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McLachlan K, Flannigan K, Temple V, Unsworth K, Cook JL. Difficulties in Daily Living Experienced by Adolescents, Transition-Aged Youth, and Adults With Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:1609-1624. [PMID: 32472600 DOI: 10.1111/acer.14385] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorder (FASD) experience a range of problems in their cognitive, affective, and physical functioning following prenatal alcohol exposure (PAE), in addition to multiple complex difficulties in daily living that impact well-being. Using the Canadian National FASD Database, we sought to profile a range of difficulties in daily living, along with risk factors, in a large cross-sectional cohort of adolescents, transition-aged youth, and adults with PAE, of which a subset was ultimately diagnosed with FASD. METHODS We summarized data for 9 current difficulties in daily living reported at the time of diagnostic assessment for 726 individuals with PAE assessed at 26 FASD diagnostic clinics across Canada, including 443 adolescents (12 to 17 years), 135 transition-aged youth (18 to 24 years), and 148 adults (25 to 60 years). Difficulties included problems related to school disruption, employment, independent living needs, supportive or sheltered housing, legal problems with victimization, legal problems with offending, incarceration, alcohol misuse, and other substance misuse. Risk factors included age, gender, living placement, postnatal trauma, and neurodevelopmental impairment. RESULTS Across the full PAE sample, adolescents, transition-aged youth, and adults presented with high rates of difficulties in daily living, including independent living support needs (63%), alcohol misuse (38%), other substance misuse (46%), employment problems (37%), legal problems with offending (30%), assisted or sheltered housing (21%), school disruption (18%), legal problems with victimization (4%), and incarceration (3%). Difficulty rates were similar for those with FASD irrespective of diagnosis (e.g., with or without sentinel facial features), but rates greater for adults, and those with low overall intellectual functioning (IQ < 70). Controlling for age and IQ, cumulative difficulty was independently associated with gender, living placement, and neurodevelopmental impairment. CONCLUSIONS Adolescents, transition-aged youth, and adults with FASD experienced a range of substantial and complex difficulties at the time of their diagnostic assessment, signaling a high level of service needs. These findings underscore the importance of developmentally informed assessment continued through childhood, as well as ongoing functional and needs-based service provision as youth with FASD transition to adulthood and beyond.
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Affiliation(s)
- Kaitlyn McLachlan
- From the, Department of Psychology (KM), University of Guelph, Guelph, Ontario, Canada
| | - Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network (KF, KU), Vancouver, British Columbia, Canada
| | | | - Kathy Unsworth
- Canada Fetal Alcohol Spectrum Disorder Research Network (KF, KU), Vancouver, British Columbia, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada (JC), Ottawa, Ontario, Canada.,Department of Obstetrics, Gynaecology and Newborn Care (JC), University of Ottawa, Ottawa, Ontario, Canada
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Caregiver-reported physical health status of children and young people with fetal alcohol spectrum disorder. J Dev Orig Health Dis 2020; 12:420-427. [PMID: 32513328 DOI: 10.1017/s2040174420000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While fetal alcohol spectrum disorder (FASD) has primarily been thought of as a neurodevelopmental condition, research is beginning to highlight its 'whole-body' implications. Accordingly, the current study sought to provide a snapshot of potential health issues. Caregivers of children (median age of 12 years) with an FASD diagnosis were invited to participate in an online survey. Information relating to sample demographics, FASD status of the child and health outcomes were collected. The prevalence of health conditions reported in the FASD sample was compared against national prevalence data. Multiple linear regression utilising a stepwise approach was used to investigate potential predictors of the number of diagnosed health conditions. Survey data were from an international cohort (n = 197), with the majority of respondents based in Australia (40.2%) or the United States (27.7%). The most commonly reported diagnosed health conditions were eye conditions (44.7%), asthma (34.5%), heart conditions (34.0%) and skin conditions (27.4%). Binomial testing indicated the proportion of children diagnosed with these disorders was generally higher in the current FASD population, compared to national prevalence data. Indicators of metabolic dysfunction including diabetes and obesity were not significantly different compared to national prevalence data. Age of FASD diagnosis, existence of comorbid mental health conditions and the primary caregiver being in paid work were identified as being associated with the prevalence of diagnosed health conditions. Overall, the study has provided an up-to-date snapshot of health problems reported in a sample of children with FASD, confirming their increased risk of adverse health outcomes.
