Psychology of Teenage Pregnancy and Fetal Alcohol Syndrome - Essay Example

Psychology of Teenage Pregnancy and Fetal Alcohol Syndrome Different studies assert that pregnancy is a period of dramatic changes in woman's life. It is a crisis time, when the woman goes through deep psychological changes, and makes absolute revision of her attitude towards herself and her own identity. These changes are usually described for adult women, but when the same process is happening to an adolescent, 'the effect is often magnified'. (Cobliner 1994, p. 18) One of the important issues, relating to the problem of teenage pregnancy, is the sexual activity of young girls, which has become the norm, and not the exception. This tendency is clearly observed in most communities. According to the recent studies, 45% of the girls between 15 and 18 are sexually active, and 36% of them became pregnant in the first two years of their sexual experience. (Jessor 2004, p. 45) The reasons for teenage pregnancy and fetal alcohol syndrome are mostly psychological and social, and it is understandable, that the influence and effects of teenage pregnancy may become terrible for young girls, if not properly treated. It is also important to note the psychological consequences of both teenage pregnancy and FAS; they may display themselves far long after the child is born. First of all, one of the most important results of the adolescent pregnancy is that children often quit their studies and leave schools. It is often an inevitable action for the young girl. In connection with this, Shonfeld and Mattson (2005) write, that 'the socialization deficits and views on stealing and obeying the law may serve as early indicators of later maladaptive behaviour. In terms of the overall moral maturity score, it is possible that this global measure is not sensitive enough in detecting delinquency in youth with prenatal alcohol exposure.' (Schonfeld & Mattson 2005, p. 24) What is meant here is that leaving school causes the lack of communication and socialization, which in its turn leads to the alcohol intake of a pregnant girl, which is destructive for her future child. The problematic issue is whether the young girl will be able to go successfully through her pregnancy, as well as the proper bringing out and caring for the child. It is a well-known fact, that pregnancy is always a period of exaggerated emotions for the future mother, even if her conditions are optimal, which cannot be said about most pregnant adolescents. The time of pregnancy is the period of absolute physical and psychological changes, and these changes are even more vivid with the young teenage girls. Schonfeld and Mattson also write in their article: 'As a developmental phase, adolescence is positioned between childhood and adulthood. Conventional theory holds that adolescence is a time during which teenagers assert their sense of identity, rebelling from the control and authority of their parents. Thus, it is not unusual to encounter a high degree of emotional turmoil in the adolescent. When a teenager becomes pregnant, however, the continuity of both the physical and the psychological growth is abruptly interrupted.' (Schonfeld & Mattson 2005, p. 24) This is also one of the main causes for the pregnant girl drinking too much alcohol, which finally leads to the FAS and thus to the most negative consequences for the child. The psychological consequences of the adolescent pregnancy are various and vary in the wide range. Pregnancy is altering the conscience of the young girl, and thus she becomes preoccupied with different dreams and fantasies in relation to her future infant. But all these fantasies towards an adolescent are always much exaggerated, especially when the pregnancy was not planned (which is the most common situation). 'The emotional confusion that surfaces in the pregnant woman may also cause her to blur the boundaries between 'self' and 'other'. (Blos, 1980) With the child developing in the girl's body, their identities often tend to merge, which happens on psychological and also on the physical level. But this sense of merging will have its resolution at the moment the child is born, and thus the separation of mother and the child occurs. At times this process is too painful for the young mother, and she goes much harder through it, than it could happen to an adult. Speaking about fetal alcohol syndrome (FAS), it should be remembered, that alcohol is a drug, as any other drug. But it is used so often, that people often forget about it being a drug. The negative tendency displays itself in the fact that more than 60 percent of teenage girls drink and about a quarter of them have an alcoholic addiction. (Chapar 1995, p. 280) In their work on FAS, Schonfeld and Mattson note, that 'FAS is caused by heavy alcohol consumption during pregnancy and is an entirely preventable developmental disability. The fact that prenatal alcohol exposure can produce adverse effects has been recognized for centuries. The central nervous system dysfunction in FAS affects the individual's daily functioning and represents the most devastating effect of heavy prenatal alcohol exposure. Importantly, these behavioural and social deficits have a striking impact on the individual, family and society. Children with prenatal alcohol exposure have poor social judgment, trouble learning from experience, failure to consider the consequences of their actions, difficulty understanding social cues, indiscriminant social behaviour and difficulty communicating in social contexts.' FAS and teenage pregnancy are closely connected by the social and psychological reasons, which lie beneath both problems, as well as by the fact, that one of the phenomenon is usually caused by another one. One of the possible psychological problems of teenage girls, is that they envision their children not as 'he' or 'she', but as 'it'. (Zuckerman 1997, p. 112) When the girls are asked to describe the fetus, which