Christie L. McGee

Fetal Alcohol Spectrum Disorders: An Overview with Emphasis on Changes in Brain and Behavior:

Fetal alcohol spectrum disorders constitute a major public health problem. This article presents an overview of important issues that surround these disorders and emphasizes the structural and neurobehavioral consequences associated with prenatal exposure to alcohol. Diagnostic criteria are discussed, and possible moderating factors for the range of outcomes are mentioned. In addition, the prevalence of fetal alcohol spectrum disorders is described, and estimates of the financial impact of these disorders are given. Heavy prenatal alcohol exposure can severely affect the physical and neurobehavioral development of a child. Autopsy and brain imaging studies indicate reductions and abnormalities in overall brain size and shape, specifically in structures such as the cerebellum, basal ganglia, and corpus callosum. A wide range of neuropsychological deficits have been found in children prenatally exposed to alcohol, including deficits in visuospatial functioning, verbal and nonverbal learning, attention, and executive functioning. These children also exhibit a variety of behavioral problems that can further affect their daily functioning. Children exposed to alcohol prenatally, with and without the physical features of fetal alcohol syndrome, display qualitatively similar deficits. Determining the behavioral phenotypes that result from heavy prenatal alcohol exposure is critical, because the identification of these children is crucial for early interventions. In addition, knowing which brain areas are involved might enable the development of better intervention strategies. However, intervention needs to go beyond the affected individual to prevent future cases. As evidenced by the staggering financial impact these disorders have on society, prevention efforts need to be aimed at high-risk groups, and this issue needs to be made a high priority in terms of public health.

Evaluation of Psychopathological Conditions in Children With Heavy Prenatal Alcohol Exposure

OBJECTIVE. This study compared the prevalence of psychopathological conditions in children with heavy prenatal alcohol exposure (N = 39) and nonexposed, typically developing peers (N = 30), matched with respect to age, gender, and socioeconomic status. METHODS. Caregivers were interviewed with either the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version, or the Computerized Diagnostic Interview Schedule for Children, Version IV. Statistical resampling methods were used to create 95% confidence intervals for the difference between the proportions of children with psychopathological conditions in the exposed and control groups. RESULTS. Group differences were seen in the attention-deficit/hyperactivity disorder, depressive disorders, oppositional defiant disorder, conduct disorder, and specific phobia outcome categories. The group difference in the attention-deficit/hyperactivity disorder category was by far the largest effect observed. CONCLUSIONS. These results suggest that fetal alcohol exposure should be considered a possible factor in the pathogenesis of childhood psychiatric disorders. These data provide clinically relevant information about the mental health problems that children with fetal alcohol exposure are likely to face.

Teratogenic effects of alcohol: a decade of brain imaging.

Heavy alcohol exposure can have serious and long‐lasting effects on the developing fetal brain. In the last decade, researchers have utilized quantitative structural magnetic resonance imaging (MRI) to examine the brains of living children and adults with histories of heavy prenatal alcohol exposure. In addition to microcephaly, these studies indicated structural abnormalities in various regions of the brain, including the cerebellum, corpus callosum, and the basal ganglia. Most recently, we have utilized novel imaging and analytic techniques to study the brain as a whole in an effort to elucidate more subtle differences than was possible with earlier techniques. Results indicated displacements in the corpus callosum, increased gray matter densities in both hemispheres in the perisylvian regions, and altered gray matter asymmetry in portions of the temporal lobes in the brains of alcohol‐exposed subjects. In addition, prominent shape abnormalities were observed in the brains of these subjects, with narrowing in the temporal region and reduced brain growth in portions of the frontal lobe. These results imply that brain growth continues to be adversely affected long after the prenatal insult and that the brain regions most affected may be consistent with the neurocognitive deficits characteristic of individuals prenatally exposed to alcohol.

Neuroimaging and fetal alcohol spectrum disorders.

Heavy prenatal alcohol exposure causes permanent structural alterations to the brain and can lead to numerous cognitive and behavioral outcomes. Consistent with many of the neuropsychological and behavioral deficits that have been reported, neuroimaging studies reveal a pattern of structural abnormalities associated with prenatal alcohol exposure. This chapter systematically reviews structural anomalies by brain region, identifying cognitive and behavioral correlates when relevant. The consensus shows that in addition to the overall reduction of brain size, prominent brain shape abnormalities have been observed, with narrowing in the parietal region and reduced brain growth in portions of the frontal lobe. Commensurating with these anomalies, volumetric and tissue density findings cite disproportionate reductions in the parietal lobe, cerebellar vermis, corpus callosum, and the caudate nucleus, suggesting that certain areas of the brain may be especially vulnerable to prenatal alcohol exposure. In sum, neuroimaging techniques have greatly advanced our understanding of brain-behavior relationships in fetal alcohol spectrum disorders (FASD), and hopefully will lead to improved diagnosis and treatment options for those affected by prenatal exposure to alcohol.

