Validity and Reliability of Executive Function Measures in Children With Heavy Prenatal Alcohol Exposure: Correspondence Between Multiple Raters and Laboratory Measures

• Published in: Alcoholism, clinical and experimental research Vol. 45; no. 3; pp. 596 - 607
• Main Authors: Bernes, Gemma A., Villodas, Miguel, Coles, Claire D., Kable, Julie A., May, Philip A., Kalberg, Wendy O., Sowell, Elizabeth R., Jones, Kenneth L., Riley, Edward P., Mattson, Sarah N.
• Format: Journal Article
• Language: English
• Published: England 01.03.2021
• Subjects: Adolescent; Alcohol Drinking - adverse effects; Alcohol Drinking - psychology; Attention Deficit Disorder with Hyperactivity; Behavior Rating Scale - standards; Behavior Rating Scales; Child; Clinical Laboratory Techniques - standards; Executive Function; Executive Function - physiology; Female; Fetal Alcohol Spectrum Disorders; Fetal Alcohol Spectrum Disorders - diagnosis; Fetal Alcohol Spectrum Disorders - psychology; Humans; Interrater Agreement; Male; Neuropsychological Tests - standards; Pregnancy; Prenatal Exposure Delayed Effects - diagnosis; Prenatal Exposure Delayed Effects - psychology; Reproducibility of Results; Validity; Validity; Behavior Rating Scales; Interrater Agreement; Executive Function; Fetal Alcohol Spectrum Disorders
• ISSN: 0145-6008; 1530-0277; 1530-0277
• DOI: 10.1111/acer.14547

Background Rating scales are designed to complement traditional performance‐based measures, and both can provide useful information about the functioning of youth with histories of prenatal alcohol exposure. Few studies, however, have compared ratings from multiple informants or the relationship between these subjective rating scale scores and the objective results from laboratory performance‐based scales. Methods The current study addressed both of these questions in 3 study groups: children with histories of prenatal alcohol exposure (n = 47), attention‐deficit/hyperactivity disorder (ADHD; n = 41), and typically developing controls (CON; n = 73). All subjects completed a standardized neuropsychological test battery, including laboratory measures of executive functioning and a self‐report measure of executive function behaviors. Parents and teachers completed corresponding rating scales of executive function behaviors for each subject. This study assessed the relationship between these behavior rating scales and corresponding neuropsychological tests, and interrater agreement among the multiple informants. Results Weak correlations were found between the rating scales and laboratory measures, indicating poor convergent validity for the behavior rating scale. Interrater reliability was found but it differed by group. Agreement was found between parent and teacher ratings for children with prenatal alcohol exposure, whereas teacher–child agreement was found for those with ADHD. Conclusions Findings from this study indicate that behavior ratings can be used to supplement laboratory measures but may not be measuring cognitive abilities regardless of whether a clinical diagnosis is present. A multimethod approach should be used when measuring skills in this domain. This was one of the first studies to examine cross‐informant agreement in a sample of children with prenatal alcohol exposure. Further research is necessary to understand why interrater agreement differed for children with prenatal alcohol exposure and those with ADHD. This study assessed the relationship between behavior ratings of executive function and neuropsychological measures in children with prenatal alcohol exposure (AE), attention‐deficit/hyperactivity disorder (ADHD), and typically developing controls (CON). Weak correlations were found between the two types of measures. Parent‐teacher agreement was significant for the AE group, not significant for the ADHD group, and mixed for the CON group. Findings reveal that parents and teachers of alcohol‐exposed children report similar difficulties but emphasize the importance of using a multi‐method approach when determining deficits in this domain.