Jacqueline Pei

Developmental cortical thinning in fetal alcohol spectrum disorders.

Regional cortical thickness was evaluated using CIVET processing of 3D T1-weighted images (i) to compare the variation in cortical thickness between 33 participants with fetal alcohol spectrum disorders (FASD) aged 6-30 years (mean age 12.3 years) versus 33 age/sex/hand-matched controls, and (ii) to examine developmental changes in cortical thickness with age from children to young adults in both groups. Significant cortical thinning was found in the participants with FASD in large areas of the bilateral middle frontal lobe, pre- and post- central areas, lateral and inferior temporal and occipital lobes compared to controls. No significant cortical thickness increases were observed for the FASD group. Cortical thinning with age in a linear model was observed in both groups, but the locations were different for each group. FASD participants showed thinning with age in the left middle frontal, bilateral precentral, bilateral precuneus and paracingulate, left inferior occipital and bilateral fusiform gyri; while controls showed decreases with age in the bilateral middle frontal gyrus, right inferior frontal gyrus, bilateral precuneus gyrus, and bilateral occipital gyrus. A battery of cognitive assessments of memory, attention, motor, and verbal abilities was conducted with many of the FASD participants, but no significant correlations were found between these cognitive scores and regional cortical thickness. Non-invasive measurements of cortical thickness in children to young adults with FASD have identified both key regions of cortex that may be more deleteriously affected by prenatal alcohol exposure as well as cortical changes with age that differ from normal developmental thinning.

Mental health issues in fetal alcohol spectrum disorder

Background. High numbers of individuals with Fetal Alcohol Spectrum Disorders (FASD) have been described as having mental health problems. Aims. This article summarizes research about mental health problems in FASD and considers related developmental and environmental issues. Method. A computer-based literature search was conducted in the databases Medline, PsycINFO, Google Scholar, Academic Search Complete, and Education Resources Information Centre for articles addressing the prevalence and types of mental health issues in individuals affected by FASD. Results. High rates of mental disorders within the FASD and prenatal alcohol exposure (PAE) population were found to be consistently reported for both internalizing and externalizing disorders. Moreover, problems that emerge in childhood may reflect a convergence of genetic, environmental, and neurophysiological factors that persist into adulthood. Conclusions. Researchers are beginning to document the impacts of PAE on later mental health development. Further longitudinal study is needed to determine whether there is an increasing severity of mental health deficits and consequences with age, and whether any such changes reflect increasingly deteriorating environmental factors or brain-based factors. Additionally, research is needed to design interventions to better address the unique mental health needs of this population.

Executive function and memory in children with Fetal Alcohol Spectrum Disorder

A complex relation exists between memory and executive functioning (EF), particularly when learning and recalling multifaceted or extensive information (Moscovitch & Winocur, 2002). A common instrument for evaluating this relationship is the Rey-Osterrieth Complex Figure (ROCF; Rey, 1941; Osterrieth, 1944). The ROCF has proved particularly useful in pediatric research; however, little research has been conducted among children with Fetal Alcohol Spectrum Disorders (FASD). Seventy children (35 FASD, 35 control), aged 6 to 12 years, were tested using the ROCF. All participants with FASD had received a diagnosis according to the Canadian guidelines for FASD (Chudley et al., 2005) using the 4-digit diagnostic code (Astley, 2004). Significant group differences were revealed with children with FASD demonstrating substantial difficulties in organization, accuracy, and memory. Among children with FASD, a distinctive profile emerged, lending support to the argument that children with FASD experience deficits in EF and memory throughout their development. Information from the present study will not only help to improve understanding of functioning in this population but also provide insight into how to deal with EF and memory deficits in terms of testing, treatment, and intervention.

A review of the verbal and visual memory impairments in children with foetal alcohol spectrum disorders.

Background: Children with Foetal Alcohol Spectrum Disorders (FASD) have significant impairments in memory, negatively affecting academics and daily functioning. Primary objective: To review published research on: (1) verbal and visual-spatial memory in children with FASD or prenatal alcohol exposure (PAE); (2) animal research on the impact of PAE on memory; and (3) brain areas involved in memory that are affected by PAE. Main outcomes: Verbal memory is one of the main areas of memory affected by gestational alcohol exposure, specifically in encoding and retrieving information. Spatial memory has emerged as a dominant deficit in individuals with FASD, consistent in children, adolescents and adults. There are regions of the brain more typically affected by PAE, which have ties to memory functioning. Animal research has confirmed the presence of impacts to key brain regions involved in memory functioning for those affected by PAE. Conclusion: Memory deficits are a prevalent finding in individuals with PAE. Research in this area is complicated by small sample sizes, difficulty linking animal research to human application and lack of effective connection between existing memory theory and functional memory testing in FASD. New research has shown that there are implications for memory and learning amelioration in children with FASD.

Affective Decision-Making on the Iowa Gambling Task in Children and Adolescents with Fetal Alcohol Spectrum Disorders

Individuals with fetal alcohol spectrum disorders (FASD) have difficulties with cognitive-based executive function (EF) tasks. The goal of the present study was to determine if children with FASD have impairments on the Iowa Gambling Task (IGT), which measures affective EF (i.e., decision-making and risk-taking). Individuals with FASD (n = 31) and healthy controls (n = 31), aged 8-17 completed the IGT. Children with FASD were significantly impaired on the IGT compared to controls. Over the course of the task, control scores improved, whereas children with FASD exhibited an overall decrease in scores. Scores increased significantly with age in the control group but did not differ significantly with age for FASD participants. Children with FASD exhibited decision-making and risk-taking impairments on a hot EF task. Children with FASD did not appear to learn from negative experiences and shift to making more positive decisions over time and their performance did not improve with age. The implications of poor task performance and a lack of age-related findings in children with FASD are discussed.