is inside, their depictions are mostly unreal or exaggerated. The period of adolescence for both girls and boys is usually characterized by having good adaptive visions, but pregnant girls are still unable to describe the feeling inside them. It is usual that adolescents are overwhelmed by wrong ideas and misperceptions of their pregnancy, which finally leads to them using alcohol as leaving the reality and coming to the fantastic world, where no misperceptions exist. It is often appears, that a young girl is using her pregnancy to express her 'unresolved dependency needs', (Chapar 1995, p. 280) that is, to find a possible substitution for the lost parent or to find some more independence. The results of these misperceptions are usually dramatic, for they lead to irregular visiting the doctor and to disregarding the recommendations in relation to the diet, alcohol consumption or smoking. According to Schonfeld and Mattson, alcohol is a teratogen, and 'numerous studies have documented the adverse sequelae of prenatal exposure to alcohol over the past 30 years.' These authors also point out, that those, who have gone through prenatal alcohol exposure, usually show low moral and psychological maturity. The noted writers pay special attention to the importance and role of home environment in its influencing the so-called delinquent behaviours. Unfortunately, they were unable to carry out a profound analysis of the groups between the three chosen home placements, because the number of participants in them was not equal. But at the same time, they were able to make a conclusion that the higher rates of delinquent behaviours was shown through biological home, where parents were addictive to alcohol, while adoptive homes with favourable atmosphere decreased this index. So, the conclusion was made, that the environment and home atmosphere is a very important psychological factor in causing the FAS, and it does not matter, whether the home is adoptive, because the main feature is that it must be protective, that is, kept from the alcohol use. (Shonfeld & Mattson, p. 29) Pregnancy is the period, when the emotional responses of women increase. At this time, the fantasies and dreams of an adolescent are mixed with fear, expectation, anxiety and depression. This moral and emotional state often leads to becoming alcohol addicted. The recent time has been characterized by the heightened attention towards the problem of inborn nervous and psychic disorders under the influence of the FAS. The most essential display of this syndrome is the delay in psychic development and the syndrome of minimal brain function (or its hyper function). But the use of alcohol during pregnancy is often combined with smoking, low social and economic status, and psycho-emotional stress, about which we speak here, and which in fact plays a key role in causing FAS between young girls. Adolescent pregnancy becomes the support for assertion girl's independence. The process of asserting independence usually takes several years and is always accompanied with the feelings of pride and a sense of accomplishment. (Zamula 1989, p. 9) But though on the one hand, pregnancy is the way to the searched independence, in reality it usually erases the progress, which has been achieved by the young girl through previous years. To some extent, the young girl may use her pregnancy to express the needs that were never realized, or to 'accomplish a pseudo-separation' from parents. But the realities of the motherhood can lead to the situation, when all girls' expectations fail. All these theories of psychological effects and reasons for teenage pregnancy and the fetal alcohol syndrome show, that these two notions are interrelated, and can't be considered separately. The psychological changes, through which the girl goes at the time of being pregnant, make her emotionally unstable, and alcohol becomes one of the paths, which, to her mind, will certainly leas her to the stability she seeks. Schonfeld and Mattson make a stress that social, economic and psychological background should be viewed as basic in making further FAS research. Unfortunately, teenage pregnancy and FAS are becoming more and more common in the community, and this tendency is combined with the increasing number of teenagers, who decide to keep the child. In this situation it is very important to find an effective method to intervene the needs of teenage development. It is very essential nowadays, and several possible methods may be chosen. According to Chapar (1995), 'One method that may be used to help these adolescents accomplish their goals has been labelled previewing, which refers to a natural process that occurs between adaptive adult mothers and their infants. In effect, the previewing process alerts the mother to the imminent developmental trends her infant will soon be undergoing. With appropriate coaching, adolescent mothers can also learn how to preview both their own maturational changes and the changes likely to occur to the infant. Thus, the adolescent mother's relationship with her child can be markedly enhanced.' The matter of adolescent pregnancy and fetal alcohol syndrome, is mainly psychological than social or economic. It is often, that young girls don't receive enough attention from their parents, thus looking for satisfaction and love elsewhere. Many authors were trying to make a profound research in this area, but still much is to be done in relation to this question. There is still no answer as for the single definite strategy of giving the necessary psychological help to pregnant teenage girls. It often happens, that the parents of the pregnant girl themselves need psychological help to get free of unnecessary motivations towards the future infant. At the same time, it is important to remember, that, as Schonfeld and Mattson put it, - 'Heavy prenatal alcohol exposure is related to immature moral judgment and higher rates of delinquent behaviours. Moral reasoning regarding family and friends and rates of delinquency were independent of other influences'. References Blos, P., 1980. 