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Mughal R, Joyce A, Hill C, Dimitriou D. Sleep disturbance as a predictor of anxiety in children with Fetal Alcohol Spectrum Disorders and typically developing children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 101:103610. [PMID: 32224364 DOI: 10.1016/j.ridd.2020.103610] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND High levels of anxiety and sleep problems are common features of Fetal Alcohol Spectrum Disorders (FASD). The strong association between sleep and anxiety has been documented in typically developing (TD) populations and is thought to be bidirectional. The association between sleep and anxiety in children with FASD has not yet been examined. METHODS Caregivers of children with FASD (n = 91) and TD children (n = 103) aged 6-16 completed the Children's Sleep Habits Questionnaire (CSHQ), Spence Children's Anxiety Scale (SCAS), and a background questionnaire. Hierarchical multiple regression analyses, group comparisons and ANCOVA interaction models were used to test the associations between sleep and anxiety within and between the two groups. RESULTS Sleep disturbances and anxiety were at clinical levels for the majority of the FASD group, and significantly higher in the FASD group than the TD group. After controlling for age and sex, 27 % of the variance in anxiety scores in TD children was attributable to sleep problems, and 33 % in children with FASD. CONCLUSION This study highlights associations between parent-reported sleep and anxiety in FASD. Sleep disturbances were significant predictors of anxiety in both children with FASD and in TD children. Given the importance of sleep to healthy neurodevelopment, there is a pressing need for sleep intervention studies in children with FASD. Early identification and intervention for sleep problems in this condition should be a therapeutic priority.
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Affiliation(s)
- Rabya Mughal
- Institute of Education, University College London.
| | - Anna Joyce
- Regent's University London Catherine Hill: University Hospital Southampton, University of Southampton
| | - Catherine Hill
- Regent's University London Catherine Hill: University Hospital Southampton, University of Southampton
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Sanders JL, Netelenbos N, Dei SO. Construct and factorial validity of Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE). BMC Psychol 2020; 8:53. [PMID: 32460861 PMCID: PMC7251837 DOI: 10.1186/s40359-020-00405-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background ND-PAE, as a condition needing further study, requires validation. Few studies have assessed the validity of ND-PAE with none using a prospective sample. Methods Fifty-eight children underwent multidisciplinary FASD assessments and were evaluated for ND-PAE using a prospective, clinical approach. Construct and factorial validity of ND-PAE were assessed, and associations between domains and symptoms described. Post hoc analysis assessed external validity of factors. Results ND-PAE demonstrated weak construct validity with variable convergence and divergence within and between symptoms. Factor analysis revealed one strong factor consisting of abilities associated with adaptive behavior and general cognitive ability. Relative contribution of symptoms and domains were variable. Conclusion This study provides an evidence-based approach to assessing ND-PAE symptoms and is a starting point to elucidating its neurobehavioral pattern.
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Affiliation(s)
- James Ladell Sanders
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada.
