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Clark CA, Nakhid D, Baldwin-Oneill G, LaPointe S, MacIsaac-Jones M, Raja S, McMorris CA. Prevalence of co-occurring diagnoses in people exposed to alcohol prenatally: Findings from a meta-analysis. J Affect Disord 2024; 358:163-174. [PMID: 38718944 DOI: 10.1016/j.jad.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Individuals with prenatal alcohol exposure (PAE) commonly experience co-occurring diagnoses, which are often overlooked and misdiagnosed and have detrimental impacts on accessing appropriate services. The prevalence of these co-occurring diagnoses varies widely in the existing literature and has not been examined in PAE without an FASD diagnosis. METHOD A search was conducted in five databases and the reference sections of three review papers, finding a total of 2180 studies. 57 studies were included in the final analysis with a cumulative sample size of 29,644. Bayesian modeling was used to determine aggregate prevalence rates of co-occurring disorders and analyze potential moderators. RESULTS 82 % of people with PAE had a co-occurring diagnosis. All disorders had a higher prevalence in individuals with PAE than the general population with attention deficit hyperactivity disorder, learning disorder, and intellectual disability (ID) being the most prevalent. Age, diagnostic status, and sex moderated the prevalence of multiple disorders. LIMITATIONS While prevalence of disorders is crucial information, it does not provide a direct representation of daily functioning and available supports. Results should be interpreted in collaboration with more individualized research to provide the most comprehensive representation of the experience of individuals with PAE. CONCLUSIONS Co-occurring diagnoses are extremely prevalent in people with PAE, with older individuals, females, and those diagnosed with FASD being most at risk for having a co-occurring disorder. These findings provide a more rigorous examination of the challenges faced by individuals with PAE than has existed in the literature, providing clinicians with information to ensure early identification and effective treatment of concerns to prevent lifelong challenges.
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Affiliation(s)
- C A Clark
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Canada; Alberta Children's Hospital Research Institute (ACHRI), Canada.
| | - D Nakhid
- Alberta Children's Hospital Research Institute (ACHRI), Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | | | - S LaPointe
- Department of Psychology, University of Calgary, Canada
| | | | - S Raja
- Department of Psychology, University of Calgary, Canada
| | - C A McMorris
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Canada; Alberta Children's Hospital Research Institute (ACHRI), Canada; Department of Psychology, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
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Popova S, Dozet D, Faulkner MR, Howie L, Temple V. Prenatal Exposures, Diagnostic Outcomes, and Life Experiences of Children and Youths with Fetal Alcohol Spectrum Disorder. Nutrients 2024; 16:1655. [PMID: 38892588 PMCID: PMC11174948 DOI: 10.3390/nu16111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Children and youths diagnosed with FASD may experience a range of adverse health and social outcomes. This cross-sectional study investigated the characteristics and outcomes of children and youths diagnosed with FASD between 2015 and 2018 at the Sunny Hill Centre in British Columbia, Canada and examined the relationships between prenatal substance exposures, FASD diagnostic categories, and adverse health and social outcomes. Patient chart data were obtained for 1187 children and youths diagnosed with FASD and analyzed. The patients (mean age: 9.7 years; range: 2-19) had up to 6 physical and 11 mental health disorders. Prenatal exposure to other substances (in addition to alcohol) significantly increased the severity of FASD diagnosis (OR: 1.18): the odds of FASD with sentinel facial features (SFF) were 41% higher with prenatal cigarette/nicotine/tobacco exposure; 75% higher with exposure to cocaine/crack; and two times higher with exposure to opioids. Maternal mental health issues and poor nutrition also increase the severity of FASD diagnosis (60% and 6%, respectively). Prenatal exposure to other substances in addition to alcohol significantly predicts involvement in the child welfare system (OR: 1.52) and current substance use when adjusted for age (aOR: 1.51). Diagnosis of FASD with SFF is associated with an increased number of physical (R2 = 0.071, F (3,1183) = 30.51, p = 0.000) and mental health comorbidities (R2 = 0.023, F (3,1185) = 9.51, p = 0.000) as compared to FASD without SFF adjusted for age and the number of prenatal substances. Screening of pregnant women for alcohol and other substance use, mental health status, and nutrition is extremely important.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON M5S 1V4, Canada
| | - Danijela Dozet
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - Mary-Rose Faulkner
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada; (D.D.); (M.-R.F.)
| | - Lesley Howie
- North Island Hospital Comox Valley, 101 Lerwick Rd, Courtenay, BC V9N 0B9, Canada;
| | - Valerie Temple
- Surrey Place, 2 Surrey Place, Toronto, ON M5S 2C2, Canada;
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Chandler-Mather N, Crichton A, Shelton D, Harris K, Donovan C, Dawe S. Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Child Neuropsychol 2024:1-22. [PMID: 38607688 DOI: 10.1080/09297049.2024.2337715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.
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Affiliation(s)
| | - Ali Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Doug Shelton
- Gold Coast University Hospital, Southport, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Australia
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4
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Long M, Kar P, Forkert ND, Landman BA, Gibbard WB, Tortorelli C, McMorris CA, Huo Y, Lebel CA. Sex and age effects on gray matter volume trajectories in young children with prenatal alcohol exposure. Front Hum Neurosci 2024; 18:1379959. [PMID: 38660010 PMCID: PMC11039858 DOI: 10.3389/fnhum.2024.1379959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Prenatal alcohol exposure (PAE) occurs in ~11% of North American pregnancies and is the most common known cause of neurodevelopmental disabilities such as fetal alcohol spectrum disorder (FASD; ~2-5% prevalence). PAE has been consistently associated with smaller gray matter volumes in children, adolescents, and adults. A small number of longitudinal studies show altered gray matter development trajectories in late childhood/early adolescence, but patterns in early childhood and potential sex differences have not been characterized in young children. Using longitudinal T1-weighted MRI, the present study characterized gray matter volume development in young children with PAE (N = 42, 84 scans, ages 3-8 years) compared to unexposed children (N = 127, 450 scans, ages 2-8.5 years). Overall, we observed altered global and regional gray matter development trajectories in the PAE group, wherein they had attenuated age-related increases and more volume decreases relative to unexposed children. Moreover, we found more pronounced sex differences in children with PAE; females with PAE having the smallest gray matter volumes and the least age-related changes of all groups. This pattern of altered development may indicate reduced brain plasticity and/or accelerated maturation and may underlie the cognitive/behavioral difficulties often experienced by children with PAE. In conjunction with previous research on older children, adolescents, and adults with PAE, our results suggest that gray matter volume differences associated with PAE vary by age and may become more apparent in older children.
