3.6 Executive function deficits in FASD and ADHD (Kingdon et al., 2015)

Question 1

FAS is characterizes by symptoms in three areas:

Answer 1

1. Prenatal and/or postnatal growth retardation
2. Craniofacial abnormalities
3. Central nervous system dysfunction, including a compley pattern of cognitive and behavioural abnormalities.

Question 2

Partial FAS (pFAS)

Answer 2

Children who do not have all the features of FAS, but do have dysmorphic facial features and one of the following:
- Growth deficit
- Microcephaly(much smaller head)
- Behavioural/cognitive impairment

Question 3

Children with FASD have higher risk on:

Answer 3

1. Specific neuropsychological deficits
2. Secondary impairments and mental health problems
3. Learning disabilities
4. Behavioural disorders and ADHD

Question 4

Overlap FASD and ADHD

Answer 4

Overlap limits accurate diagnosis of FASD, especially when information about maternal prenatal alcohol consumption is unavailable.

49-94% of children with FASD have ADHD, and they show the same kind of impairments as children with FASD making alcohol-affected children less able to be identified.

Children with FASD do not respond as well to stimulant medication used to treat ADHD.

Alcohol-affected children identified and treated early have better academic and cognitive outcomes. So important to distinguish FASD from ADHD early-on.

Question 5

Executive function

Answer 5

Multiple, interrelated higher order cognitive provesses that are responsible for purposeful, goal-directed behaviour.
In this article:
- Planning
- Set-shifting
- Working memory
- Fluency
- Response inhibition
- Attentional vagilance

(Hoef ik niet uit mn hoofd te kennen, maar wel handig om te weten.)

Question 6

Executive function and FASD and ADHD

Answer 6

Children with FASD and ADHD have deficits in executive function.

Both children have hyperactivity, impulsivity, inattenion, poor judgement and inability to see consequences.

ADHD: behavioural problems come from underlying deficits in delay aversion and executive deficits in response inhibtion.

FASD: it is still unclear which executive functions are most impaired.

Question 7

Results

FASD vs control

Answer 7

• Overall effect size: moderate executive function impairments for FASD groups vs control.
• Dysmorphic FASD: consistently large deficits in planning, set-shifting and working memory
• Moderate deficits in vigilance and inhibition among FASD groups vs control

Question 8

Results

Non-dysmorphic FASD vs control

Answer 8

• Moderate executive impairments in non-dysmorphic FASD vs control.
• Large deficits in planning, fluency and set-shifting, as well as moderate deficits in working memory.
• Small deficits in inhibition and attential vigilance

Question 9

Results

FASD vs ADHD

Answer 9

• FASD exhibited more executive dysfunction overall than ADHD.
• FASD: stronger and more consistent deficits in planning, set-shifting and fluency compared to ADHD.
• No discrepancies among groups in terms of attentional vigilance or inhibition.
• ADHD: consistently deficits primarily in vigilance and inhibition tasks.
• Set-shifting and fluency showed weaker associations with ADHD compared to other executive function tasks.

Question 10

Results

Moderator analysis

Answer 10

• Older age
• More dysmorphic participants
• Greater IQ difference

between groups were moderateros, hence greater dysfunction in FASD.

Question 11

Discussion

Answer 11

• FASD is associated with global executive impairments and diagnosis of FASD should focus more on CNS deficits than craniofacial dysmorphia.
• Strongest and most consistent deficits were for: planning, set-shidting, fluency and working memory.
• FASD outcomes are influenced by the dorsage and pattern of alcohol consumption.