COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

466
Mental retardation
attention problems, ultimately effecting the executive
functioning of these individuals.
Neuropsychological considerations
Current research ®ndings describing the neuropsychological
impact of prenatal alcohol exposure, continue to
con®rm that a spectrum of cognitive de®cits present in
individuals with FASD. As the studies are re®ned over
time, it is becoming more obvious that distinctions such
as the presence or absence of dysmorphic features, or
higher or lower IQ in individuals with FAS, do not
necessarily change the fact that underlying cognitive
disturbances appear to be related to the FASD disorders
phenotype. The studies described are examples of this
overall ®nding.
Neuropsychological research demonstrates that individuals
with prenatal alcohol exposure have a wide range
of neuropsychological impairment in tests measuring
language, verbal learning, memory, academic skills,
®ne-motor speed, and visual-motor integration [30].
Additionally, research ®ndings are suggesting that these
disabilities exist in both FAS and in individuals with
heavy prenatal alcohol exposure without the features
necessary for a diagnosis of FAS. It appears from these
studies that these neuropsychological de®cits present a
consistent pattern in individuals affected. Mattson and
Riley [30] evaluated whether socioeconomic factors or
cognitive ability may be responsible for the behavioral
problems observed in children with heavy prenatal
alcohol exposure. They employed a non-exposed
control group matched with the prenatal alcohol
exposed group for age, sex, verbal IQ, socioeconomic
status and ethnicity. The group of children with
prenatal alcohol exposure was composed of both
individuals with FAS and heavy prenatal alcohol
exposure without meeting the FAS criteria. They
concluded that there was a clinically signi®cant
elevation of scores in the social, aggression, attention
and delinquent domains of the Child Behavior Checklist
(CBC) in the FAS and the prenatally alcohol
exposed group when compared with the non-exposed
control group. The study demonstrates that socioeconomic
factors and verbal IQ were not responsible
for clinically signi®cant behavior scores in children with
heavy prenatal alcohol exposure. The behavior rating
scores of the two alcohol-exposed groups were more
similar to one another than they were to the control
group [30].
Coles et al. [31 .. ] compared two groups of adolescents
(an alcohol exposed group with an unexposed control
group of adolescents with attention de®cit hyperactivity
disorder (ADHD)) on tests of visual sustained attention
and auditory processing. She and her team found that
the group with prenatal alcohol exposure had intact
scores in auditory processing, but impaired scores in
visual processing. This provides additional evidence that
the attention problems of individuals with prenatal
alcohol exposure may be different than in those with
ADHD without alcohol exposure.
Kerns et al. [32] demonstrated that adults with FAS
who had borderline to below average IQ, exhibited
similar neuropsychological impairment when compared
to adults who have FAS with average to above average
IQ. Similarly executive functioning (EF) is shown to
be impaired in individuals with prenatal alcohol
exposure with and without mental retardation, and is
important because of the profound effects impaired EF
has on daily living skills and self-perception. Mattson
et al. [33] demonstrated this ®nding in a study
evaluating executive function, using several assessment
instruments covering four areas felt to re¯ect normal
executive function. In their study, executive function
was impaired in individuals with and without FAS or
mental retardation on all domains of executive function,
including planning ability, cognitive ¯exibility,
selective inhibition, concept formation, and reasoning.
The team correlated the neuroanatomical ®ndings of
volume reduction of speci®c structures within the
fronto-subcortical system as the possible neuroanatomical
substrate grossly underlying this dysfunction
[33].
Memory in children with FASD may also be impaired as
a conseqeunce of prenatal alcohol exposure [34]. A study
by LaForce et al. [34] demonstrated that explicit memory
(conscious awareness, social adaptation) is impaired and
implicit memory (accessed through performance) is
preserved in FASD. The authors also suggest that
incremental skill learning may be impaired in this
population. This skill is important in the ability to
acquire a skill after `extensive' practice.
Neuropsychiatric complications of prenatal
alcohol exposure
It is generally accepted that individuals with prenatal
alcohol exposure suffer from neuropsychiatric disorders
that are multifactorial in origin [35,36]. In addition to the
direct and indirect effect of alcohol exposure on the
CNS, environment, genetic predisposition to psychiatric
illness, history of trauma, multiple foster placements, use
of other drugs by the mother during gestation, smoking,
stress, and physical illness all contribute to a high
percentage of alcohol exposed individuals having serious
life-long neuropsychiatric disability [37].
The presence of psychopathology in alcohol-exposed
individuals has been a prevailing theme since FAS was
®rst identi®ed 30 years ago. Although individuals with
FAS and related disorders are heterogeneous with