Social and Neuropsychological Functioning in Fetal Valproate Spectrum Disorder

Abstract

This thesis comprises three papers investigating social and neuropsychological outcomes of individuals exposed to Valproate in utero and those with Fetal Valproate Spectrum Disorder (FVSD): a systematic review, an empirical study and a critical appraisal. For the review, systematic searching was used to identify all available literature pertaining to neuropsychological outcomes following in utero exposure to Valproate or diagnosed FVSD. Thirty studies were identified for inclusion and underwent quality assessment. Results were analysed using a meta-analysis of Intelligence Quotient (IQ). All other outcomes were synthesised narratively. It was found that Valproate exposure in utero was associated with dose-dependent declines in a broad range of neuropsychological skills, with emerging evidence of a more severe presentation in individuals with diagnosed FVSD. The findings called for support in education and work settings for affected individuals. The empirical study explored social functioning outcomes in young people with FVSD. Mothers of adolescents and young adults with FVSD were invited to report on social skills, alongside broader cognitive and executive functioning skills. Young people with FVSD were also invited to take part. Eighty-six young people were studied. Those with FVSD had significantly more social difficulties than unexposed individuals. Poorer social functioning was significantly related to cognitive and executive functioning impairments, but not to covariates such as dose of Valproate exposure and family history of Autism Spectrum Disorder (ASD). The findings illustrated that social difficulties are a core feature of this cohort that warrants more routine ASD screening in FVSD. Finally, the critical appraisal detailed strengths and limitations of the systematic review and empirical study. Justifications and reflections on the process of designing and conducting the research are discussed, along with theoretical and clinical implications of the findings.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Supervisor) & Rebecca Bromley (Supervisor)