Play Behaviors and Executive Function in Children with Fetal Alcohol Spectrum Disorder

• In Event: Poster Session 13
  In Poster Session: PS 13 Topic - Developmental Disabilities

Abstract

Background
Children with fetal alcohol spectrum disorder (FASD) experience a variety of challenges in everyday functioning, with patterns of deficits that include reduced social ability and behavioral control (Garrison et al., 2019). In particular, relative to typical development, children with FASD demonstrate lower play quality (Molteno et al., 2010; Pearton et al., 2014) and deficits in executive function, notably in inhibition, shifting, and emotional control (Kingdon et al., 2016; Rasmussen et al., 2007). It is unknown, however, how play quality and executive function are related in children with FASD. Such an understanding may help direct specific behavioral interventions, particularly because quality of play and executive function each play a role in the broader development of behavior regulation in typical development (Slot et al. 2016). This study tested the association between play behaviors and documented areas of executive dysfunction – inhibition, shifting, and emotional control – in children with FASD.

Methods
Participants with FASD (N=17, 8 female) were ages 4-9 years (M=7.0 years; SD=1.6 years), diagnosed using the 4-digit code system (Astley, 2004). A parent completed the Behavioral Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000). The normative mean of the BRIEF is 50; a T-score of 65 is clinically noteworthy and suggests impairment. The BRIEF subscales of interest were Inhibit, Shift, and Emotional Control. Parent-child dyads were video-recorded during an unstructured, 12-16 minute free-play session with a standardized toy set. Trained and reliable coders coded child play behaviors, adapted from the Child Behavior Rating Scale (Van keer, 2017), yielding persistence (extent to which child continues a play action despite perceived difficulty); involvement (intensity with which child is motivated to participate in play); and initiating activities (extent to which child initiates play activities). Play behaviors were coded in two-minute intervals on a 1-to 5-point Likert scale and averaged across time epochs (Van keer, 2017).

Results
Mean BRIEF and child play scores are in Table 1. Pearson correlation coefficients for BRIEF subscales and child play measures are in Table 2. Overall, children with higher BRIEF-Inhibit, Shift, and Emotional Control scores (poorer executive function) demonstrated worse persistence (ps<.04) and higher levels of involvement (ps<.03) and initiating activities (Inhibit only, p<.01).

Conclusions
Parent-reported difficulty with inhibition, shifting, and emotional control have previously been shown to be clinically elevated in FASD (Mohamed et al., 2019; Rai et al., 2017). In the current study, individual differences in these aspects of everyday executive function were correlated with observer-rated child behaviors during play, including persistence, involvement, and initiating activities. Children with poorer parent-rated executive function were less persistent during play. Further, those with less ability to self-regulate (BRIEF-Inhibit) demonstrated higher observer-rated involvement and activity-initiating; less flexible shifting (BRIEF-Shift) was also associated with higher involvement. These findings suggest that specific immaturities in play are nuanced and may be related to particular elements of executive dysfunction in children with FASD. Further research is needed to determine whether behavioral and emotional supports targeting play may generalize to improvements in aspects of executive function, and vice versa.

Authors

• Julia Mattson, University of Washington
  Presenting Author

• Hannah Mikus, University Of Washington
  Non-Presenting Author

• Natalie Stagnone, University Of Washington
  Non-Presenting Author

• John Thorne, University of Washington
  Non-Presenting Author

• Sara T Kover, University of Washington
  Non-Presenting Author