Autism characteristics in children with fetal alcohol spectrum disorders

Background: Children with fetal alcohol spectrum disorders (FASD) exhibit difficulties in many cognitive and behavioral domains and also have high comorbidity with other disorders such as attention deficit/hyperactivity disorder (ADHD) and conduct disorder as well as autism. Although the FASD profile is shown to be distinct from ADHD and conduct disorder, far less is known about the commonalities with autism. The current study used a parent-rated questionnaire containing an autism subscale to explore the autistic-like features that children with FASD exhibit. Methods: Studied were 25 children with FASD (age: M = 10.3 years) and 17 normal controls (NCs; age: M = 10.2 years). As part of a larger study, all parents/caregivers completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008), which in addition to evaluating social skills and behavior problems globally, includes an Autism subscale. Results: Between-group comparisons showed the FASD group not only scored significantly lower in social skills and significantly higher in behavior problems than the NC group but children with FASD also scored significantly higher on the Autism subscale. Item analysis revealed they showed the most difficulty in terms of social and communicative functioning and the least in repetitive and restrictive behaviors. Conclusion: Current findings signify that FASD and autism share similarities with regard to social and communicative functioning. These findings, which further our knowledge of the FASD phenotype, may be useful in specifying the particular interventions these children need.     

Neuropsychological impairments on the NEPSY-II among children with FASD

Background: We examined the pattern of neuropsychological impairments of children with FASD (compared to controls) on NEPSY-II measures of attention and executive functioning, language, memory, visuospatial processing, and social perception.

Methods: Participants included 32 children with FASD and 30 typically developing control children, ranging in age from 6 to 16 years. Children were tested on the following subtests of the NEPSY-II: Attention and Executive Functioning (animal sorting, auditory attention/response set, and inhibition), Language (comprehension of instructions and speeded naming), Memory (memory for names/delayed memory for names), Visual-Spatial Processing (arrows), and Social Perception (theory of mind). Groups were compared using MANOVA.

Results: Children with FASD were impaired relative to controls on the following subtests: animal sorting, response set, inhibition (naming and switching conditions), comprehension of instructions, speeded naming, and memory for names total and delayed, but group differences were not significant on auditory attention, inhibition (inhibition condition), arrows, and theory of mind. Among the FASD group, IQ scores were not correlated with performance on the NEPSY-II subtests, and there were no significant differences between those with and without comorbid ADHD.

Conclusions: The NEPSY-II is an effective and useful tool for measuring a variety of neuropsychological impairments among children with FASD. Children with FASD displayed a pattern of results with impairments (relative to controls) on measures of executive functioning (set shifting, concept formation, and inhibition), language, and memory, and relative strengths on measures of basic attention, visual spatial processing, and social perception.     

Improving executive functioning in children with fetal alcohol spectrum disorders

An extensive body of literature has documented executive function (EF) impairments in children with fetal alcohol spectrum disorders (FASD); however, few studies have aimed specifically at improving EF. One treatment program that shows promise for children with FASD is the Alert Program for Self-Regulation®, which is a 12-week treatment specifically designed to target self-regulation, a component of EF. The present study sought to examine if Alert would produce improvements in self-regulation that would generalize to other aspects of EF, behavior, and social skills in children with FASD. Twenty-five children aged 8–12 years diagnosed with an FASD were assigned in alternating sequence to either an immediate treatment (TXT) or a delayed treatment control (DTC) group. Both groups received a comprehensive evaluation of EF at baseline and upon completing therapy (TXT), or after a 12- to 14-week interval from baseline (DTC). Parents also completed questionnaires assessing EF and behavior at both time points. For the TXT group only, parent questionnaires were readministered at 6-month follow-up. At the 12-week follow-up, the TXT group displayed significant improvements in inhibitory control and social cognition. Parents of children in the TXT group reported improved behavioral and emotional regulation, as well as reduced externalizing behavior problems. These behavioral improvements along with further improved parent-rated inhibitory control was maintained at the 6-month follow-up. The EF disabilities in children with FASD can be remediated through a targeted treatment approach aimed at facilitating self-regulation skills.     

