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Descriptive Statistics for BRIEF Parent Report and Performance-Based Tests in Aboriginal Canadian Children with FASD. 

Descriptive Statistics for BRIEF Parent Report and Performance-Based Tests in Aboriginal Canadian Children with FASD. 

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Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Fu...

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... scores were used in subsequent analyses. Table 2 presents the BRIEF and neuropsychological test results. All of the mean BRIEF scale and index scores were in the impaired range, with the exception of Organization of Materials. ...
Context 2
... BRIEF and neuropsychological test scores had a bimodal distribution (Table 2). For most BRIEF scales, a first peak was observed around the cutoff for impairment, while a second peak reflected more severe impairment. ...
Context 3
... scores were used in subsequent analyses. Table 2 presents the BRIEF and neuropsychological test results. All of the mean BRIEF scale and index scores were in the impaired range, with the exception of Organization of Materials. ...
Context 4
... BRIEF and neuropsychological test scores had a bimodal distribution (Table 2). For most BRIEF scales, a first peak was observed around the cutoff for impairment, while a second peak reflected more severe impairment. ...

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... Likewise, the influence of gender on the expression of difficulties in executive and behavioral functioning in cases of comorbidity with ADHD should be considered [17]. In this sense, gender plays an important role in the profile of cognitive and behavioral functioning, with a greater deterioration in males [18]. ...
... In the first instance, the BRIEF-2 neuropsychological test provides a measure of executive function assessment based on an ecological perspective [14]. There are three previous studies that apply the BRIEF-2 test for the assessment of all executive functions in the population affected by FASD in the United Kingdom and Canada, showing significant alterations in most of the domains assessed by the test, except in the domain "organization of materials" [12,18,22]. The results of this study follow a similar pattern to those obtained in different works [12,18,23]. ...
... There are three previous studies that apply the BRIEF-2 test for the assessment of all executive functions in the population affected by FASD in the United Kingdom and Canada, showing significant alterations in most of the domains assessed by the test, except in the domain "organization of materials" [12,18,22]. The results of this study follow a similar pattern to those obtained in different works [12,18,23]. That is, participants affected by FASD show significant differences in the executive functioning domains assessed (inhibition, self-monitoring, flexibility, emotional control, initiative, working memory, planning and organization, task monitoring, and organization of materials), with working memory being the most impaired variable and organization of materials the least impaired, although in some cases they continue to belong to the clinical population. ...
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Associations and families demand the need to raise awareness of the implications in the cognitive and behavioral development of children with Fetal Alcohol Spectrum Disorder (FASD) that affect their learning and school participation. This study aims to generate a profile of executive and behavioral functioning in children and adolescents diagnosed with FASD. A probabilistic sampling by clusters (associations for individuals with FASD) is applied. The sample is composed of 66 families from three associations. The BRIEF-2 and SENA tests were administered to assess executive and behavioral functioning domains. Data analysis found that the executive and behavioral functioning profile of individuals with FASD varies with age, with greater impairment in middle and late adolescence. Likewise, the domain of executive functioning most affected in any of the developmental stages is working memory. Finally, cognitive impairment in the executive functioning domains has a direct impact on the social and adaptive functioning of people with FASD.
... Psychosocial impacts associated with PAE can include cognitive impairment; impaired executive function skills such as behavior regulation, decision-making, and planning; a greater likelihood of having mental health challenges such as depression and anxiety; and higher rates of contact with juvenile justice and child welfare systems. These can occur in the absence of distinguishable facial characteristics (Bagheri et al., 1998;Beckett, 2011;Brownell et al., 2019;Kaemingk & Halverson, 2000;Rai et al., 2017). These impacts can rise to the level of diagnosable conditions (e.g., fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder, neurobehavioral disorder associated with PAE) that collectively are referred to as fetal alcohol spectrum disorders (FASDs). ...
