Brain Development: Normal Processes and the Effects of Alcohol ...

functioning (Streissguth , 1997) . Tw o task s that have
been use d to evaluate functioning in this area are progressive
planning tasks (e.g., Tower of London; Shal -
lice, 1982) and tasks assessing learning and reversa l or
shifts i n discriminativ e stimuli (i.e., Wisconsin Car d
Sort Task [WCST] ; Heato n e t al, 1993) . Bot h kinds
of tasks were originally used t o measure th e effect s o f
frontal lobe damag e i n adult s (Shallice , 1982) . Pro -
gressive planning task s require tha t th e perso n bein g
tested replicat e a visuall y presente d desig n b y rearranging
circular disks or balls that are placed o n vertical
pegs. There are rules restraining the numbe r an d
type o f moves permitted . Th e tas k require s tha t th e
subject retai n these rule s a s well a s the sequenc e o f
moves in working memory to correctly solve the prob -
lem. Initially , th e tas k i s simpl e an d require s littl e
planning, bu t a s task complexity increases , the indi -
vidual must be able to visualize a multistep sequence
of moves to complete th e tas k successfully .
Hie WCST and similar tasks require the individual
to identif y o r sor t according to specifi c characteristics
of the stimul i (i.e., color, number, o r shape) presente d
to them, with feedback provided to facilitate learning.
For th e initia l se t o f trials , th e correc t dimensio n
may be color, so that all responses that match i n color
are rewarded . Once th e correc t dimensio n i s reliably
learned, a differen t dimension become s "correct " s o
that, fo r instance, numbe r become s th e correc t solution
and i s rewarded. This task requires cognitive flexibility,
becaus e th e individua l must inhibi t previously
learned response s an d shif t set s or rule s learned fro m
previous trials.
Using both kinds of tasks, children wit h FAS have
been foun d to perform more poorly than control s and
to mak e perseveratio n error s (repetition o f response s
that ar e incorrec t o r no t reinforced ) (Kodituwakk u
et al, 1995 ; Cole s e t al. , 1997 ; Kern s et al, 1997) .
These findings suggest that they have difficulty incor -
porating environmental feedback to correct a response.
Children wit h FA S typicall y hav e mor e difficult y
learning th e shifts , particularl y reversa l shifts , tha n
would b e expecte d (Kodituwakk u et al., 1995 ; Cole s
et al, 1997 ; Kerns et al., 1997) , a pattern implying difficulties
wit h inhibitio n o f learne d response s o r a n
inattentiveness to new information.
Kodituwakku and colleague s (2001 ) used anothe r
paradigm t o discriminat e emotion-lade n learnin g
from conceptua l se t shiftin g (th e reversa l shif t task s
discussed above ) to further document neurodevelopmental
impairment s associate d wit h FAS . These au -
PRENATAL ALCOHOL EXPOSURE AND HUMAN DEVELOPMENT 13 3
thors expecte d performanc e of alcohol-exposed indi -
viduals to be impaire d i n tasks that involve d an emo -
tional component. I n this study, performance on th e
WCST wa s contrasted wit h tha t o n a differen t tas k
that assessed visual-discrimination reversal learning as
well a s extinctio n o f reward-respons e association s
(Rolls et al., 1994) . This second tas k was assumed t o
measure emotion-relate d learnin g becaus e a reward
was provided rather than the feedback provided in the
WCST. Afte r controllin g fo r conceptua l se t shiftin g
(performance on the WCST) and for general intellec -
tual abilities , school-age , alcohol-expose d childre n
perform mor e poorl y tha n th e referenc e sampl e o n
emotion-related learning; they achieve fewer reversals
and sho w mor e variabilit y in extinction . I n addition ,
there i s a significant relationship between thes e mea -
sures of emotion-related learnin g and conceptua l shift -
ing and parent-reported behavio r problems. Th e ability
to regulate arousal may have affected performanc e on
this learning task, although thi s issue i s not addresse d
in this studv.
ACADEMIC ACHIEVEMENT
Given th e neurocognitiv e problem s identifie d i n exposed
individuals , i t i s no t surprisin g tha t academi c
achievement i s frequentl y affected . Learnin g prob -
lems, schoo l failure , repeatin g grades , an d droppin g
out of school have all been cite d as negative outcome s
associated wit h FA S in clinica l sample s (Streissgut h
et al, 1996 ; Autti-Ramo, 2000). It is important to bear
in min d tha t fo r alcohol-expose d a s well a s for othe r
children, academi c achievemen t i s determine d b y
complex interaction s betwee n th e child's neurodevelopmental
status, environmental supports for academic
success, and emotional stability.
Overall academi c achievemen t i s predicted b y the
individual's genera l intellectua l abilit y an d b y SES .
Academic problem s consisten t with globa l abilit y
deficits ar e typically seen. There ma y also be specifi c
areas of academic weaknes s for the child wit h FAS beyond
those associate d with cognitive deficit an d social
disadvantage. Researc h suggest s that , relativ e t o gen -
eral intellectua l ability , alcohol-exposed childre n an d
adolescents hav e specific learning problems with mathematics
(Spoh r an d Steinhausen , 1984 ; Streissgut h
et al., 1994) . Deficit s in math achievemen t associate d
with prenata l alcoho l exposur e hav e bee n identifie d
regularly i n bot h longitudina l an d clinica l studie s