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 Moscovitch, M. and Winocur, G. 2002. “The frontal cortex and working with memory”. In Principles of frontal lobe functioning, Edited by: Stuss, D. T. and Knight, R. T. 188–209. New York, NY: Oxford University Press.  [Google Scholar]). A common instrument for evaluating this relationship is the Rey-Osterrieth Complex Figure (ROCF; Rey, 1941 Rey, A. 1941. L'examen psychologique dans le cas d'encephalopathie traumatique [Psychological examination of traumatic encephalopathy]. Archives de Psychologie, 28: 286–340.  [Google Scholar]; Osterrieth, 1944 Osterrieth, P. A. 1944. Le test de copie d'une figure complexe: Contribution à l’étude de la perception et de la mémoire [The test of copying a complex figure: A contribution to the study of perception and memory]. Archives de Psychologie, 30: 286–350.  [Google Scholar]). 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 Chudley, A. E., Conry, J., Cook, J. L., Loock, C., Rosales, T. and LeBlanc, N. 2005. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. The Canadian Medical Association Journal, 172: 1–21. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) using the 4-digit diagnostic code (Astley, 2004 Astley, S. J. 2004. Diagnostic guide for fetal alcohol spectrum disorders: The 4-digit diagnostic code, 3rd, Seattle, WA: University of Washington.  [Google Scholar]). 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.     

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.     

Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in Fetal Alcohol Spectrum Disorders: data from the UK national specialist clinic

Extant literature is sparse with regards to the relationship between caregiver reports and neuropsychological tests of executive functioning in Fetal Alcohol Spectrum Disorders (FASD). The goal of this paper was determining the clinical utilities of executive functioning measures used in the United Kingdom national FASD clinic. We examined relationships between outcomes on the Behavior Rating Inventory of Executive Function (BRIEF) and the Delis-Kaplan Executive Function System (D-KEFS), as part of an ongoing service evaluation. Profiles of executive functioning measures were reported in order to contribute to delineating a profile of executive dysfunction in FASD. Caregivers of 49 people with FASD completed the Parent BRIEF, and 61 people with FASD were administered the D-KEFS. Pearson’s Correlations between all 11 BRIEF scales and the 18 selected D-KEFS subscales showed little relationship. The BRIEF showed a profile of clinically significant elevations in all three Index scores and seven out of the eight Scale scores. Several D-KEFS tests showed below average executive functioning. Both executive function measures have separate clinical utility in demonstrating executive function deficits in FASD. The sample population used in this study also show a similar pattern to FASD populations internationally, suggesting a similar neuropsychological profile is seen in the United Kingdom. However, caregiver reports display little relationship to neuropsychological tests. These measures likely monitor different aspects of executive functioning in different settings. Future research should focus on identifying tests that better relate findings from clinical settings to behavior in daily life.     

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.     

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.     

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.     

Executive function in preschool children prenatally exposed to methadone or buprenorphine

Although an increasing number of children are born with prenatal methadone or buprenorphine exposure, little is still known about the potential long-term effects of these opioids. The aim of this study was to investigate executive function (EF) in children of women in opioid maintenance therapy (OMT). A total of 66 children (aged 48–57 months) participated in the study, 35 of which had histories of prenatal methadone or buprenorphine exposure. EF was measured using a battery of neuropsychological tests and the Behavior Rating Inventory of Executive Function—Preschool Version (BRIEF-P). Results showed that children of women in OMT perform lower on tasks of short-term memory and inhibition compared to nonexposed children, which was mainly associated with lower maternal education and employment rate. The OMT group scored significantly lower on all EF tasks compared to the nonexposed group, although scores fell within the average range on all measures. The development of these children should be monitored to assess for the possible problem behaviors and to promote optimal outcomes.     

Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ?70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.     

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.     

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.     

Executive performance on the preschool executive task assessment in children with sickle cell anemia and matched controls

Executive deficits are commonly reported in children with sickle cell anemia. Earlier identification of executive deficits would give more scope for intervention, but this cognitive domain has not been routinely investigated due to a lack of age-appropriate tasks normed for preschool children. In particular, information relating to patient performance on an executive task that reflects an everyday activity in the classroom could provide important insight and practical recommendations for the classroom teacher at this key developmental juncture as they enter the academic domain. The performance of 22 children with sickle cell anemia was compared to 24 matched control children on the Preschool Executive Task Assessment. Findings reveal that children with sickle cell anemia are performing poorer than their matched peers on this multi-step assessment. In particular, children with sickle cell anemia required more structured support to shift focus after a completed step, as reflected by poorer scores in the quantitative Sequencing and Completion domains. They also required more support to stay on task, as seen by poorer ratings in the qualitative Distractibility domain.

