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Lobato-Camacho FJ, Faísca L. Object Recognition Memory Deficits in ADHD: A Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09645-3. [PMID: 38907905 DOI: 10.1007/s11065-024-09645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 05/27/2024] [Indexed: 06/24/2024]
Abstract
Object recognition memory allows us to identify previously seen objects. This type of declarative memory is a primary process for learning. Despite its crucial role in everyday life, object recognition has received far less attention in ADHD research compared to verbal recognition memory. In addition to the existence of a small number of published studies, the results have been inconsistent, possibly due to the diversity of tasks used to assess recognition memory. In the present meta-analysis, we have collected studies from Web of Science, Scopus, PubMed, and Google Scholar databases up to May 2023. We have compiled studies that assessed visual object recognition memory with specific visual recognition tests (sample-match delayed tasks) in children and adolescents diagnosed with ADHD. A total of 28 studies with 1619 participants diagnosed with ADHD were included. The studies were assessed for risk of bias using the Quadas-2 tool and for each study, Cohen's d was calculated to estimate the magnitude of the difference in performance between groups. As a main result, we have found a worse recognition memory performance in ADHD participants when compared to their matched controls (overall Cohen's d ~ 0.492). We also observed greater heterogeneity in the magnitude of this deficit among medicated participants compared to non-medicated individuals, as well as a smaller deficit in studies with a higher proportion of female participants. The magnitude of the object recognition memory impairment in ADHD also seems to depend on the assessment method used.
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Affiliation(s)
- Francisco José Lobato-Camacho
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Calle Camilo José Cela, 41018, Seville, S/N, Spain.
| | - Luís Faísca
- Departamento de Psicología e Ciências da Educação & Center for Research in Health Technologies and Information Systems (CINTESIS@RISE), Universidade Do Algarve, 8005-139, Faro, Portugal
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2
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Toward a Strengths-Based Cognitive Profile of Children with Fetal Alcohol Spectrum Disorders: Implications for Intervention. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00245-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Cases-Solé R, Varillas-Delgado D, Astals-Vizcaino M, García-Algar Ó. Efficacy and Feasibility of an Osteopathic Intervention for Neurocognitive and Behavioral Symptoms Usually Associated With Fetal Alcohol Spectrum Disorder. Front Behav Neurosci 2022; 16:860223. [PMID: 35368309 PMCID: PMC8965441 DOI: 10.3389/fnbeh.2022.860223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy and feasibility of a 4-week planned osteopathic manipulative treatment intervention on the improvement of neurocognitive and behavioral symptoms usually associated with fetal alcohol spectrum disorder. Thirty-two symptomatic children without fetal alcohol spectrum disorder aged 3-6 years with low level of attention from two schools and an osteopathic center were recruited in a prospective randomized pilot study in an osteopathic manipulative treatment group [osteopathic manipulative treatment (OMT)] or a control group (standard support measures). Neurocognitive maturity test results for attention (A), iconic memory (IM), spatial structuration (SS), and visual perception (VP) were recorded at baseline and post-intervention. No adverse effects were communicated and there were no dropouts. A significant increase in neurocognitive assessments was observed in children in the OMT group at post-treatment. Intergroup post-intervention statistical differences were found for A, SS, and IM were p = 0.005, p < 0.001, and p < 0.001, respectively; no differences were seen for VP (p = 0.097). This study shows that a 4-week osteopathic manipulative treatment intervention may be a feasible and effective therapeutic approach for neurocognitive and behavioral symptoms usually present in fetal alcohol spectrum disorder, justifying more studies on children affected by this condition.
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Affiliation(s)
- Ramon Cases-Solé
- Centre Osteopatia La Seu, Lleida, Spain
- Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
| | | | - Marta Astals-Vizcaino
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, Barcelona, Spain
| | - Óscar García-Algar
- Department of Surgery and Medical-Surgical Specialties, Universitat de Barcelona, Barcelona, Spain
- Department of Neonatology, Hospital Clínic-Maternitat, ICGON, BCNatal, Barcelona, Spain
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4
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Pinheiro-da-Silva J, Agues-Barbosa T, Luchiari AC. Embryonic Exposure to Ethanol Increases Anxiety-Like Behavior in Fry Zebrafish. Alcohol Alcohol 2021; 55:581-590. [PMID: 32886092 DOI: 10.1093/alcalc/agaa087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 07/31/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Fetal alcohol spectrum disorder (FASD) is an umbrella term to describe the effects of ethanol (Eth) exposure during embryonic development, including several conditions from malformation to cognitive deficits. Zebrafish (Danio rerio) are a translational model popularly applied in brain disorders and drug screening studies due to its genetic and physiology homology to humans added to its transparent eggs and fast development. In this study, we investigated how early ethanol exposure affects zebrafish behavior during the initial growth phase. METHODS Fish eggs were exposed to 0.0 (control), 0.25 and 0.5% ethanol at 24 h post-fertilization. Later, fry zebrafish (10 days old) were tested in a novel tank task and an inhibitory avoidance protocol to inquire about morphology and behavioral alterations. RESULTS Analysis of variance showed that ethanol doses of 0.25 and 0.5% do not cause morphological malformations and did not impair associative learning but increased anxiety-like behavior responses and lower exploratory behavior when compared to the control. CONCLUSION Our results demonstrate that one can detect behavioral abnormalities in the zebrafish induced by embryonic ethanol as early as 10 days post-fertilization and that alcohol increases anxious behavior during young development in zebrafish.