'Modifications in the traditional psychoanalytic theory of female adolescent development.' Adolescent Psychiatry 8: 8-24 Chapar, George N., 1995. 'Psychological variables associated with teenage pregnancy'. Adolescence 30 (118): 277-283 Cobliner, W.G., 1994. 'Pregnancy in the single adolescent girl: The role of cognitive functions'. Journal of Youth and Adolescence 3(1): 17-29 Jessor, R., 2004. Adolescent development and behavioural health. A Handbook of Health Enhancement and Disease Prevention. New York: John Wiley and Son, 44-58. Schonfeld, Amy & Mattson, Sarah, 2005. 'Moral maturity and delinquency after prenatal alcohol exposure'. Adolescence 12: 24-32 Zamula, Evelyn, 1989. 'Drugs and pregnancy: Often the two don't mix'. FDA Consumer 23(5): 7-11. Zuckerman, B.S., 1997. 'Mental health of adolescent mothers: The implications of depression and drug use'. Journal of Developmental and Behavioural Pediatrics 8: 111-116. Moral Maturity and Delinquency after Prenatal Alcohol Exposure *. by Amy M. Schonfeld , Sarah N. Mattson , Edward P. Riley FLETAL ALCOHOL SYNDROME (FAS) is caused by heavy alcohol consumption during pregnancy and is an entirely preventable developmental disability. The fact that prenatal alcohol exposure can produce adverse effects has been recognized for centuries, whereas formal studies of its effects emerged in the 1970s (Jones and Smith, 1973; Jones et al., 1973; Lemoine et al., 1968). The diagnostic criteria for FAS identified by Jones and Smith (1973) and reiterated by the Institute of Medicine (Stratton et al., 1996) are the following: (1) pre- and/or postnatal growth deficiency (more than 2 standard deviations below the mean or below the 10th percentile); (2) central nervous system dysfunction (e.g., intellectual deficiency, attention deficits, structural brain malformation, microcephaly and/or motor disturbances); and (3) a specific pattern of facial anomalies (e.g., short palpebral fissures, smooth philtrum, thin upper lip; Jones and Smith, 1973; Jones et al., 1973; Stratton et al., 1996). FAS occurs in approximately 0.5-2 per 1,000 live births, although when including exposed individuals who do not meet all three criteria above, prevalence rates of affected individuals are approximately 10 cases per 1,000 (May and Gossage, 2001; Sampson et al., 1997). As a developmental phase, adolescence is positioned between childhood and adulthood. Conventional theory holds that adolescence is a time during which teenagers assert their sense of identity, rebelling from the control and authority of their parents. Thus, it is not unusual to encounter a high degree of emotional turmoil in the adolescent. When a teenager becomes pregnant, however, the continuity of both the physical and the psychological growth is abruptly interrupted. The central nervous system dysfunction in FAS affects the individual's daily functioning and represents the most devastating effect of heavy prenatal alcohol exposure (Clarren and Smith, 1978). For example, FAS is cited as a leading cause of mental retardation (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1997; Pulsifer, 1996). These cognitive deficits have been evident since the earliest reports (Jones et al., 1973; Lemoine et al., 1968), and continued study has revealed additional deficits across various neuropsychological (Mattson et al., 1998; Noland et al., 2003), behavioural (Kodimwakku et al., 2001; Mattson and Riley, 2000), psychiatric (Famy et al., 1998; Steinhausen and Spohr, 1998) and adaptive domains (Thomas et al., 1998; Streissguth et al., 1991). Notably, these impairments are also observed in those with histories of heavy prenatal exposure to alcohol who do not meet diagnostic criteria for FAS (Conry, 1990; Mattson et al., 1996, 1998; Carmichael Olson et al., 1992). Importantly, these behavioural and social deficits have a striking impact on the individual, family and society. Children with prenatal alcohol exposure have poor social judgment, trouble learning from experience, failure to consider the consequences of their actions, difficulty understanding social cues, indiscriminant social behaviour and difficulty communicating in social contexts. (Carmichael Olson et al., 1998a,b; Streissguth et al., 1991, 1997). Their social skills increasingly fall behind same-age peers as they develop (Thomas et al., 1998; Whaley et al., 2001), and by adulthood they are reported to have social abilities at the 6-year-old level (Streissguth et al., 1991). As early as preschool age, children with FAS are noted to be impulsive and "lack guilt after misbehaving" (Janzen et al., 1995), and delinquent behaviour is reported in children and adolescents (Streissguth et al., 1996). In one report, 61% of teens, 58% of adults and 14% of children between 6 and 11 years had a history of trouble with the law (Streissguth et al., 1996). Furthermore, in an inpatient forensic psychiatry service of 287 adolescents, 3 (1%) were diagnosed with FAS and 64 (22%) with fetal alcohol effects (Fast et al., 1999) underscoring the overrepresentation of fetal alcohol-exposed teens in the juvenile justice system. Additionally, parent report corroborates the significant rates of delinquency in children and adolescents with heavy prenatal alcohol exposure with and without FAS (Mattson and Riley, 2000; Roebuck et al., 1999). In delinquent populations, there is overwhelming evidence for impaired moral judgment and reasoning; and even individuals at risk for delinquency (i.e., "predelinquents") evidence lower levels of moral maturity than nondelinquent age peers, even when controlling for the effects of intelligence and environment (McColgan et al., 1983). There is also a suggestion that, in individuals with behaviour problems or intellectual deficiency caused by organic causes, moral maturity remains discrepant from controls even after considering differences in IQ (Kahn, 1983; Taylor and Achenbach, 1975). Despite these findings, no known studies of moral judgment and reasoning have been reported in children and adolescents with prenatal alcohol exposure. Therefore, it is possible that moral development remains immature in those with prenatal alcohol exposure given their high rates of misbehaviour. Moral development unfolds in a predictable sequence from a superficial, concrete orientation to a complex one with interpersonal and societal relationships in mind; in other words, from the immature to mature. Delinquency problems, on the other hand, are stable and begin to occur very early in life with less severe behaviours occurring first (Chamberlain, 2003). For example, noncompliance and tantrums may be the early childhood manifestations and progress to delinquent acts by middle school. