importance of identifying functional cognition difficulties during and after crises. For occupational therapy, the results support the use of functional cognition screening in school settings to guide timely, individualized interventions that promote children’s participation in daily activities and learning.