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Affiliation(s)
| | - Thais Agues-Barbosa
- Department of Physiology and Behavior, Universidade Federal do Rio Grande do Norte, Rio Grande do Norte, Brazil
| | - Ana Carolina Luchiari
- Department of Physiology and Behavior, Universidade Federal do Rio Grande do Norte, Rio Grande do Norte, Brazil
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5
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Alger JR, O'Neill J, O'Connor MJ, Kalender G, Ly R, Ng A, Dillon A, Narr KL, Loo SK, Levitt JG. Neuroimaging of Supraventricular Frontal White Matter in Children with Familial Attention-Deficit Hyperactivity Disorder and Attention-Deficit Hyperactivity Disorder Due to Prenatal Alcohol Exposure. Neurotox Res 2021; 39:1054-1075. [PMID: 33751467 PMCID: PMC8442735 DOI: 10.1007/s12640-021-00342-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
Attention-deficit hyperactivity disorder (ADHD) is common in patients with (ADHD+PAE) and without (ADHD-PAE) prenatal alcohol exposure (PAE). Many patients diagnosed with idiopathic ADHD actually have covert PAE, a treatment-relevant distinction. To improve differential diagnosis, we sought to identify brain differences between ADHD+PAE and ADHD-PAE using neurobehavioral, magnetic resonance spectroscopy, and diffusion tensor imaging metrics that had shown promise in past research. Children 8-13 were recruited in three groups: 23 ADHD+PAE, 19 familial ADHD-PAE, and 28 typically developing controls (TD). Neurobehavioral instruments included the Conners 3 Parent Behavior Rating Scale and the Delis-Kaplan Executive Function System (D-KEFS). Two dimensional magnetic resonance spectroscopic imaging was acquired from supraventricular white matter to measure N-acetylaspartate compounds, glutamate, creatine + phosphocreatine (creatine), and choline-compounds (choline). Whole brain diffusion tensor imaging was acquired and used to to calculate fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity from the same superventricular white matter regions that produced magnetic resonance spectroscopy data. The Conners 3 Parent Hyperactivity/Impulsivity Score, glutamate, mean diffusivity, axial diffusivity, and radial diffusivity were all higher in ADHD+PAE than ADHD-PAE. Glutamate was lower in ADHD-PAE than TD. Within ADHD+PAE, inferior performance on the D-KEFS Tower Test correlated with higher neurometabolite levels. These findings suggest white matter differences between the PAE and familial etiologies of ADHD. Abnormalities detected by magnetic resonance spectroscopy and diffusion tensor imaging co-localize in supraventricular white matter and are relevant to executive function symptoms of ADHD.
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Affiliation(s)
- Jeffry R Alger
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA.
- Neurospectroscopics, LLC, Sherman Oaks, CA, USA.
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Hura Imaging Inc, Calabas, CA, USA.
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Mary J O'Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Guldamla Kalender
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Ng
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Andrea Dillon
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, MC 708522, Los Angeles, CA, 90024, USA
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Jennifer G Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Instutute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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6
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Pinson MR, Holloway KN, Douglas JC, Kane CJM, Miranda RC, Drew PD. Divergent and overlapping hippocampal and cerebellar transcriptome responses following developmental ethanol exposure during the secondary neurogenic period. Alcohol Clin Exp Res 2021; 45:1408-1423. [PMID: 34060105 PMCID: PMC8312515 DOI: 10.1111/acer.14633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/16/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022]
Abstract
Background The developing hippocampus and cerebellum, unique among brain regions, exhibit a secondary surge in neurogenesis during the third trimester of pregnancy. Ethanol (EtOH) exposure during this period is results in a loss of tissue volume and associated neurobehavioral deficits. However, mechanisms that link EtOH exposure to teratology in these regions are not well understood. We therefore analyzed transcriptomic adaptations to EtOH exposure to identify mechanistic linkages. Methods Hippocampi and cerebella were microdissected at postnatal day (P)10, from control C57BL/6J mouse pups, and pups treated with 4 g/kg of EtOH from P4 to P9. RNA was isolated and RNA‐seq analysis was performed. We compared gene expression in EtOH‐ and vehicle‐treated control neonates and performed biological pathway‐overrepresentation analysis. Results While EtOH exposure resulted in the general induction of genes associated with the S‐phase of mitosis in both cerebellum and hippocampus, overall there was little overlap in differentially regulated genes and associated biological pathways between these regions. In cerebellum, EtOH additionally induced gene expression associated with the G2/M‐phases of the cell cycle and sonic hedgehog signaling, while in hippocampus, EtOH‐induced the pathways for ribosome biogenesis and protein translation. Moreover, EtOH inhibited the transcriptomic identities associated with inhibitory interneuron subpopulations in the hippocampus, while in the cerebellum there was a more pronounced inhibition of transcripts across multiple oligodendrocyte maturation stages. Conclusions These data indicate that during the delayed neurogenic period, EtOH may stimulate the cell cycle, but it otherwise results in widely divergent molecular effects in the hippocampus and cerebellum. Moreover, these data provide evidence for region‐ and cell‐type‐specific vulnerability, which may contribute to the pathogenic effects of developmental EtOH exposure.
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Affiliation(s)
- Marisa R Pinson
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Kalee N Holloway
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James C Douglas
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Cynthia J M Kane
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University Health Science Center, Bryan, TX, USA
| | - Paul D Drew
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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7
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Suchy Y, Mullen CM, Brothers S, Niermeyer MA. Interpreting executive and lower-order error scores on the timed subtests of the Delis-Kaplan Executive Function System (D-KEFS) battery: Error analysis across the adult lifespan. J Clin Exp Neuropsychol 2020; 42:982-997. [PMID: 33267731 DOI: 10.1080/13803395.2020.1832203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The Delis-Kaplan Executive Function System (D-KEFS) is a battery of tests designed to measure executive functions (EF). Additionally, the D-KEFS contains lower-order tasks, designed to control for speed of visual scanning, sequencing, and verbal and graphomotor output. The construct and criterion validities of D-KEFS scores that are time-based are well established. However, the constructs measured by the D-KEFS error scores are poorly understood, making clinical interpretations of such scores difficult. This study examined the construct validity of D-KEFS errors committed on EF tasks and tasks designed to measure lower-order processes (i.e., non-EF tasks), across the adult lifespan. METHOD Participants were 427 adults (18-93 years) who completed the timed subtests of the D-KEFS. Four hundred two participants also completed the Push-Turn-Taptap (PTT; a separate measure of EF) to allow cross-validation. RESULTS General linear regressions showed that D-KEFS errors committed on the EF tests were associated with EF timed performance (assessed using the D-KEFS time-based scores and the PTT), but only among older adults. Importantly, errors committed on the D-KEFS tasks of lower-order processes were also associated with D-KEFS time-based EF performance, and this relationship held across the adult lifespan. CONCLUSIONS These findings suggest that among older adults EF errors on the D-KEFS can be interpreted as indices of EF, but such interpretations are not automatically warranted for younger adults. Additionally, errors committed on non-EF tasks contained within the D-KEFS battery can be interpreted as reflecting EF weaknesses across the adult lifespan.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Christine M Mullen
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
| | - Stacey Brothers
- Department of Psychology, University of Utah , Salt Lake City, Utah
| | - Madison A Niermeyer
- Department of Physical Medicine & Rehabilitation, University of Utah , Salt Lake City, Utah
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8
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Coles CD, Kalberg W, Kable JA, Tabachnick B, May PA, Chambers CD. Characterizing Alcohol-Related Neurodevelopmental Disorder: Prenatal Alcohol Exposure and the Spectrum of Outcomes. Alcohol Clin Exp Res 2020; 44:1245-1260. [PMID: 32173870 DOI: 10.1111/acer.14325] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effects of prenatal alcohol exposure (PAE) are conceptualized as fetal alcohol spectrum disorder, with fetal alcohol syndrome (FAS) as the most severe. Many find it more difficult to characterize behavioral and cognitive effects of exposure on the central nervous system when physical signs are not present. In the current study, an operational definition of alcohol-related neurodevelopmental disorder (ARND) was examined to determine its usefulness in discrimination of children classified as ARND based on behavior (ARND/B) and cognition (ARND/C) from children in 4 contrast groups: (i) children exposed to study-defined "risky drinking"; (ii) children with any reported PAE; (iii) children classified as "Higher Risk" for developmental problems; and (iv) children classified as "Lower Risk." METHODS A total of 1,842 children seen as part of a surveillance study (J Am Med Assoc, 319, 2018, 474) were evaluated for alcohol exposure and physical characteristics of FAS, and completed neurodevelopmental testing. Ninety-one were identified as either ARND/B or ARND/C and contrasted with other groups to further identify distinguishing patterns. Multinomial logistic regression (MLR) was used to examine the accuracy of classification and to identify factors contributing to such classification. RESULTS Children described as ARND/C were distinct from other groups based on cognition and behavior as well as demographic factors (e.g., age, race, SES), child characteristics (e.g., gestational age; sex), and other drug exposures, while those described as ARND/B differed only on behavior and other drug exposures. MLR models successfully discriminated ARND groups from children in other groups with accuracy ranging from 79% (Higher Risk) to 86.7% (Low Risk). CONCLUSIONS ARND has been a subject of debate. This analysis suggests the effects of alcohol on behavior and cognition even in the absence of the characteristic facial features and growth deficiency that can be identified. The results also indicate that it may be possible to distinguish such children from those in other high-risk groups.