| | - Nicole Netelenbos
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada
| | - Samuel Ofori Dei
- Faculty of Health Sciences, University of Lethbridge, 4401 University Dr W, Lethbridge, Alberta, T1K 3M4, Canada
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55
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Connor S, Tan KY, Pestell CF, Fitzpatrick JP. The Demographic and Neurocognitive Profile of Clients Diagnosed With Fetal Alcohol Spectrum Disorder in PATCHES Paediatrics Clinics Across Western Australia and the Northern Territory. Alcohol Clin Exp Res 2020; 44:1284-1291. [PMID: 32333805 DOI: 10.1111/acer.14345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a diagnosis relating to neurocognitive impairments associated with prenatal alcohol exposure. A key aspect of improving FASD diagnostic processes and management is understanding the demographic and neurocognitive profile of those living with FASD. The aim of this study was to describe the demographic and neurocognitive profile of the first 199 individuals diagnosed with FASD in PATCHES Paediatrics clinics. METHODS A retrospective cross-sectional descriptive study design was conducted with individuals diagnosed with FASD between 2013 and 2018 through a multidisciplinary team according to the Australian FASD Diagnostic Guidelines. RESULTS Participants were primarily male 133 (66.8%) and Aboriginal Australian 147 (73.9%), aged 2 to 31 (mean 10.5), with 94 (47.3%) from remote or very remote parts of Western Australia. Participants came from low 119 (59.8%), medium 48 (24.1%), and high 32 (16.1%) socioeconomic (SE) backgrounds. Low SE background was found to be a predictor of number of sentinel facial features (Wald χ2 (1) = 4.03, p < 0.05). Most received a diagnosis of FASD with <3 sentinel features 165 (82.9%). Participants either had 6 or more 46 (23.1%), 5 44 (22.1%), 4 55 (27.6%), or 3 (27.1%) neurodevelopmental domains impaired. Executive functioning was the most commonly impaired neurodevelopmental domain 158 (79.4%), and 31 (61%) reported sleep disturbance. ADHD was the most observed comorbid condition (41.7%). CONCLUSIONS This study improves our current understanding of neurocognitive and demographic profiles in individuals with FASD that have been clinically referred for diagnosis within Western Australia and the Northern Territory, and highlights the importance of prevention and early assessment/diagnosis as well as guidance regarding more targeted interventions. FASD affects individuals from all cultural and SE backgrounds. Individuals from middle to higher SE groups are at risk of FASD with prevention efforts needing to target these sectors of society. Suggestions for future research directions are also provided.
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Affiliation(s)
- Sophia Connor
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - Kuen Yee Tan
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - Carmela F Pestell
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - James P Fitzpatrick
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
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Alberry BLJ, Castellani CA, Singh SM. Hippocampal transcriptome analysis following maternal separation implicates altered RNA processing in a mouse model of fetal alcohol spectrum disorder. J Neurodev Disord 2020; 12:15. [PMID: 32416732 PMCID: PMC7231420 DOI: 10.1186/s11689-020-09316-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/16/2020] [Indexed: 01/05/2023] Open
Abstract
Background Fetal alcohol spectrum disorders (FASD) are common, seen in 1–5% of the population in the USA and Canada. Children diagnosed with FASD are not likely to remain with their biological parents, facing early maternal separation and foster placements throughout childhood. Methods We model FASD in mice via prenatal alcohol exposure and further induce early life stress through maternal separation. We use RNA-seq followed by clustering of expression profiles through weighted gene co-expression network analysis (WGCNA) to analyze transcriptomic changes that result from the treatments. We use reverse transcription qPCR to validate these changes in the mouse hippocampus. Results We report an association between adult hippocampal gene expression and prenatal ethanol exposure followed by postnatal separation stress that is related to behavioral changes. Expression profile clustering using WGCNA identifies a set of transcripts, module 19, associated with anxiety-like behavior (r = 0.79, p = 0.002) as well as treatment group (r = 0.68, p = 0.015). Genes in this module are overrepresented by genes involved in transcriptional regulation and other pathways related to neurodevelopment. Interestingly, one member of this module, Polr2a, polymerase (RNA) II (DNA directed) polypeptide A, is downregulated by the combination of prenatal ethanol and postnatal stress in an RNA-Seq experiment and qPCR validation (q = 2e−12, p = 0.004, respectively). Conclusions Together, transcriptional control in the hippocampus is implicated as a potential underlying mechanism leading to anxiety-like behavior via environmental insults. Further research is required to elucidate the mechanism involved and use this insight towards early diagnosis and amelioration strategies involving children born with FASD.
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Affiliation(s)
- Bonnie L J Alberry
- Department of Biology, Western University, 1151 Richmond St, London, Ontario, N6A 5B7, Canada
| | - Christina A Castellani
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| | - Shiva M Singh
- Department of Biology, Western University, 1151 Richmond St, London, Ontario, N6A 5B7, Canada.
