Academic Difficulties in Children with Prenatal Alcohol Exposure: Presence, Profile, and Neural Correlates

Abstract

Background Academic achievement was evaluated in children with heavy prenatal alcohol exposure to determine potential strengths and weaknesses, evaluate the utility of different definitions for identifying low academic performance, and explore the neural correlates that may underlie academic performance. Methods Children (8–16 years) were assessed using the WIAT-II. Patterns of performance were examined in two subject groups: children with heavy prenatal alcohol exposure (n=67) and controls (n=61). A repeated-measures MANCOVA examining group differences on academic domain (reading, spelling, math) scores was conducted. Post-hoc comparisons examined within-group profiles. Numbers and percentage of children with low achievement were calculated using several criteria. In a subsample (n=42), neural correlates were analyzed using FreeSurfer-v5.3 to examine relations between cortical structure (thickness and surface area) and performance. Results The alcohol-exposed group performed worse than controls on all domains and had a unique academic profile, supported by a significant group × academic domain interaction (p<.001). For the alcohol-exposed group, math reasoning was significantly lower than numerical operations, which was significantly lower than spelling and word reading. Over half of the alcohol-exposed group (58.2%) demonstrated low achievement on one or more academic domains. The number and percentage of children meeting criteria for low achievement varied based on the domain and definition used. The imaging analysis identified several surface area clusters that were differentially related to math (L superior parietal and R lateral/middle occipital) and spelling (bilateral inferior and medial temporal) performance by group, with no relations for the other academic domains. Generally, scores improved as surface area decreased in controls, whereas no relation or a positive relation was observed in the alcohol-exposed group. Conclusion Alcohol-exposed children demonstrated deficits in academic performance across domains and definitions with a relative weakness in math functioning. Atypical brain development may contribute to these impairments in academic achievement. Understanding academic difficulties can assist in advocating effectively for alcohol-exposed children.

Characterizing Alcohol‐Related Neurodevelopmental Disorder: Prenatal Alcohol Exposure and the Spectrum of Outcomes

“…Often children with an FASD have cognitive abilities within the average or low average range, but have specific executive functioning, memory, attention, and visual‐perception impairments that may deter or limit their success (Matton et al, 2013; Mattson and Riley, 2011; Streissguth et al, 1999; Ware et al, 2012). In addition, while maintaining overall intellectual skills within the average range, children prenatally exposed to alcohol frequently have behavioral concerns related to attentional abilities, impulse control and mood, or self‐regulation (Crocker et al, 2015; Glass et al, 2017, 2013; Howell et al, 2006; Matton et al, 2013; Rasmussen et al, 2013; Ware et al, 2013). Based on our understanding of these patterns of functioning, the decision was made to set qualification criteria for classification at the eighth percentile below the mean or at the 92nd percentile above the mean for all testing done with the exception of BBCS‐R (the early learning measure).…”

Fetal Alcohol Spectrum Disorders: A Review of the Neurobehavioral Deficits Associated With Prenatal Alcohol Exposure

“…Interventions targeting mathematical skills in children with FASD have been effective in improving some of these academic challenges (Coles et al., ). In addition to mathematical impairments, lower performance on spelling and reading is found in association with FASD (Glass et al., , ; Jirikowic et al., ). These impairments are thought to be related to deficits in working memory (Glass et al., ).…”

“…However, greater impairments have been reported for children with FASD compared to those with ADHD (but without histories of prenatal alcohol exposure) on assessments of planning, fluency, set‐shifting, working memory (Kingdon et al., ), encoding, visual–spatial skills, problem‐solving flexibility (Coles et al., ), interference control (Graham et al., ), IQ (Vaurio et al., ), social cognition, and facial emotion processing ability (Greenbaum et al., ). Children with FASD have greater deficits in arithmetic, while ADHD children are relatively more impaired on measures of reading (Coles et al., ), although both domains are impacted in FASD (Glass et al., ). Both clinical groups of children have higher rates of psychiatric disorders compared to controls, with nonexposed children with ADHD displaying higher rates of comorbid generalized anxiety disorder and oppositional defiant disorder compared to children with FASD (Ware et al., ).…”

Regional Patterns of Alcohol‐Induced Neuronal Loss Depend on Genetics: Implications for Fetal Alcohol Spectrum Disorder

“…These structural changes include microencephaly, neuronal ectopia, cerebellar hypoplasia, agenesis of the corpus callosum, reductions in gray matter and white matter volumes, altered cortical connectivity, and many others (Fryer et al, 2006). These differences in structural abnormalities are often paralleled by differences in neurological and cognitive deficits, so that ataxia is the most prominent symptom in some affected children, while behavior problems, attention deficit disorder, epilepsy, or learning problems are most notable in others (Boronat et al 2017; Glass et al, 2017; Infante et al, 2015).…”