SUMMARY INFORMATION REGARDING CRITERIA FOR DETERMINING

FUNDING FOR ADULTS WITH

FETAL ALCOHOL SPECTRUM DISORDER (FASD)
Prepared By: Janine Odishaw, PhD.
________________________________________________________________________
THE ISSUE
Current policies within Alberta and throughout other provinces and states in Canada and
the U.S., respectively, remain heavily reliant on IQ scores when determining funding
eligibility for persons with developmental disabilities, including those with Fetal Alcohol
Spectrum Disorder (FASD). Within Alberta, the PDD Program, which falls under the
Ministry of Seniors and Community Supports, is responsible for ascertaining which
individuals qualify for service provision on the basis of a developmental disability. As is
stated within PDD guidelines, one of the three key criteria for determining a
developmental disability is that a person evidence significantly below average
intellectual ability(in practice this is said to be an IQ score equal to or less than 70 to
75). Along with this, limitations in adaptive skills and onset prior to age 18 must also be
established when deciding on the presence of a developmental disability. Although these
criteria may be appropriate for some developmental disability groups, there are serious
issues with this formulation as it applies to persons with FASD. Like individuals with
frontal lobe damage, many persons with FASD can achieve IQ scores above the
traditional cut-off for an intellectual disability (i.e., IQ = 70) despite the presence of
significant cognitive delays and adaptive behaviour limitations. This finding appears to
be, at least in part, a function of the failure of IQ tests to assess Executive Functioning
(EF), a specific area of cognition that is impacted by frontal lobe damage and prenatal
exposure to alcohol.
Although funding bodies such as PDD consider adaptive skill limitations when
determining funding and service provision, adaptive limitations are regarded as
secondary to a primary cognitive impairment. That is, deficits in adaptive abilities, if not
coupled with a low IQ score, are not deemed sufficient to ascertain a developmental
disability. For this reason, there are many persons with FASD who, despite the presence
of adaptive skill limitations, fail to qualify for services on the basis of IQ scores. These
adaptive limitations are not inconsequential as they most often place the affected person
at high risk for many emotionally and financially costly secondary disabilities.
A recent study conducted through the University of Alberta (Odishaw, 2007) explored the
relationships between IQ, EF and adaptive skills in persons with FASD. The findings
from this study are convergent with other research findings that suggest that government
funding structures may not adequately capture particular disability groups.
The following section provides a background to the issue, some specific findings of this
research study, along with recommendations for future consideration.

________________________________________________________________________
BACKGROUND
Central Nervous System (CNS) dysfunction is arguably the most devastating
consequence of prenatal alcohol exposure. Historically, traditional IQ tests, including
those developed by Wechsler and Stanford-Binet, have been a primary means for
measuring CNS deficits in persons with FASD (Mattson & Riley, 1998). IQ tests are
frequently mandated at the level of public policy (Kranzler, 1997; Reschly, 1997; Ramey
& Ramey, 2000), and decisions surrounding access to government supports are often
based on scores derived from these measures. Performance on such tests has led to the
understanding that alcohol exposure is the number one non-genetic cause of intellectual
deficiency in the Western world (Abel & Sokol, 1987). Although many individuals
impacted by prenatal alcohol exposure display deficits in overall intellectual functioning
as assessed by traditional IQ tests, many others achieve IQ scores within the average and
above-average ranges (Kerns et al., 1997; Mattson & Riley, 1998; Streissguth et al.,
1996). In fact, a large-scale study conducted in the U.S. found only 13% of participants to
have an IQ score below 70 (Streissguth et al., 2004). What is troubling is that IQ scores
often fail to accurately reflect the cognitive functioning of alcohol-exposed persons. That
is, the predictive validity of IQ scores and the inference of a positive relationship between
performance on IQ tests and real life success are unsupported by recent findings within
FASD research (Odishaw & Snart, 2005; Odishaw, 2007). Many individuals with FASD
experience significant cognitive deficits and challenges with adaptive behaviour that are
unexplained by IQ (Mattson, Goodman, Caine, Delis, & Riley, 1999; Thomas et al.,
1998). FASD research counter-intuitively suggests that individuals with IQ scores above
70 (the cut-off for a designation of an intellectual deficiency) are at greater risk for
developing a secondary disability than those with lower IQ scores (Streissguth et al.,
1996; Streissguth et al., 2004). These secondary disabilities have implications for many
areas of an affected persons life and include problems with independent living and
employment, mental health problems, disrupted school experience, trouble with the law,
confinement, inappropriate sexual behaviour, and alcohol/drug problems. There are
several possible reasons as to why a higher IQ might place an individual at greater risk
for developing disabilities; however, the most plausible explanation is that individuals
with higher IQ scores are barred from accessing needed services that would lessen the
likelihood that such disabilities develop. Policy that dictates the continued use of
traditional IQ tests in determining access to services limits the probability of identifying
certain individuals with FASD who might benefit from intervention and supports.
The failure of traditional IQ tests to adequately capture executive functioning (EF)
(Ardila et al., 2000; Crinella & Yu, 2000) might explain why researchers continue to find
the functional problems of persons with FASD to be greater than that predicted by fullscale IQ scores. EF is associated with the frontal lobe and has been described as the
ability to maintain an appropriate problem solving set for attainment of a future
goal(Welsh & Pennington, 1988, p.201). Deficits in EF are prevalent among persons
with FASD and are often unrelated or fully explained by diagnostic category or IQ scores
(Connor et al., 2000; Kerns et al., 1997; Mattson et al., 1999; Schonfeld et al., 2001).
They are thought to underlie many of the day-to-day problems faced by persons with

