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Camilli MP, Simko OM, Bevelander B, Thebeau JM, Masood F, da Silva MCB, Raza MF, Markova S, Obshta O, Jose MS, Biganski S, Kozii IV, Zabrodski MW, Moshynskyy I, Simko E, Wood SC. Fetal Alcohol Spectrum Disorder: The Honey Bee as a Social Animal Model. Life (Basel) 2024; 14:434. [PMID: 38672706 PMCID: PMC11051024 DOI: 10.3390/life14040434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Animal models have been essential for advancing research of fetal alcohol spectrum disorder (FASD) in humans, but few animal species effectively replicate the behavioural and clinical signs of FASD. The honey bee (Apis mellifera) is a previously unexplored research model for FASD that offers the distinct benefit of highly social behaviour. In this study, we chronically exposed honey bee larvae to incremental concentrations of 0, 3, 6, and 10% ethanol in the larval diet using an in vitro rearing protocol and measured developmental time and survival to adult eclosion, as well as body weight and motor activity of newly emerged adult bees. Larvae reared on 6 and 10% dietary ethanol demonstrated significant, dose-responsive delays to pupation and decreased survival and adult body weight. All ethanol-reared adults showed significantly decreased motor activity. These results suggest that honey bees may be a suitable social animal model for future FASD research.
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Affiliation(s)
- Marcelo P. Camilli
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Olena M. Simko
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Breanne Bevelander
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Jenna M. Thebeau
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Fatima Masood
- Department of Veterinary Microbiology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada
| | - Marina C. Bezerra da Silva
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Muhammad Fahim Raza
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Sofiia Markova
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Oleksii Obshta
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Midhun S. Jose
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Sarah Biganski
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Ivanna V. Kozii
- Prairie Diagnostic Services Inc., Saskatoon, SK S7N 5B4, Canada
| | | | - Igor Moshynskyy
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Elemir Simko
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
| | - Sarah C. Wood
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, SK S7N 5B4, Canada; (M.P.C.)
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Glass L, Moore EM, Mattson SN. Current considerations for fetal alcohol spectrum disorders: identification to intervention. Curr Opin Psychiatry 2023; 36:249-256. [PMID: 36939372 PMCID: PMC10079626 DOI: 10.1097/yco.0000000000000862] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent findings regarding the prevalence, public health impact, clinical presentation, intervention access and conceptualization of fetal alcohol spectrum disorders (FASDs). Despite ongoing work in prevention and identification of this population, the rates of drinking during pregnancy have increased and significant gaps remain in diagnosis and intervention. RECENT FINDINGS Prenatal alcohol exposure is the most common preventable cause of developmental disability in the world. Research has focused on improving diagnostic clarity, utilizing technology and neuroimaging to facilitate identification, engaging broader stakeholders (including self-advocates) to inform understanding and needs, and increasing access to effective interventions. There is an emerging focus on developmental trajectories and experiences in young and middle adulthood. Public policy advocacy has also made great strides in recent years. SUMMARY Increases in public awareness, greater concordance of diagnostic schema, leveraged use of novel technology, and the development of targeted interventions within a holistic, strengths-based conceptualization are important considerations for this population.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, USA
| | - Eileen M. Moore
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Sarah N. Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
