{"id":{"repo_id":"salford","oai_identifier":"oai:salford-repository.worktribe.com:1367577"},"canonical_url":"https://search.dev.ndltd.org/etd/salford/oai:salford-repository.worktribe.com:1367577","repository":{"repo_id":"salford","name":"U. of Salford","base_url":"https://salford-repository.worktribe.com/oaiprovider"},"display":{"title":"The impact of traumatic childhood experiences on cognitive and behavioural functioning in children with foetal alcohol spectrum disorders","abstract":"Prenatal alcohol exposure (PAE) can cause lasting physical damage to the developing foetusincluding the brain. This brain damage can manifest as cognitive dysfunction and behaviouraldifficulties, which can be diagnosed as foetal alcohol spectrum disorders (FASD). FASD is thought tobe common in the UK, with estimates ranging from 3.24% up to 17% of the population affected,although rates of diagnosis are much lower than this. Children with FASD are at increased risk of arange of traumatic or adverse childhood experiences, such as neglect or abuse. Studies into the longtermeffects of neglect or abuse show a similar range of cognitive dysfunction and behaviouraldifficulties as those seen in FASD, but there is a lack of evidence on the impact of a dual exposure ofPAE and trauma. This is especially necessary for clinicians, who may need to use the presence oftrauma to inform and potentially exclude a diagnosis on the foetal alcohol spectrum. This aim of thisthesis was to investigate the impact of childhood trauma on the cognitive and behaviouralfunctioning of children with FASD. A wide-ranging overview of the literature on the effects of PAEand trauma as separate exposures was conducted and was followed by a systematic literaturereview of studies into the dual exposure of PAE and trauma. The reviews showed that only fivestudies had investigated the impact of both exposures, although one further study was publishedmore recently. The literature reviews, including the one new study showed that, although there hadonly been a small number of studies conducted, a pattern was emerging that children with bothFASD and trauma were more similar to children with just FASD than they were to children with justtrauma, in terms of their cognitive and behavioural functioning.The findings of the reviews were used to develop four original studies, which advanced theevidence in this area. The studies were designed to assess the damage caused by dual exposure atfour levels: neurological, cognitive, behavioural, and finally the effect of behavioural problems onother people. A neuroimaging study measured task-related blood oxygenation in the prefrontalcortex in 15 children aged 8-14 years with FASD with and without a history of trauma. A series ofcognitive tasks assessed verbal, non-verbal and overall intelligence, working memory and inhibitorycontrol in 25 children aged 8-14 years with FASD with and without a history of trauma. Aninformant-report survey that assessed Adverse Childhood experiences, cognitive, affective andoverall empathy, behavioural strengths and difficulties, and comorbid diagnoses was completed bythe carers of children aged 4-16 years with FASD. A series of semi-structured interviews wasconducted with caregivers of children aged 8-14 years with FASD, with and without a history oftrauma.Children with FASD had high levels of adverse childhood experiences including neglect andabuse, poor empathy, high levels of behavioural difficulties, and high levels of comorbid diagnoses,particularly attention deficit hyperactivity disorder (ADHD). They also had verbal, non-verbal andoverall intelligence in the average range, and working memory and inhibitory control scores thatwere similar to the scores of typically developing children of the same age. Children with both FASDand a history of trauma were found not to be significantly different from children with FASD withouttrauma in terms of their task-related prefrontal activity, verbal, non-verbal and overall intelligence,working memory, inhibitory control, and empathy. There was a slight tendency for children withhigher numbers of adverse childhood experiences to exhibit more severe behavioural difficulties,particularly conduct problems. Caregivers of children with both exposures described experienceswith the same themes as those whose children had FASD without trauma. Caregivers described theirchildren as difficult to manage, but also described many strengths and rewarding moments.Caregivers were critical of service providers including medical and educational services, socialservices, adoption agencies and local authorities, who lacked knowledge and understanding of FASD.This led to their children being misunderstood and offered insufficient or inappropriate services.The findings of this thesis