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) indicates that children as young as 5-6 may show signs of conduct disorder (CD), although it is more common for CD to appear in late childhood or adolescence (American Psychiatric Association, 1994). Therefore, as children age, delinquency or conduct problems become more sophisticated (or "worse"), whereas moral maturity also becomes more sophisticated (or "better"). The current study was designed to test the hypothesis that youth with prenatal alcohol exposure will also display impairments in moral judgment and reasoning, which would be related to their maladaptive behaviours. The primary aim was to investigate moral judgment and reasoning in children and adolescents with heavy prenatal alcohol exposure, with and without a diagnosis of FAS, using a measure based on Kohlberg's stages of moral development that was developed for children beginning at age 10 (Colby and Kohlberg, 1987; Kohlberg, 1963). An ancillary aim was to investigate whether these youth had higher rates of self-reported delinquency and if their moral maturity was predictive of this behaviour. Method Participants Participants consisted of 56 children and adolescents between the ages of 10 and 18 from two groups: an alcohol-exposed (ALC) group and a nonexposed control (CON) group. Groups were matched on age, gender, handedness, socioeconomic status and ethnicity (see Results below). Exclusionary criteria for both groups included English as a second language, history of a head injury, age out of range, Verbal IQ out of range (see below) or any physical handicap that would preclude the participant from being able to complete the test battery (e.g., severe vision problems). Children of mothers who used drugs other than alcohol were not excluded from this study, because doing so would limit our sample. However, in the case in which a mother reported that other drugs were her primary usage, we excluded the child from our study. The ALC group consisted of 27 participants with histories of heavy prenatal alcohol exposure, both with FAS (n = 12) and without this diagnosis (n = 15). Those without FAS lacked the group of physical features necessary for the diagnosis and are referred to here as the prenatal exposure to alcohol (PEA) subgroup. The biological mothers for the ALC group were reported to misuse alcohol (e.g., drinking a fifth of distilled spirits or more per occasion), drinking daily or in a heavy episodic pattern throughout their pregnancies. The CON group consisted of 29 children who had no history of exposure to alcohol in utero. Prenatal alcohol exposure history, or lack thereof, was confirmed through caregiver self-report, collateral report and medical, legal and social records. All children with prenatal alcohol exposure were evaluated and diagnosed prior to recruitment and participation in the current study by Kenneth Lyons Jones, M.D., a pediatric dysmorphologist at the University of California, San Diego. Thus, these children were originally clinic-referred and then enrolled to take part in neurobehavioural follow-up by the Center for Behavioural Teratology. A smaller number of ALC children and all of the CON children were referred by other health professionals, educators or were self-referred as a result of our recruitment efforts in the community. If children did not meet the physical criteria necessary for a diagnosis of FAS, but had a confirmed history of heavy prenatal alcohol exposure, they were assigned to the PEA subgroup. The FAS and PEA subgroups were combined into the ALC group, because they have been shown to have similar profiles on numerous measures of functioning (Mattson et al., 1997, 1998). Procedures All participants had already taken part in a larger research project on alcohol's teratogenicity at the Center for Behavioural Teratology, San Diego State University. As part of this protocol, they had completed a test battery that included an age-appropriate intelligence test (i.e., the Wechsler Intelligence Scales). Because of the verbal nature of the tests given, children were eligible for the current study if their verbal IQ was in the range of 70 to 110. This IQ truncation excluded those individuals with mental retardation, because they might not understand the requirements of the tests used in this study. This truncation also ensured that neither group included individuals with IQ scores above the limits of the average range, thereby inflating normal population estimates on the dependent variables. Because of the sensitive nature of information gathered, confidentiality was assured and outlined during all phases of the recruitment and testing process, and a Certificate of Confidentiality was issued by the NIAAA for this study. Informed consent and child assent were received prior to initiating testing. All recruitment methods were approved by the San Diego State University Committee on the Protection of Human Subjects. Measures The Sociomoral Reflection Measure-Short Form. The Sociomoral Reflection Measure-Short Form (SRM-SF; Gibbs et al., 1992) was used to evaluate moral judgment and reasoning. The SRM-SF