Para‐limbic Structural Abnormalities Are Associated With Internalizing Symptoms in Children With Prenatal Alcohol Exposure

Background Prenatal alcohol exposure (PAE) is associated with a variety of structural abnormalities in the brain, including several within the para‐limbic system. Children with PAE have higher rates of internalizing disorders, including depression and anxiety, which may be related to underlying limbic system anomalies. Methods Children aged 8 to 16 with PAE (n = 41) or without PAE (n = 36) underwent an magnetic resonance imaging of the brain and parents completed behavioral questionnaires about their children. Semi‐automated procedures (FreeSurfer) were used to derive para‐limbic volumes from T1‐weighted anatomical images. Results There were significant group differences (PAE vs. nonexposed controls) in the caudate, hippocampus, and the putamen; children with PAE had smaller volumes in these regions even after controlling for total intracranial volume. A trend‐level association was seen between caudate volume and internalizing symptoms in children with PAE; smaller caudate volumes (presumably reflecting less optimal neurodevelopment) were associated with higher levels of anxiety and depression symptoms in these children. Conclusions Caudate structure may be disproportionately affected by PAE and may be associated with the later development of internalizing symptoms in those affected by PAE. Children with prenatal alcohol exposure (PAE) have higher rates of internalizing disorders, including depression and anxiety, which may be related to underlying para‐limbic system anomalies. This study revealed that smaller caudate volumes were associated with higher levels of anxiety and depression symptoms in children with PAE. Caudate structure may be disproportionately affected by PAE and may be associated with the later development of internalizing symptoms.