Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders

Abstract

Objective To provide an analysis of multiple predictors of cognitive and behavioral traits for children with fetal alcohol spectrum disorders (FASD). Method Multivariate correlation techniques were employed with maternal and child data from epidemiologic studies in a community in South Africa. Data on 561 first grade children with fetal alcohol syndrome (FAS), partial FAS (PFAS), and not FASD and their mothers were analyzed by grouping 19 maternal variables into categories (physical, demographic, childbearing, and drinking) and employed in structural equation models (SEM) to assess correlates of child intelligence (verbal and non-verbal) and behavior. Results A first SEM utilizing only seven maternal alcohol use variables to predict cognitive/behavioral traits was statistically significant (B = 3.10, p < .05), but explained only 17.3% of the variance. The second model incorporated multiple maternal variables and was statistically significant explaining 55.3% of the variance. Significantly correlated with low intelligence and problem behavior were demographic (B = 3.83, p < .05) (low maternal education, low socioeconomic status (SES), and rural residence) and maternal physical characteristics (B = 2.70, p < .05) (short stature, small head circumference, and low weight). Childbearing history and alcohol use composites were not statistically significant in the final complex model, and were overpowered by SES and maternal physical traits. Conclusions While other analytic techniques have amply demonstrated the negative effects of maternal drinking on intelligence and behavior, this highly-controlled analysis of multiple maternal influences reveals that maternal demographics and physical traits make a significant enabling or disabling contribution to child functioning in FASD.

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“…These performances shown in Figure 2, were consistent with those described in the literature, in which FAS individuals had a more compromised IQ 22 and individuals with FASD have a performance within the borderline and middle low ranges. 11 However, one clinical sample of a high-quality study was classifi ed in the middle range, possibly due to environmental factors that favoured the cognitive development of children.…”

“…13,15,16,20,[25][26][27][28][29][30][31][32][33][34]45 This fi nding was consistent with the revisions included in this study. 11,12,22,32,38,39 Curiously, while compiling the studies data, we found that the intellectual performance injury occurs diff erently depending on the individual diagnosis. This injury appears to come together with the continuum of FASD, FAS being the most adverse diagnosis and with major intellectual impairment, ARND, the least adverse and with better performance and pFAS, the intermediate diagnosis, comprehending a wider spectrum (Figure 2).…”

“…15,16 Eight studies provided the results of Wechsler Scales subtests. [15][16][17][18][19][20][21][22][23] The individuals who were prenatally exposed to alcohol had worse performances in the arithmetic subtest (44.4% of the samples had a scaled score below 6) 16,20,23 and signifi cantly underperformed in relation to the control group as shown in studies by Woods et al 16 and Gautam et al 21 Moreover, the samples that were exposed to alcohol showed impaired performance in the comprehension and vocabulary subtests (30% of the exposed samples had a scaled score below 6 in each subtest). 18,20,23 The performances that were least negatively affected in this population were in the symbol search subtest 15,18,20,21,23 (with 81.8% of the samples exposed to alcohol scoring above 6) and the picture arrangement subtest 15,18,20,21,23 (all samples scored above 6).…”

Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders

“…Possibly because fewer of the children who had FAS remained in the study for testing (58% vs 70% with PFAS and 100% with ARND), the PFAS and ARND children performed most poorly compared with controls, especially on verbal IQ, working memory, general conceptual ability, and behavioral problems. Although total dysmorphology and poor cognitive/behavioral traits are correlated, 11,12,34,54 there is also individual variation among the children on most every variable, each category of dysmorphology and performance. …”

Misattributions and Potential Consequences: The Case of Child Mental Health Problems and Fetal Alcohol Spectrum Disorders

“…For example, in a FASD study within a school-based sample, measures of PAE explained only a modest portion of cognitive and behavioural outcomes and these association were no longer significant once other risk factors (for example, lower maternal education) were included in the multivariate model. 18 Another study, based on a sample derived from a maternity clinic, found PAE was related to child behavioural problems at follow-up but explained only 0.6% to 1.7% of outcome variance; in contrast, a measure of maternal psychopathology explained 13.0% to 29.1% of the variance. 19 In a population-based study examining the impact of lowto-moderate PAE, the association with ADHD symptoms became statistically insignificant once the multivariate model factored in measures of social adversity.…”