Deficits in Social Problem Solving in Adolescents with Prenatal Exposure to Alcohol

This study evaluated the social problem solving skills of adolescents with histories of prenatal alcohol exposure. Adolescents (28 alcohol-exposed, 15 controls) completed a standardized questionnaire of social problem solving, and caregivers completed a parent-report measure of executive functioning. Both questionnaires were mailed to families, and caregivers were asked to recruit a non-exposed control. Results suggest that alcohol-exposed adolescents have substantial impairments in their abilities to solve problems in their everyday life, even in the absence of mental retardation. Such impairments are likely to have a significant impact on social and academic functioning and reflect their need for critical services otherwise unavailable to them.

Impaired Language Performance in Young Children with Heavy Prenatal Alcohol Exposure

The aims of this study were to evaluate the language abilities of young children with heavy prenatal alcohol exposure and to determine if these abilities represent a relative strength or weakness for this population. Two matched groups of children (ages 3 to 5) completed the Clinical Evaluation of Language Fundamentals, Preschool version: 25 children with heavy prenatal alcohol exposure (ALC) and 26 non-exposed controls (CON). Consistent with previous research, the CON group had significantly higher full scale IQ (FSIQ) scores than the ALC group. Receptive and expressive language skills of the two groups were compared. The ALC group had significantly poorer language skills than the CON group and both groups had better receptive than expressive abilities. Language performance did not significantly deviate from what would be predicted by FSIQ for either group. These results indicate that receptive and expressive language abilities are impaired in children with heavy prenatal alcohol exposure but not more so than general intellectual functioning. However, these deficits are likely to impact the social interactions and behavioral adjustment of children with prenatal alcohol exposure.

Social Information Processing Skills in Children with Histories of Heavy Prenatal Alcohol Exposure

Based on caregiver report, children with prenatal alcohol exposure have difficulty with social functioning, but little is known about their social cognition. The current study assessed the social information processing patterns of school-age children with heavy prenatal alcohol exposure using a paradigm based on Crick and Dodge’s reformulated six-stage model. Fifty-two children (aged 7–11) with and without heavy prenatal alcohol exposure were tested using a structured interview measure of social information processing involving 18 videotaped vignettes of children in group entry and provocation situations. Alcohol-exposed children displayed maladaptive processing patterns on the goal, response generation, and response evaluation steps in group entry situations, and encoding, attribution, response evaluation, and enactment steps during provocation situations. Children with heavy prenatal alcohol exposure also had difficulty on the Test of Problem Solving, and performance correlated with social information processing measures. Such difficulties may lead to problems in social functioning and warrant early intervention.

Children With Heavy Prenatal Alcohol Exposure Demonstrate Deficits on Multiple Measures of Concept Formation

BACKGROUND Children with heavy prenatal alcohol exposure have documented impairments in executive functioning (EF). One component of EF, concept formation, has not been well studied in this group. METHODS Children (8 to 18 years) with histories of heavy prenatal alcohol exposure, with and without fetal alcohol syndrome (FAS), were compared to typically developing controls on 2 measures of concept formation and conceptual set shifting: the Wisconsin Card Sorting Test and the Card Sorting Test from the Delis-Kaplan Executive Functioning System. In addition to between-group comparisons, performance relative to overall intellectual functioning was examined. RESULTS Children with histories of heavy prenatal alcohol exposure showed impairment on both tests of concept formation compared to non-exposed controls. These deficits included difficulty generating and verbalizing concepts, increased error rates and perseverative responses, and poorer response to feedback. However, in comparison to controls, alcohol-exposed children performed better on measures of concept formation than predicted by their overall IQ scores. Exploratory analyses suggest that this may be due to differences in how the measures relate at different IQ levels and may not be specific to prenatal alcohol exposure. CONCLUSIONS Deficits in concept formation and conceptual set shifting were observed in alcohol-exposed children with or without the diagnosis of FAS and in the absence of mental retardation. These deficits likely impact problem solving skills and adaptive functioning and have implications for therapeutic interventions in this population.

Cognitive Discrepancies in Children at the Ends of the Bell Curve: A Note of Caution for Clinical Interpretation

Discrepancies between IQ scores on the Wechsler Abbreviated Scale of Intelligence (WASI) and scores from the Delis-Kaplan Executive Function System (D-KEFS) were examined at different levels of intellectual functioning in 470 normal-functioning youths (aged 8–19) from the co-standardization sample of the WASI and D-KEFS. Results demonstrated that children with lower IQ scores often had significantly higher D-KEFS scores, whereas children with higher IQ scores often had significantly lower D-KEFS scores. Similar patterns were identified for discrepancies between Verbal and Performance IQ indices. These findings are similar to those found in the adult literature. Clinicians are advised to be cautious when weighing the clinical significance of cognitive discrepancies at the ends of the bell-curve and should avoid interpreting discrepancies in isolation.