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Jirikowic TL, Thorne JC, McLaughlin SA, Waddington T, Lee AKC, Astley Hemingway SJ. Prevalence and patterns of sensory processing behaviors in a large clinical sample of children with prenatal alcohol exposure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103617. [PMID: 32203885 DOI: 10.1016/j.ridd.2020.103617] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/07/2019] [Accepted: 02/24/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Atypical behavioral responses to sensation are reported in a large proportion of children affected by prenatal alcohol exposure (PAE). Systematic examination of symptoms across the fetal alcohol spectrum in a large clinical sample is needed to inform diagnosis and intervention. AIMS To describe the prevalence and patterns of atypical sensory processing symptoms in a clinical sample of children with PAE. METHODS Retrospective analysis of diagnostic clinical data from the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network (FASDPN). Participants were ages 3 through 11 years, had a diagnosis on the fetal alcohol spectrum, and Short Sensory Profile (SSP) assessment. The proportions of children categorized with definite differences on the SSP across selected clinical and demographic features were examined with chi-square analyses. OUTCOMES The sample consisted of 325 children; 73.2 % had SSP total scores in the definite difference range. Atypical sensory processing symptoms were significantly more prevalent among children with higher reported levels of PAE. The prevalence of atypical symptoms was comparably high across age, levels of diagnostic severity, and other prenatal/postnatal risks. CONCLUSIONS Results lend support for altered sensory processing as another domain of brain function affected by the teratogenic impact of PAE, guiding clinical work and research.
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Affiliation(s)
- Tracy L Jirikowic
- University of Washington School of Medicine, Department of Rehabilitation Medicine, Division of Occupational Therapy, United States.
| | - John C Thorne
- Department of Speech & Hearing Sciences, University of Washington, United States
| | - Susan A McLaughlin
- Institute for Learning & Brain Sciences, University of Washington, United States
| | - Tiffany Waddington
- Institute for Learning & Brain Sciences, University of Washington, United States
| | - Adrian K C Lee
- Department of Speech & Hearing Sciences and Institute for Learning & Brain Sciences, University of Washington, United States
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Katz J, Knight V, Mercer SH, Skinner SY. Effects of a Universal School-Based Mental Health Program on the Self-concept, Coping Skills, and Perceptions of Social Support of Students with Developmental Disabilities. J Autism Dev Disord 2020; 50:4069-4084. [DOI: 10.1007/s10803-020-04472-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Alberry BL, Singh SM. Hippocampal DNA Methylation in a Mouse Model of Fetal Alcohol Spectrum Disorder That Includes Maternal Separation Stress Only Partially Explains Changes in Gene Expression. Front Genet 2020; 11:70. [PMID: 32174962 PMCID: PMC7056727 DOI: 10.3389/fgene.2020.00070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is characterized by developmental and behavioral deficits caused by maternal drinking during pregnancy. Children born with FASD often face additional stresses, including maternal separation, that add yet additional deficits. The mechanism associated with this interaction is not known. We have used a mouse model for prenatal ethanol exposure and maternal separation to demonstrate that the combination of the two treatments results in more than additive deficits. Furthermore, the behavioral deficits are associated with changes in hippocampal gene expression that persist into adulthood. What initiates and maintains these changes remains to be established and forms the focus of this report. Specifically, MeDIP-Seq was used to assess if changes in promoter DNA methylation are affected by exposure to prenatal ethanol and maternal separation including its relationship to gene expression. The novel results show that different sets of genes implicated by promoter DNA methylation are affected by both treatments independently, and a relatively unique set of genes are affected by the combination of the two treatments. Prenatal ethanol exposure leads to altered promoter DNA methylation at genes important for transcriptional regulation. Maternal separation leads to changes at genes important for histone methylation and immune response, and the combination of two treatments results in DNA methylation changes at genes important for neuronal migration and immune response. Our dual results from the same hippocampal samples suggest there is minimal complementarity between changes in promoter DNA methylation and gene expression, although genes involved tend to be critical for brain development and function. While remaining to be validated, such results argue that mechanisms beyond promoter DNA methylation must be involved in lasting gene expression alterations leading to behavioral deficits implicated in FASD. They may facilitate early and reliable diagnosis, as well as novel strategies for the amelioration of FASD-related deficits.
