Social cognition, executive functioning and IQ. What are the important influences on adaptive functioning in children with Fetal Alcohol Spectrum Disorder?

Abstract

Fetal Alcohol Spectrum Disorder (FASD) is one of the leading causes of intellectual disability and learning difficulties around the world. International research suggests a higher prevalence of FASD in Indigenous populations, however, this must be considered within the context of colonisation and historical trauma having direct effect on the health of Indigenous populations. This research was supported by a strong partnership with Te Wāhanga Hauora Māori (Māori Health Service) and findings are discussed with regard to both the psychological literature, colonised history of Aotearoa New Zealand and Te Ao Māori worldview. Children with FASD often have extremely low adaptive behaviour due to the severity of brain impairment, sometimes lower than expected given their level of intellectual functioning. Impairments in executive functioning (e.g. planning, cognitive flexibility and self-regulation) are thought to underlie many difficulties in adaptive functioning. Recent findings suggest children with FAS may also have difficulties with social cognition (e.g. emotion recognition, theory of mind social problem-solving). This research project aimed to investigate which factors (IQ, executive functioning, social cognition and Adverse Childhood Events, ACEs) predict adaptive functioning in children (8-12 years) with FASD. A comparison group was included which was matched on age, gender, ethnicity, maternal education and deprivation index. Findings were also considered within the context of psychosocial complexity that exists for children with FASD in this study, including implications for required support services. Children in the FASD group performed significantly below the comparison group, on all cognitive tasks and all measures of adaptive functioning, and demonstrated severe neurological impairment. Although IQ, executive functioning, social cognition and ACEs were significantly correlated with teacher-rated adaptive functioning for the FASD group, when multiple linear regression analyses were performed, social cognition, especially recognising emotions on adults’ faces, was the only significant independent predictor of teacher-rated adaptive function, even after including for IQ, executive functioning and ACEs in the model. This is important from a Te Ao Māori perspective as Māori society is built upon whakapapa and whanaungatanga which requires highly developed social and emotional skills. In addition, children with FASD have limited contact with tertiary level health and education services despite experiencing severe neurological impairments, often in the context of significant psychosocial issues. These systems are an example of institutional racism where systems benefit the dominant race and penalise minority groups. Solutions are discussed which aim to; build skills in the child, build support in the whānau, develop solutions that are holistic and culturally responsive.