support previous research showing that children with FASD havehigh levels of behavioural difficulties, poor empathy, and high levels of comorbid diagnoses. Itprovides the first data on levels of adverse childhood experiences in children with FASD, which arealso high. The main finding of the thesis is that the impact of traumatic childhood experiences on thecognitive and behavioural functioning of children with FASD may be very subtle, especially in termsof cognitive functioning. Clinicians and other professionals should be aware that a history of neglector abuse does not appear to be a better explanation for cognitive dysfunction or behaviouraldifficulties than prenatal alcohol exposure. Where children have a history of both exposures, theyshould primarily be treated as children with FASD, and provided appropriate support andinterventions specifically designed for FASD.","abstract_html":"Prenatal alcohol exposure (PAE) can cause lasting physical damage to the developing foetusincluding the brain. This brain damage can manifest as cognitive dysfunction and behaviouraldifficulties, which can be diagnosed as foetal alcohol spectrum disorders (FASD). FASD is thought tobe common in the UK, with estimates ranging from 3.24% up to 17% of the population affected,although rates of diagnosis are much lower than this. Children with FASD are at increased risk of arange of traumatic or adverse childhood experiences, such as neglect or abuse. Studies into the longtermeffects of neglect or abuse show a similar range of cognitive dysfunction and behaviouraldifficulties as those seen in FASD, but there is a lack of evidence on the impact of a dual exposure ofPAE and trauma. This is especially necessary for clinicians, who may need to use the presence oftrauma to inform and potentially exclude a diagnosis on the foetal alcohol spectrum. This aim of thisthesis was to investigate the impact of childhood trauma on the cognitive and behaviouralfunctioning of children with FASD. A wide-ranging overview of the literature on the effects of PAEand trauma as separate exposures was conducted and was followed by a systematic literaturereview of studies into the dual exposure of PAE and trauma. The reviews showed that only fivestudies had investigated the impact of both exposures, although one further study was publishedmore recently. The literature reviews, including the one new study showed that, although there hadonly been a small number of studies conducted, a pattern was emerging that children with bothFASD and trauma were more similar to children with just FASD than they were to children with justtrauma, in terms of their cognitive and behavioural functioning.The findings of the reviews were used to develop four original studies, which advanced theevidence in this area. The studies were designed to assess the damage caused by dual exposure atfour levels: neurological, cognitive, behavioural, and finally the effect of behavioural problems onother people. A neuroimaging study measured task-related blood oxygenation in the prefrontalcortex in 15 children aged 8-14 years with FASD with and without a history of trauma. A series ofcognitive tasks assessed verbal, non-verbal and overall intelligence, working memory and inhibitorycontrol in 25 children aged 8-14 years with FASD with and without a history of trauma. Aninformant-report survey that assessed Adverse Childhood experiences, cognitive, affective andoverall empathy, behavioural strengths and difficulties, and comorbid diagnoses was completed bythe carers of children aged 4-16 years with FASD. A series of semi-structured interviews wasconducted with caregivers of children aged 8-14 years with FASD, with and without a history oftrauma.Children with FASD had high levels of adverse childhood experiences including neglect andabuse, poor empathy, high levels of behavioural difficulties, and high levels of comorbid diagnoses,particularly attention deficit hyperactivity disorder (ADHD). They also had verbal, non-verbal andoverall intelligence in the average range, and working memory and inhibitory control scores thatwere similar to the scores of typically developing children of the same age. Children with both FASDand a history of trauma were found not to be significantly different from children with FASD withouttrauma in terms of their task-related prefrontal activity, verbal, non-verbal and overall intelligence,working memory, inhibitory control, and empathy. There was a slight tendency for children withhigher numbers of adverse childhood experiences to exhibit more severe behavioural difficulties,particularly conduct problems. Caregivers of children with both exposures described experienceswith the same themes as those whose children had FASD without trauma. Caregivers described