Theory of Mind in Children with Fetal Alcohol Spectrum Disorders

Abstract

Background Theory of mind (ToM) refers to the ability to understand and make inferences about other people’s intentions, feelings, and beliefs. Although children with fetal alcohol spectrum disorders (FASD) are known to have deficits in social-cognitive function, little is known about ToM in FASD. Methods ToM ability was assessed using a developmentally sensitive ToM battery, including the Reading the Mind in the Eyes (RME) test, a measure of mental inferential ability that has been found to be impaired in other clinical populations. IQ and executive function (EF) were assessed as potential mediating variables. The battery was administered to 63 children (aged 9–11 years) from Cape Town, South Africa, whose mothers had been prospectively recruited during pregnancy. Children with fetal alcohol syndrome (FAS; n=8) and partial FAS (PFAS; n=19), as well as nonsyndromal heavily exposed children (HE; n=17), were compared to children born to abstaining or light drinkers (n=19) from the same community. Results No FASD group differences were found on the less challenging ToM tasks. By contrast, children with FAS and PFAS performed more poorly than controls on a more challenging ToM task, the RME test. A continuous measure of prenatal alcohol exposure was more sensitive than FASD diagnosis in that it was related to four higher-order ToM measures, particularly the ability to attribute mental states assessed on RME. IQ only partially mediated the effect of exposure on RME performance, and these effects were not mediated by EF. Hence, the data suggest that these ToM measures tap into a specific alcohol-related social-cognitive deficit that does not merely reflect poorer EF. FASD diagnosis and prenatal alcohol exposure were each also related to RME after control for Attention Deficit/Hyperactivity Disorder. Conclusions These findings suggest that deficits in higher-order ToM function may play a significant role in the social-cognitive behavioural impairment in FASD.

Reductions in Corpus Callosum Volume Partially Mediate Effects of Prenatal Alcohol Exposure on IQ

“…However, we have previously validated the TLFB interview used in this study in relation to levels of fatty acid ethyl ester metabolites in meconium samples obtained from newborns in this cohort (Bearer et al, 2003 ). In addition, this TLFB interview has been shown to predict a broad range of behavioral (Jacobson et al, 2002 , 2008 ; Lewis et al, 2015 ; Lindinger et al, 2016 ; Fortin et al, 2017 ) and neuroimaging outcomes (De Guio et al, 2014 ; Meintjes et al, 2014 ; du Plessis et al, 2015 ; Jacobson et al, 2017 ). A second limitation relates to the difficulty assessing effects of timing of exposure in a human study.…”

Differential Recruitment of Brain Regions During Response Inhibition in Children Prenatally Exposed to Alcohol

“…The teratogenicity of prenatal alcohol exposure has been extensively documented during the past 4 decades, and alcohol consumption during pregnancy has been linked to a broad range of impairments known collectively as fetal alcohol spectrum disorders (FASD) (Cook et al., ; Hoyme et al., ). In addition to growth and cognitive problems (e.g., Carter et al., ), children with FASD have numerous behavioral problems including difficulty in response inhibition, as evidenced in problems with emotional regulation, impulsivity, attention, hyperactivity, and socially inappropriate behaviors (Carmichael Olson et al., ; Dodge et al., ; Jacobson et al., ; Lindinger et al., ; Mattson and Riley, ).…”

Fetal Alcohol Growth Restriction and Cognitive Impairment

“…14 At 10 years, we also administered the California Verbal Learning Test-Children's Version 23 and the Delis-Kaplan Verbal Fluency test, an executive function measure of cognitive flexibility. 24 Tests were administered in the language of instruction used in the child's classroom.…”