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Tribal communities face critical challenges in identifying and addressing substance use by pregnant women. These challenges are often exacerbated by limited resources for services and limited research on effective interventions. To address these challenges, tribal communities are developing innovative and culturally resonant approaches to address prenatal alcohol exposure (PAE) and prenatal substance exposure (PSE). This article describes an environmental scan that was completed to understand and support the important work of these communities. It concludes with a discussion of the implications for tribal practitioners, specifically those in child welfare as well as policymakers and funders in child welfare and allied service provision systems, and provides potential directions for future research.
... This supported previous recommendations that BRIEF should be considered alongside current diagnostic assessments when establishing the presence of FASD [40], as clinically elevated scores appear widely among FASD populations. This finding is also consistent with international reports of elevated BRIEF scores among children with FASD [41,42], suggesting the phenomenon persists cross-culturally. There was variation in the ASD responses to the BRIEF. ...
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... En el caso concerniente, existen tres estudios anteriores que aplican la prueba BRIEF-2 para la evaluación de todas las funciones ejecutivas en población afectada por TEAF en Reino Unido y Canadá, manifestándose alteraciones significativas en la mayoría de los dominios que evalúa la prueba, excepto en el dominio "organización de materiales" (Rai et al., 2017;Rasmussen et al., 2006;Zameer et al., 2020). Los resultados de este estudio discurren siguiendo un patrón similar a los obtenidos en los trabajos de Rai et al. (2017), McLachlan et al. (2017, Zameer et al. (2020) entre otros, esto es, los participantes afectados por TEAF muestran diferencias significativas en los dominios de funcionamiento ejecutivo evaluados (inhibición, supervisión de sí mismo, flexibilidad, control emocional, iniciativa, memoria de trabajo, planificación y organización, supervisión de la tarea y organización de materiales). ...
... En el caso concerniente, existen tres estudios anteriores que aplican la prueba BRIEF-2 para la evaluación de todas las funciones ejecutivas en población afectada por TEAF en Reino Unido y Canadá, manifestándose alteraciones significativas en la mayoría de los dominios que evalúa la prueba, excepto en el dominio "organización de materiales" (Rai et al., 2017;Rasmussen et al., 2006;Zameer et al., 2020). Los resultados de este estudio discurren siguiendo un patrón similar a los obtenidos en los trabajos de Rai et al. (2017), McLachlan et al. (2017, Zameer et al. (2020) entre otros, esto es, los participantes afectados por TEAF muestran diferencias significativas en los dominios de funcionamiento ejecutivo evaluados (inhibición, supervisión de sí mismo, flexibilidad, control emocional, iniciativa, memoria de trabajo, planificación y organización, supervisión de la tarea y organización de materiales). ...
... Confirmándose de este modo una de las hipótesis de partida de este estudio, es decir, las diferencias encontradas en el funcionamiento ejecutivo en función del sexo son de escasa relevancia estadística en este grupo de edad. Estos resultados son confirmados por los obtenidos en los trabajos de Herman et al. (2008) o Rai et al. (2017), en los que no se detectan diferencias estadísticamente significativas entre las mediciones del deterioro del funcionamiento ejecutivo entre niños y niñas mediante la prueba BRIEF-2. ...
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... It is sensitive to deficits in language and pragmatic communication. As parent-reported and directly measured abilities often do not align among this population (e.g., Gross, Deling, Wozniak & Boys, 2015;Nguyen et al., 2014;Glass et al., 2014;Rai et al., 2017;Mohamed et al., 2019), inclusion of parent-reported general language abilities provides a comprehensive profile of overall language abilities and allows for examination of direct versus subjective measures. The General Communication Composite standard score (M = 100, SD = 15) was used in analyses as a measure of general language abilities. ...
