Objective:Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental condition associated with deficits in cognitive functioning (executive functioning [EF], attention, working memory, etc.), behavioral impairments, and abnormalities in brain structure including cortical and subcortical volumes. Rates of comorbid attention-deficit/hyperactivity disorder (ADHD) are high in children with FASD and contribute to significant functional impairments. Sluggish cognitive tempo (SCT) includes a cluster of symptoms (e.g. underactive/slow-moving, confusion, fogginess, daydreaming) found to be related to but distinct from ADHD, and previous research suggests that it may be common in FASD. We explored SCT by examining the relationship between SCT and both brain volumes (corpus callosum, caudate, and hippocampus) and objective EF measures in children with FASD vs. typically developing controls.Participants and Methods:This is a secondary analysis of a larger longitudinal CIFASD study that consisted of 35 children with prenatal alcohol exposure (PAE) and 30 controls between the ages of 9 to 18 at follow-up. Children completed a set of cognitive assessments (WISC-IV, DKEFS, & NIH Toolbox) and an MRI scan, while parents completed the Child Behavior Checklist (CBCL), which includes a SCT scale. We examined group differences between PAE and controls in relation to SCT symptoms, EF scores, and subcortical volumes. Then, we performed within-and between-group comparisons with and without controlling for total intracranial volume, age, attention problems, and ADHD problems between SCT and subcortical brain volumes. Finally, we performed correlations between SCT and EF measures for both groups.Results:Compared to controls, participants with PAE showed significantly more SCT symptoms on the CBCL (t [57] = 3.66, p = 0.0006), more parent-rated attention problems and ADHD symptoms, lower scores across several EF measures (DKEFS Trail-Making and Verbal Fluency; WISC-IV Digit Span, Symbol Search, and Coding; effect sizes ranging from 0.44 to 1.16), and smaller regional volumes in the caudate, hippocampus, and posterior areas of the corpus callosum. In the PAE group, a smaller hippocampus was associated with more SCT symptoms (controlling for parent-rated attention problems and ADHD problems, age, and intracranial volume). However, in the control group, a larger mid posterior and posterior corpus callosum were significantly associated with more SCT symptoms (controlling for parent-rated attention problems, intracranial volume, and age; r [24] = 0.499, p = 0.009; r [24] = 0.517, p = 0.007). In terms of executive functioning, children in the PAE group with more SCT symptoms performed worse on letter sequencing of the Trail-Making subtest (controlling attention problems & ADHD symptoms). In comparison, those in the control group with more SCT symptoms performed better on letter sequencing and combined number letter sequencing of the Trail-Making subtest (controlling attention problems).Conclusions:Findings suggest that children with FASD experience elevated SCT symptoms compared to typically developing controls, which may be associated with worse performance on EF tasks and smaller subcortical volumes (hippocampus) when taking attention difficulties and ADHD symptoms into account. Additional research into the underlying causes and correlates of SCT in FASD could result in improved tailoring of interventions for this population.

中文翻译：

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1 患有胎儿酒精谱系障碍的儿童和青少年认知速度缓慢：与执行功能和皮质下体积的关联

目的：胎儿酒精谱系障碍 (FASD) 是一种常见的神经发育疾病，与认知功能（执行功能 [EF]、注意力、工作记忆等）缺陷、行为障碍以及大脑结构（包括皮质和皮质下体积）异常相关。FASD 儿童合并注意力缺陷/多动障碍 (ADHD) 的比例很高，并会导致严重的功能障碍。认知节奏迟缓 (SCT) 包括一系列与 ADHD 相关但又不同的症状（例如活动不足/行动迟缓、精神错乱、迷糊、做白日梦），之前的研究表明这在 FASD 中可能很常见。我们通过检查 FASD 儿童与典型发育对照儿童的 SCT 与脑体积（胼胝体、尾状核和海马体）和客观 EF 测量之间的关系来探索 SCT。 参与者和方法：这是对更大的纵向 CIFASD 的二次分析该研究由 35 名产前酒精暴露 (PAE) 儿童和 30 名年龄在 9 至 18 岁之间的对照组组成。孩子们完成了一系列认知评估（WISC-IV、DKEFS 和 NIH Toolbox）和 MRI 扫描，而家长则完成了儿童行为检查表 (CBCL)，其中包括 SCT 量表。我们检查了 PAE 和对照组之间在 SCT 症状、EF 评分和皮质下体积方面的组间差异。然后，我们在控制和不控制 SCT 和皮层下脑体积之间的颅内总体积、年龄、注意力问题和 ADHD 问题的情况下进行组内和组间比较。最后，我们对两组的 SCT 和 EF 测量值进行了相关性分析。结果：与对照组相比，患有 PAE 的参与者在 CBCL 上表现出明显更多的 SCT 症状（t [57] = 3.66，p= 0.0006），更多家长评价的注意力问题和 ADHD 症状，多项 EF 指标的得分较低（DKEFS 路径制作和语言流畅性；WISC-IV 数字跨度、符号搜索和编码；效应大小范围从 0.44 到 1.16），尾状核、海马体和胼胝体后部区域的区域体积较小。在 PAE 组中，较小的海马体与更多的 SCT 症状相关（控制了父母评价的注意力问题和 ADHD 问题、年龄和颅内容积）。然而，在对照组中，较大的中后部和后部胼胝体与更多的 SCT 症状显着相关（控制了父母评价的注意力问题、颅内容积和年龄；r[24] = 0.499，p= 0.009;r[24] = 0.517，p= 0.007)。在执行功能方面，具有更多 SCT 症状的 PAE 组儿童在 Trail-Making 子测试（控制注意力问题和 ADHD 症状）的字母排序中表现较差。相比之下，对照组中具有更多 SCT 症状的儿童在 Trail-Making 子测试（控制注意力问题）的字母排序和组合数字字母排序方面表现更好。 结论：研究结果表明，与正常发育的儿童相比，患有 FASD 的儿童经历了更严重的 SCT 症状考虑到注意力困难和 ADHD 症状，这可能与 EF 任务表现较差和皮质下体积（海马体）较小有关。对 FASD 中 SCT 的根本原因和相关性进行更多研究可能会改进针对该人群的干预措施。