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Affiliation(s)
- Claire D Coles
- From the, Department of Psychiatry and Behavioral Sciences and Pediatrics, (CDC, JAK), Emory University School of Medicine, Atlanta, Georgia
| | - Wendy Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, (WK), The University of New Mexico, Albuquerque, New Mexico
| | - Julie A Kable
- From the, Department of Psychiatry and Behavioral Sciences and Pediatrics, (CDC, JAK), Emory University School of Medicine, Atlanta, Georgia
| | | | - Philip A May
- Department of Nutrition, (PAM), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Christina D Chambers
- Departments of Pediatrics and Family Medicine and Public Health, (CDC), University of California San Diego School of Medicine, La Jolla, California
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9
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Khoury JE, Milligan K. Comparing Executive Functioning in Children and Adolescents With Fetal Alcohol Spectrum Disorders and ADHD: A Meta-Analysis. J Atten Disord 2019; 23:1801-1815. [PMID: 26729621 DOI: 10.1177/1087054715622016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: Fetal alcohol spectrum disorders (FASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. Method: The present meta-analysis was undertaken to disentangle the behavioral phenotype of FASD and ADHD by quantitatively differentiating executive functioning differences between these two groups. The current meta-analysis reviews 15 studies comparing children and adolescents with FASD and ADHD to typically developing (TD) samples, on a variety of executive function measures. Results: Results indicate that when compared with TD samples, FASD and ADHD samples demonstrate significant executive function deficits (d = 0.82 and d = 0.55, respectively). In addition, FASD samples experience significantly greater deficits when compared with ADHD samples (d = 0.25). Results were moderated by IQ and socioeconomic status. Conclusion: These findings further our understanding of the cognitive differences between FASD and ADHD samples and have the potential to influence future basic research, assessment, and intervention.
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Agnihotri S, Subramaniapillai S, Keightley M, Rasmussen C, Cameron D, Ryan J, Rovet J. Everyday memory difficulties in children and adolescents with Fetal Alcohol Spectrum Disorder. Dev Neurorehabil 2019; 22:462-469. [PMID: 30289318 DOI: 10.1080/17518423.2018.1519608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose: To investigate whether significant differences exist in everyday memory between youth with Fetal Alcohol Spectrum (FASD) compared with a nonexposed (NE) control group, while controlling for socioeconomic status and other comorbidities. Methods: Caregiver ratings using the Everyday Memory Questionnaire were obtained for 105 youth (9-17 years of age). Scores were compared between youth with a FASD diagnosis (N = 41; 56% male) and the NE group (N = 64; 53% male) using multivariate analysis of variance. Results: Significantly poorer scores were found across all domains of everyday memory in youth with FASD (p<0.01 for all comparisons). Findings maintained significance after controlling for group differences in socioeconomic status, presence of learning, and attention disorders, as well as exposure to other teratogens. Conclusions: This study provides important insights regarding the memory issues that underlie daily functional challenges faced by youth with FASD and the need for future intervention research.
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Affiliation(s)
- Sabrina Agnihotri
- Bloorview Research Institute, Holland-Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | | | - Michelle Keightley
- Bloorview Research Institute, Holland-Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta , Edmonton , Alberta , Canada
| | - Debra Cameron
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto , Toronto , Ontario , Canada
| | - Jennifer Ryan
- Rotman Research Institute, Baycrest Hospital , Toronto , Ontario , Canada
| | - Joanne Rovet
- The Hospital for Sick Children , Toronto , Ontario , Canada
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11
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Using the Delis–Kaplan Executive Function System Tower Test to Examine ADHD Sensitivity in Children: Expanding Analysis Beyond the Summary Score. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2019. [DOI: 10.1007/s40817-019-00068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Doyle LR, Glass L, Wozniak JR, Kable JA, Riley EP, Coles CD, Sowell ER, Jones KL, Mattson SN. Relation Between Oppositional/Conduct Behaviors and Executive Function Among Youth with Histories of Heavy Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2019; 43:1135-1144. [PMID: 30908651 DOI: 10.1111/acer.14036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Youth with heavy prenatal alcohol exposure have high rates of behavioral concerns and psychopathology, including increased oppositional and conduct behaviors. The relation between those concerns and executive function (EF) deficits is unknown. We investigated the association of oppositional and conduct behavior and EF in adolescents to inform targeted intervention. METHODS Subjects (N = 267) ages 10 to 17 years comprised 3 groups: alcohol-exposed with oppositional/conduct behaviors (AE+), alcohol-exposed without oppositional/conduct behaviors (AE-), and controls (CON). Group differences on direct neuropsychological (Delis-Kaplan Executive Function System [D-KEFS]) and indirect parent-report (Behavior Rating Inventory of Executive Function [BRIEF]) EF measures were tested with multivariate analysis of covariances, followed by univariate analysis of variances and pairwise comparisons. The contribution of attention-deficit/hyperactivity disorder (ADHD) within the AE groups was assessed in secondary analyses. RESULTS On the D-KEFS, there was an omnibus main effect of group, with significant main effects on 3 of 6 variables (CON>AE+, AE-). Within the AE groups, ADHD did not alter the results. On the BRIEF, there was an omnibus significant main effect of group, with significant main effects on all scales (CON<AE-<AE+). Within the AE groups, the AE+ group had higher BRIEF scores (i.e., more difficulty) than the AE- group on 4 of 8 subscales when accounting for presence of ADHD. CONCLUSIONS EF deficits in youth with histories of prenatal alcohol exposure were confirmed using direct and indirect measures. Oppositional/conduct behaviors related to EF deficits on indirect but not direct EF measures. Greater understanding of the contribution of concurrent psychopathology to long-term outcomes for alcohol-exposed youth requires further investigation.