Abbreviations:PETA: Preschool Executive Task Assessment; SCA: Sickle Cell Anemia; EF: Executive Functioning.     

An investigation of intra-individual variability in children with fetal alcohol spectrum disorder (FASD)

Intra-individual variability (IIV) is defined as systematic within-person variation in performance either across test sessions (e.g., test/retest performance on the same task) or in one session (e.g., variations in performance on multiple trials of a single task). Higher levels of IIV have been noted as a characteristic of neurodevelopmental disorders such as attention deficit/hyperactivity disorder? (ADHD), but IIV is yet to be investigated in fetal alcohol spectrum disorder (FASD). FASD is a term used to describe a range of conditions resulting from prenatal exposure to alcohol. As part of a comprehensive neuropsychological battery, four study groups (1. fetal alcohol syndrome/partial fetal alcohol syndrome; 2. static encephalopathy/alcohol exposed; 3. neurobehavioral disorder/alcohol exposed as diagnosed using the University of Washington FASD 4-Digit Code; 4. typically-developing (TD) age-matched children with no prenatal alcohol exposure) were administered measures of motor response and inhibitory control, attention, and adaptive behavior. The results indicate increased levels of IIV in those with FASD compared to the TD controls. It was found that IIV uniquely contributes to predicting adaptive behavior above and beyond attention, while attention partially mediates the relationship between IIV and adaptive behavior. This is the first study to the authors’ knowledge to show the presence of increased IIV in children with FASD. It additionally provides evidence that IIV measures some inherent variability in performance independent of poor attention in children with FASD.     

Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders

The purpose of the current study was to evaluate the relationship between parent-report and objective measures of executive function in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD). The participants were a clinical sample of 551 children who completed 597 evaluations, including initial and re-evaluations. Participants were 6–16 years old, with a mean age of 10. Pearson correlations were used to determine the relationship between performance-based measures and parent-report measures of executive functioning. Relationships among the same types of measures, that is, performance based or parent report, were also evaluated. The data largely demonstrate low nonsignificant correlations between performance-based measures and parental report of executive function. Parent-report measures were internally consistent as were objective measures. It is possible that a third variable, for example, parental frustration, significantly influences parent reports. It is also likely that objective measures, which are administered in a controlled environment, do not fully capture children’s day-to-day functioning. That is, a child may have the executive function abilities (i.e., good performance on objective measures) but may be unable to deploy the appropriate skills in their daily lives, as evidenced by parental report. Children with FASD who have executive function abilities but not implementation skills likely require different interventions than children who lack abilities and skills.     

学龄前孤独谱系障碍儿童汉语核心语法的习得

学龄前孤独谱系障碍(Autism Spectrum Disorders; ASD)儿童对语言的习得程度是决定ASD儿童早期科学干预效果和最终预后水平的关键。以往ASD儿童语言研究多局限于英语ASD儿童, 较少有研究探讨不同语种ASD儿童语言习得的普遍机制。本研究拟结合汉语独特的语法属性, 通过多通道优先注视范式眼动实验考察2~5岁ASD儿童汉语核心语法的理解程度, 通过共同注意游戏评估ASD儿童的社会交流能力, 同时分析ASD儿童语言环境中相关语法结构的输入频率。研究旨在通过探讨学龄前ASD儿童的语法习得, 进一步探索人类语言习得的深层机制, 包括探索人类特有的语言机能对包括ASD儿童语言习得在内的人类语言习得的作用, 同时考察社会交流障碍与语言环境对人类语言习得过程的影响。     

Higher cortisol is associated with poorer executive functioning in preschool children: The role of parenting stress,parent coping and quality of daycare

Child executive functions (cognitive flexibility, inhibitory control, working memory) are key to success in school. Cortisol, the primary stress hormone, is known to affect cognition; however, there is limited information about how child cortisol levels, parenting factors and child care context relate to executive functions in young children. The aim of this study was to examine relationships between child cortisol, parenting stress, parent coping, and daycare quality in relation to executive functions in children aged 3–5 years. We hypothesized that (1) poorer executive functioning would be related to higher child cortisol and higher parenting stress, and (2) positive daycare quality and positive parent coping style would buffer the effects of child cortisol and parenting stress on executive functions. A total of 101 children (53 girls, 48 boys, mean age 4.24 years ±0.74) with complete data on all measures were included. Three saliva samples to measure cortisol were collected at the child’s daycare/preschool in one morning. Parents completed the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P), Parenting Stress Index (PSI), and Ways of Coping Questionnaire (WCQ). The Early Childhood Environment Rating Scale – Revised (ECERS-R) was used to measure the quality of daycare. It was found that children with poorer executive functioning had higher levels of salivary cortisol, and their parents reported higher parenting stress. However, parent coping style and quality of daycare did not modulate these relationships. Identifying ways to promote child executive functioning is an important direction for improving school readiness.     

