Paul D. Connor

Direct and indirect effects of prenatal alcohol damage on executive function.

Patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) often have difficulty functioning appropriately in everyday life and seem to employ poor problem-solving strategies. Tests of executive function are relevant for quantifying the functional deficits and underlying real-life problems associated with prenatal alcohol exposure. This study considers two pathways for the effects of prenatal alcohol on executive function: a direct effect and an indirect effect through prenatal alcohols effect on IQ. We compared 30 men who had been diagnosed with FAS or FAE with young adults participating in a longitudinal prospective study (n = 419) and 15 control participants that comprised a comparison group. This study is unique in its analysis of the same battery of assessments of executive function in both a large low dose longitudinal study sample and a clinically diagnosed group. Participants were evaluated on 9 tests (including 58 scores) of executive function. For some but not all of the tests in this executive function battery, the decrement in the alcohol exposure group is greater than would be predicted from their IQ scores. We found that 3 of 6 Stroop scores, 2 of 4 Trails scores, 9 of 16 Wisconsin Card Sorting scores, 1 of 2 Ruffs Figural Fluency scores, and 2 of 4 Consonant Trigrams scores appear to be particularly sensitive to the direct effects of prenatal alcohol damage for patients with FAS and FAE. The findings suggest that these executive function tests would be particularly useful in clinical evaluations of persons suspected of fetal alcohol damage because they would not simply reflect deficits in IQ or facial stigmata.

Corpus callosum shape and neuropsychological deficits in adult males with heavy fetal alcohol exposure.

Persons with brain damage consequent to prenatal alcohol exposure have typically been diagnosed with either fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE), depending on facial features. There is great variability of behavioral deficits within these groups. We sought to combine neuroanatomical measures with neurocognitive and neuromotor measures in criteria of greater sensitivity over the variety of consequences of alcohol exposure. To this end, midline curves of the corpus callosum were carefully digitized in three dimensions from T1-weighted MR scans of 15 adult males diagnosed with FAS, 15 with FAE, and 15 who were unexposed and clinically normal. From 5 h of neuropsychological testing we extracted 260 scores and ratings pertaining to attention, memory, executive function, fine and gross motor performance, and intelligence. Callosal midline shape was analyzed by new morphometric methods, and the relation of shape to behavior by partial least squares. The FAS and FAE subgroups have strikingly more variability of callosal shape than our normal subjects. With the excess shape variation are associated two different profiles of behavioral deficit unrelated to full-scale IQ or to the FAS/FAE distinction within the exposed subgroup. A relatively thick callosum is associated with a pattern of deficit in executive function; one that is relatively thin, with a deficit in motor function. The two combine in a very promising bipolar discrimination of the exposed from the unexposed in this sample. Thus there is considerable information in callosal form for prognosis of neuropsychological deficits in this frequently encountered birth defect.

Midline corpus callosum is a neuroanatomical focus of fetal alcohol damage

Prenatal exposure to high levels of alcohol often induces birth defects that combine morphological stigmata with neurological or neuropsychological deficits. But it has proved problematic to diagnose these syndromes in adolescents and adults, in whom the morphological signs are absent or attenuated, the behavioral deficits nonspecific, and the exposure history often difficult to reconstruct. Localizing the associated brain abnormalities might circumvent most of these difficulties. To this end, three‐dimensional (3D) locations were recorded for 67 homologous points on or near the corpus callosum in magnetic resonance (MR) brain images from 60 adolescents and adults who were normal, 60 diagnosed with fetal alcohol syndrome, and 60 diagnosed with fetal alcohol effects. We combined the standard statistical approach to this type of geometric data, Procrustes analysis, with a multivariate strategy focusing on differences in variability. In this data set, the shape of the corpus callosum and its vicinity proves systematically much more variable in the alcohol‐affected brains than in those of the normal subjects. From this excess variability follows a promising classification rule, having both high sensitivity (100 out of 117) and high specificity (49 out of 60) in this sample. The discrimination uses four landmark points and two summary scores of callosal outline shape. The information from the corpus callosum and vicinity, as viewed in MR brain images of full‐grown subjects, may serve as a permanent record of the prenatal effects of alcohol, even in patients who are first suspected of these syndromes relatively late in life or who lack the facial signs of prenatal alcohol damage. The statistical pattern underlying the callosal diagnosis also leads to speculations on mechanisms of the prenatal damage. Anat Rec (New Anat) 269:162–174, 2002.

