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Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths

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Abstract

Children and adolescents with fetal alcohol spectrum disorder (FASD) experience significant impairments in cognitive functioning, though substantial within-group heterogeneity is often observed. The purpose of this study was to characterize the cognitive profile of children and adolescents with FASD with a special focus on examining moderators of functioning and cognitive strengths. Children and adolescents with FASD (n = 87) and controls (n = 110), ages 5 to 18 years completed a cognitive test battery. MANOVA was used to evaluate between-group cognitive differences, as well as the role of age and gender as potential moderators. Relative strengths were evaluated using both within-subject and between-group methods. Participants with FASD were found to show significant impairment on all cognitive tasks relative to controls, with substantial deficits evident on a measure of mathematical skill. Though neither age nor gender emerged as moderators, significant three-way interactions between age, gender, and group were evident on measures of executive functioning (inhibition), verbal memory, and word identification. Tasks measuring higher-order complex attention and visuospatial processing emerged as possible relative strengths in the FASD group. Children and adolescents with FASD had significant cognitive impairment across multiple domains confirming high need for interventions. Differences in the cognitive functioning for boys and girls with FASD at different developmental periods, along with relative strengths, may serve to inform interventions and future longitudinal research.

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Acknowledgements

Authors had full access to data, are responsible for its integrity, and accuracy of analysis. Support from our clinical partners at data collection is gratefully acknowledged, including the Asante Centre, the Glenrose Rehabilitation Hospital Program, Lakeland Centre for FASD, Kingston’s Hotel Dieu Hospital Child Development Centre, and the Ottawa Children’s Hospital of Eastern Ontario. Importantly, this work would not be possible without the dedication of participating families, to whom we extend our most sincere appreciation.

Funding Information

This work was supported by funding from NeuroDevNet (EPC, PP, KM), Women and Children’s Health Research Institute (KM) and the Sunnyhill Health Centre for Children Foundation (TFO).

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Authors and Affiliations

  1. Department of Psychology, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada

    Kaitlyn McLachlan

  2. Centre for Neuroscience Studies, Queens University, Kingston, ON, Canada

    Angelina Paolozza, Dawa Samdup & James N. Reynolds

  3. Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada

    Katrina Kully-Martens & Jacqueline Pei

  4. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Elodie Portales-Casamar, Christine Loock & Tim F. Oberlander

  5. B.C. Children’s Hospital Research Institute, Vancouver, BC, Canada

    Elodie Portales-Casamar

  6. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

    Paul Pavlidis

  7. Centre for High-Throughput Biology, University of British Columbia, Vancouver, BC, Canada

    Paul Pavlidis

  8. Department of Pediatrics, University of Alberta, Edmonton, AB, Canada

    Gail Andrew & Carmen Rasmussen

  9. Glenrose Rehabilitation Hospital, Edmonton, AB, Canada

    Gail Andrew

  10. Manitoba FASD Centre, Winnipeg, MB, Canada

    Ana Hanlon-Dearman

  11. Lakeland Centre for FASD, Cold Lake, AB, Canada

    Audrey McFarlane

  12. Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada

    Sarah M. Nikkel

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  1. Kaitlyn McLachlan
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  2. Angelina Paolozza
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  3. Katrina Kully-Martens
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  4. Elodie Portales-Casamar
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  5. Paul Pavlidis
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  6. Gail Andrew
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  7. Ana Hanlon-Dearman
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  8. Christine Loock
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  9. Audrey McFarlane
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  10. Sarah M. Nikkel
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  11. Jacqueline Pei
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  12. Tim F. Oberlander
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  13. Dawa Samdup
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  14. James N. Reynolds
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  15. Carmen Rasmussen
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Contributions

KM participated in the execution of the study, conducted data analysis, and led the manuscript preparation. AP participated in study execution and assisted with data analysis and manuscript development. KKM participated in study execution and assisted with manuscript development. EPC assisted with data analysis and preparation of the manuscript. PP assisted with data analysis and preparation of the manuscript. GA assisted with the study design and editing of the manuscript. AHD assisted with study execution and editing of the manuscript. CL assisted with study execution and editing of the manuscript. AM assisted with study execution and editing of the manuscript. SN assisted with study execution and editing of the manuscript. JP participated in the study design, assisted with study execution, assisted in the interpretation of data, and assisted in editing the manuscript. TFO assisted in the execution of the study and editing of the manuscript. DS assisted with study execution and editing of the manuscript. JRN co-led the study design for the overall NeuroDevNet FASD Research Program, participated in the execution of the study, and assisted in the writing and editing of the manuscript. CR co-led the study design for the overall NeuroDevNet FASD Research Program, participated in the execution of the study, and assisted in data analysis, and manuscript development and revision.

Corresponding author

Correspondence to Kaitlyn McLachlan.

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Conflict of Interest

The authors declare that they have no conflict of interest.

All study procedures were approved by Research Ethics Boards at the University of British Columbia, University of Alberta, University of Manitoba, Queen’s University, and the Children’s Hospital of Eastern Ontario, and adhered to governing ethical guidelines. Informed consent was obtained from legal guardians, and assent obtained from all children.

Additional information

Dr. McLachlan’s affiliations Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada and Department of Pediatrics, University of Alberta, Edmonton, AB, Canada were in place during her work on this study.

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McLachlan, K., Paolozza, A., Kully-Martens, K. et al. Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths. Adv Neurodev Disord 1, 271–282 (2017). https://doi.org/10.1007/s41252-017-0034-4

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