Higher functioning children with prenatal alcohol exposure: Is there a specific neurocognitive profile?

Abstract

Recent attempts to identify a neurocognitive profile of children with prenatal alcohol exposure (PAE) have led to an emerging "generalized deficit" conceptualization marked by diffuse information processing and integration difficulties as opposed to a specific profile. This study examines whether this conceptualization can be extended to higher functioning children with PAE who are without intellectual disability and addresses several limitations of previous research. One hundred twenty-five children aged 6-12 years with social skills deficits, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD), underwent a comprehensive, multi-informant assessment of neurocognitive, emotional, social, behavioral, and adaptive functioning. Multivariate analyses of variance examined differences in functioning between the PAE group and a nonexposed comparison group with and without controlling for child IQ. Results indicated that the PAE group returned significantly poorer scores than the nonexposed group on every construct assessed, including executive functioning, attention, working/visuospatial memory, linguistic abstraction, adaptive behavior, emotional/behavioral functioning, and social cognition. These differences largely maintained after controlling for IQ and were similar regardless of informant, although teachers reported somewhat fewer group differences. Within the PAE group, no differences were found across FASD subtypes. These results provide evidence extending the emerging generalized deficit conceptualization of children with PAE to those higher functioning individuals without global intellectual disability.

Executive Functioning in Children and Adolescents Prenatally Exposed to Alcohol: A Meta-Analytic Review

“…Rasmussen et al (2013) supported this argument by demonstrating greater differences between FASD and comparison groups on complex tasks that require both inhibition and switching, compared to tasks that only require inhibition. These findings are also consistent with prior research showing that children with FASD, compared to children without FASD, experience more pronounced challenges on set shifting (d= 0.78) compared to auditory working memory (d=0.50) tasks (Quattlebaum and O'Connor 2013). Thus, children and adolescents with FASD may demonstrate more profound deficits on set shifting tasks, as these tasks draw on a variety of cognitive abilities, each of which independently present difficulty, and combined may pose cumulative impairments.…”

“…EF deficits are part of the core of the neurobehavioral phenotype of FASD (Nash et al 2015). Understanding the role of EF is important because these functions pervade many neuropsychological tasks, contributing to performance deficits across neurocognitive domains (Quattlebaum and O'Connor 2013).…”

Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths

“…Though the field has yielded mixed results, our findings are consistent with studies that have demonstrated comparable levels of cognitive deficits between children with the physical features of FASD (e.g., FAS and pFAS) and those without physical features (e.g., ARND), suggesting that the degree of deficits observed following PAE may occur independently from any physical effects (Green et al 2009b;Mattson et al 1997Mattson et al , 1998Quattlebaum and O'Connor 2012). Alternatively, Astley's (2010) large scale cohort in Washington found a linear trend differentiating cognitive functioning among individuals with ND/AE, SE/AE, and FAS/pFAS, and Chasnoff et al (2010) similarly found differences in functioning between children with FAS compared with those with pFAS and ARND.…”

“…Interestingly, deficits in visuospatial processing (using other measures) have previously been identified as particularly affected by PAE (Korkman et al 2003;Mattson et al 1998;Pei et al 2011), even after accounting for IQ (Quattlebaum and O'Connor 2012). However, one study found children with FASD performed similarly to IQ-matched controls on a visuospatial processing task (Vaurio et al 2011), and another found no significant group differences in this area using the same NEPSY-II subtest ).…”

“…Similarly, Nash et al (2013) found that children with FASD were more impaired on tasks evaluating verbal reasoning, memory, language, and mathematics relative to children with PAE who did not receive an FASD diagnosis. Alternatively, other studies have shown few or no statistical differences in cognitive functioning between subgroups on the diagnostic spectrum (Green et al 2009a;Mattson et al 1997Mattson et al , 1998Quattlebaum and O'Connor 2012). These inconsistencies may be the by-product of methodological differences, varying FASD diagnostic systems and classifications, and/or limited sample sizes that fail to accurately differentiate the broad range of individuals who do not present with the physical features of FASD (ARND).…”