consists of 11 short-answer items addressing five sociomoral values: contract and truth (questions 1-4), affiliation (questions 5-6), life (questions 7-8), property and law (questions 9-10) and legal justice (question 11). The five sociomoral values assess, respectively, the child's reasons for (1) maintaining one's word and telling the truth, (2) providing help to family and friends, (3) preserving life, (4) refraining from stealing or breaking the law and (5) incarcerating lawbreakers. The overall moral maturity score is based on the reasoning regarding the importance of each value. This test was designed to be amenable to group administration using written responding. Because this instrument was administered in individual format and because participants included younger children, this procedure was modified as suggested on the SRM-SF such that items were verbally administered (Gibbs et al., 1992). The dependent variable analyzed from this measure was the overall Sociomoral Reflection Maturity Score (SRMS), which is the mean of the item ratings for each question. The overall SRMS can range from a 1.0 (exclusively Stage 1 ratings) to a 4.0 (exclusively Stage 4 ratings). These stages are based on Kohlberg (Colby and Kohlberg, 1987; Kohlberg, 1976) as follows: Stage 1 scores indicate concern with physical consequences or benefit to the self; Stage 2 scores involve responses reflecting reciprocal exchange between individuals to avoid negative consequences or to benefit oneself; Stage 3 scores involve knowledge of social norms and values and prosocial responding; and Stage 4 scores involve responses indicative of placing societal functioning before oneself. As suggested by the test authors, the SRMS was multiplied by 100 to yield a range of 100 to 400 for data analyses. In addition to the SRMS, average moral stage scores were evaluated for each of the five sociomoral values described previously. The SRM-SF demonstrates good reliability (test-retest r = .88; Cronbach's [alpha] = .92) and validity (Concurrent validity with Kohlberg's Moral Judgment Interview, r = .69; Gibbs et al., 1992). Protocols were scored according to the SRM-SF manual by the examiner (A.M.S.) and a second senior undergraduate rater. Interrater reliability for half of the moral judgment protocols was high (Cronbach's [alpha] = .98), which is consistent with that reported in the SRM-SF between an expert and an undergraduate rater. Delis-Kaplan Executive Function System Color Word Interference Test. Inhibition deficits are well established in this population (Driscoll et al., 1990; Kodituwakku et al., 1995; Mattson et al., 1999; Riley et al., 1979), and in other populations such deficits are related to moral maturity (Gargiulo, 1984) and delinquency (Bassarath, 2001; Kerr et al., 1997; Tremblay et al., 1994; White et al., 1994). Therefore, inhibition was evaluated using the Color-Word Interference Test from the Delis-Kaplan Executive Function System (Delis et al., 2001). Specifically, this test measures executive or cognitive inhibition, which requires inhibiting a response to reach a future goal. The ability to inhibit responding was determined by the scaled score difference between two tasks: the time to complete a simple color naming task (i.e., say "green" when encountering a green patch) and time to complete a traditional Stroop interference task (i.e., naming the ink color that a discrepant "color word" is printed in so that "red" is the correct response when the word "blue" is printed in red ink). Lower scaled scores indicate more difficulty with inhibition. The Marlowe-Crowne Social Desirability Scale. The Marlowe-Crowne Social Desirability Scale (MCSD) was used to assess social desirability (Crowne and Marlowe, 1960). This measure is widely used in the study of both moral reasoning and delinquency in order to control for the participant responding favorably to please the examiner (Basinger and Gibbs, 1987; Gavaghan et al., 1983; Gibbs et al., 1984b; Tracy and Cross, 1973). The MCSD involves responding to 33 true/false items such as "No matter who I'm talking to, I'm always a good listener" or "There have been occasions when I felt like smashing things." Answering "true" and "false," respectively, to these above questions would indicate socially desirable responding. Although initially developed for adolescents and adults, the MCSD has been used with children (Adams and Jones, 1981; Gavaghan et al., 1983; Gibbs et al., 1984b; Steiner, 1992; Watkins, 1996), and in some cases wording was adapted for such purposes (Fritz et al., 1994). For the present study, adapted wording of the MCSD was used as in the study by Fritz et al. (1994), because the sample consisted of children as young as age 10. The total of socially desirable responses was each subject's raw score (higher scores represent greater social desirability). The Conduct Disorder Questionnaire. The Conduct Disorder Questionnaire (CDQ) was used to assess delinquent behaviour (Brown et al., 1996; Myers et al., 1995). This CDQ is a structured interview measuring the existence, prevalence and age of onset of a number of conduct or delinquency problems (e.g., skipping school, stealing, lying or fighting). Within the questionnaire are the 15 behaviours that are included in the diagnostic criteria for CD (American Psychiatric Association, 1994). This measure has been used with preadolescents and adolescents aged 12-18 (Brown et al., 1996). Data were scored in two ways. First, the number of delinquent behaviours endorsed was summed, and the proportion of delinquent behaviours from the total possible was computed. A proportion score was used because some questions are asked only to children above a certain age (e.g., 15), and not all children receive the same number of questions. This estimate provided an indication of overall delinquent behaviour across the child or adolescent's lifetime. Second, the number of children with probable CDs, based on DSM-IV criteria (three