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Affiliation(s)
- Madison Long
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Preeti Kar
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Nils D. Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Bennett A. Landman
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
| | - W. Ben Gibbard
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada
| | - Christina Tortorelli
- Department of Child Studies and Social Work, Mount Royal University, Calgary, AB, Canada
| | - Carly A. McMorris
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
| | - Yuankai Huo
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, United States
- Department of Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Catherine A. Lebel
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Owerko Centre, Alberta Children Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Koponen AM, Gissler M, Nissinen NM, Autti-Rämö I, Kahila H, Sarkola T. Cumulative risk factors for injuries and poisoning requiring hospital care in youth with prenatal substance exposure: A longitudinal controlled cohort study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2024; 41:156-174. [PMID: 38645973 PMCID: PMC11027846 DOI: 10.1177/14550725231202074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/04/2023] [Indexed: 04/23/2024] Open
Abstract
Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15-24 years, n = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls (n = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016). Cox regression models were used in the analyses accounting for associated child and maternal risk factors. Results: Half (50.4%) of the exposed group and 40.6% of controls had been in hospital care due to injury or poisoning during the follow-up (p < 0.001). The difference between groups was diminished after controlling for postnatal child and maternal risk factors (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.72-1.07, p > 0.05). Cumulative adversity, especially out-of-home care in combination with a diagnosed attention or behavioural dysregulation problem, posed the highest risk in both groups (exposed: HR = 1.65, 95% CI 1.24-2.19, p < 0.001; controls: HR = 1.84, 95% CI 1.33-2.56, p < 0.001). Conclusion: Hospital care for injury and poisoning is more common in youth with PSE, but this is largely explained by the related postnatal child and maternal factors. Long-term support to families with maternal substance abuse problems could prevent injury and poisoning among youth with PSE.
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Affiliation(s)
- Anne M. Koponen
- Department of Public Health, and Social Psychology Unit, Folkhälsan Research Center, and University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland; Research Centre for Child Psychiatry, University of Turku, Turku, Finland; Academic Primary Health Care Centre, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Ilona Autti-Rämö
- Department of Child Neurology, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
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6
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Kerry J, Tan GKY, Panton KR, Mutch R, Freeman J, Passmore H, Pestell CF. Neuropsychological profiles of adolescents sentenced to detention in Western Australia with and without prenatal alcohol exposure. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:163-181. [PMID: 38268129 DOI: 10.1002/cbm.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND/AIMS Youth with prenatal alcohol exposure (PAE) are under-recognised in the justice system, warranting improved identification. This study aimed to compare neuropsychological profiles of adolescents, with and without PAE and identify neuropsychological tasks predictive of PAE-group membership. It was hypothesised that participants with PAE would score significantly lower on neuropsychological tests. METHODS Participants included 85 young people sentenced to detention (mean 15.7 years, 78 males), 46 with PAE. A one-way-multivariate analysis of variance tested differences in neuropsychological functioning between PAE/No-PAE groups, while logistic regression determined tests predictive of PAE. RESULTS No statistically significant difference in test scores emerged between groups, and regression was not indicative of any models predictive of PAE-group membership. Neuropsychological profiles were characterised by both strengths and weaknesses, with lower verbal and mathematical skills. CONCLUSION(S) While no statistically significant differences were found between the groups, the results provided a unique insight into the neurocognitive profile of Australian youth in detention. Routine screening assessments were recommended for young people sentenced to detention.
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Affiliation(s)
- Jed Kerry
- School of Psychological Science, University of WA, Perth, Western Australia, Australia
| | - Grace Kuen Yee Tan
- School of Psychological Science, University of WA, Perth, Western Australia, Australia
| | - Kirsten R Panton
- School of Psychological Science, University of WA, Perth, Western Australia, Australia
| | - Raewyn Mutch
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, Western Australia, Australia
- Department of General Paediatrics, Child and Adolescent Health Service, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Health, Perth, Western Australia, Australia
- Department of Paediatrics, Faculty of Health and Medical Sciences, Medical School, University of WA, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, Perth, Western Australia, Australia
- Invited Faculty, Harvard Program for Refugee Trauma, Harvard Medical School and School of Public Health and Massachusetts General Hospital, Cambridge, Massachusetts, USA
| | - Jacinta Freeman
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, Western Australia, Australia
| | - Hayley Passmore
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, Western Australia, Australia
- School of Law, University of WA, Crawley, Perth, Western Australia, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of WA, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Perth, Western Australia, Australia
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Warmingham J, Petrenko C, Rockhold M, Alto M, Manly JT, Toth S. Investigating the associations between prenatal exposure to substances and intergenerational maltreatment and symptoms of psychopathology for adolescent girls from families with low income. CHILD ABUSE & NEGLECT 2024; 147:106594. [PMID: 38086214 PMCID: PMC10843548 DOI: 10.1016/j.chiabu.2023.106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/21/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Adolescent girls whose families experience poverty are more vulnerable to psychopathology, and it is vital to investigate biopsychosocial factors contributing to mental health functioning. OBJECTIVE To test associations between prenatal exposure to substances, intergenerational maltreatment, and adolescent mental health symptoms. PARTICIPANTS AND SETTING Baseline data were used from a randomized controlled trial testing the efficacy of Interpersonal Psychotherapy (IPT-A) for depression among girls with and without maltreatment exposure. Adolescents (Aged 13-16; 63.5 % Black/African-American, 21.0 % White, 15.57 % other racial identity; 12.57 % Latina/x) were recruited from families experiencing financial adversity (income <200 % poverty threshold). METHODS Adolescent maltreatment status was determined by using multiple sources (child protective service records, parental report, and adolescent report). Mothers reported on prenatal substance exposure, experiences of maltreatment in their own childhood, and rated adolescent internalizing and externalizing symptoms. Latent Class Analysis was used to determine common patterns of prenatal substance exposure (tobacco, alcohol, marijuana, and cocaine). Structural Equation Modeling was used to evaluate associations between maltreatment in two generations, prenatal exposure to substances, and adolescent mental health symptoms. RESULTS Two profiles of prenatal substance exposure emerged: one typified by low substance exposure (92.8 %), and one with moderate to high substance exposure (7.2 %). Both prenatal substance exposure and maternal history of maltreatment were associated with adolescent maltreatment, which in turn, was associated with greater adolescent externalizing symptoms. Parental history of maltreatment was directly associated with greater adolescent internalizing symptoms. CONCLUSION Prenatal exposure to substances and intergenerational maltreatment each confer risk for mental health symptoms in adolescent girls.
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Affiliation(s)
- Jennifer Warmingham
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America.
| | - Christie Petrenko
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States of America.