theirchildren as difficult to manage, but also described many strengths and rewarding moments.Caregivers were critical of service providers including medical and educational services, socialservices, adoption agencies and local authorities, who lacked knowledge and understanding of FASD.This led to their children being misunderstood and offered insufficient or inappropriate services.The findings of this thesis support previous research showing that children with FASD havehigh levels of behavioural difficulties, poor empathy, and high levels of comorbid diagnoses. Itprovides the first data on levels of adverse childhood experiences in children with FASD, which arealso high. The main finding of the thesis is that the impact of traumatic childhood experiences on thecognitive and behavioural functioning of children with FASD may be very subtle, especially in termsof cognitive functioning. Clinicians and other professionals should be aware that a history of neglector abuse does not appear to be a better explanation for cognitive dysfunction or behaviouraldifficulties than prenatal alcohol exposure. Where children have a history of both exposures, theyshould primarily be treated as children with FASD, and provided appropriate support andinterventions specifically designed for FASD.","abstract_has_math":false,"creators":["Price, Alan"],"institution":null,"degree_name":null,"degree_level":"Doctoral (Level 8)","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2026,"date_issued":"2026","date_published":"2026","updated_at":"2026-07-24T04:26:20Z","subjects":[],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["oai:salford-repository.worktribe.com:1367577"],"render_values":[{"text":"oai:salford-repository.worktribe.com:1367577","href":null,"code":true}]},{"key":"dc:creator.authoridentifier","label":"Author Identifier","values":["0000-0002-3208-7214"],"render_values":[{"text":"0000-0002-3208-7214","href":"https://orcid.org/0000-0002-3208-7214","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.17866/fjnm-h491","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.sponsor","label":"Sponsor","values":["University of Salford"]},{"key":"dc:creator","label":"Author","values":["Price, Alan"]},{"key":"dc:creator.authoridentifier","label":"Author Identifier","values":["0000-0002-3208-7214"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2026-07-24"]},{"key":"dc:date.issued","label":"Date","values":["2026"]},{"key":"dc:relation.isreferencedby","label":"Dc Relation Isreferencedby","values":["https://salford-repository.worktribe.com/output/1367577"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral (Level 8)"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["oai:salford-repository.worktribe.com:1367577","https://doi.org/10.17866/fjnm-h491"]},{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://salford-repository.worktribe.com/file/1367577/1/Alan%20Price%20corrected%20thesis.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Prenatal alcohol exposure (PAE) can cause lasting physical damage to the developing foetusincluding the brain. This brain damage can manifest as cognitive dysfunction and behaviouraldifficulties, which can be diagnosed as foetal alcohol spectrum disorders (FASD). FASD is thought tobe common in the UK, with estimates ranging from 3.24% up to 17% of the population affected,although rates of diagnosis are much lower than this. Children with FASD are at increased risk of arange of traumatic or adverse childhood experiences, such as neglect or abuse. Studies into the longtermeffects of neglect or abuse show a similar range of cognitive dysfunction and behaviouraldifficulties as those seen in FASD, but there is a lack of evidence on the impact of a dual exposure ofPAE and trauma. This is especially necessary for clinicians, who may need to use the presence oftrauma to inform and potentially exclude a diagnosis on the foetal alcohol spectrum. This aim of thisthesis was to investigate the impact of childhood trauma on the cognitive and behaviouralfunctioning of children with FASD. A wide-ranging overview of the literature on the effects of PAEand trauma as separate exposures was conducted and was followed by a systematic literaturereview of studies into the dual exposure of PAE and trauma. The reviews showed that only fivestudies had investigated the impact of both exposures, although one further study was publishedmore recently. The literature reviews, including the one new study showed that, although there hadonly been a small number of studies conducted, a pattern was emerging that children with bothFASD and trauma were more similar to children with just FASD than they were to children with justtrauma, in terms of their cognitive and behavioural functioning.The findings of the reviews