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The Association Between Executive Functioning, Attention, and Adaptive Functioning Among Children and Adolescents with Prenatal Alcohol Exposure

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Abstract

Objectives

Individuals with prenatal alcohol exposure (PAE) may be diagnosed with fetal alcohol spectrum disorder (FASD) if they have significant impairments in at least three different areas of functioning. The areas of functioning are viewed as separate entities for diagnostic consideration; however, some areas, including executive functioning (EF), attention, and adaptive functioning, may overlap. Therefore, the objective of this study was to examine the relationship between EF, attention, and adaptive functioning among children with PAE and determine whether specific moderators influence the association.

Methods

Charts of 257 children seen for an FASD diagnostic assessment were reviewed (60% males; Mage = 10.0 years). Measures included diagnosis of ADHD; informant ratings of EF, attention, and adaptive functioning; and tests of EF. Correlation and moderator analyses were conducted to examine the association between the variables.

Results

Significant associations were found between informant ratings of adaptive functioning and informant ratings (r =  − .15 to − .58) and tests scores (r = .20 to .42) of EF. Correlations between measures assessed by the same informant were stronger than those assessed by different informants. Age, gender, and ADHD diagnostic status significantly moderated a few correlations.

Conclusions

Although none of the correlations were indicative of convergent validity, our results suggest a lack of discriminant validity across the measures. The findings suggest that our assessment tools were measuring distinct but overlapping constructs, and this overlap should be considered in future research on clinical decision-making regarding diagnosis and interventions that target these areas of functioning.

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Data Availability

Ethics approval for this project did not include the transmission of data outside of our study team and institution, the SSCY Centre. Based on the ethics approval of this project, all data were required to remain on-site and to be physically housed and accessed internally at the SSCY Centre.

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Acknowledgements

We would like to thank the participating families and their children; the Manitoba FASD Centre, Specialized Services for Children and Youth (SSCY) Centre; the Department of Clinical Health Psychology, University of Manitoba; the Excellence in Neurodevelopment & Rehabilitation Research in Child Health (ENRRICH); and the Children’s Hospital Research Institute of Manitoba (CHRIM); Marvin Routley, Sydney Lisi, Kristi MacDonald, and Kevin Solar for their assistance with data entry. We would also like to thank Drs. Nicole Taylor and Lesley Graff for their helpful suggestions, and Drs. Tracie Afifi and Leslie Roos for their mentorship.

Funding

This study was funded by the Office of the VP (Research & International), University of Manitoba; the Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba; and the Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba.

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Authors and Affiliations

  1. Department of Clinical Health Psychology, University of Manitoba, 1155 Notre Dame Avenue, Winnipeg, MB, R3E 3G1, Canada

    Kristene Cheung

  2. Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada

    Kristene Cheung

  3. Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada

    Erin Johns

  4. Department of Clinical Health Psychology, University of Manitoba, 685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada

    David Willoughby

  5. Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada

    Cari Slayen

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  1. Kristene Cheung
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  4. Cari Slayen
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Contributions

KC: designed and executed the study, completed data analyses, analyzed the data, and wrote sections of the paper. EJ and DW: designed and executed the study, assisted with data analysis planning, analyzed the data, and wrote sections of the paper. CS: completed data entry, assisted with literature review, and editing of the final manuscript. All authors approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Kristene Cheung.

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Ethics Approval

This retrospective chart review study involving human participants was approved by the University of Manitoba Research Ethics Board and the Specialized Services for Children and Youth (SSCY) Research and Evaluation Committee. Given the retrospective nature of this study, informed consent to participate and publish was not required based on the above ethics approval.

Competing Interests

The authors declare no competing interests.

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Cheung, K., Johns, E., Willoughby, D. et al. The Association Between Executive Functioning, Attention, and Adaptive Functioning Among Children and Adolescents with Prenatal Alcohol Exposure. Adv Neurodev Disord 5, 431–445 (2021). https://doi.org/10.1007/s41252-021-00216-8

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