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Affiliation(s)
- Lauren R Doyle
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
| | - Leila Glass
- Semel Institute for Neuroscience and Human Behavior , University of California, Los Angeles, California
| | - Jeffrey R Wozniak
- Department of Psychiatry , University of Minnesota, Minneapolis, Minnesota
| | - Julie A Kable
- Department of Pediatrics , Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Riley
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
| | - Claire D Coles
- Department of Pediatrics , Emory University School of Medicine, Atlanta, Georgia.,Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine, Atlanta, Georgia
| | - Elizabeth R Sowell
- Department of Pediatrics , Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kenneth Lyons Jones
- Department of Pediatrics , San Diego School of Medicine, University of California, San Diego, California
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology , San Diego State University, San Diego, California
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13
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Doyle LR, Moore EM, Coles CD, Kable JA, Sowell ER, Wozniak JR, Jones KL, Riley EP, Mattson SN. Executive Functioning Correlates With Communication Ability in Youth With Histories of Heavy Prenatal Alcohol Exposure. J Int Neuropsychol Soc 2018; 24:1026-1037. [PMID: 30322415 PMCID: PMC6237635 DOI: 10.1017/s1355617718000772] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. METHODS Subjects (ages 10-16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales - Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. RESULTS Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. CONCLUSIONS Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026-1037).
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Affiliation(s)
- Lauren R. Doyle
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Eileen M. Moore
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Pediatrics, Emory University School of Medicine
| | - Julie A. Kable
- Department of Pediatrics, Emory University School of Medicine
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, University of Southern California
| | | | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
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Wetherill L, Foroud T, Goodlett C. Meta-Analyses of Externalizing Disorders: Genetics or Prenatal Alcohol Exposure? Alcohol Clin Exp Res 2017; 42:162-172. [PMID: 29063614 DOI: 10.1111/acer.13535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/12/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Externalizing disorders are heritable precursors to alcohol dependence, common in children of alcoholics (COA), and in children with prenatal alcohol exposure (PAE). Pregnancies involving alcohol exposure sufficient to affect the fetus may involve women with genetic risk for alcohol dependence. We hypothesized that known PAE will increase the odds of having an externalizing disorder compared to COA. METHODS The odds ratios of 3 externalizing disorders (attention-deficit hyperactivity disorder [ADHD], conduct disorder [CD], and oppositional defiant disorder [ODD]) were obtained for 2 domains: (i) PAE and (ii) COA, by estimating the logged odds ratio (LOR) for each study. Permutation tests were implemented to compare LORs for PAE versus COA studies within each disorder, including PAE versus an alcohol dependent (AD) mother and PAE versus an AD father. RESULTS In PAE studies, the odds of ADHD and CD were elevated. Rates of all 3 disorders were elevated in COA studies. Permutation tests revealed that the mean LOR for ADHD was significantly higher in PAE studies compared to: COA (p = 0.01), AD mother (p < 0.05), and AD father (p = 0.03). No differences were found for ODD (p = 0.09) or CD (p = 0.21). CONCLUSIONS These results provide compelling evidence of an increased risk of ADHD in those with PAE beyond that due to parental alcohol dependence or a genetic liability, consistent with a unique etiology most likely due to direct alcohol exposure during prenatal development.
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Affiliation(s)
- Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Charles Goodlett
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Abstract
This grand rounds manuscript reviews important considerations in developing case conceptualizations for individuals with a history of prenatal alcohol exposure. This case study provides an introduction to fetal alcohol spectrum disorders, diagnostic issues, a detailed description of the individual's history, presenting symptoms, neuropsychological test results, and an integrated summary. We describe a 9-year old girl diagnosed with a fetal alcohol spectrum disorder (FASD): Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). This patient is a composite of a prototypical child who participated as part of a research project at the Center for Behavioral Teratology who was subsequently seen at an outpatient child psychiatry facility.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
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Graham DM, Glass L, Mattson SN. The Influence of Extrinsic Reinforcement on Children with Heavy Prenatal Alcohol Exposure. Alcohol Clin Exp Res 2016; 40:348-58. [PMID: 26842253 DOI: 10.1111/acer.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 11/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal alcohol exposure affects inhibitory control and other aspects of attention and executive function. However, the efficacy of extrinsic reinforcement on these behaviors has not been tested. METHODS Alcohol-exposed children (AE; n = 34), children with attention-deficit/hyperactivity disorder (ADHD; n = 23), and controls (CON; n = 31) completed a flanker task with 4 reward conditions (no reward, reward, reward+occasional response cost, equal probability of reward+response cost). Inhibitory control was tested in the no reward conditions using a 3(group) × 2(flanker type) ANCOVA. Response to reinforcement was tested using 3(group) × 4(reward condition) × 4(flanker type) analysis of covariance (ANCOVA). Response time (RT) and accuracy were tested independently. RESULTS Groups did not differ on demographic variables. The flanker task was successful in taxing interference control, an aspect of executive attention (i.e., responses to incongruent stimuli were slower than to congruent stimuli) and the AE group demonstrated impaired executive control over the other groups. Overall, the AE group had significantly slower RTs compared to the CON and ADHD groups, which did not differ. However, reinforcement improved RT in all groups. While occasional response cost had the greatest benefit in the CON group, the type of reinforcement did not differentially affect the AE and ADHD groups. Accuracy across reward conditions did not differ by group, but was dependent on flanker type and reward condition. CONCLUSIONS Alcohol-exposed children, but not children with ADHD, had impaired interference control in comparison with controls, supporting a differential neurobehavioral profile in these 2 groups. Both clinical groups were equally affected by introduction of reinforcement, although the type of reinforcement did not differentially affect performance as it did in the control group, suggesting that reward or response cost could be used interchangeably to result in the same benefit.
