Transcript Slide 1

Behavioral Problems in Children with
Fetal Alcohol Spectrum Disorder: Lying
and Parental Ratings of Executive
Functions
Carmen Rasmussen, PhD
Department of Pediatrics
University of Alberta
Neurobehavioral Deficits in FASD
• FASD is a term used to refer to an individual who have
physical, mental, behavioral, and/or learning disabilities
as a result of maternal alcohol consumption.
• Executive functioning (EF) is one of the core deficits in
children with FASD.
• These EF deficits in FASD have been documented on
tests of cognitive flexibility, inhibition, planning and
strategy use, concept formation and verbal reasoning,
set shifting, working memory measures, and fluency – all
cognitive-based or ‘cool’ EF tests.
• However, very few researchers have examined emotionrelated or ‘hot’ EF in FASD and even less have looked at
‘real-world’ EF behaviors in FASD.
The Behavioral Ratings Inventory of
Executive Functioning (BRIEF)
• The BRIEF is a parental and teacher rating scale of
a child’s executive functioning behaviors in everyday
situations and settings.
• Appears to uniquely evaluate a set of metacognitive,
behavioral, and emotional abilities that go beyond
common psychopathology and behavioral
disturbances measured by other behavior rating
scales.
• Useful in identifying differences in other disorders
(ADHD, autism, and traumatic brain injury) and thus
shows great promise in highlighting differences
between different neurodevelopmental profiles.
The BRIEF
• Consists of eight clinical scales:
• Behavioral Regulation Index (BRI)
• Inhibit
• Shift
• Emotional Control
• Metacognition Index (MI)
• Initiate
• Working Memory
• Plan/Organize
• Organization of Materials
• Monitor
• The BRI and MI combine to form the Global Executive
Composite (GEC).
Goals of the study:
• To determine whether children with FASD show
deficits on the BRIEF, and more importantly, whether
they show a distinctive pattern of strengths and
weaknesses on scales of the BRIEF.
 Important for developing instruction and
remediation that can target specific areas of
weakness or build upon areas of strength.
• To examine whether gender and age are related to
performance on the BRIEF.
 Important for understanding the developmental
trajectory and gender effects related to EF deficits
in FASD, which has strong implications for
diagnosis and remediation.
Method
• Parents/guardians completed the BRIEF on 64 children
(37 males, 27 females) with FASD.
• All children had a medical diagnosis of an FASD.
• The mean age of participants was 8 years, 10 months
with a range of 5-16 years.
Results
• On all scales, mean T scores were significantly higher
(meaning more deficit) than the mean of 50 (using 99%
confidence intervals).
• All mean T scores were in the clinically significant range
(65 or above).
• Children with FASD displayed deficits on all scales of the
BRIEF, with most difficulty on the Inhibit, Working
Memory, and Initiate scales and the best performance on
Organization of Materials and Plan/Organize.
Performance on the BRIEF
80
T Score
70
60
50
40
Inhibit
Shift
Emotional
Control
Initiate
Working
Memory
Plan/Org.
Org. of
Materials
Monitor
Results continued…
• Gender effects: Females scored significantly higher
(relative to other females) than males (relative to
other males) on the Inhibit scale as well as on the
BRI.
• Age differences: On average, older children tended
to have higher scores (relative to the norm) than
younger children, but this difference was only
significant on the Initiate and Working Memory
scales.
Performance on the BRIEF as a
Function of Age Group
85
5-8 years
80
9-16 years
T Score
75
70
65
60
55
50
inhibit
shift
emotional
control
initiate
working
memory
plan/organize
org of
materials
monitor
To examine age effects, children were divided into a younger (5-8 years, n=38) and older (9-16 years, n=26) age group.
Conclusions
• Children with FASD demonstrated profound EF
deficits on the BRIEF.
• A distinct pattern of strengths and weaknesses
emerged, with scores being poorest on the Inhibit,
Working Memory, and Initiate and best on
Organization of Materials and Plan/Organize.
• Females tended to have significant difficulties on
Inhibition which has implications for tailoring
intervention for females.
Conclusions continued…
• The finding that older children showed more difficulty
(relative to the norm) than younger children suggests
that perhaps adolescence places extra demand on EF
behaviors, particularly Working Memory and Initiation,
resulting in more pronounced deficits in these areas.
• However, further longitudinal research is needed to
substantiate this finding.
• The BRIEF appears to be a very important tool for
documenting ‘real-life’ EF behaviors in children and
provides useful clinical data on the complexity of
difficulties faced by children with FASD that may not be
obtained from traditional cognitive scales.
Study #2: Lying in FASD
• Secondary disabilities: mental health problems, trouble
with the law, confinement, inappropriate sexual behavior,
alcohol and drug abuse, dropping out of school.
• Behavioral problems and poor social skills.
• Impulsive and lack guilt, aggression, delinquency, and
low moral maturity.