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Objective Language and communication are largely understudied among youth with fetal alcohol spectrum disorders (FASD). Findings have been mixed, and have generally focused on more severely affected (i.e., children with FAS alone) or younger children. This study aimed to elucidate the profiles of language (i.e., receptive, expressive, general language) and communication (i.e., functional, social) abilities in adolescents with FASD. Method Participants aged 12–17 years with (AE = 31) and without (CON = 29) prenatal alcohol exposure were included. Receptive and expressive language were measured by the Clinical Evaluation of Language Fundamentals – Fifth Edition (CELF-5). Parents or caregivers completed the Children’s Communication Checklist – Second Edition as a subjective measure of general language skills. Functional communication was measured by the Student Functional Assessment of Verbal Reasoning and Executive Strategies and parents or caregivers completed the Social Skills Improvement System Rating Scales as a measure of social communication. Multivariate analysis of variance determined the overall profiles of language and communication and whether they differed between groups. Results The AE group performed significantly lower than the CON group on receptive language and parent report of general language while groups did not significantly differ on expressive language. Groups did not significantly differ on functional communication while social communication was significantly lower in the AE group. Conclusions Results of this study provide important information regarding the overall profile of basic language abilities and higher-level communication skills of adolescents with FASD. Ultimately, improving communication skills of youth with FASD may translate to better overall functioning.
... The Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) is one of the most frequently used forms of indirect assessment of executive functioning across research and clinical contexts (e.g., Khoury & Milligan, 2019) and is the only executive functioning rating scale listed in the Canadian guidelines (Cook et al., 2016). Studies using the BRIEF have consistently demonstrated that caregivers of children with PAE often report significant concerns around applying executive functioning skills, with most mean ratings falling near or above the clinically elevated range (e.g., Astley et al., 2009;Gross et al., 2015;Mohamed et al., 2019;Nguyen et al., 2014;Rai et al., 2017;Taylor & Enns, 2019). ...
... The first Canadian study to examine this relationship among children with FASD used all of the BRIEF clinical scales, index, and composite scores and several tests that were not included in previous studies (Rai et al., 2017). Scores on a measure of cognitive flexibility, the Wisconsin Card Sorting Test, were found to be significantly correlated with the Organization of Materials scale (r = -.31) and the MI (r = -.34). ...
... Examining this association among additional clinical populations is also important from a research standpoint given that executive functioning skills may vary across clinical groups. For example, Mohamed et al. (2019) found higher mean caregiver ratings across the BRIEF scales among a sample of children diagnosed with FASD at The FASD National Behavior Clinic in the United Kingdom (UK) than a sample of children with FASD who were assessed through private practice in Alberta, Canada (Rai et al., 2017). ...
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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.
... Gender may also significantly moderate the association; however, studies of gender differences across EF test scores were largely non-existent, except for research that has found that females with FASD demonstrated lower perseverative errors on a task of concept formation and set shifting (Rai et al., 2017) and performed better on tests of working memory (Herman et al., 2008) than males with FASD. In contrast, one study found that caregiver and teacher ratings of inattentiveness and caregiver (but not teacher) ratings of difficulties applying EF skills were significantly higher among females than males with FASD (Rasmussen et al., 2006), while other studies have failed to demonstrate significant gender differences in EF ratings (e.g., Rai et al., 2017). ...
... Gender may also significantly moderate the association; however, studies of gender differences across EF test scores were largely non-existent, except for research that has found that females with FASD demonstrated lower perseverative errors on a task of concept formation and set shifting (Rai et al., 2017) and performed better on tests of working memory (Herman et al., 2008) than males with FASD. In contrast, one study found that caregiver and teacher ratings of inattentiveness and caregiver (but not teacher) ratings of difficulties applying EF skills were significantly higher among females than males with FASD (Rasmussen et al., 2006), while other studies have failed to demonstrate significant gender differences in EF ratings (e.g., Rai et al., 2017). In terms of adaptive functioning, one study found significantly lower overall scores on the Vineland-II for males than females with PAE (Sakano et al., 2019). ...
... Considering caregiver ratings of GEC and teacher ratings of inattention have been reported to be higher among females than males with FASD (Rasmussen et al., 2006) and one study demonstrated lower adaptive ratings among males than females with PAE (Sakano et al., 2019), the influence of gender may have been washed out. The lack of significance is also consistent with other studies that have failed to find significant gender differences based on informant ratings of EF (Kingdon et al., 2016;Rai et al., 2017) and attention (Herman et al., 2008). Further studies are required to clarify the relationship between demographic characteristics and the correlations examined in the current study. ...