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Affiliation(s)
- Diana M Graham
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
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17
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Young S, Absoud M, Blackburn C, Branney P, Colley B, Farrag E, Fleisher S, Gregory G, Gudjonsson GH, Kim K, O'Malley KD, Plant M, Rodriguez A, Ozer S, Takon I, Woodhouse E, Mukherjee R. Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus. BMC Psychiatry 2016; 16:324. [PMID: 27655132 PMCID: PMC5032241 DOI: 10.1186/s12888-016-1027-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The association of attention deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorders (FASD) results in a complex constellation of symptoms that complicates the successful diagnosis and treatment of the affected individual. Current literature lacks formal guidelines, randomized control trials, and evidence-based treatment plans for individuals with ADHD and associated FASD. Therefore, a meeting of professional experts was organized with the aim of producing a consensus on identification and treatment guidelines that will aid clinicians in caring for this unique patient population. METHODS Experts from multiple disciplines in the fields of ADHD and FASD convened in London, United Kingdom, for a meeting hosted by the United Kingdom ADHD Partnership (UKAP; www.UKADHD.com ) in June 2015. The meeting provided the opportunity to address the complexities of ADHD and FASD from different perspectives and included presentations, discussions, and group work. The attendees worked towards producing a consensus for a unified approach to ADHD and associated FASD. RESULTS The authors successfully came to consensus and produced recommended guidelines with specific regards to identification and assessment, interventions and treatments, and multiagency liaisons and care management, highlighting that a lifespan approach to treatment needs to be adopted by all involved. Included in the guidelines are: 1) unique 'red flags', which when identified in the ADHD population can lead to an accurate associated FASD diagnosis, 2) a treatment decision tree, and 3) recommendations for multiagency care management. CONCLUSIONS While clinically useful guidelines were achieved, more research is still needed to contribute to the knowledge base about the diagnosis, treatment, and management of those with ADHD and associated FASD.
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Affiliation(s)
- Susan Young
- Imperial College London, London, UK.
- Broadmoor Hospital, West London Mental Health Trust, Crowthorne, Berkshire, UK.
| | - Michael Absoud
- Children's Neurosciences, Evelina London Children's Hospital at Guy's & St Thomas' NHS Foundation Trust, Kings Health Partners Academic Health Science Centre, London, UK
| | - Carolyn Blackburn
- Centre for the Study of Practice and Culture in Education, Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | | | | | - Emad Farrag
- Sussex Partnership NHS Foundation Trust, Children & Young People's Service, Tunbridge Wells, Kent, UK
| | - Susan Fleisher
- National Organisation for Foetal Alcohol Syndrome-UK (NOFAS-UK), London, UK
| | - Ges Gregory
- Integrated Child Health, Cambridge and Peterborough Foundation Trust, 80 Thorpe Road, Peterborough, PE3 6AP, UK
| | - Gisli H Gudjonsson
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Keira Kim
- Contracted Medical Writer, San Diego, CA, USA
| | - Kieran D O'Malley
- Child and Adolescent Psychiatrist, FASD Specialist, Slievemore Clinic, Dublin, Ireland
- President Elect, Intellectual Disability Section Royal Society Medicine, London, UK
| | - Moira Plant
- University of the West of England, Bristol, UK
- National Drug Research Institute Curtin University, Perth, Australia
| | - Alina Rodriguez
- Imperial College London, London, UK
- Sweden University, Department of Psychology Campus Östersund, Östersund, Sweden
| | - Susan Ozer
- East and North Hertfordshire NHS Trust, Hatfield, Hertfordshire, UK
| | - Inyang Takon
- East and North Hertfordshire NHS Trust. Centre for Child and Adolescent Mental Health, University College Ibadan, Hatfield, Hertfordshire, UK
| | - Emma Woodhouse
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Raja Mukherjee
- FASD Specialist Behaviour Clinic, Surrey and Borders Partnership NHS Foundation Trust, Oxted, Surrey, UK
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Rai JK, Abecassis M, Casey JE, Flaro L, Erdodi LA, Roth RM. Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children. Child Neuropsychol 2016; 23:713-732. [DOI: 10.1080/09297049.2016.1191628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jaspreet K. Rai
- Department of Psychology, University of Windsor, Ontario, Canada
| | - Maurissa Abecassis
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Joseph E. Casey
- Department of Psychology, University of Windsor, Ontario, Canada
| | | | - Laszlo A. Erdodi
- Department of Psychology, University of Windsor, Ontario, Canada
| | - Robert M. Roth
- Neuropsychology Program, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Kingdon D, Cardoso C, McGrath JJ. Research Review: Executive function deficits in fetal alcohol spectrum disorders and attention-deficit/hyperactivity disorder - a meta-analysis. J Child Psychol Psychiatry 2016; 57:116-31. [PMID: 26251262 PMCID: PMC5760222 DOI: 10.1111/jcpp.12451] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD)-like symptoms are common in fetal alcohol spectrum disorders (FASD). FASD and ADHD groups both display executive function impairments; however, there is ongoing debate whether the pattern and magnitude of executive function deficits differs between these two types of disorders. METHODS An electronic literature search was conducted (PubMed, PsychInfo; 1972-2013) to identify studies comparing the executive functioning of children with FASD with ADHD or control groups. FASD groups included those with and without dysmorphy (i.e., FAS, pFAS, ARND, and other FASD diagnoses). Effect sizes (Hedges' g, standardized mean difference) were calculated. Random effects meta-analytic models were performed using the metafor package for R. RESULTS Fifty-one studies met inclusion criteria (FASD N = 2,115; ADHD N = 453; controls N = 1,990). Children with FASD showed the strongest and most consistent deficits in planning, fluency, and set-shifting compared to controls (Hedges' g = -0.94, -0.78) and children with ADHD (Hedges' g = -0.72, -0.32). FASD was associated with moderate to large impairments in working memory, compared to controls (Hedges' g = -.84, -.58) and small impairments relative to groups with ADHD (Hedges' g = -.26). Smaller and less consistent deficits were found on measures of inhibition and vigilance relative to controls (Hedges' g = -0.52, -0.31); FASD and ADHD were not differentiated on these measures. Moderator analyses indicated executive dysfunction was associated with older age, dysmorphy, and larger group differences in IQ. Sex and diagnostic system were not consistently related to effect size. CONCLUSIONS While FASD is associated with global executive impairments, executive function weaknesses are most consistent for measures of planning, fluency, and set-shifting. Neuropsychological measures assessing these executive function domains may improve differential diagnosis and treatment of FASD.
