Karen Milligan

Executive Functioning in Children and Adolescents Prenatally Exposed to Alcohol: A Meta-Analytic Review

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.

Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis

BackgroundImplementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings.MethodsIn a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system).ResultsOn average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention.ConclusionsAs has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.

Maternal attachment and mind-mindedness: the role of emotional specificity

We explored the relation between maternal mind-mindedness (i.e., a mother’s tendency to verbally refer to her infant’s mental world through use of infant-directed mental state terms) and maternal attachment. Mothers (N = 76), classified prenatally as Autonomous, Dismissing, Preoccupied, and Unresolved using the Adult Attachment Interview (AAI), simulated speaking to their 6-month-old infants in positive and negative emotion contexts. Mothers’ utterances were coded for frequency of use of emotion and cognition-related mind-minded terms. Results indicated a significant negative relation between coherence of mind scores on the AAI and emotion mind-mindedness in the positive emotion context. When differences between insecure attachment categories and mind-mindedness were explored, results indicated that mothers with Preoccupied attachments were significantly more likely to use emotion-related terms than mothers with Dismissing attachments and that these differences were most pronounced in the negative emotion context. A similar pattern was found for mothers with Unresolved attachments compared to those with organized (Autonomous, Dismissing, Preoccupied) attachment classifications, however use of emotion mind-minded terms did not differ by emotional context. Future research directions highlighting the importance of exploring the unique contribution of Preoccupied, Dismissing and Unresolved attachment and emotional context in the exploration of mind-mindedness are discussed.

Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs

Abstract Treatment of maternal substance-related problems is often complicated by complex pictures of risk, including mental and physical illness and social-contextual risk. In motherhood, systemic barriers, such as lack of childcare and stigma, further complicate access and sustained treatment engagement. Integrated programs are designed to address this issue by providing treatment for substance use, as well as services to address other maternal, parenting, and child needs, ideally at a single access point. Despite growth in integrated programs, a common theoretical framework to inform service provision is lacking. This has resulted in considerable heterogeneity among integrated programs and hindered multi-site evaluation. This study sought to develop a theoretical model of integrated treatment, with a focus on the therapeutic relationship and how the relationship serves to support two common areas of need in this population: emotion regulation (ER) and executive functions (EF). As part of a multi-site evaluation of integrated substance use treatment, six client focus groups (Nu2009=u200950) were conducted to explore client perspectives on integrated treatment and specifically aspects of the therapeutic relationship they found most/least helpful. Thematic analysis revealed approaches and behaviors of counselors that support ER and EF. These themes are presented and contextualized within the literature that addresses ER and EF risk from a mental health and socio-contextual risk perspective. A theoretical model of these processes is presented, along with practice and policy implications.

Comparing Executive Functioning in Children and Adolescents With Fetal Alcohol Spectrum Disorders and ADHD A Meta-Analysis

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.

Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care

Integrated treatment programs comprehensively address the unique and varied needs of pregnant and parenting women with problematic substance use. Despite the growth of these programs and evidence supporting their effectiveness, a clear picture of services that comprise integrated treatment is lacking. To address this gap in knowledge, we explored the services provided by 12 integrated treatment programs in one Canadian province. We found that integrated programs routinely provided substance use and mental health services, yet there was marked variability in other supportive services that address other central needs of women, such as prenatal and primary care, therapeutic childcare, housing and transportation support. Using survey data, we further examined client perceptions of care within integrated treatment programs (Nu202f=u202f106) compared to standard treatment programs (Nu202f=u202f207), and thematically analyzed qualitative feedback provided by integrated program clients to gain insight into how services may or may not be promoting positive perceptions of care. We found that integrated treatment program clients perceive their care more positively than clients in standard treatment programs and services provided impact on these perceptions. Implications for treatment development and research are discussed.

Risk for Childhood Internalizing and Externalizing Behavior Problems in the Context of Prenatal Alcohol Exposure: A Meta-Analysis and Comprehensive Examination of Moderators

Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long-lasting impacts on children, adolescents, and their families. The present meta-analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta-analysis included 65 studies comparing children and adolescents with PAE to non- or light-exposed controls and attention-deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (dxa0=xa00.71, medium effect) and externalizing (dxa0=xa00.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE.

Social Competence: Consideration of Behavioral, Cognitive, and Emotional Factors

In this chapter, we explore the ways in which social competence has been defined. Cognitive, emotional, and behavioral factors associated with social competence are explored, drawing from research in developmental psychology, as well as research with clinical populations, such as children with neurodevelopmental disorders [e.g., learning disabilities, autism spectrum disorder (ASD), and ADHD]. We review and critically evaluate the extent to which behavioral, cognitive, and emotional aspects of social competence are included in the content and program delivery of interventions for typically developing and neurodevelopmental populations, as well empirical evidence of their impact. Finally, we provide a description of the Integra Social ACES program, a social competence intervention for children with learning disabilities, as an exemplar of an individually adapted manualized intervention that attends to behavioral, cognitive, and emotional aspects of social competence. Future directions for clinical practice and research are discussed.

We need psychologists! Paediatr Child Health

Paediatricians are more likely than ever to encounter patients with mental health problems on a daily basis. There is a need for investment in proven treatments, such as psychology-based interventions, for children identified with mental health disorders. There are four main arguments supporting the engagement of psychologists for children with mental health problems: there is clear evidence that psychological interventions can effectively treat a wide range of mental health disorders; many parents and children are more open to exploring psychological therapies rather than medication for mental health problems; psychologists are trained and licensed to perform psychoeducational assessments, which can provide invaluable information about a child’s learning profile, attention problems and overall intelligence; and behaviour problems in children can be prevented or improved through parent-based interventions. The authors’ strongly advocate for the public funding of psychology services – both in collaborative primary care models and in the school setting.