BACKGROUND: The ability to identify and interpret facial emotions plays a critical role in effective social functioning, which may be impaired in individuals with fetal alcohol spectrum disorders (FASD). We previously reported deficits in children with fetal alcohol syndrome (FAS) and partial FAS (PFAS) on the "Reading the Mind in the Eyes" (RME) test, which assesses interpretation of facial emotion. This adolescent follow-up study was designed to determine whether this impairment persists or represents a developmental delay; to classify the RME stimuli by valence (positive, negative or neutral) and determine whether RME deficits differ by affective valence; and to explore how components of executive function mediate these associations.

METHODS: The RME stimuli were rated and grouped according to valence. 62 participants who had been administered the RME in late childhood were re-administered this test during adolescence. Overall and valence-specific RME accuracy was examined in relation to prenatal alcohol exposure (PAE) and FASD diagnosis.

RESULTS: Children with FAS (n=8) and PFAS (n=15) performed more poorly on the RME than non-syndromal heavily exposed (HE; n=19) and controls (n=20). By adolescence, the PFAS group performed similarly to HE and controls, whereas the FAS group continued to perform more poorly. No deficits were seen for positively-valenced items in any of the groups. For negative and neutral items, in late childhood those with FAS and PFAS performed more poorly than HE and controls, but by adolescence only the FAS continued to perform more poorly. Test-retest reliability was moderate across the two ages. At both timepoints, the effects in the FAS group were partially mediated by Verbal Fluency but not by other aspects of executive function.

CONCLUSIONS: Individuals with full FAS have greater difficulty interpreting facial emotions than nonsyndromal HE and healthy controls in both childhood and adolescence. By contrast, RME deficits in individuals with PFAS in childhood represent developmental delay.