or more criteria within 12 months), was computed. Results General Analytic Procedure For each dependent variable in this study, violations of statistical assumptions were investigated. The homogeneity of variance assumption was examined using Levene's test for homogeneity of variance. In addition, a visual inspection of the data was made for outliers and is discussed within the relevant analyses. The general data analytic approach used hierarchical multiple regression analyses, multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA) and chi-square analysis. Finally, t tests were conducted between the FAS and PEA subgroups for each dependent variable. Alpha levels for all analyses were set at p < .05. Demographic analyses Age, socioeconomic status (SES) and Verbal IQ (VIQ) were analyzed by independent one-way ANOVA. Results revealed that groups did not differ on the demographic variables of age (F = 0.75, 1/54 df, p > .05) or SES (F = 0.06, 1/54 df, p > .05). VIQ differed significantly between the ALC (mean = 89.59) and CON (mean = 97.90) groups (F = 9.68, 1/54 df, p< .01). Chi-square analysis revealed that groups did not differ in terms of gender ([chi square] 0.06, 1 df, p >.05), handedness ([chi square] = 0.76, 1 df, p > .05) or ethnicity ([chi square] = 4.22, 4 df, p > .05). However, groups differed on home placement ([chi square] = 23.89, 2 df, p< .001), with more children in the ALC group being raised away from their biological families. See Table 1 for CON and ALC group demographics. Finally, the previously described analyses were repeated on the PEA and FAS participants within the ALC group. These two subgroups did not differ from one another on any demographic variable (p's >.05). See Table 2 for FAS and PEA subgroup demographics. Moral Maturity A one-way ANOVA revealed that the ALC group had significantly lower moral maturity scores than the CON group (F = 5.38, 1/54 df, p < .05), indicating that those in the CON group reasoned primarily at moral Stage 3, whereas those in the ALC group reasoned primarily at moral Stage 2. See Figure 1 for performance on the SRM-SF and Table 3 for group means on this measure. [FIGURE 1 OMITTED] Because the overall moral maturity score comprised five separate sociomoral values, they were analyzed by MANOVA. For this analysis, one child from the ALC group was excluded because of an unscorable response for one sociomoral value. Results revealed a Value x Group interaction, suggesting different patterns of group performance across the five values (Pillai's F = 2.56, 4/50 df, p .05). Because the univariate tests indicated that the groups significantly differed on the Affiliation domain, a similar regression analysis was conducted analyzing the contribution of VIQ and group to the Affiliation value. Again, VIQ predicted a significant amount of variance in Affiliation ([R.sup.2] = 0.19, p = < .01); but, in this case, group predicted performance beyond VIQ ([R.sup.2.sub.change] = 0.09, p < .05) indicating that the deficit in relations with family and friends is specific to prenatal alcohol exposure and not simply due to overall lowering of cognitive ability. Additional individual hierarchical multiple regression analyses were conducted as previously described to investigate the relative contributions of group combined with age, social desirability, inhibition, gender and home placement to overall moral maturity, beyond the influence of VIQ. Three cases were identified as having unusually low scores on the inhibition variable and were excluded from the relevant analysis. Results indicated that age explained a significant amount of additional variance ([R.sup.2.sub.change] = 0.472, p< .001) suggesting that across groups moral maturity increased as age increased (the age by group interaction was not significant, p >.05). Although socially desirable responding was not predictive of moral maturity (p > .05), an age by social desirability interaction ([R.sup.2.sub.change] = 0.037, p< .05) indicated that, as moral maturity increases, age increases and socially desirable responding decreases. The inhibition task was predictive of moral maturity beyond the influence of VIQ ([R.sup.2.sub.change] = 0.098, p < .05). Finally, gender and home placement were not significant predictors of moral maturity (p's >.05) beyond the influence of VIQ. Delinquency A one-way ANOVA was conducted with the overall score on the CDQ serving as the dependent variable. The scores on this questionnaire were higher in the ALC group, suggesting that, as a group, the participants with heavy prenatal alcohol exposure had significantly higher rates of delinquent behaviours than the CON group (F = 14.24, 1/54 df, p < .001; see Figure 2). [FIGURE 2 OMITTED] Individual hierarchical multiple regression analyses were conducted with the same predictors as described (VIQ, age, social desirability, inhibition, gender and home placement). For the analysis on inhibition, the three outliers described previously were excluded. In individual regression analyses, the following variables represented significant predictors of delinquency: age ([R.sup.2] = 0.09, p< .05), gender ([R.sup.2] = 0.11, p < .05), home placement ([R.sup.2] = 0.11, p < .05) and social desirability ([R.sup.2] = 0.36, p < .001). However, when added to these models, group membership accounted for a significant amount of the variance beyond age ([R.sup.2.sub.change] = 0.18, p = .001), gender ([R.sup.2.sub.change] = 0.19, p < .001), home placement ([R.sup.2.sub.change] = 0.20, p < .001) and social desirability ([R.sup.2.sub.change] = 0.11, p < .01). Neither VIQ nor inhibition was predictive of delinquency (p's >.05), and group membership continued to explain a significant amount of the variance in delinquency scores beyond these individual variables (p's < .001). Notably, with respect to the home placement finding, there was unequal representation of home placements between groups, making detailed comparisons across foster, adoptive