Skip to main content
Log in

Discrepancies in Performance-Based Measures and Teacher Ratings of Executive Function in the Assessment of FASD

  • ORIGINAL PAPER
  • Published:
Advances in Neurodevelopmental Disorders Aims and scope Submit manuscript

Abstract

Objectives

Canadian guidelines for diagnosing fetal alcohol spectrum disorder (FASD) recommend that test scores and informant ratings be used to assess executive functioning skills; however, there are discrepancies between these forms of measurement and most studies only use caregiver ratings. As children spend half their time at school, this neglects a significant source of information. The purpose of the present study was to examine the relationship between tests and teacher ratings of executive function in children with prenatal alcohol exposure (PAE), with and without the diagnosis of FASD.

Methods

A retrospective chart review of 303 children with PAE was completed. Teacher ratings of executive functioning were measured using the Behavior Rating Inventory of Executive Function. Direct measures of executive functioning included select subtests from the Delis-Kaplan Executive Function System; NEuroPSYchological Assessment, Second Edition; Wechsler Intelligence Scale for Children, Fourth Edition; Wechsler Intelligence Scale for Children, Fifth Edition; and Wechsler Adult Intelligence Scale, Fourth Edition.

Results

This research found significant group differences across all teacher ratings of executive functioning. Most correlations between tests and teacher ratings of executive function that we expected to be related were not significantly associated.

Conclusions

Results suggest that tests and teacher ratings of executive functioning may not measure the same construct or other factors may be impacting this relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data Availability

Ethics approval for this project did not include the transmission of data outside of our study team and institution, the SSCY Centre. Based on the ethics approval of this project, all data was required to remain on-site and to be physically housed and accessed internally at the SSCY Centre.

References

  • Ahmed, S., Tang, S., Waters, N., & Davis-Kean, P. (2018). Executive function and academic achievement: Longitudinal relations from early childhood to adolescence. Journal of Educational Psychology, 111(3), 446–458. https://doi.org/10.1037/edu0000296

    Article  Google Scholar 

  • Astley, S. J., Olson, H. C., Kerns, K., Brooks, A., Aylward, E. H., Coggins, T. E., Davies, J., Dorn, S., Gendler, B., Jirikowic, T., Kraegel, P., Maravilla, K., & Richards, T. (2009). Neuropsychological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Canadian Journal of Clinical Pharmacology, 16(1), e178–e201.

    Google Scholar 

  • Berenguer, C., Miranda, A., Colomer, C., Baixauli, I., & Roselló, B. (2018). Contribution of theory of mind, executive functioning, and pragmatics to socialization behaviors of children with high-functioning autism. Journal of Autism and Developmental Disorders, 48(2), 430–441. https://doi.org/10.1007/s10803-017-3349-0

    Article  PubMed  Google Scholar 

  • Bernes, G. A. (2020). Inter-rater agreement of executive function abilities in children with FASD or ADHD, and relation to laboratory measures (Master’s thesis). Retrieved from San Diego State University Theses and Dissertations Collection: https://digitallibrary.sdsu.edu/islandora/object/sdsu%3A59950

  • Bernes, G. A., Villodas, M., Coles, C. D., Kable, J. A., May, P. A., Kalberg, W. O., Sowell, E. R., Jones, K. L., Riley, E. P., Mattson, S. N., & CIFASD. (2021). Validity and reliability of executive function measures in children with heavy prenatal alcohol exposure: Correspondence between multiple raters and laboratory measures. Alcoholism: Clinical and Experimental Research, 45(3), 596–607. https://doi.org/10.1111/acer.14547

    Article  Google Scholar 

  • Cheung, K., & Doyle, S. (2020, October 7–8). Differences between ratings and tests of executive functioning among children with prenatal alcohol exposure with and without FASD [Oral presentation]. 16th Annual Child Health Research Days, Virtual Conference.

  • Cheung, K., Johns, E., Willoughby, D., & Slayen, C. (2021). The association between executive functioning, attention, and adaptive functioning among children and adolescents with prenatal alcohol exposure. Advances in Neurodevelopmental Disorders. Advance online publication. https://doi.org/10.1007/s41252-021-00216-8

  • Cheung, K., & Taylor, N. (2020, November 26–27). The association between performance-based measures and caregiver ratings of executive functioning among children and adolescents with prenatal alcohol exposure. 7th Biennial Conference on Developmental Disabilities: Health and Wellbeing across the Lifespan, Virtual Conference. https://interprofessional.ubc.ca/initiatives/dd2020/

  • Chudley, A. E., Conry, J., Cook, J. L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ, 172(5 suppl), S1–S21. https://doi.org/10.1503/cmaj.1040302

    Article  PubMed  PubMed Central  Google Scholar 

  • Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., Conry, J. L., LeBlanc, N., Loock, C. A., Lutke, J., Mallon, B. F., McFarlane, A. A., Temple, V. K., Rosales, T., & Mallon, B. F. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. CMAJ, 188(3), 191–197. https://doi.org/10.1503/cmaj.141593

    Article  PubMed  PubMed Central  Google Scholar 

  • Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan Executive Function System (D-KEFS). The Psychological Corporation.

  • Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. https://doi.org/10.1146/annurev-psych-113011-143750

    Article  PubMed  Google Scholar 

  • Elliott, R. (2003). Executive functions and their disorders. British Medical Bulletin, 65, 49–59. https://doi.org/10.1093/bmb/65.1.49

    Article  PubMed  Google Scholar 

  • Enns, L. N., & Taylor, N. M. (2019). Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment. Child Neuropsychology, 24(4), 203–225. https://doi.org/10.1080/09297049.2016.1251894

    Article  Google Scholar 

  • Fuhs, M. W., Farran, D. C., & Nesbitt, K. T. (2015). Prekindergarten children’s executive functioning skills and achievement gains: The utility of direct assessments and teacher ratings. Journal of Educational Psychology, 107(1), 207–221. https://doi.org/10.1037/a0037366

    Article  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). BRIEF: Behavior Rating Inventory of Executive Function. Psychological Assessment Resources.

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2015). BRIEF2: Behavior Rating Inventory of Executive Function, Second Edition. Psychological Assessment Resources.

  • Gross, A. C., Deling, L. A., Wozniak, J. R., & Boys, C. J. (2015). Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders. Child Neuropsychology, 21(4), 531–538. https://doi.org/10.1080/09297049.2014.911271

    Article  PubMed  Google Scholar 

  • Hronis, A., Roberts, L., & Kneebone, I. I. (2017). A review of cognitive impairments in children with intellectual disabilities: Implications for cognitive behaviour therapy. British Journal of Clinical Psychology, 56(2), 189–207. https://doi.org/10.1111/bjc.12133

    Article  Google Scholar 

  • Khoury, J. E., & Milligan, K. (2019). Comparing executive functioning in children and adolescents with fetal alcohol spectrum disorders and ADHD: A meta-analysis. Journal of Attention Disorders, 23(14), 1801–1815. https://doi.org/10.1177/1087054715622016

    Article  PubMed  Google Scholar 

  • Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY-II (2nd ed.). Harcourt Assessment.

  • Lonergan, A., Doyle, C., Cassidy, C., Mahon, S. M., Roche, R. A., Boran, L., & Bramham, J. (2019). A meta-analysis of executive functioning in dyslexia with consideration of the impact of comorbid ADHD. Journal of Cognitive Psychology, 31(7), 725–749. https://doi.org/10.1080/20445911.2019.1669609

    Article  Google Scholar 

  • Mohamed, Z., Carlisle, A., Livesey, A., & Mukherjee, R. (2019). Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in fetal alcohol spectrum disorders: Data from the UK national specialist clinic. Child Neuropsychology, 25(5), 648–663. https://doi.org/10.1080/09297049.2018.1516202

    Article  PubMed  Google Scholar 

  • Nguyen, T., Glass, L., Coles, C., Kable, J., May, P., Kalberg, W., Sowell, E. R., Jones, K. L., Riley, E. P., Mattson, S. N., & the CIFASD. (2014). The clinical utility and specificity of parent report of executive function among children with prenatal alcohol exposure. Journal of the International Neuropsychological Society, 20(7), 704–716. https://doi.org/10.1017/S1355617714000599

    Article  PubMed  PubMed Central  Google Scholar 

  • Pastor-Cerezuela, G., Fernández-Andrés, M. I., Sanz-Cervera, P., & Marín-Suelves, D. (2020). The impact of sensory processing on executive and cognitive functions in children with autism spectrum disorder in the school context. Research in Developmental Disabilities, 96, 103540. https://doi.org/10.1016/j.ridd.2019.103540

    Article  PubMed  Google Scholar 

  • Rai, J. K., Abecassis, M., Casey, J. E., Flaro, L., Erdodi, L. A., & Roth, R. M. (2017). Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children. Child Neuropsychology, 23(6), 713–732. https://doi.org/10.1080/09297049.2016.1191628

    Article  PubMed  Google Scholar 

  • Rasmussen, C., & Bisanz, J. (2009). Executive functioning in children with fetal alcohol spectrum disorders: Profiles and age-related differences. Child Neuropsychology, 15(3), 201–215. https://doi.org/10.1080/09297040802385400

