Skip to main content

The Association Between Performance-Based Measures and Caregiver Ratings of Executive Functioning Among Children with Prenatal Alcohol Exposure

Abstract

Research to date has found discrepancies between performance-based measures and caregiver ratings of executive functioning among children with fetal alcohol spectrum disorder (FASD). These studies are limited by the participant sample, the assessment measures available, and the type of analyses used to examine this relationship. The main objective of the current study was to extend the literature on the association between tests and caregiver ratings of executive functioning by addressing limitations of past research and examining this association among children with prenatal alcohol exposure (PAE) with and without a diagnosis of FASD. Participants were 212 children with PAE, including 99 children with and 113 without FASD. Caregiver ratings and most of the scores on tests of executive functioning were above and below the normative mean range, respectively. None of the correlations between tests and caregiver ratings of executive functioning were significant across the groups. The results of this study suggest that tests and caregiver ratings of executive functioning may not measure the same construct or other factors may be impacting the strength and significance of the relationship. Directions for future research and clinical implications are provided.

This is a preview of subscription content, access via your institution.

Data availability

The data is housed at the Manitoba FASD Centre at SSCY Centre and is not permitted to be removed or electronically transmitted from the premises.

Code Availability

Not applicable.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).: American Psychiatric Publishing.

  • Astley, S. J., Olson, H. C., Kerns, K., Brooks, A., Aylward, E. H., Coggins, T. E., Davies, J., Dorn, S., Gendler, B., Jirikowic, T., Kraegel, P., Maravilla, K., & Richards, T. (2009). Neuropsychological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Canadian Journal of Clinical Pharmacology, 16(1), e178–e201.

    Google Scholar 

  • Bechara, A. (2004). The role of emotion in decision-making: Evidence from neurological patients with orbitofrontal damage. Brain and Cognition, 55(1), 30–40. https://doi.org/10.1016/j.bandc.2003.04.001

    Article  PubMed  Google Scholar 

  • Bernes, G. A. (2000). Inter-rater agreement of executive function abilities in children with FASD or ADHD, and relation to laboratory measures (Master’s thesis). Retrieved from San Diego State University Theses and Dissertations Collection: https://digitallibrary.sdsu.edu/islandora/object/sdsu%3A59950

  • Carlson, S. M., Zelazo, P. D., & Faja, S. (2013). Executive function. In P. D. Zelazo (Ed.), The Oxford handbook of developmental psychology (Vol. 1): Body and mind (pp. 706–743). Oxford University Press

  • Cheung, K., Clayton, K., & Doyle, S. (2021). Discrepancies in performance-based measures and teacher ratings of executive function in the assessment of FASD. Advances in Neurodevelopmental Disorders. Advance online publication. https://doi.org/10.1007/s41252-021-00219-5

  • Chudley, A. E., Conry, J., Cook, J. L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ, 172, S1–S21. https://doi.org/10.1503/cmaj.1040302

    Article  PubMed  PubMed Central  Google Scholar 

  • Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., Conry, J. L., LeBlanc, N., Loock, C. A., Lutke, J., Mallon, B. F., McFarlane, A. A., Temple, V. K., Rosales, T., & Mallon, B. F. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. CMAJ, 188(3), 191–197. https://doi.org/10.1503/cmaj.141593

    Article  PubMed  PubMed Central  Google Scholar 

  • Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive Function System (D-KEFS). The Psychological Corporation.

  • Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

    Article  PubMed  Google Scholar 

  • Doney, R., Lucas, B. R., Jirikowic, T., Tsang, T. W., Watkins, R. E., Sauer, K., Howat, P., Latimer, J., Fitzpatrick, J. P., Oscar, J., Carter, M., & Elliot, E. J. (2017). Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population-based study in remote Australia. Australian Occupational Therapy Journal, 64(1), 68–78. https://doi.org/10.1111/1440-1630.12326

    Article  PubMed  Google Scholar 

  • Enns, L. N., & Taylor, N. M. (2018). Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment. Child Neuropsychology, 24(4), 203–225. https://doi.org/10.1080/09297049.2016.1251894

    Article  PubMed  Google Scholar 

  • Eslinger, P. J., Flaherty-Craig, C., & Benton, A. L. (2004). Developmental outcomes after early prefrontal cortex damage. Brain and Cognition, 55(1), 84–1403. https://doi.org/10.1016/S0278-2626(03)00281-1

    Article  PubMed  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). BRIEF: Behavior Rating Inventory of Executive Function. Psychological Assessment Resources.

