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Kerdreux E, Fraize J, Garzón P, Chalain E, Etchebarren L, Sitbon D, Maruani A, Boespflug-Tanguy O, Hertz-Pannier L, Noulhiane M, Pinabiaux C, Germanaud D. Questioning cognitive heterogeneity and intellectual functioning in fetal alcohol spectrum disorders from the Wechsler Intelligence Scale for Children. Clin Neuropsychol 2024; 38:1109-1132. [PMID: 37974061 DOI: 10.1080/13854046.2023.2281703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
Introduction: Fetal Alcohol Spectrum Disorders (FASD) are characterized by a variety of multiple cognitive and behavioral impairments, with intellectual, attentional, and executive impairments being the most commonly reported. In populations with multiple neurodevelopmental disorders, the Full Scale Intelligence Quotient (FSIQ) may not be a proper measure of intellectual abilities, rarely interpreted in FASD clinical practice because the heterogeneity of the cognitive profile is deemed too strong. We propose a quantitative characterization of this heterogeneity, of the strengths and weaknesses profile, and a differential analysis between global cognitive (FSIQ) and elementary reasoning abilities in a large retrospective monocentric FASD sample. Methods: Using clinical and cognitive data (Wechsler Intelligence Scale for Children) from 107 children with FASD, we characterized subject heterogeneity (variance and scatter of scaled/composite scores), searched for strengths and weaknesses, and specified intellectual functioning in terms of FSIQ and elementary reasoning (General Abilities Index, Highest Reasoning Scaled Score), in comparison with standardization norms and a Monte-Carlo-simulated sample from normalization data. Results: Performance of children with FASD was lower on all subtests, with a significant weakness in working memory and processing speed. We found no increase in the variance and scatter of the scores, but a discordance between the assessment of global cognitive functioning (28% borderline, 23% deficient) and that of global and elementary reasoning abilities (23-9% borderline, 15-14% deficient). Conclusion: Our results question the notion of WISC profile heterogeneity in FASD and point to working memory and processing speed over-impairment, with global repercussions but most often preserved elementary reasoning abilities.
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Affiliation(s)
- Eliot Kerdreux
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
| | - Justine Fraize
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
| | - Pauline Garzón
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
| | - Esther Chalain
- Genetics Department, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Léa Etchebarren
- Pediatric Neurology Department, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Delphine Sitbon
- Pediatric Neurology Department, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | - Anna Maruani
- Child and Adolescent Psychiatry Department, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
| | | | - Lucie Hertz-Pannier
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
| | - Marion Noulhiane
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
| | - Charlotte Pinabiaux
- Université Paris Nanterre, Department of Psychology, DysCo Lab, Nanterre, France
| | - David Germanaud
- CEA Paris-Saclay, Frederic Joliot Institute, NeuroSpin, UNIACT, Gif-sur-Yvette, France
- Université Paris Cité, Inserm, NeuroDiderot, inDEV, Paris, France
- Genetics Department, Centre of Excellence InovAND, Robert-Debré Hospital, AP-HP, Paris, France
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2
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O'Neill J, O'Connor MJ, Kalender G, Ly R, Ng A, Dillon A, Narr KL, Loo SK, Alger JR, Levitt JG. Combining neuroimaging and behavior to discriminate children with attention deficit-hyperactivity disorder with and without prenatal alcohol exposure. Brain Imaging Behav 2022; 16:69-77. [PMID: 34089460 PMCID: PMC8643366 DOI: 10.1007/s11682-021-00477-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/03/2023]
Abstract
In many patients, ostensible idiopathic attention deficit-hyperactivity disorder (ADHD) may actually stem from covert prenatal alcohol exposure (PAE), a treatment-relevant distinction. This study attempted a receiver-operator characteristic (ROC) classification of children with ADHD into those with PAE (ADHD+PAE) and those without (ADHD-PAE) using neurobehavioral instruments alongside magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of supraventricular brain white matter. Neurobehavioral, MRS, and DTI endpoints had been suggested by prior findings. Participants included children aged 8-13 years, 23 with ADHD+PAE, 19 with familial ADHD-PAE, and 28 typically developing (TD) controls. With area-under-the-curve (AUC) >0.90, the Conners 3 Parent Rating Scale Inattention (CIn) and Hyperactivity/Impulsivity (CHp) scores and the Behavioral Regulation Index (BRI) of the Behavior Rating Inventory of Executive Function (BRIEF2) excellently distinguished the clinical groups from TD, but not from each other (AUC < 0.70). Combinations of MRS glutamate (Glu) and N-acetyl-compounds (NAA) and DTI mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) yielded "good" (AUC > 0.80) discrimination. Neuroimaging combined with CIn and BRI achieved AUC 0.72 and AUC 0.84, respectively. But neuroimaging combined with CHp yielded 14 excellent combinations with AUC ≥ 0.90 (all p < 0.0005), the best being Glu·AD·RD·CHp/(NAA·FA) (AUC 0.92, sensitivity 1.00, specificity 0.82, p < 0.0005). Using Cho in lieu of Glu yielded AUC 0.83. White-matter microstructure and metabolism may assist efforts to discriminate ADHD etiologies and to detect PAE, beyond the ability of commonly used neurobehavioral measures alone.