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Affiliation(s)
| | - Shiva M. Singh
- Department of Biology, Western University, London, ON, Canada
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60
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Reid N, Moritz KM, Akison LK. Adverse health outcomes associated with fetal alcohol exposure: A systematic review focused on immune-related outcomes. Pediatr Allergy Immunol 2019; 30:698-707. [PMID: 31215695 DOI: 10.1111/pai.13099] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 01/12/2023]
Abstract
Prenatal alcohol exposure (PAE) has well-known teratogenic effects on the developing fetus, potentially resulting in neurologic impairments. However, there is increasing interest regarding other potential adverse health outcomes related to prenatal alcohol exposure. The objective of this study was to undertake a systematic review to identify all the available clinical and preclinical literature investigating immune-related outcomes in offspring with PAE. A systematic review searching four electronic databases (PubMed, CINAHL, Web of Science, and Embase) was conducted. Potential articles were screened against strict inclusion/exclusion criteria. This review specifically focused on evaluating studies related to immune-related outcomes following PAE. Twelve clinical studies were included in the current review. Six included allergy outcomes, four included infection outcomes, and two studies included both. Thirty-nine preclinical studies were identified examining a wide range of immune outcomes. The current review provides some preliminary clinical evidence that PAE can influence immune function, including atopic allergy and infection outcomes. However, there was variability in results across studies, particularly in the atopy area. Preclinical studies demonstrated some changes in lymphocytes and cytokines in offspring following PAE. More research investigating the effects of PAE on immune responses is warranted.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Karen M Moritz
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.,School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Lisa K Akison
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.,School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Mukherjee RA, Cook PA, Norgate SH, Price AD. Neurodevelopmental outcomes in individuals with fetal alcohol spectrum disorder (FASD) with and without exposure to neglect: Clinical cohort data from a national FASD diagnostic clinic. Alcohol 2019; 76:23-28. [PMID: 30544006 DOI: 10.1016/j.alcohol.2018.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 01/24/2023]
Abstract
Disentangling the relative developmental impact of prenatal alcohol exposure from postnatal neglect is clinically valuable for informing future service provision. In this study, developmental outcomes across groups are compared in a 'natural experiment'. METHODS Clinical data from 99 persons with fetal alcohol spectrum disorder (FASD) diagnoses were audited. Developmental outcomes (diagnosis of attention deficit hyperactivity disorder, ADHD; social and communication disorder, SCD; or Autistic Spectrum Disorder, ASD; Short Sensory Profile, SSP; Vineland II Adaptive Behaviour Scales) were compared across two exposure groups: prenatal alcohol only; and mixed prenatal alcohol and neglect. RESULTS ADHD (74%) and ASD/SCD (68%) were common, with no significant difference between groups (ADHD, p = 0.924; ASD, p = 0.742). Vineland age equivalence scores were lower than chronological age (11.1 years - prenatal alcohol only, and 12.7 years - neglect) across all domains, especially receptive language (3.7 years for both groups). Age equivalence did not differ between groups, with the exception of domestic daily living (neglect: 7.7 years vs. prenatal alcohol only: 5.8 years, p = 0.027). A probable/definite difference on SSP was more common in the prenatal alcohol only (96% vs. 67%, p = 0.006). For the individual subscales of SSP, there were no significant differences by neglect category. DISCUSSION Postnatal neglect in this group did not make the developmental outcome any worse, suggesting that prenatal alcohol influences these outcomes independently. Professionals who support families looking after a child with both FASD and a history of neglect should be aware that the behavioral difficulties are likely to be related to prenatal alcohol exposure and not necessarily reflective of parenting quality.