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2015). BRIEF2: Behavior Rating Inventory of Executive Function, Second Edition. Psychological Assessment Resources.

  • Gross, A. C., Deling, L. A., Wozniak, J. R., & Boys, C. J. (2015). Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders. Child Neuropsychology, 21(4), 531–538. https://doi.org/10.1080/09297049.2014.911271

    Article  PubMed  Google Scholar 

  • Jewsbury, P. A., Bowden, S. C., & Strauss, M. E. (2016). Integrating the switching, inhibition, and updating model of executive function with the Cattell—Horn—Carroll model. Journal of Experimental Psychology: General, 145(2), 220–245. https://doi.org/10.1037/xge0000119

    Article  Google Scholar 

  • Khoury, J. E., & Milligan, K. (2019). Comparing executive functioning in children and adolescents with fetal alcohol spectrum disorders and ADHD: A meta-analysis. Journal of Attention Disorders, 23(14), 1801–1815. https://doi.org/10.1177/1087054715622016

    Article  PubMed  Google Scholar 

  • Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY-II (2nd ed.). Harcourt Assessment

  • Luria, A. R. (1980). Higher cortical functions. Basic Books.

    Book  Google Scholar 

  • McAuley, T., Chen, S., Goos, L., Schachar, R., & Crosbie, J. (2010). Is the behavior rating inventory of executive function more strongly associated with measures of impairment or executive function? Journal of the International Neuropsychological Society, 16(3), 495–505. https://doi.org/10.1017/s1355617710000093

    Article  PubMed  Google Scholar 

  • Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., Houts, R., Poulton, R., Roberts, B. W., Ross, S., Sears, M. R., Thomson, W. M., & Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 2693–2698. https://doi.org/10.1073/pnas.1010076108

    Article  PubMed  PubMed Central  Google Scholar 

  • Mohamed, Z., Carlisle, A., Livesey, A., & Mukherjee, R. (2019). Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in fetal alcohol spectrum disorders: Data from the UK national specialist clinic. Child Neuropsychology, 25(5), 648–663. https://doi.org/10.1080/09297049.2018.1516202

    Article  PubMed  Google Scholar 

  • Nguyen, T., Glass, L., Coles, C., Kable, J., May, P., Kalberg, W., Sowell, E. R., Jones, K. L., Riley, E. P., Mattson, S., & CIFASD. (2014). The clinical utility and specificity of parent report of executive function among children with prenatal alcohol exposure. Journal of the International Neuropsychological Society, 20(7), 704–716. https://doi.org/10.1017/S1355617714000599

    Article  PubMed  PubMed Central  Google Scholar 

  • Rai, J. K., Abecassis, M., Casey, J. E., Flaro, L., Erdodi, L. A., & Roth, R. M. (2017). Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children. Child Neuropsychology, 23(6), 713–732. https://doi.org/10.1080/09297049.2016.1191628

    Article  PubMed  Google Scholar 

  • Rasmussen, C., & Bisanz, J. (2009). Executive functioning in children with fetal alcohol spectrum disorders: Profiles and age-related differences. Child Neuropsychology, 15(3), 201–215. https://doi.org/10.1080/09297040802385400

    Article  PubMed  Google Scholar 

  • Reynolds, C. R., & Horton, A. M., Jr. (2008). Assessing executive functions: A life-span perspective. Psychology in the Schools, 45(9), 875–892. https://doi.org/10.1002/pits.20332

    Article  Google Scholar 

  • Tamana, S., Pei, J., Massey, D., Massey, V., & Rasmussen, C. (2014). Neuropsychological impairments and age-related differences in children and adolescents with fetal alcohol spectrum disorders. Journal of Population Therapeutics and Clinical Pharmacology, 21(2), e167–e180.