and biological environments in the CON and ALC groups difficult. However, within the ALC group, higher rates of delinquent behaviours were endorsed by youth in biological and foster homes versus adoptive placements. The ALC children in adoptive homes endorsed about 20% of delinquent behaviours queried, whereas those in biological and foster home placements reported about 36%. Moral maturity only marginally predicted delinquent behaviour ([R.sup.2.sub.change] = .05, p = .054) beyond the combined influence of group and age. However, in light of group differences on the sociomoral values of Affiliation and Property and Law, a similar regression analysis indicated that these two values significantly added to the model in predicting delinquency ([R.sup.2.sub.change] = .09, p < .05) beyond group and age ([R.sup.2] = 0.27, p < .001). Lastly, those in the ALC group were more likely to have probable CD (n = 8) than the CON participants (n = 2; [chi square] = 4.92, 1 df, p < .05). However, within the ALC group, only PEA participants met criteria for probable CD ([chi square] = 9.09, 1 df, p < .01). That is, 53% of those with PEA met criteria for this diagnosis, although none of the children or adolescents in the FAS subgroup did. Notably, the FAS and PEA groups did not differ on any other dependent variable in the study (p's > .05). However, in light of this difference between the FAS and PEA subgroups, the analyses on moral maturity and the relationship between moral maturity and delinquency were repeated with these two subgroups. Results indicated no differences on the overall measure of moral maturity or any of the specific values. In addition, diagnosis (FAS or PEA) did not account for a significant amount of variance in any of the regression analyses. Discussion Alcohol is a known teratogen, and numerous studies have documented the adverse sequelae of prenatal exposure to alcohol over the past 30 years. In light of the related central nervous system impairments and secondary disabilities in those with prenatal alcohol exposure (Fast et al., 1999; Mattson and Riley, 1998; Roebuck et al., 1999; Streissguth et al., 1996), moral maturity and its relation to delinquency were assessed in the current investigation. Children and adolescents with histories of prenatal alcohol exposure demonstrated lower overall moral maturity compared with the CON group. According to Kohlberg's stages of moral development, the ALC group was primarily concerned with minimizing negative consequences to self (i.e., Stage 2), whereas the CON group demonstrated concern for others and what is socially normative (i.e., Stage 3). Although the overall moral maturity deficit was secondary to lowered overall verbal intelligence in the ALC group, the results of this study indicate that moral maturity is a weakness warranting further attention. Group differences in the sociomoral value of Affiliation (i.e., reasoning about helping family and friends) remained significant even after accounting for VIQ. This lends additional support to the idea that impaired socialization and interpersonal relationship skills represent a core deficit following prenatal alcohol exposure beyond the influence of depressed IQ scores (Mattson and Riley, 2000; Thomas et al., 1998; Whaley et al., 2001). Consistent with the hypotheses, ALC participants engaged in significantly more delinquent behaviours than the CON group. As expected, males had higher rates of delinquency than females, which is consistent with previous evaluations of prenatally exposed youth (Coles et al., 2000; Streissguth et al., 1996) and general delinquent samples (Bassarath, 2001). In addition, reasoning about Affiliation and Property and Law represented significant predictors of delinquency. An unexpected finding was that social desirability predicted delinquency for both groups, suggesting a possible under-reporting of behaviours. Of note is the influence of home environment on delinquent behaviours. Unfortunately, meaningful comparisons between groups across the three home placements were difficult to achieve, as the groups had unequal numbers of participants across home placements. Higher rates of delinquent behaviours were endorsed by ALC youth in biological and foster homes versus adoptive placements, and home placement was predictive of delinquency. Furthermore, for those PEA participants with probable CD, 4 resided in biological homes, 3 resided in foster homes and 1 lived in an adoptive home. It has been shown that, in those with prenatal alcohol exposure, placement in a stable home environment was protective against secondary disabilities (Streissguth et al., 1996). In one study in which foster children were reunified with their biological homes, problem behaviours increased, supporting the notion that biological homes are not necessarily protective if such an environment is chaotic (Taussig et al., 2001). However, adoptive and foster placements predict externalizing or maladaptive behaviour in the general delinquency literature (Deater-Deckard and Plomin, 1999; Sharma et al., 1998), although positive outcomes have been shown after adoption (Sharma et al., 1998). Clearly, a stable home environment has been found to be protective, which includes keeping homes free of current drug or alcohol use. Future study may wish to clarify further the relationship between home environment, delinquency and moral maturity in individuals with prenatal alcohol exposure. In studies of moral judgment and reasoning, moral maturity is consistently related to delinquent behaviour (Nelson et al., 1990). Although the overall moral maturity score was not predictive of delinquency for ALC participants in this study, reasoning regarding "affiliation" and "property and law" was. This suggests that the socialization deficits and views on stealing and obeying the law may serve as early indicators of later maladaptive behaviour. In terms of the overall moral maturity score, it is possible that this global