Emotion recognition in children with Fetal Alcohol Spectrum Disorders

There is a limited amount of research that examines social-emotional functioning in children with Fetal Alcohol Spectrum Disorder (FASD), and the majority of it relies on parent and teacher reports of social impairments. Because these provide broad measures of social function, they fail to elucidate the underlying specific skills with which this group of children has difficulty. The current study examines emotion-recognition abilities in children with FASD, as it plays a central role in social interaction. Participants were 22 children with diagnosed FASD (ages 8–14), and age- and gender-matched typically developing controls. Tasks included measures of emotion recognition from three nonlinguistic modalities: facial expressions, emotional tone of voice, and body positioning and movement. Participant’s parents completed measures of adaptive and behavioral function that were related to children’s performance on aspects of emotion recognition. Overall, the results show that children with FASD have more difficulties with emotion recognition than typically developing age-matched peers, but these difficulties may not be clinically significant (e.g., smaller effect size) or may be specific to the age of the individual exhibiting the emotion (i.e., child vs. adult). These results are discussed in the context of previous studies.     

Can Attention Deficit Hyperactivity Disorder and Fetal Alcohol Spectrum Disorder be differentiated by motor and balance deficits?

There is an ongoing debate regarding the diagnostic overlap between Attention Deficit Hyperactivity Disorder (ADHD) and Fetal Alcohol Spectrum Disorder (FASD). Differential diagnosis is important because of treatment implications. Children aged 7–10 years (47 ADHD, 30 FASD, 39 controls) participated. The Movement Assessment Battery for Children (M-ABC) and the Clinical Observations of Motor and Postural Skills (COMPS) were used. Force plate and electromyography data were collected during static balance and balance perturbation. On the M-ABC both children with ADHD and FASD had more motor problems than controls. The ADHD-Combined and the ADHD-Predominantly Inattentive subgroups were similarly affected in their fine motor skills. On the COMPS, the majority of children in both groups performed in the normal range, but for those children clinically affected, it was the children with ADHD who were more likely to be severely impaired. The children with ADHD were characterized by early onset latencies of the tibialis anterior muscles and increased amplitudes of the gastrocnemius muscles. Difficulty scaling muscle force reflecting medial cerebellar involvement may be the key problem in ADHD. Cerebellar involvement in the postural instability in FASD awaits further study.     

Higher functioning children with prenatal alcohol exposure: Is there a specific neurocognitive profile?

Recent attempts to identify a neurocognitive profile of children with prenatal alcohol exposure (PAE) have led to an emerging “generalized deficit” conceptualization marked by diffuse information processing and integration difficulties as opposed to a specific profile. This study examines whether this conceptualization can be extended to higher functioning children with PAE who are without intellectual disability and addresses several limitations of previous research. One hundred twenty-five children aged 6–12 years with social skills deficits, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD), underwent a comprehensive, multi-informant assessment of neurocognitive, emotional, social, behavioral, and adaptive functioning. Multivariate analyses of variance examined differences in functioning between the PAE group and a nonexposed comparison group with and without controlling for child IQ. Results indicated that the PAE group returned significantly poorer scores than the nonexposed group on every construct assessed, including executive functioning, attention, working/visuospatial memory, linguistic abstraction, adaptive behavior, emotional/behavioral functioning, and social cognition. These differences largely maintained after controlling for IQ and were similar regardless of informant, although teachers reported somewhat fewer group differences. Within the PAE group, no differences were found across FASD subtypes. These results provide evidence extending the emerging generalized deficit conceptualization of children with PAE to those higher functioning individuals without global intellectual disability.     

Facial memory deficits in children with fetal alcohol spectrum disorders

Prenatal exposure to alcohol may lead to a range of neurobehavioral effects, including impaired learning and memory. Although children with fetal alcohol spectrum disorders (FASD) exhibit both verbal and nonverbal memory impairments, their memory for faces has not been as thoroughly investigated and the extent literature provides inconsistent results. The aim of the current study was to determine whether difficulties in face memory exist in children with FASD and whether the difficulties are mediated by task demands. To address this, we used two measures of immediate and delayed facial recognition memory, the Children's Memory Scale (CMS) and Test of Memory and Learning (TOMAL). Compared to typically developing controls, children with FASD showed memory deficits on all tests and were more likely to perform in a clinically significant range. As well, children performed more poorly on the CMS compared to TOMAL, a finding consistent with the greater difficulty of the CMS task. Our results are consistent with our hypothesis that children with FASD show impairment in facial memory, particularly on demanding memory tasks.     