    PubMed  Google Scholar 

  • Taylor, N. M., & Enns, L. N. (2018). Age-related differences in neuropsychological assessment of fetal alcohol spectrum disorder: A cross-sectional study. Biochemistry and Cell Biology, 96(2), 252–259. https://doi.org/10.1139/bcb-2017-0081

    Article  PubMed  Google Scholar 

  • Taylor, N. M., & Enns, L. N. (2019). Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings. Child Neuropsychology, 25(4), 507–527. https://doi.org/10.1080/09297049.2018.1495187

    Article  PubMed  Google Scholar 

  • Theule, J., Wiener, J., Jenkins, J. M., & Tannock, R. (2013). Parenting stress in families of children with ADHD: A meta-analysis. Journal of Emotional and Behavioral Disorders, 21(1), 3–17. https://doi.org/10.1177/1063426610387433

    Article  Google Scholar 

  • Toplak, M. E., Bucciarelli, S. M., Jain, U., & Tannock, R. (2008). Executive functions: Performance-based measures and the Behavior Rating Inventory of Executive Function (BRIEF) in adolescents with attention deficit/hyperactivity disorder (ADHD). Child Neuropsychology, 15(1), 53–72. https://doi.org/10.1080/09297040802070929

    Article  Google Scholar 

  • Ware, A. L., Crocker, N., O’Brien, J. W., Deweese, B. N., Roesch, S. C., Coles, C. D., Kable, J., May, P., Kalberg, W., Sowell, E., Jones, K., Riley, E., Mattson, S., & CIFASD. (2012). Executive function predicts adaptive behavior in children with histories of heavy prenatal alcohol exposure and attention-deficit/hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 36(8), 1431–1441. https://doi.org/10.1111/j.1530-0277.2011.01718.x

  • Wechsler, D. (2008). WAIS-IV: Technical and interpretive manual. Psychological Corporation.

  • Wechsler, D. (2003). WISC-IV: Technical and interpretive manual. Psychological Corporation.

  • Wechsler, D. (2014). WISC-V: Technical and interpretive manual. Pearson.

  • Zelazo, P. D., & Carlson, S. M. (2012). Hot and cool executive function in childhood and adolescence: Development and plasticity. Child Development Perspectives, 6(4), 354–360. https://doi.org/10.1111/j.1750-8606.2012.00246.x

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the participating families and their children; the families that inspired this research; the Manitoba FASD Centre, SSCY Centre; The Department of Clinical Health Psychology, University of Manitoba; The Excellence in Neurodevelopment & Rehabilitation Research in Child Health (ENRRICH)—Research Theme; The Children's Hospital Research Institute of Manitoba (CHRIM); Cari Slayen for her assistance with data entry, literature review, and manuscript preparation; Marvin Routley, Sydney Lisi, Kristi MacDonald, and Kevin Solar for their assistance with data entry. We would also like to thank Dr. Lesley Graff for her helpful suggestions, and Drs. Tracie Afifi and Leslie E. Roos for their mentorship. Finally, thank you to Drs. Alexandra Livesey and Raja Mukherjee for sharing the BRIEF caregiver rating data from the Mohamed et al. (2019) publication.

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 & Child Health, Rady Faculty of Health Sciences, University of Manitoba.

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Kristene Cheung, Susan Doyle, and Nicole Taylor. Data analysis planning and interpretation of results were performed by Kristene Cheung, Susan Doyle, and Kylee Clayton. The first draft of the manuscript was written by Kristene Cheung, Susan Doyle, and Kylee Clayton, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding was obtained by Kristene Cheung.

Corresponding author

Correspondence to Kristene Cheung.

Ethics declarations

Ethics Approval

This research was approved by The University of Manitoba Research Ethics Boards and the Specialized Services for Children and Youth (SSCY) Research and Evaluation Committee.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cheung, K., Doyle, S., Clayton, K. et al. The Association Between Performance-Based Measures and Caregiver Ratings of Executive Functioning Among Children with Prenatal Alcohol Exposure. J Pediatr Neuropsychol 8, 32–44 (2022). https://doi.org/10.1007/s40817-021-00115-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40817-021-00115-9

Keywords

  • BRIEF
  • D-KEFS
  • Executive function
  • FASD
  • Prenatal alcohol exposure