Mt. Hope Family Center, University of Rochester, Rochester, New York, USA.
Alcohol Clin Exp Res. 2021 Dec;45(12):2430-2447. doi: 10.1111/acer.14728. Epub 2021 Nov 9.
Fetal alcohol spectrum disorders (FASD) are highly prevalent developmental disabilities associated with prenatal alcohol exposure. In addition to varied strengths and unique talents, people with FASD experience significant challenges, including in adaptive functioning. Adaptive functioning refers to skills related to everyday life such as communication, practical skills, and social skills. For the current review, we aimed to understand how adaptive functioning in FASD compares to that of alcohol nonexposed individuals and those with attention deficit-hyperactivity disorder (ADHD). Additionally, we investigated how this relationship may change based on IQ, executive functioning, and age.
The current review was registered in the International Prospective Register of Systematic Reviews. Studies were eligible for inclusion if they measured adaptive functioning and included an FASD group and at least one eligible comparison group. Articles available in May 2021 in PubMed, PsycInfo, Scopus, and ProQuest Dissertations were searched. Publication bias was assessed using Egger's regression and three-level random effects models were computed for all domains of adaptive functioning. Possible moderation by IQ, executive functioning, and age were investigated when heterogeneity analyses were significant. A post hoc moderation analysis of recruitment method was also completed.
Thirty studies were included. Individuals with FASD had significantly lower adaptive functioning than other groups, with effect sizes ranging from 1.04 to 1.35 compared to alcohol nonexposed groups and from 0.30 to 0.43 compared to ADHD groups. No significant moderating effects were found for IQ or age; executive functioning significantly moderated communication skills in FASD compared to the alcohol nonexposed group. Recruitment method significantly affected this relationship, with larger effect sizes on average found for clinically identified samples than at-risk or population samples.
Individuals with FASD have impairments in adaptive functioning relative to alcohol nonexposed and ADHD groups, regardless of IQ, executive functioning, or age. Limitations of the review include small sample sizes in some comparisons and a limited age range.
胎儿酒精谱系障碍（FASD）是一种与产前酒精暴露相关的高度普遍的发育障碍。除了不同的优势和独特的才能外，患有 FASD 的人还面临着重大挑战，包括适应功能方面的挑战。适应功能是指与日常生活相关的技能，如沟通、实用技能和社交技能。在当前的综述中，我们旨在了解 FASD 患者的适应功能与未接触酒精的个体和注意力缺陷多动障碍（ADHD）患者的适应功能有何不同。此外，我们还研究了这种关系如何根据智商、执行功能和年龄而变化。
本综述已在国际前瞻性系统评价注册中心注册。如果研究测量了适应功能，并包括 FASD 组和至少一个合格的对照组，则符合纳入标准。于 2021 年 5 月在 PubMed、PsycInfo、Scopus 和 ProQuest Dissertations 中搜索了可用的文章。使用 Egger 回归评估发表偏倚，并对所有适应功能领域计算了三级随机效应模型。当异质性分析显著时，研究了智商、执行功能和年龄的可能调节作用。还对招募方法进行了事后调节分析。
共纳入 30 项研究。与未接触酒精的组和 ADHD 组相比，FASD 个体的适应功能明显较低，与未接触酒精的组相比，效应大小范围为 1.04 至 1.35，与 ADHD 组相比，效应大小范围为 0.30 至 0.43。未发现智商或年龄的显著调节作用；与未接触酒精的组相比，执行功能显著调节了 FASD 患者的沟通技能。招募方法显著影响了这种关系，与高危或人群样本相比，平均而言，从临床识别样本中发现的效应大小更大。
与未接触酒精的组和 ADHD 组相比，FASD 个体的适应功能存在障碍，无论智商、执行功能或年龄如何。本综述的局限性包括一些比较的样本量较小以及年龄范围有限。
