Prenatal exposure to alcohol often results in disruption to thebrain's cognitive and behavioral domains, which include executivefunction (EF) and adaptive functioning. A study of these domains inchildren with heavy prenatal alcohol exposure (PAE), non-exposedchildren with attention-deficit/hyperactivity disorder ( ADHD ), and children without PAE or ADHD has found that, despitesimilarities in the relation between EF and adaptive abilitiesamong children with ADHD or PAE, the patterns of abilities in thesechildren were different. Results will be published in the August 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View. "The comparison between populations with prenatal alcohol exposure(PAE) and attention-deficit/hyperactivity disorder (ADHD) iscritical because children with PAE often have ADHD or symptoms ofADHD," said Sarah N.
Mattson, associate director of the Center forBehavioral Teratology, professor in the department of Psychology atSan Diego State University, and corresponding author for the study."This comparison allows us to determine if deficits that are seenin children with PAE are specific to the disorder or are moregenerally associated with developmental conditions common inchildhood. Clarifying which deficits are specific to PAE will pavethe way for targeted interventions." "This area of research is very practical because it focuses ontrying to understand how important, complex thinking skills or EFrelate to 'real world' behavior or adaptive functioning," saidHeather Carmichael Olson, psychologist and faculty member of thedepartment of psychiatry and behavioral sciences at the Universityof Washington. Executive functions are a set of 'higher-order' thinking skillsthat can be thought of as the 'CEO' of the brain, Carmichael Olsonexplained. "These involve the ability to plan, organize, worktoward goals, manage materials, and monitor oneself doing things,"she said. "These also include the ability to stop impulses, controlemotions, not make repeated mistakes, and be mentally flexible.Adaptive functioning refers to the wide variety of skills thatpeople use to live day-to-day.
While the specific skills change andbecome more complicated as children grow up, becoming teens andthen adults, adaptive functioning skills always basically fall intothree categories. These are communication, daily living skills, andsocialization. The current study is especially relevant forindividuals with ADHD, fetal alcohol spectrum disorders (FASD), orheavy PAE, who might have troubles in these two areas." "Previous studies have shown that both EF and adaptive behavior areimpaired in children with PAE," noted Mattson. "These impairmentshave been related to ADHD and the two disorders share somefeatures. However, there are differences as well. Axial Hydraulic Pumps
Previous studiesonly looked at EF and adaptive behavior separately." As part of a multisite study called The Collaborative Initiative onFetal Alcohol Spectrum Disorders (CIFASD), Mattson and hercolleagues examined three groups of children eight to 18 years ofage: those with heavy PAE exposure (n=142), nonexposed childrenwith ADHD (n=82), and typically developing "controls" (n=133)without PAE or ADHD. The children completed subtests of theDelis-Kaplan Executive Function System, and their primarycaregivers completed the Vineland Adaptive Behavior Scales-II. "The key finding of this study is that EF deficits predict adaptivebehavior deficits in children with PAE," said Mattson. "Thisrelation had been shown previously in ADHD, but this is the firststudy to confirm its existence in PAE. In addition, the relationbetween the two differed by group in that only nonverbal EF scoreswere predictive of adaptive behavior in the PAE group whereas therelation was more general in the ADHD group. Tandem Hydraulic Pump
The differentialfindings add further evidence to the argument that the pattern ofdeficits seen following PAE is unique. In other words, despitesimilarities in the predictive value of EF regarding pooreradaptive behavior among children with ADHD or PAE, the patterns ofabilities in these children were different." "There is much discussion in the fields of mental health and education about whether a diagnosis of FASD, or knowledge ofheavy PAE, is at all useful in understanding a child's symptoms andcoming up with treatment recommendations," said Carmichael Olson."Some professionals have even wondered if the two clinical groupsare really the same. But this study helps to show that the clinicalpopulations of ADHD and FASD/heavy PAE are not identical, which isimportant in treatment planning. Only 60 percent of those withheavy PAE met criteria for ADHD. There was a different pattern ofrelationships between underlying thinking skills and 'real world'daily living skills for those with ADHD versus those with heavyPAE. China Komatsu Spares
And when a group of children had both heavy PAE and metcriteria for ADHD, there was 'double trouble' and they had the mostsignificant problems in daily life, and presumably greatertreatment needs." "Our findings add to the literature by comparing these twoimportant childhood disorders," said Mattson. "By clarifying whatis unique to FASD and what is shared with other developmentalconditions, we can improve differential diagnosis and provide aframework for the development of targeted interventions." Carmichael Olson agreed. "Although this article does not givespecific treatment ideas, there are a few practical treatment ideasthat might fit with study findings," she said. "For individualswith ADHD, having someone talk them through tasks might be helpfulto improve success in daily living. Study results suggest this maynot be as useful for those with heavy PAE.
