Executive Functioning and Service Use Among Individuals with Fetal Alcohol Spectrum Disorder
Creators: McNeil, Allison, L
Publisher: name: University of Alberta Library
Year: 2022

<p>In this manuscript-based thesis, I investigated the development of executive functioning (EF) in individuals with FASD, the types and intensity of services individuals with FASD and their caregivers access, and the associations between early EF, adaptive functioning, mental health, and later outcomes among individuals with FASD. Following a review of the relevant literature, two studies are presented. In Study 1, Longitudinal Development of EF Among Individuals with FASD, I investigated the developmental trajectory of EF among 16 individuals with FASD from adolescence (Mage = 13.1 years) into young adulthood (Mage = 19.4 years). EF was measured using both performance-based tasks (NEPSY and D-KEFS) and behavioural reports (BRIEF caregiver form). Associations between early EF skills and later outcomes were also investigated. Later outcomes included a measure of adaptive functioning (ABAS-II) and indicators of mental health (BASC-2). EF skills among this group are generally impaired and stable throughout this developmental period, with mean scores well below the normative average on the majority of measures. Only metacognitive skills, as measured via behavioural reports, increased significantly in severity during young adulthood. Notably, pockets of normative strength were indicated on a performance-based task of switching at both time points, and on a performance-based task of inhibition during young adulthood only. When intraindividual variation was examined, a large portion of the sample evidenced significant change in performance, with 30% experiencing change on the BRIEF and 45% experiencing change on at least one performance-based task. Finally, multiple significant correlations were found between early EF skills and later outcomes, particularly, adaptive functioning. Areas of EF also predicted later adaptive skills. Results highlight important areas of personal strength for this population while also emphasizing the importance of considering the heterogeneity of this disorder. Findings also shed light on important relationships between early EF skills and later functioning. Suggestions for future research and clinical implications are discussed. <br>
    In study two, Supporting Individuals with FASD: Trends in Service Use, I investigated service use trends among the same sample at the same time points. Service use was measured across five domains: medical services, mental health services, social services, educational services, and caregiver services. I then explored the relationships between early EF, mental health, and adaptive functioning and later trends in service use. All services were accessed throughout both adolescence and young adulthood for this population, with education services accessed most frequently at both time points. The frequency of service used remained stable for all services except caregiver services, which increased significantly during young adulthood. Multiple significant associations were also found between early EF, adaptive skills, and mental health functioning and later service use. Findings highlight the importance of early functioning and the relationships with later supports. Suggestions for future research and clinical implications are discussed.</p>