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Veziris CR, Hyland MT, Kable JA, Wozniak JR, Coles CD, May PA, Kalberg WO, Sowell ER, Jones KL, Riley EP, Mattson SN. Validation of the ND-PAE Diagnosis in Children with Heavy Prenatal Alcohol Exposure. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01740-z. [PMID: 39083167 DOI: 10.1007/s10578-024-01740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Abstract
This study evaluated criteria for neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). Kable et al. (Child Psychiatry Hum Dev 55:426, 2022) assessed the validity of this diagnosis in a sample with low exposure to alcohol. The current study expanded this assessment to a sample with a wider age range and heavier alcohol exposure. Data were collected from participants (5-17 years) with prenatal alcohol exposure (PAE) and typically developing controls at six Collaborative Initiative on Fetal Alcohol Spectrum Disorders sites using neuropsychological assessment and caregiver reports. Impairment was tested at 1SD, 1.5SD, and 2SD below the normative average and a modification of the adaptive functioning requirement was tested. Testing impairment at 1SD resulted in the highest endorsement rates in both groups. Our findings replicated the study by Kable et al. and show that current criteria captured a high rate of those with PAE and that requiring fewer adaptive functioning criteria resulted in higher sensitivity to PAE.
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Affiliation(s)
- Christina R Veziris
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Matthew T Hyland
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Philip A May
- Nutrition Research Institute, University of North Carolina, Chapel Hill, USA
| | - Wendy O Kalberg
- Center On Alcoholism, Substance Abuse, and Addiction, University of New Mexico, Albuquerque, USA
| | - Elizabeth R Sowell
- Department of Pediatrics, Neurology, and Psychology, Keck School of Medicine of USC, Los Angeles, USA
| | - Kenneth L Jones
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, USA
| | - Edward P Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, 6330 Alvarado Court, Suite 100, San Diego, CA, 92120, USA.
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Suttie M, Kable J, Mahnke AH, Bandoli G. Machine learning approaches to the identification of children affected by prenatal alcohol exposure: A narrative review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:585-595. [PMID: 38302824 PMCID: PMC11015982 DOI: 10.1111/acer.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/05/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Abstract
Fetal alcohol spectrum disorders (FASDs) affect at least 0.8% of the population globally. The diagnosis of FASD is uniquely complex, with a heterogeneous physical and neurobehavioral presentation that requires multidisciplinary expertise for diagnosis. Many researchers have begun to incorporate machine learning approaches into FASD research to identify children who are affected by prenatal alcohol exposure, including those with FASD. This narrative review highlights these efforts. Following an introduction to machine learning, we summarize examples from the literature of neurobehavioral screening tools and physiologic markers of exposure. We discuss individual efforts, including models that classify FASD based on parent-reported neurocognitive or behavioral questionnaires, 3D facial imaging, brain imaging, DNA methylation patterns, microRNA profiles, cardiac orienting response, and dysmorphic facial features. We highlight model performance and discuss the limitations of these approaches. We conclude by considering the scalability of these approaches and how these machine learning models, largely developed from clinical samples or highly exposed birth cohorts, may perform in the general population.
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Affiliation(s)
- Michael Suttie
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, UK
- Big Data Institute, University of Oxford, UK
| | - Julie Kable
- Departments of Psychiatry and Behavioral Science and Pediatrics, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA, 30322, USA
| | - Amanda H. Mahnke
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, 8447 Riverside Parkway, Bryan, TX 77807, USA
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
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Kable JA, Coles CD, Holton JE, Kalberg WO, May PA, Chambers CD, Bandoli G. Characteristics of the Symptoms of the Proposed ND-PAE Disorder in First Grade Children in a Community Sample. Child Psychiatry Hum Dev 2024; 55:426-438. [PMID: 36042156 PMCID: PMC10874642 DOI: 10.1007/s10578-022-01414-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
The proposed symptoms for Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) were evaluated in children who participated in the Collaboration on Fetal Alcohol Spectrum Disorders Prevalence study. Children "at-risk" for ND-PAE (n = 204) were contrasted to children with no prenatal alcohol exposure, alcohol-related dysmorphia or growth deficits (n = 908). Symptoms were defined based on neuropsychological testing using two diagnostic threshold levels (1.0 and 1.5 STD). Individuals at risk for ND-PAE had higher endorsement rates of the self-regulation and adaptive impairments at the 1.0 threshold and of the neurocognitive and self-regulation impairments at the 1.5 threshold. Endorsement of the disorder significantly differed at the 1.0 threshold. Receiver operating characteristic curve analysis indicated that having an IQ below 70 was not predictive of the diagnosis but modifications of the IQ criterion improved predictive validity. Discrimination validity was poor without documentation of PAE which continues to be a necessity for a diagnosis of ND-PAE.