Social perception in children with fetal alcohol spectrum disorder

Although the profile of social cognitive difficulties is well recognized in children with certain neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), this profile is not as well established in other clinical pediatric populations. The objective of the present study is to examine patterns of social perception in children with fetal alcohol spectrum disorder (FASD) compared to typically-developing (TD) control children. A total of 56 children between 8 and 12 years of age—35 with FASD and 21 TD—completed the Reading the Mind in the Eyes Task – Children’s Version (RMET-C). The RMET-C accuracy scores were compared between groups and also by item difficulty and emotional valence. The relation between cognitive functioning, age, FASD severity, and RMET-C performance was also investigated. The children in the FASD group did not perform as well as the children in the TD group on the RMET-C Total score and Easy items, as well as the Positive, Negative, and Neutral emotional valence items. When age and IQ were investigated, there was a significant effect of age on the Positive items in the TD group, with scores increasing with age. With regard to FASD severity, children with alcohol-related neurodevelopmental disorder were outperformed by children with full/partial fetal alcohol syndrome on the Positive and Negative items. Overall, these results further the understanding of the social cognitive profile in children with FASD and how this profile relates to other childhood-onset neurodevelopmental disorders.     

‘Play skills’ for shy children: development of a Social Skills Facilitated Play early intervention program for extremely inhibited preschoolers

The aim of the present study was to develop and provide a preliminary evaluation of a social‐skills‐based early intervention program specifically designed to assist extremely inhibited preschoolers. Participants were a sample of n=22 extremely inhibited preschool‐aged children, who were randomly assigned to either the Social Skills Facilitated Play (SST) or Waitlist Control (WLC) condition. As compared to wait‐list controls, extremely inhibited children who participated in the SST‐facilitated play program sessions demonstrated a significantly greater post‐intervention decrease in observed socially wary behaviours and a significantly greater increase in social and socially competent behaviours at preschool. Results are discussed in terms of the importance of developing and refining early intervention programs for extremely inhibited young children. Copyright © 2010 John Wiley & Sons, Ltd.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.     

Improving FASD Children’s Self-Regulation: Piloting Phase 1 of the GoFAR Intervention

ABSTRACT

The initial parent training component of GoFAR, an intervention designed to improve the self-regulation and adaptive living skills of children with Fetal Alcohol Spectrum Disorders (FASDs), was piloted in a small, randomized clinical trial of 28 participants assigned to either a time-lapsed control group or one of two parent training groups who differed on whether the child’s computerized instruction was congruent or incongruent with the parent instruction. Parental compliance and achievement of therapy goals were indicators of improvement in the child’s self-regulation skills. Children who received computerized instruction consistent with the parent training demonstrated greater self-regulation improvements than those receiving incongruent computerized instruction.     

Using a Naturalistic Sport Context to Train Social Skills in Children

ABSTRACT

Researchers have utilized sports activities to deliver social skills training (SST) programs to children. Using a multiple-baseline across behaviors design, we examined whether a brief SST program delivered during a soccer camp would increase social skills and athletic competencies. Each participant’s self-concept, and his interest in soccer were evaluated. Results suggest that the SST procedure effectively increased targeted social skills. Further, participants reported increased interest in soccer and higher overall self-concept. Our results suggest that similar effects can be achieved in a relatively short, but intense, camp that utilizes SST and sports-skill training components. Limitations and implications are discussed.     

Racial bias in behavioral assessment of children's social skills

The social skills of 20 second- and sixth-grade students were assessed by 20 trained raters using the Social Skills Test for Children (SST-C). Rater and child characteristics were examined to determine whether differences in social skills ratings were due to the race of the rater or the race of the children being rated or due to the interactive effects of these characteristics, which would suggest racial bias in the ratings procedure. The results showed that the race of the rater did affect some behavioral observations. Black raters gave higher scores than white raters on four behavioral categories: response latency, appropriate assertion, effective assertion, and smiling. White raters gave higher scores for head position and gestures. The results of this study replicated earlier findings of significant differences in social skills ratings due to the race and age of the child being rated. The results also showed modest racial bias effects in that black and white raters scored black and white children differentially on two behavioral categories: overall skill ratings and smiling. These results suggested that most behavioral categories of the SST-C were not systematically affected by racial bias. However, the most subjective rating, overall skill, did evidence racial bias effects. This finding is consistent with previous data showing that subjective ratings may be most affected by racial bias.     