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Lebel CA, McMorris CA, Kar P, Ritter C, Andre Q, Tortorelli C, Gibbard WB. Characterizing adverse prenatal and postnatal experiences in children. Birth Defects Res 2019; 111:848-858. [PMID: 30690931 DOI: 10.1002/bdr2.1464] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/24/2018] [Accepted: 01/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prenatal and postnatal adversities, including prenatal alcohol exposure (PAE), prenatal exposure to other substances, toxic stress, lack of adequate resources, and postnatal abuse or neglect, often co-occur. These exposures can have cumulative effects, or interact with each other, leading to worse outcomes than single exposures. However, given their complexity and heterogeneity, exposures can be difficult to characterize. Clinical services and research often overlook additional exposures and attribute outcomes solely to one factor. METHODS We propose a framework for characterizing adverse prenatal and postnatal exposures and apply it to a cohort of 77 children. Our approach considers type, timing, and frequency to quantify PAE, other prenatal substance exposure, prenatal toxic stress, postnatal threat (harm or threat of harm), and postnatal deprivation (failure to meet basic needs) using a 4-point Likert-type scale. Postnatal deprivation and harm were separated into early (<24 months of age) and late (≥24 months) time periods, giving seven exposure variables. Exposures were ascertained via health records, child welfare records, interviews with birth parents, caregivers, and/or close family/friends. RESULTS Nearly all children had co-occurring prenatal exposures, and two-thirds had both prenatal and postnatal adversities. Children with high PAE were more likely to experience late postnatal adversities, and children with other prenatal substance exposure were more likely to have early postnatal deprivation. Postnatal adversities were more likely to co-occur. CONCLUSION This framework provides a comprehensive picture of a child's adverse exposures, which can inform assessment and intervention approaches and policy and will be useful for future research.
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Affiliation(s)
- Catherine A Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Preeti Kar
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Chantel Ritter
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Quinn Andre
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Zouini B, Sfendla A, Hedman Ahlström B, Senhaji M, Kerekes N. Mental health profile and its relation with parental alcohol use problems and/or the experience of abuse in a sample of Moroccan high school students: an explorative study. Ann Gen Psychiatry 2019; 18:27. [PMID: 31889971 PMCID: PMC6923982 DOI: 10.1186/s12991-019-0251-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 12/02/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Studies on mental health are scarce from Arab countries, especially studies focusing on adolescents. In addition to the neurobiological and physiological changes that occur during adolescent development, psychological, societal and cultural influences have strong effects on adolescents' behavior and on their somatic and mental health. The present study aimed (1) to describe the mental health profile, operationalized as psychological distress, of a sample of Moroccan adolescents, and (2) to investigate how specific psychosocial factors (parental alcohol use problems and the experience of physical and/or psychological abuse) may affect adolescents' mental health. METHODS The sample included 375 adolescents from conveniently selected classes of four high schools in the city of Tetouan in Morocco. The participants responded to an anonymous survey containing, beside other inventories, the Brief Symptom Inventory (BSI) and identified those reporting parental alcohol use problems and/or the previous experience of abuse. The sample characteristics were defined using descriptive statistics. The effects of the defined psychosocial factors were identified using the Kruskal-Wallis test, followed by the post hoc Fisher's least significant difference test. RESULTS The most common problems found in high school students from an urban region of Morocco were memory problems, concentration difficulties, restlessness, fear, nervosity and feelings of inadequacy during interpersonal interactions. The female students reported significantly higher psychological distress levels when compared to the male students (p < 0.001). The adolescents reporting parental alcohol use problems and the experience of physical/psychological abuse showed significantly higher levels of psychological distress (p = 0.02), especially symptoms of somatization (p < 0.001), hostility (p = 0.005) and anxiety (p = 0.01), than those not reporting any of these psychosocial factors. CONCLUSION The mental health profile of female adolescents from an urban area of Morocco is worse than that of their male fellow students. Adolescents reporting parental alcohol use problems and/or the experience of physical/psychological abuse need synchronized support from social- and healthcare services.