• In a large study of adolescents and adults with FASD it
was found that 60% of the sample had been in trouble
with the law and 50% had been confined.
• A Canadian study found that 23% of youth remanded for
a psychiatric inpatient assessment had FASD.
(Streissguth et al., 1996; Janzen, et al., 1995; Mattson & Riley, 2000; Roebuck et al., 1999; Sood et al., 2001; Schonfeld et al., 2005;
Fast et al., 1999).
Study #2: Lying in FASD
• Children start telling lies as young as 2 years of age.
• Most studies of children’s lying use a temptation
resistance paradigm, where children are given the
opportunity to lie.
• The child is placed in room with a toy and told not to
peek at the toy while the experimenter is absent (80-90%
of children do peek). They then have a naturalistic
opportunity to spontaneously lie when the experimenter
returns and asks whether or not the children peeked.
• The majority of children between 4 and 7 years of age lie
about peeking at a toy, while only 1/3 of 3-year-olds lie.
• Some children as young as 3 years of age, and most
children by 4 years of age, can and will tell lies.
(Newton, et al., 2000; Talwar & Lee, 2002)
Study #2: Lying in FASD
• The behavioral disturbances, poor social and moral
development, along with executive functioning deficits
may make children with FASD more likely to lie.
• Difficulty with inhibition combined with not understanding
the consequences of their actions (cause and effect
reasoning) could lead to delinquent behaviors such as
lying.
• Although lying has frequently been noted as a concern
among caregivers of children with FASD there has been
no research specifically examining lying in children with
FASD.
Our Study
• The goal of this study was to examine lying among
young children (aged 4 to 8 years) with FASD.
• Participants: 47 children aged 4-8 years:
• FASD group: 23 children (11 girls and 12 boys) with
a diagnosis of an FASD. 13 preschool and 10 early
elementary children.
• Control group: 24 children (11 girls and 13 boys)
without FASD. 12 preschool and 12 early elementary
children.
E: What do you think it is?
C
C: Elmo!
E
C
E: Oops, I forgot something in the
other room, so I have to go get it. I
am going to play the last toy for you
and you have to guess what it is.
But don’t peek at the toy.
• Did you turn around and peek at
the toy?
• What do you think the toy is?
E
• How do you know what the toy is?
Results
Peeking
• A similar proportion of children in the FASD group (78%)
and Non-FASD group (75%) peeked.
• No age or gender differences.
Lying: “Did you peek to look at the toy?”
• For the FASD group, of the 18 children who peeked, 17
(94.4%) children lied, while only 1 child confessed.
• In the Non-FASD group, of the 18 children who peeked,
13 (72.2%) children lied about peeking.
100
% of lie-tellers
80
60
Non FASD children
FASD children
40
20
0
Preschoolers
Elementary
Results
“Who do you think it is?”
• Assesses the child’s ability to maintain semantic leakage
control.
• Children responded by either saying the correct answer
(Mickey Mouse) and thereby implicating themselves in
peeking and lying, or they concealed their lie by feigning
ignorance or guessing another toy.
• 58.8% of the children in the FASD group concealed by
either feigning ignorance or guessing another toy, as
compared to 38.5% in the Non-FASD group.
• For the FASD group only, older children were more likely
to conceal their lie than younger children.
Conclusions
• Children with FASD were more likely to lie than NonFASD children.
• Unlike Non-FASD children, age was not related to lying
ability among the FASD group, in that high rates of lying
were observed at all ages.
• Children with FASD were surprisingly good at
maintaining their lies indicating they may be more skilled
lie-tellers at an earlier age.
Implications
• Previous research indicates children who engage in
more delinquent behavior are more likely to lie to
conceal their behavior and learn to lie successfully.
• In this study, children with FASD had a higher rate of
lying and were better at concealing their lies, suggesting
that FASD children may learn to use lying as a strategy
to conceal their transgressions at a young age.
• These lying behaviors may be related to later secondary
disabilities common in FASD such as trouble with the law
and delinquency.
(Achenbach & Edelbrock, 1981; Stouthamer-Loeber, 1986; Gervais et al., 2000).
Implications
• Because this was a game-like experiment, the results do
not necessarily mean that children with FASD will lie
more often in everyday situations.
• Further research is needed to determine whether
children with FASD lie more often in other contexts and
also whether lying is correlated with later secondary
disabilities and frequency of transgressive behaviors.
• Research is needed to determine factors that may be
related to lying such as executive function deficits.
• Special emphasis on helping children with FASD
understand the consequences of lying as well as causeand-effect reasoning may be beneficial.
Collaborators
•
•
•
•
•
•
Rosalyn McAuley, University of Alberta
Gail Andrew, Glenrose Rehabilitation Hospital
Carly Loomes, University of Alberta
Shazeen Manji, University of Alberta
Victoria Talwar, McGill University
Katy Wyper, University of Alberta
 Special thanks to all those children and families who
have participated in our research!
References
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