TABLE 3

Developmental Emergence of Neurocognitive and Behavioral Deficits Associated With FASD

Infancy: 0–2 y
Areas of Brain Vulnerability in FASDNeurocognitive/Behavioral Deficits Associated With Developmental Stage
• Cortical synaptogenesisNeurocognitive• Delayed cognitive development or global developmental delay
• Development of cortical gray matter
• Myelination of sensory pathwaysSelf-Regulation• Tremulousness, increased jitteriness
• Maturation of the limbic system• Difficulty with self-soothing, and being soothed
• Emotional withdrawal, decreased infant affective functioning
• Impaired stress reactivity; deficits in pain regulation
• Less complex play
• Myelination of motor pathwaysAdaptive• Delayed gross and fine motor milestones
• Poor feeding: poor sucking. Easily fatigued
Toddler/Preschool: 3–5 y
Areas of Brain Vulnerability in FASDNeurocognitive/Behavioral Deficits Associated With Developmental Stage
• SynaptogenesisNeurocognitive• Delayed cognitive development or global developmental delay
• Development of cortical gray matter
• Development of prefrontal cortexSelf-Regulation• Attention: difficulties with attention regulation; hyperactivity and impulsivity; difficulty shifting attention; impaired visual and auditory attention; difficulty with sustained attention
• Executive function: difficulty encoding information; difficulty with multistep directions; difficulty with planning and organization; poor understanding of consequences
• Development of temporal lobes• Sleep deficits: shortened sleep duration; increased sleep anxiety; parasomnias
• Sensory processing: difficulty modulating sensory input; sensory seeking
• Development of dorsal motor cortexAdaptive• Delayed gross motor function: balance, coordination problems; “clumsiness”
• Poor fine motor skills: difficulty with writing/drawing; poor dexterity; visual-spatial deficits; impaired visual-motor coordination
• Development of temporal lobes• Delayed auditory processing: central auditory delay
• Speech and language deficits: difficulties with language acquisition; receptive, expressive language delays; deficits in word processing/word recognition; articulation errors; deficits in social pragmatics
• Memory deficits: difficulty remembering things previously learned
School-age: 6–12 y
Areas of Brain Vulnerability in FASDNeurocognitive/Behavioral Deficits Associated With Developmental Stage
• Decreased intracranial volume:Neurocognitive• Lower intellectual quotient
 • Decreased volume of parietal and temporal lobes• Learning disabilities
 • White matter abnormalities• Deficits in mathematics (numerical operations/global mathematics skills)
• Prefrontal cortexSelf-Regulation• Executive function deficits: decreased working memory, decreased verbal fluency, poorer planning, sequencing, organization
• Attention deficits: hyperactivity; impulsivity
• Temporal lobeAdaptive• Language: deficits in higher order language processing
• Social pragmatics: deficits in social cognition: inappropriate social initiation/social interaction; inappropriate sexual behaviors
• Memory: difficulty encoding/consolidating new memory
• Parietal lobe• Language processing: impaired gestural communication; deficits in social perception
• Visual-spatial: deficits in spatial processing; poor handwriting; impaired visual-motor integration
Adolescence: 13–21 y
Areas of Brain Vulnerability in FASDNeurocognitive/Behavioral Deficits Associated With Developmental Stage
• Decreased intracranial volume:Neurocognitive• Lower intellectual quotient
 • Decreased volume of parietal and temporal lobes• Learning disabilities
 • White matter abnormalities• Deficits in mathematics skills (numerical operations/global mathematics skills)
• Myelination of prefrontal cortex (PFC)Self-Regulation• Executive function deficits: decreased verbal fluency, poorer planning, sequencing, organization; slow processing; deficits in judgment and metacognition
• Development of connections between PFC and basal ganglia• Attention deficits: inattention
• Temporal lobeAdaptive• Language: deficits in higher order language processing
• Social pragmatics: deficits in social cognition: inappropriate social initiation/social interaction; inappropriate sexual behaviors
• Working memory: difficulty encoding new memories; difficulty with memory recall
• Parietal lobe• Language processing: deficits in social perception
• Visual-spatial: deficits in spatial processing; poor handwriting; impaired visual-motor integration