A comparison of skill-building and desensitization strategies for intervention with aggressive children

Social skills training and desensitization interventions were conducted with 41 institutionalized aggressive children aged 7–13. Subjects were randomly assigned after blocking by aggression and cooperative play to either of the treatments. Dependent measures were direct observations of playground play and teacher ratings. Subjects in the social skills program mastered the basic cognitive skills presented to them. Observational data indicated that both groups experienced marked reduction in aggressive behavior and increases in cooperative play. The social skills training intervention engendered incremental improvement in aggression in comparison to the desensitization condition. However, none of the behavioral changes evident in the observations were reflected in teacher ratings.     

Model of Social Competence in an Early Childhood Environment

Maintaining relationships and interacting socially are essential aspects of children's occupational performance. A Model of Social Competence in an Early Childhood environment has been formulated to guide the assessment of and intervention for young children with issues in social skills. This article aims to (1) present the constructs that contribute to social competence for young children, (2) describe the interrelated contextual, foundation and environmental influences on social competence using the Model of Social Competence in an Early Childhood environment as a means of systematically examining these factors, and (3) discuss future directions for early intervention for children with social competence concerns. Cultural considerations will be discussed in relation to the Singaporean early childhood context.     

The social and emotional skills of bullies,victims, and bully–victims of Egyptian primary school children

This study examined whether bullies, victims, bully–victims (who are both bullies and victims), and students who reported no or low levels of bullying and victimization differed in their levels of social and emotional skills. Data were collected from 623 children in fifth and sixth grades from four Egyptian elementary schools; their ages ranged from 10 to 12 years. K‐means cluster analysis revealed four groups: bullies (n = 138), victims (n = 178), bully–victims (n = 59), and children who were not involved in bullying behaviour (n = 248). Data were analyzed using multinomial logistic regression. The findings indicated that boys were more involved in bullying behaviour than girls, and both bullies and bully–victims were less likely to adhere to social rules and politeness than children who were not involved in bullying. Both bullies and victims were less aware of the physiological reactions of their emotions than uninvolved children, and were less able to apply social rules in social interaction. Both victims and bully–victims reported less likeability than children not involved in bullying. Verbal sharing, attending to others’ emotions, and analysis of emotions did not have a statistically significant relationship with the probabilities of classifying children to any bullying group versus children not involved in bullying. Social skills were more important than emotional awareness in predicting the likelihood of classifying children in one of the three bullying groups versus children who not involved in bullying. The main conclusion is that social and emotional skills together may provide an effective means of intervention for bullying problems.     

APPLICATION OF A SOCIAL SKILLS TRAINING PROGRAM IN THE MODIFICATION OF INTERPERSONAL DEFICITS AMONG RETARDED ADULTS: A CLINICAL REPLICATION

Six mentally retarded adults, equally divided into two treatment groups, were provided with individualized social skills training programs. Treatment, evaluated via a multiple-baseline design strategy, was sequentially and cumulatively applied across target behaviors over a four-week intervention period. Behavioral observation probes and social validation measures served as the primary dependent variables. Results indicated that (a) treatment was effective for virtually all behaviors across all subjects, (b) improvements occurred for both training and generalization scenes, and (c) behavioral performance was maintained one month following the termination of treatment.     

Parent perceptions of an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering

PurposeRecent research has identified approximately half of children who stutter present with self-regulation challenges. These manifest in elevated inattentive and/or impulsive behaviours, aligned with attention deficit hyperactivity disorder (ADHD) symptoms. These symptoms have been found to influence the child’s responsiveness to their stuttering treatment, and may exacerbate the psychosocial consequences of stuttering for them and their families. Early stuttering intervention identifies parents as key agents of change in the management of their children’s stuttering. This study sought feedback from parents regarding their experiences with an integrated stuttering treatment and behavioral self-regulation program for early developmental stuttering, addressing the child’s self-regulation challenges.MethodEight parents of children who stutter who had co-occurring self-regulation challenges completed the integrated program. This incorporated the Triple P--Positive Parenting Program adapted for the developmental stuttering population, and the Curtin University Stuttering Program (CUSP). Semi-structured qualitative interviews were conducted to capture parents’ reflections on, and experiences with, the integrated program.ResultsThematic analysis identified several major themes regarding the parents’ experiences with the integrated program: emotional impact on parents, child self-regulation, link between stuttering and behaviour, parent self-regulation, impact on family dynamics, and overall positive perceptions of the integrated program. All of the parents indicated they would recommend the program to future parents of children who stutter.ConclusionThis study provides insights into parents’ perceptions regarding an integrated intervention approach for early stuttering and behavior management. It also indicates how adopting a holistic approach to stuttering intervention is positive and has social validity.