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Affiliation(s)
- Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer E Holton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy O Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Philip A May
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Gretchen Bandoli
- School of Medicine, University of California, San Diego, La Jolla, USA
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Veziris CR, Hyland MT, Kable JA, Wozniak JR, Coles CD, May PA, Kalberg WO, Sowell ER, Jones KL, Riley EP, Mattson SN. Validation of the ND-PAE Diagnosis in Children with Heavy Prenatal Alcohol Exposure. RESEARCH SQUARE 2024:rs.3.rs-3922436. [PMID: 38410428 PMCID: PMC10896399 DOI: 10.21203/rs.3.rs-3922436/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This study evaluated criteria for Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). Kable et al. (2022) assessed the validity of this diagnosis in a sample with low exposure to alcohol. The current study expanded this assessment to a sample with a wider age range and heavier alcohol exposure. Data were collected from participants (5-17y) with prenatal alcohol exposure (PAE) and typically developing controls at six Collaborative Initiative on Fetal Alcohol Spectrum Disorders sites using neuropsychological assessment and caregiver reports. Impairment was tested at 1SD, 1.5SD, and 2SD below the normative average and a modification of the adaptive functioning requirement was tested. Testing impairment at 1SD resulted in the highest endorsement rates in both groups. Our findings replicated the study by Kable et al. and show that current criteria captured a high rate of those with PAE and that requiring fewer adaptive functioning criteria resulted in higher sensitivity to PAE.
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Waite D, Burd L. Common developmental trajectories and clinical identification of children with fetal alcohol spectrum disorders: A synthesis of the literature. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10877. [PMID: 38389815 PMCID: PMC10880764 DOI: 10.3389/adar.2023.10877] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2024]
Abstract
At an estimated prevalence of up to five percent in the general population, fetal alcohol spectrum disorders (FASD) are the most common neurodevelopmental disorder, at least if not more prevalent than autism (2.3%). Despite this prevalence in the general population, pediatricians and other developmental specialists have thus far failed to diagnose this disability, leaving most children and adults without the supports provided for most other disabilities. This paper will provide a review of clinically relevant literature that describes the developmental challenges of children with fetal alcohol spectrum disorders and addresses similarities to and differences of FASD from other neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder. A subsequent discussion will describe how a diagnosis of an FASD can establish a basis for understanding the developmental and behavioral challenges of children with an FASD, and how specific interventions can help support child development and maximize adult independence.
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Affiliation(s)
- Douglas Waite
- Developmental Pediatrics, Bronxcare Health System, Mount Sinai School of Medicine, New York, NY, United States
| | - Larry Burd
- Department of Pediatrics, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
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Coles CD, Kable JA, Granovska IV, Pashtepa AO, Wertelecki W, Chambers CD. Measurement of neurodevelopmental effects of prenatal alcohol exposure in Ukrainian preschool children. Child Neuropsychol 2021; 27:1088-1103. [PMID: 33982636 DOI: 10.1080/09297049.2021.1919298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.
