Neuropsychology of Fetal Alcohol Spectrum Disorder (FASD)
Joshua Sensenbaugh, B.S.- Wright State University, School of Professional Psychology, Psy.D. Program (Doctoral Student)
Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term for a group of neurocognitive and behavioral difficulties that are brought upon by prenatal alcohol exposure (1). Studies have estimated that the prevalence of FASD within the U.S. ranges from 1 to 5% of children (2-3). The clinical features of FASD often include: prenatal growth deficiency, minor facial anomalies, problems with various organ systems, neurocognitive deficits, and self-regulation/adaptive functioning difficulties (4-5). The most identifiable features of FASD are the sentinel facial features (i.e., thin upper lip, smooth philtrum, and small palpebral fissures) (6-8). Although the minor facial anomalies can make the identification of FASD easier, there are subsets of disorders that fall under FASD that do not require the facial features to make a diagnosis (1, 6). Thus, a thorough neuropsychological assessment, as part of an interdisciplinary team effort, is required to determine if a diagnosis of FASD fits for a suspected individual (6, 9).
The effects of alcohol exposure during pregnancy may have a direct teratogenic impact on the brain of the developing fetus, ultimately leading to neurocognitive impairments. Some of the brain areas directly impacted in the fetus include the frontal lobes, corpus callosum, basal ganglia, amygdala, hippocampus, hypothalamus, and cerebellum (10-11). Because not all children exposed to alcohol consumption during pregnancy may be affected to the same degree, the pattern, quantity, and timing of the alcohol consumption as well as different socio-emotional risk factors are important determinants of the degree of impairment (4). The various neuropsychological deficits that result from alcohol exposure during pregnancy exist on a continuum from subtle impairments to more severe deficits (12). Many studies have attempted to develop a neuropsychological profile for FASD because of the difficulties screening and diagnosing the individuals who exist on the FASD spectrum without the sentinel facial features (1, 6-8). In addition, developing a neuropsychological profile for FASD can help reduce the likelihood of individuals being misdiagnosed for other disorders like attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) (13).
Despite some features that overlap with other disorders, researchers have developed a distinct neuropsychological profile for FASD consisting of: global intellectual deficits, executive-functioning deficits, memory impairment, difficulties with learning, deficits in visual-spatial abilities and processing speed, and language/motor delays (5, 7, 8, 12). Children with FASD often exhibit global intellectual deficits, and some may meet the criteria for a diagnosis of an intellectual disability (14). In addition to intellectual difficulties, individuals with FASD often exhibit problems with achievement and learning, specifically problems related to mathematical abilities (15). Some of the difficulties in math achievement may be directly related to deficits in visual-spatial abilities (16). Further examining deficits in visual-spatial abilities, individuals with FASD may have difficulties with visual memory, visual-motor integration, spatial memory, and visual perceptual skills (17). Memory impairment in FASD is generally verbal and visual spatial memory particularly concerning encoding and retrieving information (5, 18-19). Problems with language and communication typically are common and highly variable in individuals with FASD, but they often have difficulties with pragmatics as well as understanding and using abstract or figurative language (20-21). Lastly, motor delays and deficits in motor skills and coordination are expected during childhood which persist into adulthood presenting as problems with overall balance and motor clumsiness (22-23).
As the neurocognitive impairments in FASD appear to be wide-ranging, deficits in executive-functioning skills are particularly significant and can explain some of the behavioral and social impairments in individuals with FASD (12). Since the frontal lobes of the brain are responsible for executive-functioning skills, many studies have examined the effects of prenatal alcohol exposure on frontal lobe areas finding damage and cell loss in areas, such as the left ventral frontal lobe, orbitofrontal lobe, and medial prefrontal cortex (10-11). The executive-functioning difficulties that have been discovered in FASD include: problem-solving/planning, response inhibition, attentional vigilance, working memory, fluency, and set-shifting (7, 24-25). An important point to consider is that these deficits in executive-functioning tend to be global and are not dependent on the level of IQ or the severity of the disorder (26). In addition, many of these deficits in executive-functioning can become more pronounced as an individual with FASD ages unless some form of intervention is provided (27). While efforts are continued to spread awareness of the effects of drinking alcohol during pregnancy, it’s imperative to continue efforts of further researching neuropsychological features of FASD in order to improve assessment, diagnosis, and targeting interventions.
Abstract (taken directly from ncbi.nlm.nih.gov): This grand rounds manuscript reviews important considerations in developing case conceptualizations for individuals with a history of prenatal alcohol exposure. This case study provides an introduction to fetal alcohol spectrum disorders, diagnostic issues, a detailed description of the individual’s history, presenting symptoms, neuropsychological test results, and an integrated summary. We describe a 9-year old girl diagnosed with a fetal alcohol spectrum disorder (FASD): Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). This patient is a composite of a prototypical child who participated as part of a research project at the Center for Behavioral Teratology who was subsequently seen at an outpatient child psychiatry facility.
Glass, L., & Mattson, S. N. (2017). Fetal Alcohol Spectrum Disorders: A case study. Journal of Pediatric Neuropsychology, 3(2), 114–135. http://doi.org/10.1007/s40817-016-0027-7
Fetal Alcohol Spectrum Disorders (FASD)- Presented by SAMHSA
FASD: Screening, Assessment, and Diagnosis- Presented by Carol Weitzman, MD FAAP from American Academy of Pediatrics (AAP)
FASD Intervention and Treatment- Presented by Dr. Claire Coles from NOFAS
Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., & … Rosales, T. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. Canadian Medical Association Journal, 188(3), 191-197. doi:10.1503/cmaj.141593
Davis, K., Desrocher, M., & Moore, T. (2011). Fetal Alcohol Spectrum Disorder: A review of neurodevelopmental findings and interventions. Journal of Developmental and Physical Disabilities, 23(2), 143-167. doi:10.1007/s10882-010-9204-2
Glass, L., Ware, A. L., Crocker, N., Deweese, B. N., Coles, C. D., Kable, J. A., & … Mattson, S. N. (2013). Neuropsychological deficits associated with heavy prenatal alcohol exposure are not exacerbated by ADHD. Neuropsychology, 27(6), 713-724. doi:10.1037/a0033994
Kable, J. A., O’Connor, M. J., Olson, H. C., Paley, B., Mattson, S. N., Anderson, S. M., & Riley, E. P. (2016). Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): Proposed DSM-5 diagnosis. Child Psychiatry and Human Development, 47(2), 335-346. doi:10.1007/s10578-015-0566-7
Lebel, C., Roussotte, F., & Sowell, E. R. (2011). Imaging the impact of prenatal alcohol exposure on the structure of the developing human brain. Neuropsychology Review, 21(2), 102-118. doi:10.1007/s11065-011-9163-0
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