| | - Madeline Rockhold
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States of America
| | - Michelle Alto
- Baker Center for Children and Families, Boston, MA, United States of America
| | - Jody Todd Manly
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States of America
| | - Sheree Toth
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States of America
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Holman PJ, Raineki C. Prenatal alcohol exposure and early-life adversity: A translational perspective for dissecting compounding impacts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2227-2230. [PMID: 38151784 DOI: 10.1111/acer.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Parker J Holman
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
| | - Charlis Raineki
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
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Reid N, Kent N, Hewlett N, Bagley K, Tsang TW, Goldsbury S, Williams R, Akison L, Holland L, Vanderpeet C, Doyle M, Boaden N, Hayes N. Factors to be considered as part of a holistic assessment for fetal alcohol spectrum disorder: A scoping review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2007-2021. [PMID: 38226745 DOI: 10.1111/acer.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/17/2024]
Abstract
We undertook a scoping review to identify the factors outside of current fetal alcohol spectrum disorder (FASD) diagnostic criteria to be considered as part of a holistic assessment process. This included physical, social, cultural, mental health and wellbeing factors to inform targeted recommendations and supports to improve outcomes for individuals with FASD. Evidence from this review will be used to inform the revision of the Australian Guide to the Diagnosis of FASD. Six electronic databases were searched. Studies were eligible if they included factors outside of the diagnostic criteria that cover dysmorphology, growth restriction, neurodevelopmental impairments. Data charting and content analysis were performed to synthesize the results. One hundred twenty-one studies were included that spanned 12 key areas These included physical health, sleep, adverse postnatal experiences, substance use/other risk-taking behaviors, contact with the criminal justice system, mental health, First Nations cultural considerations, transition to adult roles, involvement with the out-of-home care system, feeding and eating, strengths/interests/external resources and incontinence. Areas to be considered as part of a holistic assessment and diagnostic process spanned individual, family, and system level factors. Results provide guidance for clinicians on the wide range of factors that could influence long-term health, development, and wellbeing for individuals with prenatal alcohol exposure and FASD. In practice, this guidance can be used to inform an individualized assessment process to facilitate tailored recommendations and supports to best meet the complex needs of individuals living with FASD and their families.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nykola Kent
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Nicole Hewlett
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- The First Nations Cancer & Wellbeing Research Team, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Kerryn Bagley
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Sarah Goldsbury
- Māori/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand
| | - Robyn Williams
- Curtin Medical School, Curtin University, Bentin, Western Australia, Australia
| | - Lisa 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
| | - Lorelle Holland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Michael Doyle
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nirosha Boaden
- School of Social Work, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Queensland University of Technology, Brisbane, Queensland, Australia
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10
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Nakhid D, Patel D, McMorris CA, Gibbard WB, Tortorelli C, Pei J, Lebel C. Limbic brain subregions associated with mental health symptoms in youth with and without prenatal alcohol exposure. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2033-2044. [PMID: 38226747 DOI: 10.1111/acer.15181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/20/2023] [Accepted: 08/24/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can result in reduced brain volume and an increased risk of mental health challenges. Limbic brain structures such as the hippocampus, thalamus, and amygdala often exhibit smaller volumes in youth with PAE, and similar volume reductions are observed in unexposed youth with symptoms of depression, bipolar disorder, anxiety, and schizophrenia. However, the role of volume reductions in these brain regions in mental health challenges remains unclear for individuals with PAE. METHODS Thirty-four youth with PAE and 72 unexposed youth aged 7-16 years completed a T1-weighted magnetic resonance imaging scan. FreeSurfer was used to process and extract volumes for hippocampal subfields, thalamic subnuclei, and amygdalar subnuclei. Depression and anxiety symptoms were measured using the Behavioral Assessment System for Children (BASC-2/3-PRS), the Children's Depression Inventory, and the Multidimensional Anxiety Scale for Children. We tested whether limbic subregion volumes differed between youth with and those without PAE and whether volumes were associated with depression and/or anxiety symptoms, controlling for age and gender. RESULTS Multiple hippocampal and thalamic subregions, but not amygdalar subnuclei, were smaller in individuals with PAE. Multiple group-brain interactions were observed for depression symptoms and subregion volumes. Negative associations between anxiety and limbic subregions were observed across groups. CONCLUSIONS These findings show extensive volume reductions in the hippocampus and thalamus in youth with PAE. PAE also appears to disrupt the association between depression symptoms and limbic subregions in youth, which may have implications for interventions in these individuals. Anxiety symptoms in youth with and without PAE are similarly associated with limbic volumes.
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Affiliation(s)
- Daphne Nakhid
- Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darpal Patel
- Neuroscience, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Christina Tortorelli
- Department of Child Studies and Social Work, Mount Royal University, Calgary, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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11
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Bake S, Rouzer SK, Mavuri S, Miranda RC, Mahnke AH. The interaction of genetic sex and prenatal alcohol exposure on health across the lifespan. Front Neuroendocrinol 2023; 71:101103. [PMID: 37802472 PMCID: PMC10922031 DOI: 10.1016/j.yfrne.2023.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
Prenatal alcohol exposure (PAE) can reprogram the development of cells and tissues, resulting in a spectrum of physical and neurobehavioral teratology. PAE immediately impacts fetal growth, but its effects carry forward post-parturition, into adolescence and adulthood, and can result in a cluster of disabilities, collectively termed Fetal Alcohol Spectrum Disorders. Emerging preclinical and clinical research investigating neurological and behavioral outcomes in exposed offspring point to genetic sex as an important modifier of the effects of PAE. In this review, we discuss the literature on sex differences following PAE, with studies spanning the fetal period through adulthood, and highlight gaps in research where sex differences are likely, but currently under-investigated. Understanding how sex and PAE interact to affect offspring health outcomes across the lifespan is critical for identifying the full complement of PAE-associated secondary conditions, and for refining targeted interventions to improve the quality of life for individuals with PAE.
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Affiliation(s)
- Shameena Bake
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Medical Research and Education Building I, 8447 Riverside Parkway, Bryan, TX 77807-3620, United States
| | - Siara K Rouzer
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Medical Research and Education Building I, 8447 Riverside Parkway, Bryan, TX 77807-3620, United States
| | - Shruti Mavuri
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Medical Research and Education Building I, 8447 Riverside Parkway, Bryan, TX 77807-3620, United States
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Medical Research and Education Building I, 8447 Riverside Parkway, Bryan, TX 77807-3620, United States
| | - Amanda H Mahnke
- Department of Neuroscience and Experimental Therapeutics, Texas A&M University School of Medicine, Medical Research and Education Building I, 8447 Riverside Parkway, Bryan, TX 77807-3620, United States.
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12
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Orton SM, Millis K, Choate P. Epigenetics of Trauma Transmission and Fetal Alcohol Spectrum Disorder: What Does the Evidence Support? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6706. [PMID: 37681846 PMCID: PMC10487479 DOI: 10.3390/ijerph20176706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) results from teratogenic impacts of alcohol consumption during pregnancy. Trauma and prenatal alcohol exposure (PAE) can both cause neurodevelopmental impairment, and it has been proposed that FASD can amplify effects of trauma. Certain PAE and trauma effects are mediated via epigenetic mechanisms. The objective of this review is to present the current evidence for epigenetics in trauma transmission as it relates to FASD, to help bridge a potential knowledge gap for social workers and related health professionals. We include a primer on epigenetic mechanisms and inheritance, followed by a summary of the current biomedical evidence supporting intergenerational and transgenerational epigenetic transmission of trauma, its relevance to FASD, the intersection with social transmission, and finally the application to social work. We propose potential models of transmission, considering where social and epigenetic pathways may intersect and/or compound across generations. Overall, we aim to provide a better understanding of epigenetic-trauma transmission for its application to health professions, in particular which beliefs are (and are not) evidence-based. We discuss the lack of research and challenges of studying epigenetic transmission in humans and identify the need for public health interventions and best practices that are based on the current evidence.