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Affiliation(s)
- Claire D Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Iryna V Granovska
- OMNet, Rivne, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Ala O Pashtepa
- OMNet, Rivne, Ukraine.,Khmelnitsky Perinatal Center, Khmelnitsky, Ukraine
| | - Wladimir Wertelecki
- OMNet, Rivne, Ukraine.,Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
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- Collaborative Initiative for Fetal Alcohol Spectrum Disorders
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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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Coles CD, Kalberg W, Kable JA, Tabachnick B, May PA, Chambers CD. Characterizing Alcohol-Related Neurodevelopmental Disorder: Prenatal Alcohol Exposure and the Spectrum of Outcomes. Alcohol Clin Exp Res 2020; 44:1245-1260. [PMID: 32173870 DOI: 10.1111/acer.14325] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effects of prenatal alcohol exposure (PAE) are conceptualized as fetal alcohol spectrum disorder, with fetal alcohol syndrome (FAS) as the most severe. Many find it more difficult to characterize behavioral and cognitive effects of exposure on the central nervous system when physical signs are not present. In the current study, an operational definition of alcohol-related neurodevelopmental disorder (ARND) was examined to determine its usefulness in discrimination of children classified as ARND based on behavior (ARND/B) and cognition (ARND/C) from children in 4 contrast groups: (i) children exposed to study-defined "risky drinking"; (ii) children with any reported PAE; (iii) children classified as "Higher Risk" for developmental problems; and (iv) children classified as "Lower Risk." METHODS A total of 1,842 children seen as part of a surveillance study (J Am Med Assoc, 319, 2018, 474) were evaluated for alcohol exposure and physical characteristics of FAS, and completed neurodevelopmental testing. Ninety-one were identified as either ARND/B or ARND/C and contrasted with other groups to further identify distinguishing patterns. Multinomial logistic regression (MLR) was used to examine the accuracy of classification and to identify factors contributing to such classification. RESULTS Children described as ARND/C were distinct from other groups based on cognition and behavior as well as demographic factors (e.g., age, race, SES), child characteristics (e.g., gestational age; sex), and other drug exposures, while those described as ARND/B differed only on behavior and other drug exposures. MLR models successfully discriminated ARND groups from children in other groups with accuracy ranging from 79% (Higher Risk) to 86.7% (Low Risk). CONCLUSIONS ARND has been a subject of debate. This analysis suggests the effects of alcohol on behavior and cognition even in the absence of the characteristic facial features and growth deficiency that can be identified. The results also indicate that it may be possible to distinguish such children from those in other high-risk groups.
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Affiliation(s)
- Claire D Coles
- From the, Department of Psychiatry and Behavioral Sciences and Pediatrics, (CDC, JAK), Emory University School of Medicine, Atlanta, Georgia
| | - Wendy Kalberg
- Center on Alcoholism, Substance Abuse and Addictions, (WK), The University of New Mexico, Albuquerque, New Mexico
| | - Julie A Kable
- From the, Department of Psychiatry and Behavioral Sciences and Pediatrics, (CDC, JAK), Emory University School of Medicine, Atlanta, Georgia
| | | | - Philip A May
- Department of Nutrition, (PAM), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Kannapolis, North Carolina
| | - Christina D Chambers
- Departments of Pediatrics and Family Medicine and Public Health, (CDC), University of California San Diego School of Medicine, La Jolla, California
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Abstract
PURPOSE OF REVIEW Understanding the pathophysiologic, diagnostic, and treatment implications of the interface between mental disorder and the consequences of Prenatal Alcohol Exposure (PAE) is important for mental health professionals (MHP) seeking to provide the most effective care. This review was written to highlight the importance of identifying and intervening with regards to the unique mental health and medical needs of individual with PAE. RECENT FINDINGS Over the last year, research has identified differences in the diagnostic criteria for Neurodevelopmental Disorder Associated with PAE (ND-PAE)/Fetal Alcohol Spectrum Disorder (FASD) and called for standardization, given that diagnosis is the main route to appropriate support. Care will improve with advances in epigenetic, neuroimaging, and electrophysiological discoveries regarding the consequences of PAE. For example, recent progressions allow for improved detection of alterations in DNA methylation and functional connectivity between cortical and deep grey matter. Therapeutic innovations targeting specific neurocognitive impairment and ligand-specific symptom clusters, as well as lifelong multidisciplinary interventions to support patients, were reported as producing effective outcomes. SUMMARY Developments in genetics, epigenetics, imaging, and interventions are relevant to the current knowledge of FASD. MHP are encouraged to recognize the importance of understanding unique considerations for this population, including forensic implications and the whole-body impacts of FASD, which could assist in reducing stigma and improving quality of care.
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