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

134 ETHANOL-AFFECTE D DEVELOPMENT
(Streissguth e t al, 1994 ; Kodituwakk u e t al, 1995 ;
Goldschmidt e t al , 1996 ; Mattso n e t al , 1996) .
Streissguth an d colleague s (1993 ) repor t tha t arith -
metic disabilitie s are related t o prenatal alcoho l expo -
sure i n thei r longitudina l cohort , particularl y when
there wa s "massed" o r heavy drinking. These investigators
also note that their findings in the longitudina l
cohort ar e consisten t wit h observation s fro m thei r
older, clinical sample of patients diagnosed wit h FAS.
Other longitudinal sample s have also found evidenc e
of specific deficit s in thi s area . Coles and colleague s
(Coles e t al, 1991 , 1997 ; Howel l e t al, 2006 ) not e
specific deficit s i n mat h functionin g i n a cohor t o f
African-American schoo l childre n eve n whe n globa l
delays ar e controlled . I n thi s population , thes e prob -
lems appear to be related to deficits in visuospatial and
visual-motor functioning . Jacobson (1999 ) note prob -
lems in math i n a Detroit longitudina l cohor t a s well
and attribut e these difficultie s t o problems with working
memory and executive functioning skills.
In a sample population includin g both inner-cit y
and suburba n 4V2-year-ol d childre n wit h lo w birt h
weight, specific deficits in preacademic mathematica l
skills are identifie d among alcoho l expose d childre n
(Kable e t al, 1999) . Highe r score s o n a cumulative
risk inde x related t o alcohol an d othe r dru g us e ar e
significantly relate d t o poore r performanc e o n th e
Test of Early Mathematics Ability, 2nd Edition (Gins -
burg an d Baroody , 1990) , o n a numbe r o f specifi c
preacademic skills , including cardinality , constancy ,
counting, an d visua l recognitio n o f numbers. Apparently,
problem s wit h workin g memory , visua l per -
ception, an d executiv e functionin g underli e thes e
functional problems . Adult s wit h FA S als o showe d
mathematics-related difficulties , includin g computa -
tion, an d i n solving problems requirin g estimation o f
magnitude (Kopera-Fry e et al., 1996) . Thus , there i s
considerable evidenc e tha t thi s academi c are a i s a
problem i n affecte d individuals , due, n o doubt , t o
deficits i n cognitiv e processe s tha t suppor t mat h
achievement. Som e candidat e processes are those areas
discusse d abov e i n thi s chapter—i.e. , attention ,
executive functioning, and workin g memory as well
as visuospatial skills (Geary, 1993 ; Ashcraft, 1995) .
SOCIAL AND EMOTIONA L FUNCTIONING
Problems wit h behavior and emotiona l regulatio n are
the most frequent reason for clinical referral of children
suspected o f fetal alcoho l exposur e (e.g. , Steinhause n
et al, 1993;Janzenetal, 1995; Kopera-Frye et al, 1997 ;
Oesterheld an d Wilson , 1997 ; Roebuc k e t al, 1999 ;
Mattson an d Riley , 2000 ; Kodituwakk u et al, 2001) .
Social an d emotiona l problem s ar e so commonly re -
ported b y parents an d i n clinica l studie s i t has been
suggested that "people wit h FAS appear to differ fro m
the mentall y retarde d populatio n becaus e o f addi -
tional problem s i n th e socia l domain " (Kell y e t al. ,
2001, p . 143) . In a survey of a clinical population of
individuals with FAS and ARND, Streissgut h and col -
leagues (1996 ) repor t a hig h frequenc y o f menta l
health, legal , and social problems among the second -
ary disabilities in this group. The vas t majority (94% )
of individual s ar e reporte d t o hav e menta l healt h
problems o f some kind , with the mos t commo n psychiatric
problem s bein g ADH D an d depression .
These reports ar e certainly a concern, but i t may be
too early to interpret thes e outcome s a s the direc t results
o f the teratogeni c exposure , particularl y a s thi s
survey did no t includ e a compariso n grou p an d was
drawn fro m a clinicall y referre d populatio n tha t
should be expected t o have such problems .
In interpretin g report s fro m clinica l sample s o r
from sample s tha t ar e self-referre d (e.g. , O'Conno r
et al., 2002), some othe r factors that might influenc e
behavior shoul d b e take n int o account . Man y chil -
dren wit h FAS D experienc e environmenta l factor s
known t o contribut e t o behavioral, social, an d emo -
tional problems, an d it is disingenuous to ignore thes e
issues t o attribut e problem s t o prenata l exposure .
Children diagnose d wit h FA S often com e from low -
income or socially disadvantaged families and usually
have limited acces s to educational o r other resources .
Caregiving disruption s are the nor m rathe r than th e
exception i n children referre d to clinical settings, an d
many children are in foster car e following a history of
neglect and abuse .
To examine the frequency of behavior concerns in
a clinica l sampl e o f alcohol-affected children , Cole s
and Kabl e (unpublishe d results ) evaluate d 28 7 pa -
tients (mea n age , 4.5 years) referred for evaluation t o
a FAS specialty clinic. Of the 10 9 children diagnose d
with FAS , 54.7 % wer e describe d a s "to o active, "
30.5% had difficultie s wit h tantrums, and 41.1% were
described a s having problems wit h aggression. Whe n
these childre n ar e compared t o those referre d t o th e
same clini c wh o have n o evidenc e o f dysmorphia o r
growth problems an d t o those wit h no histor y of prenatal
alcoho l exposure , th e frequenc y o f th e sam e