https://orcid.org/0000-0003-4148-2643
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ABSTRACT
Purpose
To date, research on effects of prenatal alcohol exposure (PAE) has focused on a broad range of cognitive impairments, but relatively few studies have examined effects of PAE on development of reading skills. Although PAE has been linked to poorer reading comprehension, it remains unclear whether this impairment is attributable to deficits in phonological processing, word reading, oral language skills, and/or executive functioning.
Methods
A comprehensive reading battery was administered to 10 adolescents with fetal alcohol syndrome (FAS); 16 with partial FAS; 30 nonsyndromal heavily exposed; 49 controls.
Results
PAE was related to poorer reading comprehension but not to single-word reading or phonological processing, suggesting that the mechanics of reading are intact in adolescents with fetal alcohol spectrum disorders at this age. PAE-related impairment in reading comprehension was mediated, in part, by deficits in mastery of oral language skills, including vocabulary, language structure, and verbal fluency.
Conclusions
These results are consistent with research showing that reading comprehension in adolescence relies increasingly on linguistic comprehension abilities, especially once word reading becomes automatic and text complexity increases. Our findings suggest that reading-impaired adolescents with PAE will benefit from intervention programs targeting vocabulary knowledge, language structure, verbal fluency, and reading comprehension skills.
Acknowledgments
We thank our University of Cape Town and Wayne State University research staff, Maggie September, Beverly Arendse, Patricia Solomon, and Renee Sun, for their work on participant recruitment and data collection. We also thank H. Eugene Hoyme, M.D., Luther Robinson, M.D., and Nathaniel Khaole, M.D., who examined the children at the FASD dysmorphology clinics we conducted in 2005 and 2009; H.E. Hoyme, M.D., Greetje DeJong, M.D., and Prachi Shah, M.D., at the 2013 clinic; and H.E. Hoyme, M.D., Greetje DeJong, M.D., R. Colin Carter, M.D., M.M.Sc., Heidre Bezuidenhout, M.D., and Emma Krzesinski, at the 2016 clinic. We greatly appreciate the contributions of the mothers and children for their long-term participation in the study.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1. Maternal reported drinking levels were highly correlated between the first and second interviews (r=0.93, p<0.001) and between the second and the third interviews (r=0.79, p<0.001).
2. All 105 mothers included in the final sample were interviewed regarding their current alcohol consumption and retrospectively regarding their alcohol consumption during pregnancy using timeline follow-up interviews. They were also administered the Structured Clinical Interview for DSM-IV Disorders (SCID-I; First et al., Citation1995) to diagnose lifetime alcohol abuse and/or dependence and were asked how many years they had been drinking and the largest quantity of alcohol they had consumed on a single occasion. To provide a reliable estimate of PAE for the newly recruited adolescents, data from the prospectively recruited mothers were examined in linear regression models constructed to “predict” their alcohol use during pregnancy from current drinking, retrospectively reported drinking during pregnancy, history of alcohol abuse or dependence (yes/no), years of drinking, and most drinks on a single occasion. Multiple Rs for AA/day, AA/occasion, and days/week of drinking were 0.68, 0.66, and 0.76, respectively. These regression models were then used to estimate the three measures of maternal alcohol use during pregnancy for the participants recruited during adolescence.
3. The mothers were interviewed in their preferred language. Although a large majority of the mothers (n=83; 79.0%) were interviewed in Afrikaans, English was the principal language of instruction in school for a majority of the children (n=67; 63.8%). All of the children whose mothers were interviewed partly (n=7; 10.4%) or completely (n=15; 22.4%) in English were enrolled in schools in which English was the primary language of instruction. Among the 83 children born to mothers who were interviewed primarily in Afrikaans, a large majority (n=45; 76.2%) were enrolled in schools where English was the primary language. Thus, there was a discrepancy between home and school language in 45 of the 105 adolescents (42.9%) in this sample. However, there was no difference in reading comprehension between the adolescents whose language of instruction was the same as their home language and those for whom it was not (t=1.22, p=0.226).
4. The correlation between the two test scores that comprised the Working Measure composite was r = 0.57, p<0.001. All but one of the six intercorrelations among the four measures that comprised the Cognitive Control composite were significant at p<0.01; r’s ranged from 0.13 to 0.54 (median = 0.39, p<0.001). All but 1 of the 15 intercorrelations among the 6 measures that constituted the Verbal Fluency composite were significant at p<0.01; r’s ranged from 0.09 to 0.56 (median = 0.41, p<0.001). The correlations across age for the 6 executive function tests that were administered at 10 and 16 years ranged from 0.32 to 0.56, all p’s<0.01.