FASD, such as poor judgment, weak impulse control, and an inability to use feedback to
alter behaviour (Connor, et al., 2000; Mattson et al., 1999).
Research in the area of FASD suggests that problems with adaptive functioning and
maladaptive behaviours may be better explained as a result of deficits in EF than as a
result of an overall lowering of intellectual ability (Kodituwakku et al., 2001). If there is a
strong relationship between EF, adaptive skills, and maladaptive behaviours,
measurement systems that account for EF abilities may result in more accurate
assessment and remediation for individuals with FASD-related diagnoses.
A recent study conducted through the University of Alberta examined the relationships
between measures of EF, the Wechsler Intelligence Scale for Children Fourth Edition
(WISC-IV; PsychCorp, 2003) and the Cognitive Assessment System (CAS: Naglieri &
Das, 1997). As well, the associations between EF, intelligence, and adaptive behaviour
(Adaptive Behavior Assessment System- Second Edition; Harrison & Oakland, 2003)
were investigated. It was hypothesized that the contemporary, multidimensional CAS,
relative to the more traditional WISC-IV, would better capture EF deficits (as measured
by a battery of EF tests), a particular area of weakness in alcohol-exposed persons. In
measuring this relevant area of cognitive functioning, along with other important aspects
of cognitive processing, it was also hypothesized that the CAS would better predict
adaptive behaviour. In a sample of 38 children and adolescents with a FASD-related
diagnoses it was found that both the traditional and contemporary intelligence tests were
somewhat related to different aspects of EF; this suggests that both tests, at least in part,
measure some part of EF. It was also found that an overall IQ score, whether it was
derived from a more traditional or contemporary test of intelligence, was insufficient at
predicting parent- and teacher-rated adaptive behaviours in participant children. Whereas
the mean parent-rated adaptive behaviour score fell at the very low end of the borderline
range 70.29 (SD=17.63), the mean IQ scores were significantly higher, falling within the
low average range. The EF components of the more contemporary test of intelligence
offered the best means for predicting adaptive behaviour; however, even this fell short of
explaining the degree of deficits observed by parents and teachers. It is interesting to note
that whereas moderate relationships have been found between intelligence scores and
adaptive behaviour scores in the American standardization sample of the WISC-IV
(Wechsler et al., 2004) (the standardization sample was made up of a representative
sample of children from the general U.S. population), no relationships were observed
between IQ and adaptive behaviour in a sample of 38 Albertan children and adolescents
with FASD (Odishaw, 2007).
________________________________________________________________________
KEY MESSAGES
Currently, within Alberta, funding for adults with FASD is determined on the basis
of the 3 PDD criteria:
o 1. significantly below average intellectual functioning
o 2. related limitations in adaptive skill functioning
o 3. onset prior to 18

Whereas most adults with FASD readily meet criterion 2 and 3, such is not the case
with criterion 1.
Previous FASD studies, and a recent study conducted in Alberta, have established
the limitations of IQ tests at predicting how individuals with FASD will function in
everyday life. In fact, a large-scale study counter-intuitively found that persons
with FASD who had IQ scores above 70 were actually at greater risk of developing
secondary disabilities such as mental health problems, trouble with the law, and
sexually inappropriate behaviour (Streissguth et al., 1996; Streissguth et al., 2004).
This is presumably because an IQ score above 70 can preclude much needed
funding and access to services.
In a recent study conducted with 38 Albertan children and adolescents with a
FASD-related diagnosis, findings again pointed to the incongruence between IQ
and adaptive behaviour, with lower scores achieved in adaptive behaviour.
Although overall IQ scores generated from two comprehensive IQ tests (i.e.,
WISC-IV and CAS) were not helpful in predicting parent- or teacher-rated
adaptive behaviour scores, the EF components of the CAS were. However, like the
overall IQ scores, the EF scores from the CAS were insufficient at predicting the
degree of adaptive limitations observed by parents and teachers.
The relationship between IQ and adaptive skills appears to be different in the
general population than it is in a sample of individuals with FASD. Whereas a
significant association between these two constructs is present in a representative
sample of American children (Wechsler et al., 2004), IQ and adaptive skills do not
appear to be related for individuals with FASD.
________________________________________________________________________
RECOMMENDATIONS
In light of convergent research findings (and some from our own province) that
point to the limitations of intelligence tests at capturing the cognitive deficits and at
predicting real-life outcomes in persons with FASD, the Alberta government should
consider a stronger focus on adaptive skills when determining eligibility for
funding for this population.
The Alberta Government should form a committee of researchers, clinicians and
stakeholders who are knowledgeable in the area of FASD to explore alternative
measures that could be used for determining funding for adults with FASD.

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