behavioural by qingyunliuliu

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									 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 emotion-
  related 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



          70
T Score




          60



          50



          40
               Inhibit   Shift   Emotional   Initiate   Working   Plan/Org.    Org. of    Monitor
                                  Control               Memory                Materials
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


           80                                                                       5-8 years
                                                                                    9-16 years

           75


           70
 T Score




           65


           60


           55


           50
                inhibit    shift      emotional     initiate    working    plan/organize    org of     monitor
                                       control                  memory                     materials



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

    E: Oops, I forgot something in the
    other room, so I have to go get it. I
C   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



                    80
% of lie-tellers




                    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 Non-
  FASD 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 cause-
  and-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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     disturbed children aged four through sixteen. Monographs for the Society for Research in Child Development, 46, 1-82.
Fast, D., Conry, J., & Loock, C. (1999). Identifying Fetal Alcohol Syndrome among youth in the criminal justice system.
     Journal of Developmental and Behavioral Pediatrics, 20, 370-372.
Gervais, J., Tremblay, R. E., Desmarais-Gervais, L., & Vitaro, F. (2000). Children‟s persistent lying, gender differences, and
     disruptive behaviours: A longitudinal perspective. International Journal of Behavioral Development, 24, 213-221.
Janzen, L., Nanson, J., & Block, G. (1995). Neuropsychological evaluation of preschoolers with Fetal Alcohol Syndrome.
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