Improving Executive Functioning in Children with Fetal Alcohol Spectrum Disorders using the Alert Program for Self Regulation®
The chronic and severe executive functioning (EF) and self regulation deficits experienced by children with fetal alcohol spectrum disorders (FASD) are well documented and EF and self regulation have been identified as core targets for intervention. The goals of this dissertation were to: (i) examine the effects of a self regulation treatment for children with FASD on a range of EF measures (ii) examine neural markers of treatment outcome and determine if functional magnetic resonance imaging (fMRI) can differentiate treatment responders from nonresponders; (iii) determine if treatment effects generalize to child compliance and qualitatively examine the treatment process. Twenty-five children with FASD participated. Using a wait-list control design children were assigned to an immediate treatment (TXT; n = 12) or delayed treatment control (DTC; n = 13) condition. All children received an evaluation of EF and fMRI at baseline and 12-week follow-up. Parents also completed questionnaires assessing EF and behavior as well as a feedback questionnaire upon completion of treatment. A subset of parents tracked compliance over the course of their child’s therapy. For the TXT group only, parent questionnaires were readministered at 6 month follow-up. At 12-week follow-up, children in the TXT group displayed significant improvements in inhibitory control and social cognition. Additionally, parents reported improved behavioral and emotional regulation. This improvement, along with a further improvement in parent-rated inhibitory control, was maintained at the 6-month follow-up. Neuroplastic changes were also observed as the TXT group showed increased BOLD response in the right prefrontal cortex (PFC) and left caudate on a task of inhibitory control. When treatment responders were compared to nonresponders a pattern of increased BOLD response was found bilaterally in the PFC and left caudate. Compliance tracking revealed that self regulation therapy generalized to improved child compliance at home. Qualitative analysis indicated that perceived clinician competence, caregiver insight about child’s problems and caregiver perceptions of child’s insight about their problems, were the most commonly endorsed themes by caregivers. Results from this research signify that children with FASD are responsive to psychotherapy and following a brief intervention, showed improvements in self regulatory abilities that generalize to other EF areas and parent-reported behaviors.
Fetal Alcohol Spectrum Disorders, Intervention
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