Direct and Indirect Effects of Prenatal Alcohol Damage on Executive Function

Abstract

Patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) often have difficulty functioning appropriately in everyday life and seem to employ poor problem-solving strategies. Tests of executive function are relevant for quantifying the functional deficits and underlying real-life problems associated with prenatal alcohol exposure. This study considers two pathways for the effects of prenatal alcohol on executive function: a direct effect and an indirect effect through prenatal alcohol's effect on IQ. We compared 30 men who had been diagnosed with FAS or FAE with young adults participating in a longitudinal prospective study (n = 419) and 15 control participants that comprised a comparison group. This study is unique in its analysis of the same battery of assessments of executive function in both a large low dose longitudinal study sample and a clinically diagnosed group. Participants were evaluated on 9 tests (including 58 scores) of executive function. For some but not all of the tests in this executive function battery, the decrement in the alcohol exposure group is greater than would be predicted from their IQ scores. We found that 3 of 6 Stroop scores, 2 of 4 Trails scores, 9 of 16 Wisconsin Card Sorting scores, 1 of 2 Ruff's Figural Fluency scores, and 2 of 4 Consonant Trigrams scores appear to be particularly sensitive to the direct effects of prenatal alcohol damage for patients with FAS and FAE. The findings suggest that these executive function tests would be particularly useful in clinical evaluations of persons suspected of fetal alcohol damage because they would not simply reflect deficits in IQ or facial stigmata.

Differences in executive functioning in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder

“…In comparison to typically developing controls, our alcohol-exposed group displayed deficits on all tasks except for TMT-A, although the group difference on category fluency was only marginally significant ( p 5 .059). These deficits are consistent with previous reports of deficits on the WCST (Carmichael Olson et al, 1998;Connor et al, 2000;Kodituwakku et al, 1995), verbal fluency (Kodituwakku et al, 1995;Schonfeld et al, 2001), and trail making in this population. In addition, the ALC group displayed significantly poorer performance on letter fluency than category fluency, which is consistent with previous findings suggesting that letter fluency is better than category fluency at discriminating children with FASD from controls (Kodituwakku et al, 1995;.…”

“…Although the groups displayed similar impairment, WCST performance of the ALC group was significantly better than predicted by IQ, whereas in the ADHD group, the opposite was true. Other studies in alcohol-exposed children and adults have reported EF deficits that remain after IQ is controlled or that are worse than predicted based on IQ deficits (Carmichael Olson et al, 1998;Connor et al, 2000;Kerns et al, 1997;Schonfeld et al, 2001). Although the reason for these conflicting results is unclear, it may be due to task or sample differences.…”

"I drink": Mothers' alcohol consumption as both individualised and imposed occupation

“…However, more than half of the associated characteristics are linked to the socio-economic environments in which these mothers live and work 10,25,26,27,28 . The information gathered thus far provides limited understanding of how culture, economy and politics perpetuate marginalisation amongst women who drink during pregnancy.…”

“…The criteria for purposeful sampling were drawn from literature describing the traits of mothers who are at risk for having children with FAS 20,25,26,27 . Accounting for elements of balance and variety in age, stage of pregnancy and key socio-economic factors was of greater importance than a larger sample.…”

Occipital-temporal Reduction and Sustained Visual Attention Deficit in Prenatal Alcohol Exposed Adults

“…The first are behavioral/cognitive studies comparing the behavioral performance of exposed to nonexposed individuals on various neuropsychological tasks with the goal of understanding the neurocognitive phenotype associated with exposure. While many differences in functioning, including attention (Coles et al 1997;Nanson and Hiscock 1990), memory (Mattson et al 1996), verbal ability (Schonfeld et al 2001), and executive function (Connor et al 2000), have been identified as impaired in alcohol-exposed individuals, inconsistencies remain, however, between studies and across developmental stages. Specific behavioral markers (if there are any) have not been delineated as yet.…”