Working memory and visuospatial deficits correlate with oculomotor control in children with fetal alcohol spectrum disorder.

Previous studies have demonstrated that children with Fetal Alcohol Spectrum Disorder (FASD) exhibit deficits in measures of eye movement control that probe aspects of visuospatial processing and working memory. The goal of the present study was to examine, in a large cohort of children with FASD, prenatal alcohol exposure (PAE) but not FASD, and typically developing control children, the relationship between performance in eye movement tasks and standardized psychometric tests that assess visuospatial processing and working memory. Participants for this dataset were drawn from a large, multi-site investigation, and included children and adolescents aged 5-17 years diagnosed with an FASD (n=71), those with PAE but no clinical FASD diagnosis (n=20), and typically developing controls (n=111). Participants completed a neurobehavioral test battery and a series of saccadic eye movement tasks. The FASD group performed worse than controls on the psychometric and eye movement measures of working memory and visuospatial skills. Within the FASD group, digit recall, block recall, and animal sorting were negatively correlated with sequence errors on the memory-guided task, and arrows was negatively correlated with prosaccade endpoint error. There were no significant correlations in the control group. These data suggest that psychometric tests and eye movement control tasks may assess similar domains of cognitive function, and these assessment tools may be measuring overlapping brain regions damaged due to prenatal alcohol exposure. The results of this study demonstrate that eye movement control tasks directly relate to outcome measures obtained with psychometric tests and are able to assess multiple domains of cognition simultaneously, thereby allowing for an efficient and accurate assessment.

Deficits in response inhibition correlate with oculomotor control in children with fetal alcohol spectrum disorder and prenatal alcohol exposure.

Children with fetal alcohol spectrum disorder (FASD) or prenatal alcohol exposure (PAE) frequently exhibit impairment on tasks measuring inhibition. The objective of this study was to determine if a performance-based relationship exists between psychometric tests and eye movement tasks in children with FASD. Participants for this dataset were aged 5-17 years and included those diagnosed with an FASD (n=72), those with PAE but no clinical FASD diagnosis (n=21), and typically developing controls (n=139). Participants completed a neurobehavioral test battery, which included the NEPSY-II subtests of auditory attention, response set, and inhibition. Each participant completed a series of saccadic eye movement tasks, which included the antisaccade and memory-guided tasks. Both the FASD and the PAE groups performed worse than controls on the subtest measures of attention and inhibition. Compared with controls, the FASD group made more errors on the antisaccade and memory-guided tasks. Among the combined FASD/PAE group, inhibition and switching errors were negatively correlated with direction errors on the antisaccade task but not on the memory-guided task. There were no significant correlations in the control group. These data suggests that response inhibition deficits in children with FASD/PAE are associated with difficulty controlling saccadic eye movements which may point to overlapping brain regions damaged by prenatal alcohol exposure. The results of this study demonstrate that eye movement control tasks directly relate to outcome measures obtained with psychometric tests that are used during FASD diagnosis, and may therefore help with early identification of children who would benefit from a multidisciplinary diagnostic assessment.

Source Monitoring in Children With and Without Fetal Alcohol Spectrum Disorders

OBJECTIVES Deficits in memory are well-documented in children with fetal alcohol spectrum disorders (FASD); however, one aspect of memory not yet studied in children with FASD is source monitoring. This study examined overall source monitoring ability and performance profiles of children with FASD compared to controls. METHOD Participants included 19 children with FASD and 38 typically developing children (aged 6-12 years). Children were presented with auditory word lists and were required to recall the source of words for reality, external, and internal source monitoring tasks. RESULTS Children with FASD showed poorer performance than controls across all three conditions in both recognition memory and memory for source. However, both groups exhibited a comparable pattern of performance across conditions. Specifically, performance was lowest on the internal task and highest on the reality task. CONCLUSIONS Information about source monitoring deficits further delineates the intricacies of memory deficits in FASD, and has implications for both assessment and intervention.

Memory strategy development in children with foetal alcohol spectrum disorders.

Objective: The goal of this study was to examine whether children with foetal alcohol spectrum disorders (FASD) show the same developmental transition from visual to verbal memory strategies as in non-FASD children and whether this transition was related to executive functioning and vocabulary skills. Methods: Younger (5–6 years) and older (8–10 years) children with FASD and non-FASD children were tested on a picture memory task. Results: Among both age groups, the non-FASD children performed better than those with FASD. Younger children with FASD appeared to use a visual approach, whereas older children with FASD appeared to use a verbal approach. However, among the non-FASD group both age groups appeared to use a verbal approach. Among the FASD group, the transition from a visual to verbal approach was correlated with executive functioning skills. Implications: Strategies for classroom approaches as well as strategy training are discussed.

Information Sharing during Diagnostic Assessments: What Is Relevant for Parents?.

ABSTRACT This descriptive qualitative study facilitates the application of family-centered care within a tertiary care interdisciplinary neurodevelopmental diagnostic assessment clinic by furthering an understanding of parent perceptions of the relevance of diagnostic information provision. An interdisciplinary assessment team completed an open-ended questionnaire to describe parent information provision. Parents from 9 families completed in-depth parent interviews following clinic attendance to discuss perceptions of information received. Interviews were audiotaped, transcribed, and coded by related themes. Parents did not perceive the information in the way professionals expected. Parents acknowledged receipt of comprehensive information relevant to the diagnosis but indicated that not all their needs were met. During the interviews, parents described the assessment process, preassessment information, and “steps in their journey.” They noted that a strength-based approach and a focus on parental competency would support their coping efforts. Results underscore the need for professionals to be attentive to parents’ individualized needs.