# Subtle Cognitive Variability in Foetal Alcohol Syndrome Spectrum: Intelligence Profiles and Verbal Fluency Performance Across Diagnostic Categories in Polish Population

## TL;DR

The study examines cognitive differences in children with fetal alcohol syndrome spectrum disorders in Poland, finding significant differences from healthy controls but no clear distinction between diagnostic subtypes.

## Contribution

The study introduces machine learning to analyze cognitive profiles in fetal alcohol spectrum disorders and reveals limitations in differentiating diagnostic subtypes.

## Key findings

- FASD children showed significantly lower verbal and non-verbal intelligence compared to healthy controls.
- Verbal fluency tasks revealed clear differences between FASD children and controls.
- Machine learning had low precision and recall in distinguishing FAS subtypes.

## Abstract

Background/Objectives: The foetal alcohol syndrome spectrum is linked with neurodevelopmental delay and cognitive and educational problems. Direct consequences of prenatal alcohol exposure include impaired processes of neural migration and brain development. Among the important features present in affected children are impaired communicational skills and intelligence. Methods: Here we presented the case–control comparison of 124 children with foetal alcohol syndrome spectrum disorder (FAS: 62 (50%), pFAS: 34 (27.42%) and ARND: 28 (22.58%)) and 53 healthy controls regarding intelligence quotient and a verbal fluency task. The verbal and non-verbal intelligence was measured using the WISC-R scale, and the verbal fluency task encompassed phonemic, semantic and categorial assessment in 15 and 60 s; we used the authors’ parental/caregiver survey to determine risk factors. In statistical analysis both methods of classical parametric/non-parametric tests and machine learning algorithms were used. Results: Foetal alcohol syndrome spectrum patients were clearly distinguished from healthy controls regarding total verbal and non-verbal intelligence, as well as all three categories of verbal fluency (p < 0.01). ML methods distinguished an FAS group with 0.49 precision and 80% recall and for pFAS and ARND diagnoses we obtained: 0.50/0.33 precision and 3%/7% recall. None of the parameters analysed in our study differentiated foetal alcohol syndrome, partial foetal alcohol syndrome and alcohol-related neurodevelopmental disorders. Conclusions: Children with foetal alcohol syndrome spectrum disorder markedly differ from healthy control subjects in intelligence and verbal fluency. The diagnostic sub-types of foetal alcohol spectrum are not clearly defined in obtained neuropsychological and clinical data.