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Affiliation(s)
- Sarah M. Orton
- Faculty of Science and Technology, Department of Biology, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Kimberly Millis
- Faculty of Science and Technology, Department of Biology, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Peter Choate
- Faculty of Health, Community & Education, Department of Child Studies and Social Work, Mount Royal University, Calgary, AB T3E 6K6, Canada;
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13
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Rockhold MN, Kautz-Turnbull C, Handley ED, Petrenko CLM. The trauma experiences of children with fetal alcohol spectrum disorders: Developmental outcomes utilizing a threat/deprivation child adversity framework. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1722-1735. [PMID: 37423769 DOI: 10.1111/acer.15144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders (FASD) experience heightened rates of childhood trauma and adversity. Research has examined the negative impact adverse childhood experiences have on developmental outcomes. This study aims to take the field a step further by examining the details of traumatic events, including duration, perpetrator, whether the event significantly impacted the child, and trauma subtype. Subtype is examined using threat/deprivation dimensions and their relation to child behavior and the caregiver-child relationship. METHODS A sample of 84 children aged 4-12 with FASD, all in out-of-home placements, and their families took part in an emotion coaching intervention study. At baseline, caregivers completed questionnaires assessing child trauma, child emotion regulation and behavior, caregiver emotion socialization, and caregiver-child relationships. We used analysis of covariance to examine the differing impacts of threat, deprivation, and a combination of the two on behavioral outcomes, while controlling for age. We also used Pearson's r correlations, controlling for age, to examine whether the duration of threat or deprivation exposure was related to child outcomes. RESULTS Descriptive statistics showed that 87.5% of individuals experienced three or more subtypes of trauma. The average duration of all subtypes was 1.62 years, with a mean onset of 3.94 years. Biological parents were the most common perpetrator. There were significantly worse behavioral and caregiver-child relationship outcomes for children experiencing a combination of threat and deprivation trauma. A r correlations, controlling for age, demonstrated longer duration of deprivation was associated with greater cognitive difficulties. CONCLUSIONS We found unique patterns of behavior in children with FASD when analyzing the impact of traumatic experiences through a threat/deprivation framework. The combination of both threat and deprivation experiences leads to worse outcomes overall. Additionally, vital details surrounding the traumatic experiences point to crucial areas for intervention, including caregiver-child relationships.
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14
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Bishop L, Almquist YB, Pitkänen J, Martikainen P. Offspring hospitalization for substance use and changes in parental mental health: A Finnish register-based study. ADVANCES IN LIFE COURSE RESEARCH 2023; 57:100561. [PMID: 38054862 DOI: 10.1016/j.alcr.2023.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 12/07/2023]
Abstract
Prior research indicates that parental psychiatric disorders increase their offspring's risk of substance use problems. Though the association is likely bidirectional, the effects of an adult child's substance use on parental mental health remain understudied. We examined parents' psychotropic medication use trajectories by parental sex and educational attainment before and after a child's alcohol- or narcotics-attributable hospitalization. We identified Finnish residents, born 1979-1988, with a first hospitalization for substance use during emerging adulthood (ages 18-29, n = 12,851). Their biological mothers (n = 12,283) and/or fathers (n = 10,765) were followed for the two years before and after the hospitalization. Psychotropic medication use was measured in three-month periods centered around the time of child's hospitalization, and the probability of psychotropic medication use at each time point was assessed using generalized estimating equations logit models. Among mothers, the prevalence of psychotropic medication use increased during the year before, peaked during the 0-3 months after hospitalization, and remained at a similarly elevated level until the end of follow-up. The prevalence among fathers increased gradually and linearly across follow-up, with minimal changes evident either directly before or after the hospitalization. Parents' educational attainment did not modify these trajectories. Our results highlight the importance of considering linked lives when quantifying substance use-attributable harms and underscore the need for future research examining the intergenerational spillover effects of substance use in both directions, particularly in mother-child dyads.
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Affiliation(s)
- Lauren Bishop
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany.
| | - Ylva B Almquist
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden
| | - Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; International Max Planck Research School for Population, Health and Data Science, Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland; Max Planck-University of Helsinki Center for Social Inequalities in Population Health, 00014 Helsinki, Finland; Max Planck Institute for Demographic Research, 18057 Rostock, Germany
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15
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Chandler-Mather N, Betts J, Donovan C, Shelton D, Dawe S. Understanding the impacts of childhood adversity on sleep problems in children with fetal alcohol spectrum disorder: A comparison of cumulative and dimensional approaches. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1702-1712. [PMID: 37442612 DOI: 10.1111/acer.15152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The developmental impacts of prenatal alcohol exposure (PAE) and postnatal exposure to adversity are typically considered in isolation. However, both contribute independently to sleep problems. Children with fetal alcohol spectrum disorder (FASD) have PAE and significant sleep disturbances. What is not clear is the relative contribution to these disturbances of exposure to early life adversity. This study examined how exposure to such adversity impacts frequent insomnia symptoms and nightmares in children with FASD and "At Risk" designations. METHODS We compared two approaches to modeling adversity in children who had undergone a diagnostic assessment for FASD: a cumulative risk approach that sums adversities to create a total score and an approach that treats exposure to threat and deprivation as independent dimensions. Data on caregiver-reported exposure to adversity and sleep problems for 63 children (aged 3 years 4 months to 7 years 8 months) were extracted from clinical archives. Cumulative risk, threat exposure, and deprivation exposure scores were computed and were tested as predictors of insomnia symptoms and nightmares. All analyses controlled for age and gender. RESULTS There were high rates of caregiver-reported sleep problems with 60.3% (n = 38) of children having nightmares and 44.4% (n = 28) having a frequent insomnia symptom. The cumulative risk analysis showed that for every additional exposure to adversity, the odds of having a caregiver-reported insomnia symptom increased by 38%. The dimensional analysis showed no relationship between deprivation and sleep problems. However, every additional exposure to threat increased the odds of nightmares by 93%. CONCLUSIONS Exposure to postnatal adversity contributes to sleep disturbances in children with FASD, with unique roles for cumulative risk and the threat dimension of adversity. The implications of these findings for the etiology and treatment of sleep disturbances in children with FASD are discussed.
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Affiliation(s)
- Ned Chandler-Mather
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joseph Betts
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Doug Shelton
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Ostertag C, Reynolds JE, Kar P, Dewey D, Gibbard WB, Tortorelli C, Lebel C. Arcuate fasciculus and pre-reading language development in children with prenatal alcohol exposure. Front Neurosci 2023; 17:1174165. [PMID: 37332878 PMCID: PMC10272404 DOI: 10.3389/fnins.2023.1174165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Prenatal alcohol exposure (PAE) contributes to widespread neurodevelopmental challenges, including reading, and has been associated with altered white matter. Here, we aimed to investigate whether arcuate fasciculus (AF) development is associated with pre-reading language skills in young children with PAE. Methods A total of 51 children with confirmed PAE (25 males; 5.6 ± 1.1 years) and 116 unexposed controls (57 males; 4.6 ± 1.2 years) underwent longitudinal diffusion tensor imaging (DTI), for a total of 111 scans from participants with PAE and 381 scans in the unexposed control group. We delineated the left and right AF and extracted mean fractional anisotropy (FA) and mean diffusivity (MD). Pre-reading language ability was assessed using age-standardized phonological processing (PP) and speeded naming (SN) scores of the NEPSY-II. Linear mixed effects models were run to determine the relationship between diffusion metrics and age, group, sex, and age-by-group interactions, with subject modeled as a random factor. A secondary mixed effect model analysis assessed the influence of white matter microstructure and PAE on pre-reading language ability using diffusion metric-by-age-by-group interactions, with 51 age- and sex-matched unexposed controls. Results Phonological processing (PP) and SN scores were significantly lower in the PAE group (p < 0.001). In the right AF, there were significant age-by-group interactions for FA (p < 0.001) and MD (p = 0.0173). In the left AF, there was a nominally significant age-by-group interaction for MD that failed to survive correction (p = 0.0418). For the pre-reading analysis, a significant diffusion-by-age-by-group interaction was found for left FA (p = 0.0029) in predicting SN scores, and for the right FA (p = 0.00691) in predicting PP scores. Discussion Children with PAE showed altered developmental trajectories for the AF, compared with unexposed controls. Children with PAE, regardless of age, showed altered brain-language relationships that resembled those seen in younger typically developing children. Our findings support the contention that altered developmental trajectories in the AF may be associated with functional outcomes in young children with PAE.