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Affiliation(s)
- Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA.
| | - Mary J O'Connor
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Guldamla Kalender
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Ronald Ly
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Ng
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrea Dillon
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sandra K Loo
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeffry R Alger
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Neurospectroscopics, LLC, Sherman Oaks, CA, USA
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer G Levitt
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
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3
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Harding KD, Turner K, Howe SJ, Bagshawe MJ, Flannigan K, Mela M, McMorris CA, Badry D. Caregivers' experiences and perceptions of suicidality among their children and youth with fetal alcohol spectrum disorder. Front Psychiatry 2022; 13:931528. [PMID: 36117649 PMCID: PMC9471421 DOI: 10.3389/fpsyt.2022.931528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with Fetal Alcohol Spectrum Disorder (FASD) experience a range of biopsychosocial vulnerabilities that can increase the possibility of adverse life outcomes, including a heightened risk of suicidality. In this study, we explored the lived experiences of caregivers of children and youth with FASD and suicidality, including their perceptions of their child and youth's suicidal experiences. Between March and June 2021, six comprehensive, semi-structured interviews were conducted with five caregivers of children and youth with FASD (Mage = 14.5 years, range 11-22) who were currently experiencing suicidality or had a history of suicidality. Data were analyzed using interpretative phenomenological analysis and then developed into a composite vignette informed and organized by the social-ecological suicide prevention model (SESPM). The composite vignette revealed the narratives of families living with and caring for children and youth with FASD who experience suicidality in relation to the complex and intersectional individual, relational, community, and societal level contextual and protective factors. Findings from this study highlight the critical need for comprehensive FASD-informed suicide prevention and intervention approaches to promote the mental health and wellbeing of children and youth with FASD and their caregivers.
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Affiliation(s)
- Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Kailyn Turner
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Stephanie J Howe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Mercedes Jayne Bagshawe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
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4
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McCarthy R, Mukherjee RAS, Fleming KM, Green J, Clayton-Smith J, Price AD, Allely CS, Cook PA. Prevalence of fetal alcohol spectrum disorder in Greater Manchester, UK: An active case ascertainment study. Alcohol Clin Exp Res 2021; 45:2271-2281. [PMID: 34590329 PMCID: PMC9292152 DOI: 10.1111/acer.14705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022]
Abstract
Background Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school. Methods A 2‐phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8–9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen‐positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties. Results Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis. Conclusions FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD.
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Affiliation(s)
- Robyn McCarthy
- School of Health and Society, University of Salford, Salford, UK
| | - Raja A S Mukherjee
- School of Health and Society, University of Salford, Salford, UK.,Fetal Alcohol Spectrum Disorder Service, Surrey & Borders Partnership NHS Foundatation Trust, Redhill, UK
| | - Kate M Fleming
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Jill Clayton-Smith
- Division of Evolution & Genomic Sciences, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Alan D Price
- School of Health and Society, University of Salford, Salford, UK
| | - Clare S Allely
- School of Health and Society, University of Salford, Salford, UK
| | - Penny A Cook
- School of Health and Society, University of Salford, Salford, UK
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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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Pinner JFL, Coffman BA, Stephen JM. Covariation Between Brain Function (MEG) and Structure (DTI) Differentiates Adolescents with Fetal Alcohol Spectrum Disorder from Typically Developing Controls. Neuroscience 2020; 449:74-87. [PMID: 33010344 DOI: 10.1016/j.neuroscience.2020.09.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 07/29/2020] [Accepted: 09/24/2020] [Indexed: 01/22/2023]
Abstract
The behavioral, cognitive, and sensory difficulties experienced by individuals exposed to alcohol prenatally currently fail to provide early identification for fetal alcohol spectrum disorder (FASD). Attempting to advance this pursuit through a multivariate analysis, we collected magnetoencephalography (MEG) data during auditory, somatosensory, visual paradigms, DTI, and behavior in adolescents ages 12-21 years (FASD: N = 13; HC: N = 20). We assessed the relationship between brain function (MEG) and structure (fractional anisotropy (FA)) utilizing joint independent component analysis (jICA), and examined how this measure relates to behavior. We identified 5 components that reveal group differences in co-variation between MEG and FA. For example, component 5 (t = 3.162, p = 0.003, Hedges' g = 1.13) contained MEG activity corresponding to all three sensory modalities, most robustly in occipital lobes, and DTI-derived cerebellar FA, underlying the role of the cerebellum in sensory processing. Further, in HCs component 5's loading factor was positively correlated with verbal ability (r = 0.646, p = 0.002), indicating higher covariation was associated with better verbal performance. Interestingly, this relationship is lacking in FASD (r = 0.009, p = 0.979). Also, component 5 loading factor negatively correlated with impulsivity (r = -0.527, p = 0.002), indicating that stronger function-structure associations were associated with individuals with lower impulsivity. These findings suggest that multimodal integration of MEG and FA provides novel associations between structure and function that may help differentiate adolescents with FASD from HC.