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Affiliation(s)
- Danielle Kingdon
- Department of Psychology; Concordia University; Montreal QC Canada
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20
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Løhaugen GCC, Flak MM, Gerstner T, Sundberg C, Lerdal B, Skranes J. Establishment of the South-Eastern Norway Regional Health Authority Resource Center for Children with Prenatal Alcohol/Drug Exposure. Subst Abuse 2015; 9:67-75. [PMID: 26692762 PMCID: PMC4671549 DOI: 10.4137/sart.s23542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
This paper presents a new initiative in the South-Eastern Health Region of Norway to establish a regional resource center focusing on services for children and adolescents aged 2–18 years with prenatal exposure to alcohol or other drugs. In Norway, the prevalence of fetal alcohol spectrum (FAS) is not known but has been estimated to be between 1 and 2 children per 1000 births, while the prevalence of prenatal exposure to illicit drugs is unknown. The resource center is the first of its kind in Scandinavia and will have three main objectives: (1) provide hospital staff, community health and child welfare personnel, and special educators with information, educational courses, and seminars focused on the identification, diagnosis, and treatment of children with a history of prenatal alcohol/drug exposure; (2) provide specialized health services, such as diagnostic services and intervention planning, for children referred from hospitals in the South-Eastern Health Region of Norway; and (3) initiate multicenter studies focusing on the diagnostic process and evaluation of interventions.
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Affiliation(s)
- Gro C C Løhaugen
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Department of Laboratory Medicine, Children's and Women's Health (LBK), Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway
| | - Marianne Møretrø Flak
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Addiction Unit (ARA-K), Sørlandet Sykehus HF, Kristiansand, Norway
| | - Thorsten Gerstner
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway
| | - Cato Sundberg
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway
| | - Bjørn Lerdal
- Department of Child Neurology and Rehabilitation (HABU-K), Sørlandet Hospital HF, HABU, Kristiansand, Norway
| | - Jon Skranes
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Department of Laboratory Medicine, Children's and Women's Health (LBK), Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway
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21
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Glass L, Graham DM, Akshoomoff N, Mattson SN. Cognitive factors contributing to spelling performance in children with prenatal alcohol exposure. Neuropsychology 2015; 29:817-28. [PMID: 25643217 PMCID: PMC4522410 DOI: 10.1037/neu0000185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Heavy prenatal alcohol exposure is associated with impaired school functioning. Spelling performance has not been comprehensively evaluated. We examined whether children with heavy prenatal alcohol exposure demonstrate deficits in spelling and related abilities, including reading, and tested whether there are unique underlying mechanisms for observed deficits in this population. METHOD Ninety-six school-age children made up 2 groups: children with heavy prenatal alcohol exposure (AE, n = 49) and control children (CON, n = 47). Children completed select subtests from the Wechsler Individual Achievement Test-Second Edition and the NEPSY-II. Group differences and relations between spelling and theoretically related cognitive variables were evaluated using multivariate analysis of variance and Pearson correlations. Hierarchical regression analyses were used to assess contributions of group membership and cognitive variables to spelling performance. The specificity of these deficits and underlying mechanisms was tested by examining the relations between reading ability, group membership, and cognitive variables. RESULTS Groups differed significantly on all variables. Group membership and phonological processing significantly contributed to spelling performance, whereas for reading, group membership and all cognitive variables contributed significantly. For both reading and spelling, group × working memory interactions revealed that working memory contributed independently only for alcohol-exposed children. CONCLUSION Alcohol-exposed children demonstrated a unique pattern of spelling deficits. The relation of working memory to spelling and reading was specific to the AE group, suggesting that if prenatal alcohol exposure is known or suspected, working memory ability should be considered in the development and implementation of explicit instruction.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Diana M. Graham
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
| | - Natacha Akshoomoff
- Department of Psychiatry and Center for Human Development, University of California, San Diego, California
| | - Sarah N. Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, California
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23
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Khoury JE, Milligan K, Girard TA. Executive Functioning in Children and Adolescents Prenatally Exposed to Alcohol: A Meta-Analytic Review. Neuropsychol Rev 2015; 25:149-70. [PMID: 26037669 DOI: 10.1007/s11065-015-9289-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/15/2015] [Indexed: 01/16/2023]
Abstract
Prenatal alcohol exposure is associated with a constellation of adverse physical, neurocognitive and behavior outcomes, which comprise a continuum of disorders labeled Fetal Alcohol Spectrum Disorders (FASD). Extant research has consistently identified executive functions (EF) as a central impairment associated with FASD. Despite this, heterogeneity exists regarding the strength of the association between FASD and different EF, and this association has not yet been quantitatively synthesized. The current meta-analysis reviews 46 studies that compare children and adolescents with FASD to participants without FASD, on a variety of EF measures. In accordance with Miyake et al. Cognitive Psychology, 41, 49-100 (2000) three-factor model of EF, findings for the primary EF domains of working memory, inhibition, and set shifting are reviewed. Results indicate that children and adolescents with FASD demonstrate significant deficits across these EF, although the magnitude of effects diverged between EF, with working memory and inhibition yielding medium effects and set shifting yielding large effects. These results were moderated by sample characteristics, type of FASD diagnosis, and EF methodology. This quantitative synthesis offers novel future research directions.
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Affiliation(s)
- Jennifer E Khoury
- Department of Psychology, Ryerson University, 350 Victoria Street, M5B 2K3, Toronto, Canada,
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24
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Chasnoff IJ, Wells AM, King L. Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics 2015; 135:264-70. [PMID: 25583914 DOI: 10.1542/peds.2014-2171] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this article is to assess the rate of misdiagnosis and missed diagnoses of fetal alcohol spectrum disorders (FASD) among a population of foster and adopted youth referred to a children's mental health center. METHODS Data were collected from a sample of 547 children who underwent a comprehensive multidisciplinary diagnostic evaluation. Utilizing current diagnostic criteria, children were diagnosed, as appropriate, with fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, or alcohol-related birth defects. Changes in rates of alcohol exposure-related diagnoses and cooccurring mental health disorders pre- and postassessment were analyzed by using McNemar's test for dependent proportions. RESULTS Among 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum, 125 had never been diagnosed as affected by prenatal alcohol exposure, a missed diagnosis rate of 80.1%. Of the 31 who had been recognized before referral as affected by prenatal alcohol exposure, 10 children's FASD diagnoses were changed within the spectrum, representing a misdiagnosis rate of 6.4%. The remaining 21 (13.5%) children's diagnoses stayed the same. There also were significant changes in the rate of mental health diagnosis, and learning disorders, communication disorders, and intellectual disability, objective signs of neurocognitive damage, were not recognized in a significant number of children with FASD. CONCLUSIONS Within this clinical sample, 86.5% of youth with FASD had never been previously diagnosed or had been misdiagnosed. These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services.
