Paediatricsniche
A 7-year-old boy is referred because he is disruptive at school, cannot wait his turn, and is two years behind in reading. He has lived with his grandmother since he was two, when his mother's drinking led to his removal; she drank heavily throughout the pregnancy. He was born at 38 weeks weighing 2.3 kg. He had grommets inserted at three years and audiometry is now normal. He has no dysmorphic features. Head circumference is below the 3rd centile. Formal testing shows severe impairment in attention, memory, language and adaptive function. Which one of the following best explains his difficulties?