measure is not sensitive enough in detecting delinquency in youth with prenatal alcohol exposure. In patients with frontal lobe lesions, standardized measures in a laboratory setting were not able to detect markedly impaired behaviour in society (Bechara et al., 1994). However, results of a gambling task were more sensitive, and individuals with frontal damage made choices and decisions with immediate reward and adverse long-term consequences, which are suggestive of their real-life problems. This is applicable to the population under study because of their known structural brain anomalies (Roebuck et al., 1998), including anomalies of the basal ganglia that are well connected to the frontal lobes (Mattson et al., 1996; Mega and Cummings, 2001). Inhibition has been shown to be predictive of moral maturity (Gargiulo, 1984) and delinquency (Bassarath, 2001; Kerr et al., 1997; Tremblay et al., 1994; White et al., 1994). In the current study, inhibition was predictive of moral maturity but not delinquency. Thus, poorer performance on the Color-Word Interference test was predictive of producing less socially normative moral judgments, perhaps suggesting an inability to suppress automatic or competing responses. In contrast, a relationship between delinquency and inhibition was not found. There is the suggestion that behavioural inhibition (e.g., as shown on computerized "stop" tasks) is a better indicator of delinquency than cognitive inhibition or interference control (e.g., as measured by the Stroop type tests), which may be more strongly related to lower IQ scores (White et al., 1994). Specifically, whereas both may involve inhibition of a motor response, the former may measure one's ability to inhibit an overt or automatic motor response as opposed to the latter ability to carry out a behaviour while simultaneously inhibiting competing stimuli (Nigg, 2000). As those with the ability to inhibit behaviourally are reportedly protected against delinquency (Kerr et al., 1997), future study of inhibition and delinquency in those with prenatal alcohol exposure may benefit from inclusion of a behavioural inhibition task. Finally, approximately half of the children with PEA met probable conduct disorder criteria, whereas none of those with FAS did. This indicates that those with prenatal alcohol exposure, but without FAS, are at higher risk for maladaptive behaviours. This finding is not surprising in light of previous reports suggesting that FAS may be a protective factor against delinquency, compared with their non-FAS alcohol-exposed counterparts (Fast et al., 1999; Roebuck et al., 1999; Streissguth et al., 1996). However, aside from higher rates of probable conduct disorder in the PEA subgroup, children and adolescents in the ALC subgroups did not differ from one another on any other variable as shown in previous studies (Conry, 1990; Mattson et al., 1997, 1998; Carmichael Olson et al., 1992). Typically, subgroup differences in IQ have been used to explain the discrepancy in delinquency rates, and this would be particularly relevant in using self-report measures. However, this does not seem to explain the current results, because IQ was not different between the FAS and PEA subgroups, and VIQ scores were [greater than or equal to] 70. These findings underscore the fact that early evaluation and identification of those exposed children who do not meet criteria for FAS are imperative to prevent secondary disability. Limitations of the current study include participant matching, delinquency reporting and lack of information on the biological parent, including details of familial psychiatric history (e.g., parental externalizing behaviours) or specifics of maternal alcohol consumption (e.g., dose and timing of exposure). Attempts were made to match the ALC and CON groups on VIQ, but could not be achieved as CON children with low VIQ scores that also met the rest of the eligibility criteria for this study were not available. It would have also been ideal to match groups on home placement so that placement effects on moral judgment and delinquency could be more clearly delineated. With respect to delinquency reporting, children were used as informants, and collateral report was not obtained that may have led to a lower estimate of delinquency given our social desirability data. Finally, whereas genetic risk factors for conduct or other psychiatric problems may indeed be present for the ALC group, we did not have data, such as parental psychiatric history, on the biological families for the ALC group because only seven ALC children resided in the biological household. In conclusion, the results of this study suggest that heavy prenatal alcohol exposure is related to immature moral judgment and higher rates of delinquent behaviours. Moral reasoning regarding family and friends and rates of delinquency were independent of other influences, such as VIQ, and age and specific moral value judgments were predictive of delinquent behaviours. No empirically supported treatments exist for individuals with prenatal exposure to alcohol (NIAAA, 2000; Streissguth and O'Malley, 2000; Zevenbergen and Ferraro, 2001). Yet, results indicate that this population may benefit from moral reasoning intervention to prevent later delinquency, as has been done with other delinquent populations (Gibbs et al., 1984a; Putnins, 1997). Additionally, results provide corroborating evidence that deficits in interpersonal relations result from prenatal alcohol exposure, thus indicating that social skills training is warranted. Future studies will provide aninvaluable service to this population by investigating such interventions with the goal of preventing serious secondary disability in those with prenatal alcohol exposure. Acknowledgments The authors acknowledge the staff of the Center for Behavioural Teratology, San Diego State University, and Paul Ramirez of the University of California-Los Angeles for their assistance. Read More