Impaired Consonant Trigrams Test (CTT) performance relates to everyday working memory difficulties in children with Autism Spectrum Disorders

Individuals with Autism Spectrum Disorders (ASD) often struggle with complex tasks, such as those requiring divided attention (simultaneously completing two independent tasks) that also place high demands on working memory. Prior research shows that divided attention is impaired in adults and children with ASD and is related to ASD and comorbid attention deficit/hyperactivity disorder (ADHD) symptoms, but the impact on everyday functioning is unclear. Because ADHD symptoms are associated with poor divided attention and working memory performance in children with ASD, we also examined ADHD symptoms as moderators of divided attention performance. We examined performance on the Consonant Trigrams Test (CTT) between high-functioning 8- to 13-year-olds with ASD (n?=?28) and typically developing controls (n?=?18) matched on age and IQ. In the ASD group, we also correlated performance with ADHD symptoms and behavior ratings of everyday working memory. CTT performance in children with ASD was significantly worse than in matched controls. A significant correlation between CTT performance and everyday working memory was observed, but CTT performance was not related to comorbid ADHD symptoms in the ASD group. Divided attention with high working-memory demands is a relative weakness in children with high-functioning ASD; this weakness relates to everyday functioning, and it is independent from ADHD symptoms. That ADHD symptoms are not associated with divided attention performance is inconsistent with one prior investigation, which likely results from using different divided attention tasks in the two studies.     

Unfamiliar face recognition in children with autistic spectrum disorders

We investigated unfamiliar face recognition in low‐functioning children with autistic spectrum disorders (ASD) using a ‘part‐of‐face’ method. This method has not previously been used for unfamiliar faces with this population. The ‘part‐of‐face’ procedure provides measures of both face recognition accuracy and of processing style. We compared the performance of the children with ASD with three control groups: children with developmental delay (DD), typically developing (TD) children matched for verbal cognitive ability and TD children matched for chronological age (CA). Compared to the DD group, the ASD group showed similar processing in recognition accuracy and processing style. Compared to the TD children, the ASD group did not show the same level of accuracy as controls of the same CA, instead showing similar performance to younger TD children. However, as both children with ASD and DD showed the same performance, no ASD‐specific deficit was found. Copyright © 2009 John Wiley & Sons, Ltd.     

Executive functions and processing speed in children with mild to borderline intellectual disabilities and externalizing behavior problems

Several studies suggest impaired executive functions (EFs) in children with externalizing behavior problems and average intelligence (e.g., IQ > 85). Even though children with mild to borderline intellectual disabilities (MBID) are at higher risk of developing externalizing behavior problems compared to children with average intelligence, it is not yet clear if impaired EFs are also associated with the occurrence of externalizing behavior problems in children with MBID. In the current study, we therefore assessed three EF components (inhibition, cognitive flexibility, and working memory) as well as processing speed in children with MBID and externalizing behavior problems (n = 71) versus children with MBID with no such problems (n = 70). This was accomplished using a well-established computerized test battery. Even after IQ was controlled for, the children with MBID and externalizing behavior problems showed more impaired working memory performance. Differences for inhibition performance and processing speed were also found but less consistent across the tasks used to measure these aspects of EF. Cognitive flexibility was not more impaired in children with both MBID and externalizing behavior problems relative to children with MBID only. Our findings highlight working memory as a potential target to enhance the treatment of children with MBID and externalizing behavior problems.     

Early processing of emotional faces in children with autism: An event-related potential study

Social deficits are one of the most striking manifestations of autism spectrum disorders (ASDs). Among these social deficits, the recognition and understanding of emotional facial expressions has been widely reported to be affected in ASDs. We investigated emotional face processing in children with and without autism using event-related potentials (ERPs). High-functioning children with autism (n = 15, mean age = 10.5 ± 3.3 years) completed an implicit emotional task while visual ERPs were recorded. Two groups of typically developing children (chronological age-matched and verbal equivalent age-matched [both ns = 15, mean age = 7.7 ± 3.8 years]) also participated in this study. The early ERP responses to faces (P1 and N170) were delayed, and the P1 was smaller in children with autism than in typically developing children of the same chronological age, revealing that the first stages of emotional face processing are affected in autism. However, when matched by verbal equivalent age, only P1 amplitude remained affected in autism. Our results suggest that the emotional and facial processing difficulties in autism could start from atypicalities in visual perceptual processes involving rapid feedback to primary visual areas and subsequent holistic processing.