Neurobehavioral outcomes associated with prenatal alcohol exposure range from severe intellectual deficiency to subtle attention and motor deficits. Fetal Alcohol Spectrum Disorders (FASD) are a major public health concern, with prevalence as high as 1 in 100 live births. Early identification can lead to better outcomes;however, diagnosis of individuals with FASD can be challenging especially when physical markers are absent or prenatal histories are unavailable. In addition, due to neurobehavioral similarities, individuals with FASD and those with Attention-Deficit/Hyperactivity Disorder (ADHD) can be confused clinically, making differential diagnosis difficult. Recent research has recommended that identification of FASD be based on a neurobehavioral profile. However, some neurocognitive domains, including decision making, have received little attention. Emotion-based decision making involves strategic adaptation of behavior based on uncertain information and is essential for everyday function. Deficits in decision making in individuals with FASD are suggested by neuroanatomical abnormalities and difficulty with everyday function. The Iowa Gambling Task (IGT) is a widely used measure of decision making, simulating unpredictable reward and punishment contingencies of complex decision making and has not been used in alcohol-exposed populations. In addition, because emotion-based decision making is a higher-order function, dependent on subprocessing and parallel processing, dysfunction in another cognitive domain may contribute to decision making deficits. Specifically, intact working memory (WM), the process of temporarily storing and manipulating information, is necessary for effective decision making. The current study includes a well-matched WM task to allow for examination of the influence of WM on decision making, while also controlling for other task related factors. The overarching goal of the current study is to characterize decision making deficits and improve differential diagnosis of FASD. Thus, children with FASD, ADHD, and typically developing age-matched controls will be assessed using a computerized version of the IGT and a wellmatched measure of WM.
The specific aims of this proposal are to (1) investigate decision making in children with FASD, ADHD and typically developing controls and (2) consider the relative contribution of WM impairments to decision making across groups. This project is directly relevant to public health concerns surrounding the effects of heavy prenatal alcohol exposure, improving diagnosis of alcohol-affected individuals, and defining the profile of neurobehavioral effects that are specific to FASD. Improved identification and delineation of these features ultimately will lead to improved treatment.