    Article  PubMed  Google Scholar 

  • Samuels, W., Tournaki, N., Blackman, S., & Zilinski, C. (2016). Executive functioning predicts academic achievement in middle school: A four-year longitudinal study. Journal of Educational Research, 109(5), 478–490. https://doi.org/10.1080/00220671.2014.979913

    Article  Google Scholar 

  • Stevens, S. A., Nash, K., Fantus, E., Nulman, I., Rovet, J., & Koren, G. (2013). Towards identifying a characteristic neuropsychological profile for fetal alcohol spectrum disorders 2. Specific caregiver-and teacher-rating. Journal of Population Therapeutics and Clinical Pharmacology, 20(1), e53-62.

    PubMed  Google Scholar 

  • Taylor, N. M., & Enns, L. N. (2018). Age-related differences in neuropsychological assessment of fetal alcohol spectrum disorder: A cross-sectional study. Biochemistry and Cell Biology, 96(2), 252–259. https://doi.org/10.1139/bcb-2017-0081

    Article  PubMed  Google Scholar 

  • Taylor, N. M., & Enns, L. N. (2019). Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings. Child Neuropsychology, 25(4), 507–527. https://doi.org/10.1080/09297049.2018.1495187

    Article  PubMed  Google Scholar 

  • Vuontela, V., Carlson, S., Troberg, A., Fontell, T., Simola, P., Saarinen, S., & Aronen, E. T. (2013). Working memory, attention, inhibition, and their relation to adaptive functioning and behavioral/emotional symptoms in school-aged children. Child Psychiatry & Human Development, 44(1), 105–122. https://doi.org/10.1007/s10578-012-0313-2

    Article  Google Scholar 

  • Wechsler, D. (2003). WISC-IV: Technical and interpretive manual. Psychological Corporation.

  • Wechsler, D. (2008). WAIS-IV: Technical and interpretive manual. Psychological Corporation.

  • Wechsler, D. (2014). ​WISC​-V: Technical and interpretive manual​. Pearson.

  • Werlinger, A. (2016). The concordance of caregiver-teacher perspectives on the behavior of children with fetal alcohol spectrum disorder (Doctoral dissertation). Retrieved from UNLV Theses, Dissertations, Professional Papers, and Capstones. 2761. https://doi.org/10.34917/9112210

  • Zelazo, P. D., & Carlson, S. M. (2012). Hot and cool executive function in childhood and adolescence: Development and plasticity. Child Development Perspectives, 6(4), 354–360. https://doi.org/10.1111/j.1750-8606.2012.00246.x

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank the participating families and their children; the families that inspire this research; the Manitoba FASD Centre, SSCY Centre; The Department of Clinical Health Psychology, University of Manitoba; Excellence in Neurodevelopment and Rehabilitation Research in Child Health (ENRRICH); The Children's Hospital Research Institute of Manitoba (CHRIM); Cari Slayen for her assistance with data entry, literature review, and manuscript preparation; Alyssa Romaniuk for her assistance with manuscript preparation; and Marvin Routley, Sydney Lisi, Kristi MacDonald, and Kevin Solar for their assistance with data entry. We would also like to thank Dr. Nicole Taylor for her helpful suggestions and Drs. Tracie Afifi and Leslie E. Roos for their mentorship.

Funding

This study was funded by the Office of the VP (Research and International), University of Manitoba; the Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba; and the Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba.

Author information

Authors and Affiliations

Authors

Contributions

K. Cheung: designed and executed the study, completed data analyses, analyzed the data, and wrote sections of the paper. K. Clayton: designed and executed the study, assisted with data analysis planning, analyzed the data, and wrote sections of the paper.  S.D.: designed and executed the study, assisted with data analysis planning, analyzed the data, and wrote sections of the paper. All authors assisted with editing and reviewing of the final manuscript and approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Kristene Cheung.

Ethics declarations

Ethics Approval

This retrospective chart review study involving human participants was approved by The University of Manitoba Research Ethics Board and the Specialized Services for Children and Youth (SSCY) Research and Evaluation Committee. Given the retrospective nature of this study, informed consent to participate and publish was not required based on the above ethics approval.

Conflict of Interest

The authors declare no competing interests.

Employment

The authors have no recent, present, or anticipated employment by any organization that may gain or lose financially through publication of this manuscript.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 50 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cheung, K., Clayton, K. & Doyle, S. Discrepancies in Performance-Based Measures and Teacher Ratings of Executive Function in the Assessment of FASD. Adv Neurodev Disord 5, 463–472 (2021). https://doi.org/10.1007/s41252-021-00219-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41252-021-00219-5

Keywords

Navigation