Validity and Reliability of Executive Function Measures in Children With Heavy Prenatal Alcohol Exposure: Correspondence Between Multiple Raters and Laboratory Measures

Abstract

Background Rating scales are designed to complement traditional performance‐based measures, and both can provide useful information about the functioning of youth with histories of prenatal alcohol exposure. Few studies, however, have compared ratings from multiple informants or the relationship between these subjective rating scale scores and the objective results from laboratory performance‐based scales. Methods The current study addressed both of these questions in 3 study groups: children with histories of prenatal alcohol exposure (n = 47), attention‐deficit/hyperactivity disorder (ADHD; n = 41), and typically developing controls (CON; n = 73). All subjects completed a standardized neuropsychological test battery, including laboratory measures of executive functioning and a self‐report measure of executive function behaviors. Parents and teachers completed corresponding rating scales of executive function behaviors for each subject. This study assessed the relationship between these behavior rating scales and corresponding neuropsychological tests, and interrater agreement among the multiple informants. Results Weak correlations were found between the rating scales and laboratory measures, indicating poor convergent validity for the behavior rating scale. Interrater reliability was found but it differed by group. Agreement was found between parent and teacher ratings for children with prenatal alcohol exposure, whereas teacher–child agreement was found for those with ADHD. Conclusions Findings from this study indicate that behavior ratings can be used to supplement laboratory measures but may not be measuring cognitive abilities regardless of whether a clinical diagnosis is present. A multimethod approach should be used when measuring skills in this domain. This was one of the first studies to examine cross‐informant agreement in a sample of children with prenatal alcohol exposure. Further research is necessary to understand why interrater agreement differed for children with prenatal alcohol exposure and those with ADHD.

A Review of Associations between Externalizing Behaviors and Prenatal Cannabis Exposure: Limitations & Future Directions

“…However, this effect was also observed with paternal cannabis use, which suggests a potential gene environmental correlation [43]. Similar to previous suggestions, study designs should incorporate multimethod measures, although there has been agreement between parent and teacher behavioral ratings in children with prenatal alcohol exposure [88]. Furthermore, future study designs may want to examine fetal behavioral profiles in response to external stimulation with the intention of obtaining an objective measure of prenatal behavior, linking behavioral response rates to in utero cannabis exposure, and obtaining a behavioral foundation from fetal responses that have continuity with aspects of postnatal externalizing traits (e.g., faster response time, higher rates of behavior, or prolonged responding).…”

Results of a screening tool for fetal alcohol spectrum disorders are associated with neuropsychological and behavioral measures

“…This supports the FASD‐Tree as a clinically‐useful screening tool. Furthermore, the evidence of association between the FASD‐Tree outcome and executive function is strengthened by the use of both in‐person neuropsychological assessment and parent/caregiver ratings of behaviors associated with executive dysfunction, as these two methods may collect information about different aspects of the domain (Bernes et al, 2021; Nguyen et al, 2014). Our study also incorporated a heterogeneous control population; participants were not excluded from the control group due to a previous diagnosis of ADHD or a low IQ score.…”

Characterising fetal alcohol spectrum disorder in Canada: a national database protocol study

“…Individuals with FASD and their caregivers require access to coordinated supports and services that are informed by the pattern of brain impairment identified during the diagnostic assessment. 30 In the current service system, these supports may be lacking, and findings from the database will highlight the most common priorities for intervention, as well as the most significant gaps in FASD services.…”