were used to develop four original studies, which advanced theevidence in this area. The studies were designed to assess the damage caused by dual exposure atfour levels: neurological, cognitive, behavioural, and finally the effect of behavioural problems onother people. A neuroimaging study measured task-related blood oxygenation in the prefrontalcortex in 15 children aged 8-14 years with FASD with and without a history of trauma. A series ofcognitive tasks assessed verbal, non-verbal and overall intelligence, working memory and inhibitorycontrol in 25 children aged 8-14 years with FASD with and without a history of trauma. Aninformant-report survey that assessed Adverse Childhood experiences, cognitive, affective andoverall empathy, behavioural strengths and difficulties, and comorbid diagnoses was completed bythe carers of children aged 4-16 years with FASD. A series of semi-structured interviews wasconducted with caregivers of children aged 8-14 years with FASD, with and without a history oftrauma.Children with FASD had high levels of adverse childhood experiences including neglect andabuse, poor empathy, high levels of behavioural difficulties, and high levels of comorbid diagnoses,particularly attention deficit hyperactivity disorder (ADHD). They also had verbal, non-verbal andoverall intelligence in the average range, and working memory and inhibitory control scores thatwere similar to the scores of typically developing children of the same age. Children with both FASDand a history of trauma were found not to be significantly different from children with FASD withouttrauma in terms of their task-related prefrontal activity, verbal, non-verbal and overall intelligence,working memory, inhibitory control, and empathy. There was a slight tendency for children withhigher numbers of adverse childhood experiences to exhibit more severe behavioural difficulties,particularly conduct problems. Caregivers of children with both exposures described experienceswith the same themes as those whose children had FASD without trauma. Caregivers described theirchildren as difficult to manage, but also described many strengths and rewarding moments.Caregivers were critical of service providers including medical and educational services, socialservices, adoption agencies and local authorities, who lacked knowledge and understanding of FASD.This led to their children being misunderstood and offered insufficient or inappropriate services.The findings of this thesis support previous research showing that children with FASD havehigh levels of behavioural difficulties, poor empathy, and high levels of comorbid diagnoses. Itprovides the first data on levels of adverse childhood experiences in children with FASD, which arealso high. The main finding of the thesis is that the impact of traumatic childhood experiences on thecognitive and behavioural functioning of children with FASD may be very subtle, especially in termsof cognitive functioning. Clinicians and other professionals should be aware that a history of neglector abuse does not appear to be a better explanation for cognitive dysfunction or behaviouraldifficulties than prenatal alcohol exposure. Where children have a history of both exposures, theyshould primarily be treated as children with FASD, and provided appropriate support andinterventions specifically designed for FASD."]},{"key":"dc:title","label":"Title","values":["The impact of traumatic childhood experiences on cognitive and behavioural functioning in children with foetal alcohol spectrum disorders"]}]}],"canonical_facts":{"dc:contributor.sponsor":["University of Salford"],"dc:creator":["Price, Alan"],"dc:creator.authoridentifier":["0000-0002-3208-7214"],"dc:date":["2026-07-24"],"dc:date.issued":["2026"],"dc:description.abstract":["Prenatal alcohol exposure (PAE) can cause lasting physical damage to the developing foetusincluding the brain. This brain damage can manifest as cognitive dysfunction and behaviouraldifficulties, which can be diagnosed as foetal alcohol spectrum disorders (FASD). FASD is thought tobe common in the UK, with estimates ranging from 3.24% up to 17% of the population affected,although rates of diagnosis are much lower than this. Children with FASD are at increased risk of arange of traumatic or adverse childhood experiences, such as neglect or abuse. Studies into the longtermeffects of neglect or abuse show a similar range of cognitive dysfunction and behaviouraldifficulties as those seen in FASD, but there is a lack of evidence on the impact of a dual exposure ofPAE and trauma. This is especially necessary for clinicians, who may need to use the presence oftrauma to inform and potentially exclude a diagnosis on the foetal alcohol spectrum. This aim of thisthesis was to investigate