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Affiliation(s)
- Curtis Ostertag
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jess E. Reynolds
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Preeti Kar
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - W. Ben Gibbard
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Lebel
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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17
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MacEachern SJ, Kar P, Nakhid D, Mitevska E, Tortorelli C, Forkert ND, Lebel C, McMorris CA, Gibbard WB. Factors predicting general health concerns and atypical behaviours in children with prenatal alcohol exposure and other adverse exposures. Front Pediatr 2023; 11:1146149. [PMID: 37292380 PMCID: PMC10244621 DOI: 10.3389/fped.2023.1146149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Background Prenatal alcohol exposure (PAE) can have significant negative consequences on the health outcomes of children. Children with PAE often experience other prenatal and postnatal adverse exposures. Increased rates of general health concerns and atypical behaviours are seen in both children with PAE as well as with other patterns of adverse exposures, although these have not been systematically described. The association between multiple adverse exposures and adverse health concerns and atypical behaviours in children with PAE is unknown. Methods Demographic information, medical history, adverse exposures, health concerns, and atypical behaviours were collected from children with confirmed PAE (n = 22; 14 males, age range = 7.9-15.9 years) and their caregivers. Support vector machine learning classification models were used to predict the presence of health concerns and atypical behaviours based on adverse exposures. Associations between the sums of adverse exposures, health concerns, and atypical behaviours were examined using correlation analysis. Results All children experienced health concerns, the most common being sensitivity to sensory inputs (64%; 14/22). Similarly, all children engaged in atypical behaviours, with atypical sensory behaviour (50%; 11/22) being the most common. Prenatal alcohol exposure was most important factor for predicting some health concerns and atypical behaviours, and alone and in combination with other factors. Simple associations between adverse exposures could not be identified for many health concerns and atypical behaviours. Conclusion Children with PAE and other adverse exposures experience high rates of health concerns and atypical behaviours. This study demonstrates the complex effects of multiple adverse exposures on health and behaviour in children.
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Affiliation(s)
- Sarah J. MacEachern
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Preeti Kar
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Daphne Nakhid
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Elena Mitevska
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Nils D. Forkert
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Lebel
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carly A. McMorris
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - W. Ben Gibbard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Nissinen NM, Rangmar J, Autti-Rämö I, Gissler M, Kahila H, Raitasalo K, Sarkola T. Financial difficulties among youth prenatally exposed to substances: a longitudinal register-based cohort study. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Niina-Maria Nissinen
- Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
| | - Jenny Rangmar
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ilona Autti-Rämö
- Division of Child Neurology, University of Helsinki, Children’s Hospital, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Hanna Kahila
- Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Kirsimarja Raitasalo
- Department of Public Health and Welfare, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Kautz-Turnbull C, Rockhold M, Handley ED, Olson HC, Petrenko C. Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:577-588. [PMID: 36811189 PMCID: PMC10050124 DOI: 10.1111/acer.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) have high rates of adverse childhood experiences (ACEs). ACEs are associated with a wide range of health outcomes including difficulty with behavior regulation, an important intervention target. However, the effect of ACEs on different areas of behavior has not been well characterized in children with disabilities. This study describes ACEs in children with FASD and how they impact behavior problems. METHODS A convenience sample of 87 caregivers of children (aged 3 to 12) with FASD participating in an intervention study reported on their children's ACEs using the ACEs Questionnaire and behavior problems on the Eyberg Child Behavior Inventory (ECBI). A theorized three-factor structure of the ECBI (Oppositional Behavior, Attention Problems, and Conduct Problems) was investigated. Data were analyzed using Pearson correlations and linear regression. RESULTS On average, caregivers endorsed 3.10 (SD = 2.99) ACEs experienced by their children. The two most frequently endorsed ACE risk factors were having lived with a household member with a mental health disorder, followed by having lived with a household member with a substance use disorder. Higher total ACEs score significantly predicted a greater overall frequency of child behavior (intensity scale), but not whether the caregiver perceived the behavior to be a problem (problem scale) on the ECBI. No other variable significantly predicted the frequency of children's disruptive behavior. Exploratory regressions indicated that a higher ACEs score significantly predicted greater Conduct Problems. Total ACEs score was not associated with Attention Problems or Oppositional Behavior. DISCUSSION Children with FASD are at risk for ACEs, and those with higher ACEs had a greater frequency of problem behavior on the ECBI, especially conduct problems. Findings emphasize the need for trauma-informed clinical care for children with FASD and increased accessibility of care. Future research should examine potential mechanisms that underlie the relationship between ACEs and behavior problems to optimally inform interventions.
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Affiliation(s)
- Carson Kautz-Turnbull
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Madeline Rockhold
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Heather Carmichael Olson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christie Petrenko
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
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20
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Dawe S, Eggins E, Betts J, Webster H, Pomario T, Doak J, Chandler-Mather N, Hatzis D, Till H, Harnett P, Wood A, Shelton D. An investigation of the utility of the Australian Guide to the diagnosis of fetal alcohol spectrum disorder in young children. Alcohol Clin Exp Res 2023; 47:486-500. [PMID: 36810987 DOI: 10.1111/acer.15012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Early diagnosis of children with fetal alcohol spectrum disorder (FASD) assists in implementing critical early support. The challenge lies in having a diagnostic process that enables valid and reliable assessment of domains of functioning in young children, with the added complexity that many children will also have co-occurring exposure to childhood adversity that is likely to impact these domains. METHODS The aim of this study was to test a diagnostic assessment of FASD in young children using the Australian Guide to the Diagnosis of FASD. Ninety-four children (aged 3 to 7 years) with confirmed or suspected prenatal alcohol exposure were referred to two specialist FASD clinics for assessment in Queensland, Australia. RESULTS There was a significant risk profile with 68.1% (n = 64) children having had contact with child protection services, and most children living in kinship (n = 22, 27.7%) or foster (n = 36, 40.4%) care. Forty-one percent of the children were Indigenous Australians. The majority (64.9%, n = 61) of children met criteria for FASD, 30.9% were classified as "At Risk" for FASD (n = 29), and 4.3% received no FASD diagnosis (n = 4). Only 4 (4%) children were rated as severe for the brain domain. Over 60% of children (n = 58) had two or more comorbid diagnoses. Sensitivity analyses indicated that the removal of comorbid diagnoses in the Attention, Affect Regulation, or Adaptive Functioning domains resulted in a change in 7 of 47 cases (15%) to an "At Risk" designation. CONCLUSIONS These results highlight the complexity of presentation and the extent of impairment in the sample. The use of comorbid diagnoses to substantiate a "severe" designation in specific neurodevelopmental domains raises the question of whether there were false-positive diagnoses. The complexity of determining causal relationships between exposure to PAE and early life adversity on developmental outcomes continues to be a challenge in this young population.