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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.ResultsSignificant 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.
... disorders, such as specific learning disorders, attention-deficit/hyperactivity disorder (ADHD; Lonergan et al., 2019), autism spectrum disorder (Berenguer et al., 2018), and intellectual disabilities (Hronis et al., 2017), often demonstrate difficulties with some EF skills. Individuals with fetal alcohol spectrum disorder (FASD), also a neurodevelopmental disorder, similarly tend to exhibit more difficulties with EF skills compared to normative means or samples (Khoury & Milligan, 2019;Mohamed et al., 2019;Rai et al., 2017). Individuals with FASD also tend to demonstrate more difficulties with EF skills than individuals with prenatal alcohol exposure (PAE) without FASD (Cheung & Doyle, 2020;Cheung & Taylor, 2020;. ...
... Current Canadian guidelines for diagnosing FASD require both forms of measurement (Cook et al., 2016). This requirement is important to consider given the notable discrepancies between performance on tests and caregiver ratings of EF among children with PAE with FASD (Astley et al., 2009;Cheung & Doyle, 2020;Cheung & Taylor, 2020;Gross et al., 2015;Mohamed et al., 2019;Nguyen et al., 2014;Rai et al., 2017), as well as children with PAE without FASD (Cheung & Doyle, 2020;Cheung & Taylor, 2020). Overall, studies often fail to find significant correlations between corresponding and non-corresponding test scores and caregiver ratings of EF among children with PAE when assessed using the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) Parent Form (Cheung & Taylor, 2020;Mohamed et al., 2019;Nguyen et al., 2014;Rai et al., 2017). ...
... This requirement is important to consider given the notable discrepancies between performance on tests and caregiver ratings of EF among children with PAE with FASD (Astley et al., 2009;Cheung & Doyle, 2020;Cheung & Taylor, 2020;Gross et al., 2015;Mohamed et al., 2019;Nguyen et al., 2014;Rai et al., 2017), as well as children with PAE without FASD (Cheung & Doyle, 2020;Cheung & Taylor, 2020). Overall, studies often fail to find significant correlations between corresponding and non-corresponding test scores and caregiver ratings of EF among children with PAE when assessed using the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) Parent Form (Cheung & Taylor, 2020;Mohamed et al., 2019;Nguyen et al., 2014;Rai et al., 2017). Corresponding measures of EF refer to test scores and ratings of EF that assess the same type of EF skill (e.g., tests and ratings of inhibition). ...
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Objectives Canadian guidelines for diagnosing fetal alcohol spectrum disorder (FASD) recommend that test scores and informant ratings be used to assess executive functioning skills; however, there are discrepancies between these forms of measurement and most studies only use caregiver ratings. As children spend half their time at school, this neglects a significant source of information. The purpose of the present study was to examine the relationship between tests and teacher ratings of executive function in children with prenatal alcohol exposure (PAE), with and without the diagnosis of FASD. Methods A retrospective chart review of 303 children with PAE was completed. Teacher ratings of executive functioning were measured using the Behavior Rating Inventory of Executive Function. Direct measures of executive functioning included select subtests from the Delis-Kaplan Executive Function System; NEuroPSYchological Assessment, Second Edition; Wechsler Intelligence Scale for Children, Fourth Edition; Wechsler Intelligence Scale for Children, Fifth Edition; and Wechsler Adult Intelligence Scale, Fourth Edition. Results This research found significant group differences across all teacher ratings of executive functioning. Most correlations between tests and teacher ratings of executive function that we expected to be related were not significantly associated. Conclusions Results suggest that tests and teacher ratings of executive functioning may not measure the same construct or other factors may be impacting this relationship.
... Within the performance-based literature, individuals with FASD are found to demonstrate deficits across varied indices of concept formation, inhibition, set shifting, problem solving and planning, verbal fluency, and working memory (Khoury & Milligan, 2019;Khoury et al., 2015;Mattson et al., 2019). Similarly, studies using informant reports indicate that children and adolescents with FASD show impairment across composite indices and scales (Kodituwakku & Kodituwakku, 2014;Rai et al., 2017), as measured using the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000). Within day-to-day life, such challenges with EF may manifest as difficulties inhibiting socially inappropriate behavior, remembering rules, flexibly switching from one activity to the next, as well as with planning, decisionmaking, and complex problem solving (Dick & Overton, 2010;Gross et al., 2015). ...
