Academic journal article Alcohol Research

The Effects of Prenatal Alcohol Exposure on Executive Functioning

Academic journal article Alcohol Research

The Effects of Prenatal Alcohol Exposure on Executive Functioning

Article excerpt

Converging evidence from various research areas indicates that people who have been exposed to alcohol prenatally may exhibit impairments on the performance of relatively complex and novel tasks. These tasks include tests designed to measure executive functioning (EF)--the ability to plan and guide behavior to achieve a goal in an efficient manner. EF can be categorized into two domains, cognition-based EF and emotion-related EF. People prenatally exposed to alcohol show impaired performance on tests assessing both domains. Moreover, one cognition-based and two emotion-related measures of EF appear to be reliable and stable predictors of behavioral problems in alcohol-affected people. A deficit in flexible recruitment of brain regions to do complex tasks may underlie the EF deficits in people prenatally exposed to alcohol. KEY WORDS: prenatal alcohol exposure; cognitive and memory disorder; brain damage; brain function; emotion; mood and affect disturbance; behavioral problem; neuroimaging

The term "executive functioning" (EF) generally refers to cognitive functions involved in planning and guiding behavior in order to achieve a goal in an efficient manner. Impairments in EF have been found in patients with a wide range of neurodevelopmental disorders, including autism, attention deficit disorder, early treated phenylketonuria (PKU), (1) and Fragile X Syndrome (Pennington et al. 1996). Studies found that children who had been exposed to alcohol prenatally may also be impaired on tasks measuring competencies associated with EF (Kodituwakku et al. 1995; Mattson et al. 1999) as well as on other cognitive functions (e.g., visual processing and memory functions). This article explores the relationship between prenatal alcohol exposure and deficits in EF. It first describes the cognitive skills subsumed under EF. It then summarizes the existing literature on EF in people who have been exposed prenatally to alcohol (2) and discusses the usefulness of EF performance in defining a neurobehavioral profil e related to prenatal alcohol exposure.

EXECUTIVE FUNCTIONING

The concept of EF refers to deliberate, or effortful, actions that involve various abilities, such as holding and manipulating information "in the head" (i.e. working memory) and focusing on one task at a time (i.e., inhibiting task-irrelevant habitual responses). Such deliberate actions can be contrasted with involuntary, or automatic, actions (for a more detailed discussion of this distinction, see the sidebar).

EF can further be divided into two categories. The original concept of EF referred to cognition-based actions, and researchers and clinicians have used a variety of cognitive tests requiring deliberate attention to formally assess this type of EF. Such tests measure problem solving, conceptual set shifting (described in the following paragraph), and rapid generation of verbal or nonverbal responses. Subsequently, some scientists broadened the definition of EF to include another form of action selection that has been called emotion-related (Rolls et al. 1994), or affective (Dias et al. 1996) EF. Action selection at this level is based on rewards and punishments (i.e., positive and negative reinforcement) obtained in the past in similar situations. This emotion-related EF can be assessed using tests that measure the ability to modify behavior in response to changing reinforcement conditions.

Assessing Cognition-Based and Emotion-Related EF

The distinction between cognition-based and emotion-related EF can be further illustrated by comparing two tests commonly used to assess EF. The Wisconsin Card Sorting Test (WCST) is used to evaluate cognition-based EF. In this test, the subject is asked to sort cards by a given dimension (e.g., the cards' color) and then to shift attention to sorting them by a different dimension (e.g., the cards' form) according to the examiners feedback. Thus, the WCST measures the subject's ability to shift attention across different dimensions, a process formally known as conceptual, or extra-dimensional, set shifting. …

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