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Affiliation(s)
- John F L Pinner
- The Mind Research Network, Albuquerque, NM, United States; Department of Psychology, The University of New Mexico, Albuquerque, NM, United States.
| | - Brian A Coffman
- The Mind Research Network, Albuquerque, NM, United States; The University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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7
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Sanders JL, Netelenbos N, Dei SO. Construct and factorial validity of Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE). BMC Psychol 2020; 8:53. [PMID: 32460861 PMCID: PMC7251837 DOI: 10.1186/s40359-020-00405-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background ND-PAE, as a condition needing further study, requires validation. Few studies have assessed the validity of ND-PAE with none using a prospective sample. Methods Fifty-eight children underwent multidisciplinary FASD assessments and were evaluated for ND-PAE using a prospective, clinical approach. Construct and factorial validity of ND-PAE were assessed, and associations between domains and symptoms described. Post hoc analysis assessed external validity of factors. Results ND-PAE demonstrated weak construct validity with variable convergence and divergence within and between symptoms. Factor analysis revealed one strong factor consisting of abilities associated with adaptive behavior and general cognitive ability. Relative contribution of symptoms and domains were variable. Conclusion This study provides an evidence-based approach to assessing ND-PAE symptoms and is a starting point to elucidating its neurobehavioral pattern.
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Affiliation(s)
- James Ladell Sanders
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada.
| | - Nicole Netelenbos
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada
| | - Samuel Ofori Dei
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada
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8
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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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9
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Abstract
PURPOSE OF REVIEW Understanding the pathophysiologic, diagnostic, and treatment implications of the interface between mental disorder and the consequences of Prenatal Alcohol Exposure (PAE) is important for mental health professionals (MHP) seeking to provide the most effective care. This review was written to highlight the importance of identifying and intervening with regards to the unique mental health and medical needs of individual with PAE. RECENT FINDINGS Over the last year, research has identified differences in the diagnostic criteria for Neurodevelopmental Disorder Associated with PAE (ND-PAE)/Fetal Alcohol Spectrum Disorder (FASD) and called for standardization, given that diagnosis is the main route to appropriate support. Care will improve with advances in epigenetic, neuroimaging, and electrophysiological discoveries regarding the consequences of PAE. For example, recent progressions allow for improved detection of alterations in DNA methylation and functional connectivity between cortical and deep grey matter. Therapeutic innovations targeting specific neurocognitive impairment and ligand-specific symptom clusters, as well as lifelong multidisciplinary interventions to support patients, were reported as producing effective outcomes. SUMMARY Developments in genetics, epigenetics, imaging, and interventions are relevant to the current knowledge of FASD. MHP are encouraged to recognize the importance of understanding unique considerations for this population, including forensic implications and the whole-body impacts of FASD, which could assist in reducing stigma and improving quality of care.
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10
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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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11
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Enns LN, Taylor NM. Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment. Child Neuropsychol 2016; 24:203-225. [DOI: 10.1080/09297049.2016.1251894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Leah N. Enns
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
- Manitoba FASD Centre, SSCY Centre, Winnipeg, Canada
| | - Nicole M. Taylor
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
- Manitoba FASD Centre, SSCY Centre, Winnipeg, Canada
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Doyle LR, Mattson SN. Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Review of Evidence and Guidelines for Assessment. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015; 2:175-186. [PMID: 26509108 PMCID: PMC4617308 DOI: 10.1007/s40474-015-0054-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The effects of prenatal alcohol use have been well documented. In this review, we discuss the inclusion of Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5). We present a review of the evidence for impairment in three domains highlighted in ND-PAE: neurocognitive functioning, self2 regulation, and adaptive functioning. In addition, we provide guidelines for clinical assessment of each domain. When considering ND-PAE, it is essential to obtain as comprehensive an assessment as possible, including multidisciplinary/multimethod assessment of the individual by a qualified team. It is our aim to provide clinicians with a useful reference for assessing ND-PAE and highlight important guidelines to be followed when conducting neuropsychological assessment.
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Affiliation(s)
- Lauren R Doyle
- Center for Behavioral Teratology, San Diego State University, San Diego, CA 92120
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA 92120
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