the impact of childhood trauma on the cognitive and behaviouralfunctioning of children with FASD. A wide-ranging overview of the literature on the effects of PAEand trauma as separate exposures was conducted and was followed by a systematic literaturereview of studies into the dual exposure of PAE and trauma. The reviews showed that only fivestudies had investigated the impact of both exposures, although one further study was publishedmore recently. The literature reviews, including the one new study showed that, although there hadonly been a small number of studies conducted, a pattern was emerging that children with bothFASD and trauma were more similar to children with just FASD than they were to children with justtrauma, in terms of their cognitive and behavioural functioning.The findings of the reviews were used to develop four original studies, which advanced theevidence in this area. The studies were designed to assess the damage caused by dual exposure atfour levels: neurological, cognitive, behavioural, and finally the effect of behavioural problems onother people. A neuroimaging study measured task-related blood oxygenation in the prefrontalcortex in 15 children aged 8-14 years with FASD with and without a history of trauma. A series ofcognitive tasks assessed verbal, non-verbal and overall intelligence, working memory and inhibitorycontrol in 25 children aged 8-14 years with FASD with and without a history of trauma. Aninformant-report survey that assessed Adverse Childhood experiences, cognitive, affective andoverall empathy, behavioural strengths and difficulties, and comorbid diagnoses was completed bythe carers of children aged 4-16 years with FASD. A series of semi-structured interviews wasconducted with caregivers of children aged 8-14 years with FASD, with and without a history oftrauma.Children with FASD had high levels of adverse childhood experiences including neglect andabuse, poor empathy, high levels of behavioural difficulties, and high levels of comorbid diagnoses,particularly attention deficit hyperactivity disorder (ADHD). They also had verbal, non-verbal andoverall intelligence in the average range, and working memory and inhibitory control scores thatwere similar to the scores of typically developing children of the same age. Children with both FASDand a history of trauma were found not to be significantly different from children with FASD withouttrauma in terms of their task-related prefrontal activity, verbal, non-verbal and overall intelligence,working memory, inhibitory control, and empathy. There was a slight tendency for children withhigher numbers of adverse childhood experiences to exhibit more severe behavioural difficulties,particularly conduct problems. Caregivers of children with both exposures described experienceswith the same themes as those whose children had FASD without trauma. Caregivers described theirchildren as difficult to manage, but also described many strengths and rewarding moments.Caregivers were critical of service providers including medical and educational services, socialservices, adoption agencies and local authorities, who lacked knowledge and understanding of FASD.This led to their children being misunderstood and offered insufficient or inappropriate services.The findings of this thesis support previous research showing that children with FASD havehigh levels of behavioural difficulties, poor empathy, and high levels of comorbid diagnoses. Itprovides the first data on levels of adverse childhood experiences in children with FASD, which arealso high. The main finding of the thesis is that the impact of traumatic childhood experiences on thecognitive and behavioural functioning of children with FASD may be very subtle, especially in termsof cognitive functioning. Clinicians and other professionals should be aware that a history of neglector abuse does not appear to be a better explanation for cognitive dysfunction or behaviouraldifficulties than prenatal alcohol exposure. Where children have a history of both exposures, theyshould primarily be treated as children with FASD, and provided appropriate support andinterventions specifically designed for FASD."],"dc:identifier":["oai:salford-repository.worktribe.com:1367577","https://doi.org/10.17866/fjnm-h491"],"dc:identifier.uri":["https://salford-repository.worktribe.com/file/1367577/1/Alan%20Price%20corrected%20thesis.pdf"],"dc:language":["en"],"dc:relation.isreferencedby":["https://salford-repository.worktribe.com/output/1367577"],"dc:title":["The impact of traumatic childhood experiences on cognitive and behavioural functioning in children with foetal alcohol spectrum disorders"],"dc:type":["Thesis"],"dc:type.qualificationlevel":["Doctoral (Level 8)"]},"updated_at":"2026-07-24T04:26:20Z"}