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Affiliation(s)
- Btissame Zouini
- 1Department of Biology, Faculty of Sciences, Abdelmalek Essaadi University, Tetouan, Morocco
| | - Anis Sfendla
- Higher Institute of Nursing Professions and Health Techniques, Errachidia, Morocco
| | | | - Meftaha Senhaji
- 1Department of Biology, Faculty of Sciences, Abdelmalek Essaadi University, Tetouan, Morocco
| | - Nóra Kerekes
- 3Department of Health Sciences, University West, Trollhättan, Sweden
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Sleep Impact on Perception, Memory, and Emotion in Adults and the Effects of Early-Life Experience. HANDBOOK OF SLEEP RESEARCH 2019. [DOI: 10.1016/b978-0-12-813743-7.00039-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fallon B, Filippelli J, Joh-Carnella N, Milne E, Carradine J. Promoting Protective Factors in Environments of Risk for Young Children: An Organizing Framework for Practice, Policy, and Research. GENDER AND THE GENOME 2018. [DOI: 10.1177/2470289718820843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early childhood is an important developmental period, which lays the foundation for future learning, behaviour, physical and mental health and gene expression. The most vulnerable children in society are often referred to and receive services from the child welfare system because of a concern of abuse and neglect and/or a poor developmental trajectory. This paper presents an organizing framework for how the child welfare system, in concert with allied partners, can support interventions for young children and families by acknowledging its crucial role in improving their development and well-being. The framework is informed by research amassed from numerous disciplines, including child welfare, development, neuroscience, neurobiology and epigenetics. Although the notions of protection and well-being are central considerations in child welfare legislation in Ontario, Canada, the operationalization of wellbeing has proven challenging in child welfare practice, policy and research. The framework proposes ten key indicators and priorities for identifying and promoting optimal child development. Findings from the 2013 cycle of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), the only provincial source of aggregated child welfare investigation data, are presented to articulate the divide between the environmental context of a population of at-risk children and the conditions that both protect children and increase the likelihood that they will thrive in adulthood. This paper argues there are different points of entry and intervention across sectors and provides a foundation for further discussion on how to promote well-being for society's most vulnerable children.
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Affiliation(s)
- Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Joanne Filippelli
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Elizabeth Milne
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Jessica Carradine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Kippin NR, Leitão S, Watkins R, Finlay-Jones A, Condon C, Marriott R, Mutch RC, Bower C. Language diversity, language disorder, and fetal alcohol spectrum disorder among youth sentenced to detention in Western Australia. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:40-49. [PMID: 30420110 DOI: 10.1016/j.ijlp.2018.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND While studies confirm high prevalence of language disorder among justice-involved young people, little is known about the impact of Fetal Alcohol Spectrum Disorder (FASD) on language among this population. It is also not clear how language skills vary according to language diversity in Australian youth justice settings, where a disproportionate number of justice-involved youth are Aboriginal and may not speak Standard Australian English (SAE) as their first language. Language skills are important to understand, as language disorder and language difference can lead to a mismatch between the communication skills of a young person and the communication skills of the justice workforce with whom they are communicating. In the highly verbal environments that are common to justice systems, language disorder and language difference may result in a young person misunderstanding legal information and expectations placed on them and not being adequately understood by the justice workforce. METHODS This study examined the language skills of 98 young people sentenced to detention in Western Australia (WA), who participated in a cross-sectional study examining the prevalence of FASD. Language skills assessed using standardised and non-standardised tasks were analysed by the three major language groups identified: speakers of SAE, Aboriginal English and English as an additional language. RESULTS We identified rich diversity of languages, and multilingualism was common. Most young people for whom English was not their first language demonstrated difficulties in SAE competence. Further, nearly one in two young people were identified with language disorder - over half of whom had language disorder associated with FASD. CONCLUSIONS This study has documented language diversity and the prevalence of language disorder associated with FASD among a representative sample of youth sentenced to detention in WA. Results underscore the need for the justice workforce to consider language difference when working with justice-involved youth, as well as language disorder and FASD. The findings also demonstrate the need for speech pathology to be embedded as core service in youth justice systems, working in collaboration with local cultural and language advisors and accredited interpreters. This can better enable appropriate identification of and response to communication and associated rehabilitation needs of young people navigating youth justice systems.