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Affiliation(s)
- Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Elizabeth Eggins
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joseph Betts
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Heidi Webster
- Child Development Service, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Tania Pomario
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Jessica Doak
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ned Chandler-Mather
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Denise Hatzis
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Haydn Till
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
| | - Paul Harnett
- School of Criminology and Criminal Justice, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Wood
- School of Psychology, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Doug Shelton
- Child Development Service, Gold Coast Hospital, Gold Coast, Queensland, Australia
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McLachlan K, Minhas M, Ritter C, Kennedy K, Joly V, Faitakis M, Cook J, Unsworth K, MacKillop J, Pei J. Latent classes of neurodevelopmental profiles and needs in children and adolescents with prenatal alcohol exposure. Alcohol Clin Exp Res 2023; 47:772-785. [PMID: 36799306 DOI: 10.1111/acer.15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features. METHODS Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross-sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020. RESULTS Results revealed an optimal four-class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes. CONCLUSIONS Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes.
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Affiliation(s)
- Kaitlyn McLachlan
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Meenu Minhas
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Chantel Ritter
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Kathleen Kennedy
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Martina Faitakis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Jocelynn Cook
- The Society of Obstetricians and Gynaecologists of Canada, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Unsworth
- Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, & Homewood Research Institute, Guelph, Ontario, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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22
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Miller AP, Shoptaw S, Mvududu R, Mashele N, Coates TJ, Bekker LG, Essack Z, Groenewald C, Petersen Z, Gorbach PM, Myer L, Joseph Davey DL. Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It? AIDS Behav 2023; 27:37-50. [PMID: 35737280 PMCID: PMC9780404 DOI: 10.1007/s10461-022-03742-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 01/24/2023]
Abstract
This study examines baseline associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n = 1201) residing in a high HIV burdened community in Cape Town, South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of > 1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR = 1.33, 95% CI 1.05-1.68, for 2 risks and aOR = 1.47, 95% CI 0.95-2.27 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk were identified. Evidence-based interventions to address alcohol use and other HIV sexual risk behaviors during pregnancy in South Africa are desperately needed. Qualitative work exploring individual and community level drivers of alcohol use among pregnant and breastfeeding women in this setting could support development of a culturally tailored intervention to address these issues in this population.
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Affiliation(s)
- Amanda P Miller
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
- Department of Epidemiology, Fielding School of Public Health, 650 Charles E. Young Drive South, Room #41-295CHS, Los Angeles, CA, 90095-1772, USA.
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Faculty of Health Science, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community-Based Research, Human Sciences Research Council, Pretoria, South Africa
| | - Candice Groenewald
- Centre for Community-Based Research, Human Sciences Research Council, Pretoria, South Africa
- Psychology Department, Rhodes University, Makhanda, South Africa
| | - Zaino Petersen
- Impact and Research Development, Human Sciences Research Council, Pretoria, South Africa
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Dvora L Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- The Desmond Tutu HIV Centre, Faculty of Health Science, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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23
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Tan GKY, Symons M, Fitzpatrick J, Connor SG, Cross D, Pestell CF. Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia. BMC Pediatr 2022; 22:587. [PMID: 36217109 PMCID: PMC9549627 DOI: 10.1186/s12887-022-03654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. Results Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. Conclusion ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03654-y.
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Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Patches Australia, Subiaco, Australia. .,Telethon Kids Institute (TKI), Nedlands, Australia.
| | - Martyn Symons
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - James Fitzpatrick
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Patches Australia, Subiaco, Australia
| | | | - Donna Cross
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - Carmela F Pestell
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
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24
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Nissinen NM, Sarkola T, Autti-Rämö I, Gissler M, Kahila H, Koponen AM. Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study. J Affect Disord 2022; 308:328-336. [PMID: 35439464 DOI: 10.1016/j.jad.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prenatal substance exposure is associated with mood and neurotic disorders but this association is complex and understudied. This study investigated the recorded use of specialised healthcare services for mood and neurotic disorders among youth with prenatal substance exposure in comparison with an unexposed matched cohort. Furthermore, the influence of adverse maternal characteristics and out-of-home care (OHC) is investigated. METHODS This longitudinal register-based matched cohort study included 594 exposed and 1735 unexposed youth. Cox proportional hazard regression models were applied to study the first episode of mood and neurotic disorders in specialised healthcare from 13 years of age, and the influence of adverse maternal characteristics and OHC. Mediation analysis was applied to study the mediating effect of OHC on the association between prenatal substance exposure and the disorders. RESULTS The exposed cohort had a two-fold higher likelihood of being treated at specialised healthcare for mood and neurotic disorders compared with the unexposed cohort (HR 2.34, 95% CI 1.86-2.95), but this difference was attenuated to non-significant levels (AHR 1.29, 95% CI 0.92-1.81) following adjustments with adverse maternal characteristics and OHC. OHC mediated 61% (95% CI 0.41-0.94) of the association between prenatal substance exposure and youth's mood and neurotic disorders. LIMITATIONS Register data likely include more severe cases of disorders, and as an observational study, causality cannot be assessed. CONCLUSION Mood and neurotic disorders are more common following prenatal exposure to substances and interlinked with significant adversities in the postnatal caregiving environment and OHC.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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25
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Tan GKY, Pestell CF, Fitzpatrick J, Cross D, Adams I, Symons M. Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 30:514-535. [PMID: 37484511 PMCID: PMC10360980 DOI: 10.1080/13218719.2022.2059028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.
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Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Carmela F. Pestell
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
| | - James Fitzpatrick
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Donna Cross
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Isabelle Adams
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Martyn Symons
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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26
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Kar P, Reynolds JE, Gibbard WB, McMorris C, Tortorelli C, Lebel C. Trajectories of brain white matter development in young children with prenatal alcohol exposure. Hum Brain Mapp 2022; 43:4145-4157. [PMID: 35596624 PMCID: PMC9374879 DOI: 10.1002/hbm.25944] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/08/2022] [Accepted: 04/16/2022] [Indexed: 12/22/2022] Open
Abstract
Prenatal alcohol exposure (PAE) is associated with alterations to brain white matter microstructure. Previous studies of PAE have demonstrated different findings in young children compared to older children and adolescents, suggesting altered developmental trajectories and highlighting the need for longitudinal research. 122 datasets in 54 children with PAE (27 males) and 196 datasets in 89 children without PAE (45 males) were included in this analysis. Children underwent diffusion tensor imaging between 2 and 8 years of age, returning approximately every 6 months. Mean fractional anisotropy (FA) and mean diffusivity (MD) were obtained for 10 major brain white matter tracts and examined for age-related changes using linear mixed effects models with age, sex, group (PAE vs. control) and an age-by-group interaction. Children with PAE had slower decreases of MD over time in the genu of the corpus callosum, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. No significant age-by-group interactions were noted for FA. These findings show slower white matter development in young children with PAE than in unexposed controls. This connects previous cross-sectional findings of lower MD in young children with PAE to findings of higher MD in older children and adolescents with PAE, and further helps to understand brain development in children with PAE. This deviation from typical development trajectories may reflect altered brain plasticity, which has implications for cognitive and behavioral learning in children with PAE.