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Affiliation(s)
| | | | - Lauren King
- Children's Research Triangle, Chicago, Illinois
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25
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Rangmar J, Hjern A, Vinnerljung B, Strömland K, Aronson M, Fahlke C. Psychosocial outcomes of fetal alcohol syndrome in adulthood. Pediatrics 2015; 135:e52-8. [PMID: 25535260 DOI: 10.1542/peds.2014-1915] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS. METHODS We carried out a national register-based study of 79 adults with an FAS diagnosis, at a mean age of 32. Education, social adjustment, and mental health outcomes were analyzed and compared with 3160 comparison individuals matched on age, gender, and place of birth. RESULTS The FAS group was much more likely to have received special education (25% vs 2%), be unemployed (51% vs 15%), and receive a disability pension (31% vs 3%) than the comparisons, but the levels of criminal offenses were similar. The FAS group had higher hospital admission rates for alcohol abuse (9% vs 2%) and psychiatric disorders (33% vs 5%) and was more likely to be prescribed psychotropic drugs (57% vs 27%). CONCLUSIONS Swedish children with FAS have quite diverse psychosocial outcomes in adulthood, considerably worse than for majority population peers. Potential risk and protective factors within the FAS group deserve study to enable development of effective interventions.
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Affiliation(s)
| | - Anders Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Health Equity Studies, and
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Sweden; and
| | | | - Marita Aronson
- Department of Pediatrics, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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26
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Ware AL, Infante MA, O'Brien JW, Tapert SF, Jones KL, Riley EP, Mattson SN. An fMRI study of behavioral response inhibition in adolescents with and without histories of heavy prenatal alcohol exposure. Behav Brain Res 2014; 278:137-46. [PMID: 25281280 DOI: 10.1016/j.bbr.2014.09.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/21/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022]
Abstract
Heavy prenatal alcohol exposure results in a range of deficits, including both volumetric and functional changes in brain regions involved in response inhibition such as the prefrontal cortex and striatum. The current study examined blood oxygen level-dependent (BOLD) response during a stop signal task in adolescents (ages 13-16 y) with histories of heavy prenatal alcohol exposure (AE, n=21) and controls (CON, n=21). Task performance was measured using percent correct inhibits during three difficulty conditions: easy, medium, and hard. Group differences in BOLD response relative to baseline motor responding were examined across all inhibition trials and for each difficulty condition separately. The contrast between hard and easy trials was analyzed to determine whether increasing task difficulty affected BOLD response. Groups had similar task performance and demographic characteristics, except for full scale IQ scores (AE<CON). The AE group demonstrated greater BOLD response in frontal, sensorimotor, striatal, and cingulate regions relative to controls, especially as task difficulty increased. When contrasting hard vs. easy inhibition trials, the AE group showed greater medial/superior frontal and cuneus BOLD response than controls. Results were unchanged after demographics and FAS diagnosis were statistically controlled. This was the first fMRI study to utilize a stop signal task, isolating fronto-striatal functioning, to assess response inhibition and the effects task difficulty in adolescents with prenatal alcohol exposure. Results suggest that heavy prenatal alcohol exposure disrupts neural function of this circuitry, resulting in immature cognitive processing and motor-association learning and neural compensation during response inhibition.
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Affiliation(s)
- Ashley L Ware
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - M Alejandra Infante
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Jessica W O'Brien
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, San Diego, CA 92037, USA; VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Kenneth Lyons Jones
- University of California, San Diego, School of Medicine, Department of Pediatrics, San Diego, CA 92093, USA
| | - Edward P Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA.
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27
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Abstract
Prenatal alcohol exposure (PAE) is one of the most prevalent and modifiable risk factors for somatic, behavioral, and neurological abnormalities. Affected individuals exhibit a wide range of such features referred to as fetal alcohol spectrum disorders (FASD). These are characterized by a more or less specific pattern of minor facial dysmorphic features, growth deficiency and central nervous system symptoms. Nevertheless, whereas the diagnosis of the full-blown fetal alcohol syndrome does not pose a major challenge, only a tentative diagnosis of FASD can be reached if only mild features are present and/or maternal alcohol consumption during pregnancy cannot be verified. The respective disorders have lifelong implications. The teratogenic mechanisms induced by PAE can lead to various additional somatic findings and structural abnormalities of cerebrum and cerebellum. At the functional level, cognition, motor coordination, attention, language development, executive functions, memory, social perception and emotion processing are impaired to a variable extent. The long-term development is characterized by disruption and failure in many domains; an age-adequate independency is frequently not achieved. In addition to primary prevention, individual therapeutic interventions and tertiary prevention are warranted; provision of extensive education to affected subjects and their caregivers is crucial. Protective environments are often required to prevent negative consequences such as delinquency, indebtedness or experience of physical/sexual abuse.
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28
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The clinical utility and specificity of parent report of executive function among children with prenatal alcohol exposure. J Int Neuropsychol Soc 2014; 20:704-16. [PMID: 25033032 PMCID: PMC4228981 DOI: 10.1017/s1355617714000599] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) result in behavioral issues related to poor executive function (EF). This overlap may hinder clinical identification of alcohol-exposed children. This study examined the relation between parent and neuropsychological measures of EF and whether parent ratings aid in differential diagnosis. Neuropsychological measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), were administered to four groups of children (8-16 years): alcohol-exposed with ADHD (AE+, n=80), alcohol-exposed without ADHD (AE-, n=36), non-exposed with ADHD (ADHD, n=93), and controls (CON, n=167). Primary caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). For parent ratings, multivariate analyses of variance revealed main effects of Exposure and ADHD and an interaction between these factors, with significant differences between all groups on nearly all BRIEF scales. For neuropsychological measures, results indicated main effects of Exposure and ADHD, but no interaction. Discriminant function analysis indicated the BRIEF accurately classifies groups. These findings confirm compounded behavioral, but not neuropsychological, effects in the AE+ group over the other clinical groups. Parent-report was not correlated with neuropsychological performance in the clinical groups and may provide unique information about neurobehavior. Parent-report measures are clinically useful in predicting alcohol exposure regardless of ADHD. Results contribute to a neurobehavioral profile of prenatal alcohol exposure.