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Affiliation(s)
- Natalie R Kippin
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, Australia; FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Suze Leitão
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Perth, Australia
| | - Rochelle Watkins
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, University of Western Australia, Perth, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia
| | - Amy Finlay-Jones
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, University of Western Australia, Perth, Australia; School of Psychology, Curtin University, Perth, Australia
| | - Carmen Condon
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rhonda Marriott
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; Murdoch University Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Perth, Australia
| | - Raewyn C Mutch
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, University of Western Australia, Perth, Australia; Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Perth, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia
| | - Carol Bower
- Alcohol, Pregnancy and FASD, Telethon Kids Institute, University of Western Australia, Perth, Australia; FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, University of Western Australia, Perth, Australia
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67
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Kaiser S, Zimmet M, Fraser J, Liddle K, Roberts G. Recognition of attachment difficulties and developmental trauma is the responsibility of all paediatricians. J Paediatr Child Health 2018; 54:1110-1116. [PMID: 30294995 DOI: 10.1111/jpc.14154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Abstract
This article provides an overview of attachment theory, developmental trauma and trauma-informed care for paediatricians. The impact of difficult or impoverished parent-child relationships on brain development and long-term health is now well known. Recent neuroscience research reveals the adverse neurological impacts of developmental trauma and supports the biological basis of attachment theory. There is also an increasing body of evidence that childhood adversity is common and impacts physical and mental health throughout the life-span. Comprehensive paediatric assessment should include an understanding of attachment difficulties and developmental trauma. Viewing children and their families through a 'trauma-informed lens' can provide critical insights into their clinical presentation and care needs. All paediatricians should be providing and practicing trauma-informed care.
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Affiliation(s)
- Samantha Kaiser
- Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/).,Child Development Service, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Marcel Zimmet
- Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/).,FASD Service, The CICADA Centre NSW, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jolene Fraser
- Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/).,Craigieburn Health Service, Northern Health, Melbourne, Victoria, Australia
| | - Karen Liddle
- Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/).,Inala Indigenous Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Gehan Roberts
- Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/).,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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68
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Raineki C, Bodnar TS, Holman PJ, Baglot SL, Lan N, Weinberg J. Effects of early-life adversity on immune function are mediated by prenatal environment: Role of prenatal alcohol exposure. Brain Behav Immun 2017; 66:210-220. [PMID: 28698116 PMCID: PMC5650917 DOI: 10.1016/j.bbi.2017.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 01/07/2023] Open
Abstract
The contribution of the early postnatal environment to the pervasive effects of prenatal alcohol exposure (PAE) is poorly understood. Moreover, PAE often carries increased risk of exposure to adversity/stress during early life. Dysregulation of immune function may play a role in how pre- and/or postnatal adversity/stress alters brain development. Here, we combine two animal models to examine whether PAE differentially increases vulnerability to immune dysregulation in response to early-life adversity. PAE and control litters were exposed to either limited bedding (postnatal day [PN] 8-12) to model early-life adversity or normal bedding, and maternal behavior and pup vocalizations were recorded. Peripheral (serum) and central (amygdala) immune (cytokines and C-reactive protein - CRP) responses of PAE animals to early-life adversity were evaluated at PN12. Insufficient bedding increased negative maternal behavior in both groups. Early-life adversity increased vocalization in all animals; however, PAE pups vocalized less than controls. Early-life adversity reduced serum TNF-α, KC/GRO, and IL-10 levels in control but not PAE animals. PAE increased serum CRP, and levels were even higher in pups exposed to adversity. Finally, PAE reduced KC/GRO and increased IL-10 levels in the amygdala. Our results indicate that PAE alters immune system development and both behavioral and immune responses to early-life adversity, which could have subsequent consequences for brain development and later life health.
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Affiliation(s)
- Charlis Raineki
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada.
| | - Tamara S Bodnar
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Parker J Holman
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Samantha L Baglot
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Ni Lan
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
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