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Affiliation(s)
- Preeti Kar
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jess E Reynolds
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - William Ben Gibbard
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Carly McMorris
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | | | - Catherine Lebel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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27
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Flannigan K, McMorris C, Ewasiuk A, Badry D, Mela M, Ben Gibbard W, Unsworth K, Cook J, Harding KD. Suicidality and Associated Factors Among Individuals Assessed for Fetal Alcohol Spectrum Disorder Across the Lifespan in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:361-370. [PMID: 34738837 PMCID: PMC9065486 DOI: 10.1177/07067437211053288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals with fetal alcohol spectrum disorder (FASD) experience a range of complex neurodevelopmental, psychological, and socioenvironmental vulnerabilities. There is growing evidence that suicidal ideation, attempts, and death by suicide are significant concerns within this population. In this study, we (1) determined the rate of suicidal ideation/attempts in a large group of individuals with prenatal alcohol exposure (PAE) who were assessed for FASD in Canada and (2) investigated the associations between suicidal ideation/attempts and select demographic and biopsychosocial factors in this group. METHOD A secondary analysis of data from Canada's National FASD Database, a national repository of clinical information gathered through FASD assessment and diagnostic clinics across the country, was conducted. Descriptive analyses, chi-square/Fisher's exact tests, and binary logistic regression were used to examine demographic and biopsychosocial variables and their associations with suicidality. RESULTS In our sample of 796 participants (Mage = 17.7 years, range = 6-59; 57.6% male) assessed for FASD, 25.9% were reported to experience suicidal ideation/attempts. Numerous demographic and biopsychosocial factors were found to be significantly associated with suicidal ideation/attempts. The strongest associations with suicidal ideation/attempts were substance use, history of trauma/abuse, and impaired affect regulation. CONCLUSIONS With this study, we contribute to the emerging evidence of elevated risk of suicidality among individuals with PAE/FASD and improve our understanding of factors that may exacerbate this risk. Findings have relevance for improving screening, prevention, and proactive treatment approaches for individuals with PAE and FASD, their families, and wider support systems.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia
| | - Carly McMorris
- Werklund School of Education, 2129University of Calgary, Calgary, Alberta.,70401Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta
| | - Amanda Ewasiuk
- CASA Child, Adolescent, and Family Mental Health, Edmonton, Alberta
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,Faculty of Social Work, 2129University of Calgary, Calgary, Alberta
| | - Mansfield Mela
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - W Ben Gibbard
- 70401Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta
| | - Kathy Unsworth
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,The Society of Obstetricians and Gynaecologists of Canada; Department of Obstetrics and Gynaecology, 12365University of Ottawa, Ottawa, Onatrio
| | - Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,Department of Psychology, Laurentian University, Sudbury, Ontario
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28
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Flannigan K, Tremblay M, Potts S, Nelson M, Brintnell S, O'Riordan T, Rasmussen C, Pei J. Understanding the needs of justice-involved adults with fetal alcohol spectrum disorder in an Indigenous community. BEHAVIORAL SCIENCES & THE LAW 2022; 40:129-143. [PMID: 34904275 DOI: 10.1002/bsl.2554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience a range of neurodevelopmental challenges, often compounded by social and environmental adversity. One of the most concerning outcomes that can be associated with FASD is involvement in the justice system, where individuals with FASD are vastly over-represented. Individuals with FASD who are both justice-involved and Indigenous experience added layers of marginalization. In this community-based study, we explored the needs of 16 adults who participated in an FASD-informed restorative justice program in an Indigenous community in Alberta, Canada. Clinical record reviews and client interviews were used to gather information. Diverse needs were identified, including pervasive neurodevelopmental difficulties, notable physical and mental health challenges, complex experiences of psychosocial trauma, and varied criminogenic needs. This study increases our understanding of the unique and complex biopsychosocial and criminogenic needs of Indigenous justice-involved adults with FASD. Such an understanding is a first step in developing tailored interventions for individuals with FASD and has important practice and policy implications for supporting positive outcomes. For Indigenous individuals with FASD, intervention efforts should be integrated within the community context to promote collective healing.
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Affiliation(s)
- Katherine Flannigan
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada
| | - Melissa Tremblay
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Potts
- Yellowhead Tribal Community Corrections Society, Edmonton, Alberta, Canada
| | - Monty Nelson
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Brintnell
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Teresa O'Riordan
- Yellowhead Tribal Community Corrections Society, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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29
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Coles CD, Grant T, Kable JA, Stoner S, Perez A. Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts. Alcohol Clin Exp Res 2022; 46:232-242. [PMID: 35157325 PMCID: PMC8867925 DOI: 10.1111/acer.14761] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self-reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals. METHODS Participants (N = 292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in-person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS. RESULTS Both alcohol-exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors. CONCLUSIONS PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.
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Affiliation(s)
- Claire D. Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Therese Grant
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Julie A. Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Susan Stoner
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Alexandra Perez
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - CIFASD
- Collaborative Initiative on Fetal Alcohol Spectrum Disorders
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30
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Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D, McFarlane A. Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder. Front Psychol 2022; 12:778471. [PMID: 35145454 PMCID: PMC8821085 DOI: 10.3389/fpsyg.2021.778471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- *Correspondence: Katherine Flannigan,
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn McLachlan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Kelly Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Audrey McFarlane
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
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Harding KD, Turner K, Howe SJ, Bagshawe MJ, Flannigan K, Mela M, McMorris CA, Badry D. Caregivers' experiences and perceptions of suicidality among their children and youth with fetal alcohol spectrum disorder. Front Psychiatry 2022; 13:931528. [PMID: 36117649 PMCID: PMC9471421 DOI: 10.3389/fpsyt.2022.931528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with Fetal Alcohol Spectrum Disorder (FASD) experience a range of biopsychosocial vulnerabilities that can increase the possibility of adverse life outcomes, including a heightened risk of suicidality. In this study, we explored the lived experiences of caregivers of children and youth with FASD and suicidality, including their perceptions of their child and youth's suicidal experiences. Between March and June 2021, six comprehensive, semi-structured interviews were conducted with five caregivers of children and youth with FASD (Mage = 14.5 years, range 11-22) who were currently experiencing suicidality or had a history of suicidality. Data were analyzed using interpretative phenomenological analysis and then developed into a composite vignette informed and organized by the social-ecological suicide prevention model (SESPM). The composite vignette revealed the narratives of families living with and caring for children and youth with FASD who experience suicidality in relation to the complex and intersectional individual, relational, community, and societal level contextual and protective factors. Findings from this study highlight the critical need for comprehensive FASD-informed suicide prevention and intervention approaches to promote the mental health and wellbeing of children and youth with FASD and their caregivers.