Instead, if individualswith heavy PAE have problems in non-verbal thinking which relatesto success in daily life, it might be better to use a differentstyle of learning supports. For instance, picture schedules thatcan show steps for daily life tasks for younger ages: pictures ofthe steps for getting dressed, loading the dishwasher, or evencleaning an apartment. Similarly, a smartphone 'app' that providesautomatic reminders and visually walks an older individual with PAEthrough the steps of paying bills, or following a bus route, mightbe a low-cost intervention that would really help to improve dailyfunction. As individuals with PAE grow older, they could learn toask for help in coming up with these learning supports." Additional References Citations.
Mattson, associate director of the Center forBehavioral Teratology, professor in the department of Psychology atSan Diego State University, and corresponding author for the study."This comparison allows us to determine if deficits that are seenin children with PAE are specific to the disorder or are moregenerally associated with developmental conditions common inchildhood. Clarifying which deficits are specific to PAE will pavethe way for targeted interventions." "This area of research is very practical because it focuses ontrying to understand how important, complex thinking skills or EFrelate to 'real world' behavior or adaptive functioning," saidHeather Carmichael Olson, psychologist and faculty member of thedepartment of psychiatry and behavioral sciences at the Universityof Washington. Executive functions are a set of 'higher-order' thinking skillsthat can be thought of as the 'CEO' of the brain, Carmichael Olsonexplained. "These involve the ability to plan, organize, worktoward goals, manage materials, and monitor oneself doing things,"she said. "These also include the ability to stop impulses, controlemotions, not make repeated mistakes, and be mentally flexible.Adaptive functioning refers to the wide variety of skills thatpeople use to live day-to-day.
While the specific skills change andbecome more complicated as children grow up, becoming teens andthen adults, adaptive functioning skills always basically fall intothree categories. These are communication, daily living skills, andsocialization. The current study is especially relevant forindividuals with ADHD, fetal alcohol spectrum disorders (FASD), orheavy PAE, who might have troubles in these two areas." "Previous studies have shown that both EF and adaptive behavior areimpaired in children with PAE," noted Mattson. "These impairmentshave been related to ADHD and the two disorders share somefeatures. However, there are differences as well. Axial Hydraulic Pumps
Previous studiesonly looked at EF and adaptive behavior separately." As part of a multisite study called The Collaborative Initiative onFetal Alcohol Spectrum Disorders (CIFASD), Mattson and hercolleagues examined three groups of children eight to 18 years ofage: those with heavy PAE exposure (n=142), nonexposed childrenwith ADHD (n=82), and typically developing "controls" (n=133)without PAE or ADHD. The children completed subtests of theDelis-Kaplan Executive Function System, and their primarycaregivers completed the Vineland Adaptive Behavior Scales-II. "The key finding of this study is that EF deficits predict adaptivebehavior deficits in children with PAE," said Mattson. "Thisrelation had been shown previously in ADHD, but this is the firststudy to confirm its existence in PAE. In addition, the relationbetween the two differed by group in that only nonverbal EF scoreswere predictive of adaptive behavior in the PAE group whereas therelation was more general in the ADHD group. Tandem Hydraulic Pump
The differentialfindings add further evidence to the argument that the pattern ofdeficits seen following PAE is unique. In other words, despitesimilarities in the predictive value of EF regarding pooreradaptive behavior among children with ADHD or PAE, the patterns ofabilities in these children were different." "There is much discussion in the fields of mental health and education about whether a diagnosis of FASD, or knowledge ofheavy PAE, is at all useful in understanding a child's symptoms andcoming up with treatment recommendations," said Carmichael Olson."Some professionals have even wondered if the two clinical groupsare really the same. But this study helps to show that the clinicalpopulations of ADHD and FASD/heavy PAE are not identical, which isimportant in treatment planning. Only 60 percent of those withheavy PAE met criteria for ADHD. There was a different pattern ofrelationships between underlying thinking skills and 'real world'daily living skills for those with ADHD versus those with heavyPAE. China Komatsu Spares
And when a group of children had both heavy PAE and metcriteria for ADHD, there was 'double trouble' and they had the mostsignificant problems in daily life, and presumably greatertreatment needs." "Our findings add to the literature by comparing these twoimportant childhood disorders," said Mattson. "By clarifying whatis unique to FASD and what is shared with other developmentalconditions, we can improve differential diagnosis and provide aframework for the development of targeted interventions." Carmichael Olson agreed. "Although this article does not givespecific treatment ideas, there are a few practical treatment ideasthat might fit with study findings," she said. "For individualswith ADHD, having someone talk them through tasks might be helpfulto improve success in daily living. Study results suggest this maynot be as useful for those with heavy PAE.
Instead, if individualswith heavy PAE have problems in non-verbal thinking which relatesto success in daily life, it might be better to use a differentstyle of learning supports. For instance, picture schedules thatcan show steps for daily life tasks for younger ages: pictures ofthe steps for getting dressed, loading the dishwasher, or evencleaning an apartment. Similarly, a smartphone 'app' that providesautomatic reminders and visually walks an older individual with PAEthrough the steps of paying bills, or following a bus route, mightbe a low-cost intervention that would really help to improve dailyfunction. As individuals with PAE grow older, they could learn toask for help in coming up with these learning supports." Additional References Citations.