Effects of prenatal alcohol exposure on fine motor coordination and balance: A study of two adult samples.

Motor coordination was assessed in two samples of adult subjects: one sample (n = 90) included adults previously diagnosed with one of a number of Fetal Alcohol Spectrum Disorders (FASD) and comparison peers, the second was a prospective longitudinal study of adults who were exposed to varying levels of alcohol as fetuses (n = 402). This comparative analysis sought to determine whether motor effects seen in both clinical and nonclinical children persist into adulthood, whether any individual motor tasks show significant effects of prenatal alcohol exposure across the age range, and whether motor assessments of adults have any role in diagnostic strategies for adults suspected of FASD. Motor tests included balance and unilateral, bilateral, finger, hand and foot coordination. Three-quarters of the subjects with FASD demonstrated deficits in motor function outside the range of comparison subjects. Adults with FASD performed more poorly, on average, on all individual tests including balance and fine motor control. In the prospective longitudinal sample, only subjects who had been previously identified in childhood as having a possible diagnosis on the Fetal Alcohol Spectrum were still in deficit as adults on motor tasks, relative to comparison subjects. Thus, the dose-dependent motor coordination effects of alcohol previously found in children do not appear to persist into adulthood, except in those most highly exposed children who also have other accompanying neuropsychological effects in childhood.

A Pilot Community Intervention for Young Women with Fetal Alcohol Spectrum Disorders

Fetal Alcohol Syndrome, a permanent birth defect caused by maternal alcohol use during pregnancy, is a leading preventable cause of mental retardation. Neuropsychological deficits have been well documented, however interventions developed have not been evaluated. We describe a successful 12-month community pilot intervention with 19 young women with Fetal Alcohol Spectrum Disorders (FASD). Improved outcomes (including decreased alcohol and drug use, increased use of contraceptives and medical and mental health care services, and stable housing) were obtained by implementing a community intervention model of targeted education and collaboration with key service providers, and by using paraprofessional advocate case managers as facilitators.

Conduct-disordered adolescents with fetal alcohol spectrum disorder: intervention in secure treatment settings

Youth with fetal alcohol spectrum disorders (FASDs) are in a perilous circumstance. FASD is associated with a high rate of self-regulation problems and trouble with the law and is underdiagnosed. Standard juvenile corrections-based interventions often do not meet the needs of these vulnerable youth. This article describes what is known about conduct-disordered adolescents with FASD and the neurocognitive deficits that directly affect emotional and behavioral self-control. The authors propose guidelines for the assessment of FASD within residential treatment settings and analyze interventions that show promise for inpatient treatment of youth with FASD.

Suggestibility and Fetal Alcohol Spectrum Disorders: I'll tell you anything you want to hear

This article reviews the role of suggestibility as a psychological vulnerability in people with FASD who are arrested and questioned by police. After a review of relevant literature on suggestibility and FASD, preliminary data are presented from a small pilot study on suggestibility involving defendants with FASD in the United States who were involved in either a pre-trial or post-conviction adjudication process. Results of that study suggest that persons with FASD may be highly suggestible in interrogative situations, which appears to stem from a combination of neurologically based tendencies to acquiesce to leading questions and change responses to questions as a function of negative feedback. Interrogative suggestibility found in the FASD population, which is likely due to central nervous system dysfunction, has broad forensic implications.

A Proposed Model Standard for Forensic Assessment of Fetal Alcohol Spectrum Disorders

A model protocol is proposed for multidisciplinary assessment of Fetal Alcohol Spectrum Disorders (FASD) in the forensic context. Used effectively on both sides of the courtroom in the United States in criminal and post-conviction matters in state and federal courts, the model relies on the FASD literature and best-practice standards of care in terms of clinical as well as forensic evaluation. It is suggested that FASD diagnostic criteria for older adolescents and adults in the criminal system may need different emphasis if facial features have diminished with age and confirmation of prenatal exposure is impossible.