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Affiliation(s)
- Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Kailyn Turner
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Stephanie J Howe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Mercedes Jayne Bagshawe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
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Cook JL. Alcohol use during pregnancy and fetal alcohol spectrum disorder in Canada: who, what, where? Health Promot Chronic Dis Prev Can 2021; 41:264-266. [PMID: 34549917 PMCID: PMC8565492 DOI: 10.24095/hpcdp.41.9.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jocelynn L Cook
- Chief Scientific Officer, The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
- National Database Lead, Canada FASD Research Network, Vancouver, British Columbia, Canada
- Adjunct Professor, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
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Alberry B, Laufer BI, Chater-Diehl E, Singh SM. Epigenetic Impacts of Early Life Stress in Fetal Alcohol Spectrum Disorders Shape the Neurodevelopmental Continuum. Front Mol Neurosci 2021; 14:671891. [PMID: 34149355 PMCID: PMC8209299 DOI: 10.3389/fnmol.2021.671891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022] Open
Abstract
Neurodevelopment in humans is a long, elaborate, and highly coordinated process involving three trimesters of prenatal development followed by decades of postnatal development and maturation. Throughout this period, the brain is highly sensitive and responsive to the external environment, which may provide a range of inputs leading to positive or negative outcomes. Fetal alcohol spectrum disorders (FASD) result from prenatal alcohol exposure (PAE). Although the molecular mechanisms of FASD are not fully characterized, they involve alterations to the regulation of gene expression via epigenetic marks. As in the prenatal stages, the postnatal period of neurodevelopment is also sensitive to environmental inputs. Often this sensitivity is reflected in children facing adverse conditions, such as maternal separation. This exposure to early life stress (ELS) is implicated in the manifestation of various behavioral abnormalities. Most FASD research has focused exclusively on the effect of prenatal ethanol exposure in isolation. Here, we review the research into the effect of prenatal ethanol exposure and ELS, with a focus on the continuum of epigenomic and transcriptomic alterations. Interestingly, a select few experiments have assessed the cumulative effect of prenatal alcohol and postnatal maternal separation stress. Regulatory regions of different sets of genes are affected by both treatments independently, and a unique set of genes are affected by the combination of treatments. Notably, epigenetic and gene expression changes converge at the clustered protocadherin locus and oxidative stress pathway. Functional studies using epigenetic editing may elucidate individual contributions of regulatory regions for hub genes and further profiling efforts may lead to the development of non-invasive methods to identify children at risk. Taken together, the results favor the potential to improve neurodevelopmental outcomes by epigenetic management of children born with FASD using favorable postnatal conditions with or without therapeutic interventions.
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Affiliation(s)
- Bonnie Alberry
- Department of Biology, Faculty of Science, The University of Western Ontario, London, ON, Canada
| | - Benjamin I Laufer
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA, United States.,Genome Center, University of California, Davis, Davis, CA, United States.,MIND Institute, University of California, Davis, Davis, CA, United States
| | - Eric Chater-Diehl
- Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shiva M Singh
- Department of Biology, Faculty of Science, The University of Western Ontario, London, ON, Canada
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Lebel CA, Gibbard WB, Tortorelli C, Pei J, Beaulieu C, Bagshawe M, McMorris CA. Prenatal Exposure And Child brain and mental Health (PEACH) study: protocol for a cohort study of children and youth with prenatal alcohol exposure. BMJ Open 2021; 11:e051660. [PMID: 33980537 PMCID: PMC8118071 DOI: 10.1136/bmjopen-2021-051660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Fetal alcohol spectrum disorder (FASD), which is caused by prenatal alcohol exposure (PAE), affects an estimated 4% of North Americans, and is the most common preventable cause of intellectual disability. Mental health problems, including anxiety and depression, are experienced by nearly all individuals with FASD. However, there is very limited knowledge about effective mental health treatments for individuals with FASD; effective treatments are hindered in part due to a lack of understanding of the basic neurobiology underlying internalising disorders in youth with FASD. METHODS AND ANALYSIS The Prenatal Exposure And Child brain and mental Health (PEACH) study includes children aged 7-18 years. We will use longitudinal neuroimaging (anatomical T1-weighted, diffusion and passive viewing function MRI) and mental health assessments (Behaviour Assessment Scale for Children, Multi-dimensional Anxiety Scale for Children, Children's Depression Inventory (CDI-2), Kiddie Scale of Affective Disorders) to: (1) characterise brain development trajectories in youth with FASD, (2) determine whether brain alterations mediate increased anxiety and depression in youth with FASD and (3) identify baseline brain features that predict changes of anxiety and depression symptoms over the next 2 years. All of this will be done while considering sex and adverse postnatal experiences, which can significantly impact mental health and brain outcomes. This project will forge new understanding of FASD and mental health from a neurobiological perspective, highlighting key time periods (ie, sensitive windows) and brain regions (ie, that may be susceptible to neurostimulation), while identifying factors that predict individual trajectories of anxiety and depression symptoms. ETHICS AND DISSEMINATION This study was approved by the University of Calgary Conjoint Health Research Ethics Board and the University of Alberta Health Research Ethics Board. Study results will be disseminated in peer-reviewed journals, at relevant conferences and in conjunction with our knowledge mobilisation partners.
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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
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Jacqueline Pei
- Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Mercedes Bagshawe
- 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
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35
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Kar P, Reynolds JE, Grohs MN, Gibbard WB, McMorris C, Tortorelli C, Lebel C. White matter alterations in young children with prenatal alcohol exposure. Dev Neurobiol 2021; 81:400-410. [PMID: 33829663 DOI: 10.1002/dneu.22821] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
Prenatal alcohol exposure (PAE) can lead to cognitive, behavioural, and social-emotional challenges. Previous neuroimaging research has identified structural brain alterations in newborns, older children, adolescents, and adults with PAE; however, little is known about brain structure in young children. Extensive brain development occurs during early childhood; therefore, understanding the neurological profiles of young children with PAE is critical for early identification and effective intervention. We studied 54 children (5.21 ± 1.11 years; 27 males) with confirmed PAE (94% also had other prenatal exposures, 74% had adverse postnatal experiences) compared with 54 age- and sex-matched children without PAE. Children underwent diffusion tensor imaging between 2 and 7 years of age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were obtained for 10 major white matter tracts. Univariate analyses of covariance were used to test group differences (PAE vs. control) controlling for age and sex. The PAE group had higher FA in the genu of the corpus callosum and lower MD in the bilateral uncinate fasciculus. The PAE group also had lower tract volume in the corpus callosum, the bilateral inferior fronto-occipital fasciculi, and the right superior longitudinal fasciculus. Our findings align with studies of newborns with PAE reporting lower diffusivity, but contrast those in older populations with PAE, which consistently report lower FA and higher MD. Further research is needed to understand trajectories of white matter development and how our results of higher FA/lower MD in young children connect with lower FA/higher MD observed at older ages.
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Affiliation(s)
- Preeti Kar
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jess E Reynolds
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Melody N Grohs
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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