... As expected, and consistent with an established literature, children with PAE demonstrated significantly poorer everyday EF skills as compared to the BRIEF normative mean (Rasmussen et al., 2006). The BRIEF profile observed in our sample is also consistent with previous research, in that children and adolescents with PAE demonstrated the greatest challenges with working memory (Mohamed et al., 2019;Rai et al., 2017;Rasmussen et al., 2006), as well as with inhibition, planning/organizing, and shifting (Knuiman et al., 2015;McGee et al., 2008). Although the mean on Organization of Materials scale was significantly worse than the BRIEF normative mean, participants showed the least amount of difficulty in this area. ...
... Although the mean on Organization of Materials scale was significantly worse than the BRIEF normative mean, participants showed the least amount of difficulty in this area. Moreover, the mean score was not in the clinically significant range, which is consistent with previous research indicating that skills and abilities related to keeping personal spaces and belongings clean and organized may be relative strengths among children and youth prenatally exposed to alcohol (Knuiman et al., 2015;McGee et al., 2008;Mohamed et al., 2019;Rai et al., 2017;Rasmussen et al., 2006). Further research is needed to explore how these relative strengths may be promoted in Table 2. Predictors of adaptive skills (ABAS-II). ...
Article
Children with prenatal alcohol exposure (PAE) experience a range of adverse outcomes that impact multiple domains of functioning, including cognitive, physical, mental health, behavioral, social-emotional, communication, and learning. To inform tailored clinical intervention, the current study examined the relation between caregiver-reported cognitive skills (executive function; EF) and adaptive functioning. The study conducted a secondary analyses of data provided by caregivers of 87 children and adolescents (aged 5–18 years, M = 11.7; 52% male) with confirmed PAE, including a subset (n = 70) with Fetal Alcohol Spectrum Disorder (FASD), who reported on their child’s EF (Behavior Rating Inventory of Executive Function) and adaptive function (Adaptive Behavior Assessment System, 2nd Edition) skills. Findings from the current study showed that caregivers reported significantly poorer EF and adaptive functioning skills for children with PAE as compared to normative samples. Poorer behavior regulation skills were associated with all aspects of adaptive functioning (i.e., practical, conceptual, and social skills). Specifically, shifting skills emerged as the best predictor of adaptive functioning among children with PAE. These results highlight the possibility that targeting particular EF domains among individuals with PAE may benefit behavior regulation, which may also extend to adaptive skills. This highlights the need to develop EF interventions for children and adolescents who have been prenatally exposed to alcohol.
... Although EF performance scores were not conclusive for ADHD diagnosis, the ecological validity of these measures in children has widely been questioned. In fact, EF performance scores tend to not correlate well with behavior rating scales of EF (Rai et al., 2017;Toplak, Bucciarelli, Jain, & Tannock, 2008;Toplak, West, & Stanovich, 2013). This is likely because performance measures reflect the short-term and are administered in a structured environment (Goldberg & Podell, 2000). ...
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Objective: This study provides independent examination of the validity of the Barkley Deficits of Executive Functioning Scale–Children and Adolescents (BDEFS-CA) in a sample of children diagnosed with ADHD (n = 50) and typically developing controls (n = 50). Method: Parents of participants completed the BDEFS-CA and the Conners 3 rating scales. Validity of BDEFS-CA was examined using a confirmatory factor analysis, correlational analyses with Conners 3 ratings, and receiver operating characteristic (ROC) curve analysis of diagnostic accuracy. Results: Findings support the construct, concurrent, and discriminant validity of the BDEFS-CA in a mixed sample. Conclusion: Findings provide independent examination of the validity of the BDEFS-CA as a measure of executive dysfunction and a screening tool for ADHD.