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Treit S, Zhou D, Lebel C, Rasmussen C, Andrew G, Beaulieu C. Longitudinal MRI reveals impaired cortical thinning in children and adolescents prenatally exposed to alcohol. Hum Brain Mapp 2014; 35:4892-903. [PMID: 24700453 DOI: 10.1002/hbm.22520] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 12/12/2022] Open
Abstract
Brain imaging studies suggest that cortical thickness decreases during childhood and adolescence, in concert with underlying structural and synaptic changes required for cognitive maturation and regional specialization of function. Abnormalities of this protracted developmental process may provide key insights into the cognitive and behavioral deficits that emerge in individuals with fetal alcohol spectrum disorders (FASD). Several studies have demonstrated cortical thickness differences in children and adolescents who were prenatally exposed to alcohol, though all have been cross sectional, limiting conclusions about cortical development with age. In this study, we analyze serially collected T1 -weighted MRI from 11 children with FASD and 21 controls, scanned twice each ∼2 to 4 years apart. Mixed-models analysis of cortical thickness measurements revealed age-by-group interactions in cortical thinning, with FASD participants undergoing less developmental thinning than controls across many regions of the cortex, particularly in medial frontal and parietal areas. These results provide further longitudinal evidence in humans that prenatal alcohol exposure is associated with altered patterns of brain development that persist during childhood and adolescence.
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Affiliation(s)
- Sarah Treit
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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30
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Ware AL, Glass L, Crocker N, Deweese BN, Coles CD, Kable JA, May PA, Kalberg WO, Sowell ER, Jones KL, Riley EP, Mattson SN. Effects of prenatal alcohol exposure and attention-deficit/hyperactivity disorder on adaptive functioning. Alcohol Clin Exp Res 2014; 38:1439-47. [PMID: 24655090 DOI: 10.1111/acer.12376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heavy prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) are associated with adaptive behavior deficits. This study examined the interaction between these 2 factors on parent ratings of adaptive behavior. METHODS As part of a multisite study, primary caregivers of 317 children (8 to 16 years, M = 12.38) completed the Vineland Adaptive Behavior Scales-Second Edition (VABS-II). Four groups of subjects were included: children with prenatal alcohol exposure with ADHD (AE+, n = 82), children with prenatal alcohol exposure without ADHD (AE-, n = 34), children with ADHD (ADHD, n = 71), and control children (CON, n = 130). VABS-II domain scores (Communication, Daily Living Skills, Socialization) were examined using separate 2 (Alcohol Exposure [AE]) × 2 (ADHD diagnosis) between-subjects analyses of covariance. RESULTS There were significant main effects of AE (p < 0.001) and ADHD (p < 0.001) on all VABS-II domains; alcohol-exposed children had lower scores than children without prenatal alcohol exposure and children with ADHD had lower scores than those without ADHD. There was a significant AE × ADHD interaction effect for Communication, F(1, 308) = 7.49, p = 0.007, partial η(2) = 0.024, but not Daily Living Skills or Socialization domains (ps > 0.27). Follow-up analyses in the Communication domain indicated the effects of ADHD were stronger in comparison subjects (ADHD vs. CON) than exposed subjects (AE+ vs. AE-), and the effects of alcohol exposure were stronger in subjects without ADHD (AE- vs. CON) than in subjects with ADHD (AE+ vs. ADHD) CONCLUSION As found previously, both prenatal alcohol exposure and ADHD increase adaptive behavior deficits in all domains. However, these 2 factors interact to cause the greatest impairment in children with both prenatal alcohol exposure and ADHD for communication abilities. These results further demonstrate the deleterious effects of prenatal alcohol exposure and broaden our understanding of how ADHD exacerbates behavioral outcomes in this population.
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Affiliation(s)
- Ashley L Ware
- Center for Behavioral Teratology , San Diego State University, San Diego, California
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31
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Glass L, Graham DM, Deweese BN, Jones KL, Riley EP, Mattson SN. Correspondence of parent report and laboratory measures of inattention and hyperactivity in children with heavy prenatal alcohol exposure. Neurotoxicol Teratol 2014; 42:43-50. [PMID: 24512965 PMCID: PMC3989839 DOI: 10.1016/j.ntt.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/20/2013] [Accepted: 01/29/2014] [Indexed: 11/29/2022]
Abstract
Clinical research and practice support a multi-method approach to validating behavioral problems in children. We examined whether parent-reported symptoms of hyperactivity and inattention (using the Disruptive Behavior Disorder Rating Scale) were substantiated by objective laboratory measures [hyperactivity measured by wrist-worn actigraphy (ACT) and inattention assessed using a 20-minute continuous performance task (CPT)] in three age- and demographically-matched groups of school-age children: children with prenatal alcohol exposure (AE), non-exposed children with idiopathic ADHD (ADHD), and controls (CON). Results indicated that the clinical groups (AE, ADHD) had significantly higher parent-reported levels for both domains compared to the CON group, and did not differ from each other. On the laboratory measures, the clinical groups were more inattentive than controls on the CPT, but did not differ from each other. In contrast, the ADHD group had higher objective activity on the ACT than AE and CON, which did not differ from each other. Thus, laboratory measures differentially validated parent reports in a group-dependent manner. Actigraphy substantiated parent-reported hyperactivity for children in the ADHD group but not for children in the AE group, while the CPT validated parent-reported inattention for both clinical groups. Although the majority of children in the AE group met the criteria for ADHD, objective activity levels were not different from controls, indicating that hyperactivity may be a less prominent feature in the AE group. Thus, while there is considerable overlap between the effects of prenatal alcohol exposure and ADHD, differences in behavioral profiles may be clinically useful in differential diagnosis. Further, these data indicate that objective measures should be used to validate parent reports.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Diana M Graham
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Benjamin N Deweese
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Kenneth Lyons Jones
- University of California, San Diego, School of Medicine, Department of Pediatrics, San Diego, CA 92093, USA.
| | - Edward P Riley
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
| | - Sarah N Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA 92120, USA.
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Glass L, Ware AL, Mattson SN. Neurobehavioral, neurologic, and neuroimaging characteristics of fetal alcohol spectrum disorders. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:435-462. [PMID: 25307589 DOI: 10.1016/b978-0-444-62619-6.00025-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Alcohol consumption during pregnancy can have deleterious consequences for the fetus, including changes in central nervous system development leading to permanent neurologic alterations and cognitive and behavioral deficits. Individuals affected by prenatal alcohol exposure, including those with and without fetal alcohol syndrome, are identified under the umbrella of fetal alcohol spectrum disorders (FASD). While studies of humans and animal models confirm that even low to moderate levels of exposure can have detrimental effects, critical doses of such exposure have yet to be specified and the most clinically significant and consistent consequences occur following heavy exposure. These consequences are pervasive, devastating, and can result in long-term dysfunction. This chapter summarizes the neurobehavioral, neurologic, and neuroimaging characteristics of FASD, focusing primarily on clinical research of individuals with histories of heavy prenatal alcohol exposure, although studies of lower levels of exposure, particularly prospective, longitudinal studies, will be discussed where relevant.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Ashley L Ware
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA.
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