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Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, Riley EP, Elliott EJ. Fetal alcohol spectrum disorders. Nat Rev Dis Primers 2023; 9:11. [PMID: 36823161 DOI: 10.1038/s41572-023-00420-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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Betts JL, Eggins E, Chandler‐Mather N, Shelton D, Till H, Harnett P, Dawe S. Interventions for improving executive functions in children with foetal alcohol spectrum disorder (FASD): A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1258. [PMID: 36908848 PMCID: PMC9634003 DOI: 10.1002/cl2.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The consequences for children born with birth defects and developmental disabilities encompassed by foetal alcohol spectrum disorder (FASD) are profound, affecting all areas of social, behavioural and cognitive functioning. Given the strong evidence for a core deficit in executive functioning, underpinned by impaired self-regulation skills, there has been a growing focus on the development of interventions that enhance or support the development of executive functions (EFs). Objectives The primary objective of this review is to synthesise the evidence for structured psychological interventions that explicitly aim to improve EF in children. The review also sought to ascertain if the effectiveness of interventions were influenced by characteristics of the intervention, participants or type of EF targeted by the intervention. Search Methods Sixteen databases, 18 grey literature search locations and 9 trial registries were systematically searched to locate eligible studies (up to December 2020). These searches were supplemented with reference harvesting, forward citation searching, hand searches of topic-relevant journals and contact with experts. Selection Criteria Studies were included in the review if they reported on an impact evaluation of a psychological intervention aiming to improve EF in children 3-16 years who either had confirmed prenatal alcohol exposure or a formal diagnosis falling under the umbrella term of FASDs. Eligible study designs included randomised controlled trials (RCTs) and quasi-experimental designs with either no treatment, wait list control or an alternative treatment as a comparison condition. Single-group pre-post designs were also included. Data Collection and Analysis Standard methodological procedures expected by the Campbell Collaboration were used at all stages of this review. Standardised mean differences (SMDs) were used to estimate intervention effects, which were combined with random effects meta-analysis (data permitting). Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2) and Cochrane Risk of Bias in Non-Randomised Studies-Interventions tool (ROBINS-I). Main Results The systematic search identified 3820 unique records. After title/abstract and full-text screening, 11 eligible studies (reported in 21 eligible documents) were deemed eligible, with a combined 253 participants. Of the 11 studies, 6 were RCTs, 1 was a quasi-experiment and 4 were single-group pre-post intervention designs. All studies were rated as having an overall high or serious risk of bias, with some variation across domains for RCTs. For RCT and quasi-experimental studies, the overall effect of EF interventions on direct and indirect measures of EF generally favoured the experimental condition, but was not statistically significant. There was no difference between intervention and comparison groups on direct measures of auditory attention (k = 3; SMD = 0.06, 95% confidence interval [CI] = -1.06, 1.18), visual attention (k = 2; SMD = 0.90, 95% CI = -1.41, 3.21), cognitive flexibility (k = 2; SMD = 0.23, 95% CI = -0.40, 0.86), attentional inhibition (k = 2; SMD = 0.04, 95% CI = -0.58, 0.65), response inhibition (k = 3; SMD = 0.47, 95% CI = -0.04, 0.99), or verbal working memory (k = 1; d = 0.6827; 95% CI = -0.0196, 1.385). Significant heterogeneity was found across studies on measures of auditory attention and visual attention, but not for measures of cognitive flexibility, attentional inhibition or response inhibition. Available data prohibited further exploration of heterogeneity. There was no statistical difference between intervention and comparison groups on indirect measures of global executive functioning (k = 2; SMD = 0.21, 95% CI = -0.40, 0.82), behavioural regulation (k = 2; SMD = 0.18, 95% CI = -0.43, 0.79), or emotional control (k = 3; SMD = 0.01, 95% CI = -0.33, 0.36). Effect sizes were positive and not significant for meta-cognition (k = 1; SMD = 0.23, 95% CI = -0.72, 1.19), shifting (k = 2; SMD = 0.04, 95% CI = -0.35, 0.43), initiation (k = 1; SMD = 0.04, 95% CI = -0.40, 0.49), monitoring (k = 1; SMD = 0.25, 95% CI = -0.20, 0.70) and organisation of materials (k = 1; SMD = 0.25, 95% CI = -0.19, 0.70). Effect sizes were negative and not statistically different for effortful control (k = 1; SMD = -0.53, 95% CI = -1.50, 0.45), inhibition (k = 2; SMD = -0.08, 95% CI = -0.47, 0.31), working memory (k = 1; SMD = 0.00, 95% CI = -0.45, 0.44), and planning and organisation (k = 1; SMD = -0.10, 95% CI = -0.55, 0.34). No statistically significant heterogeneity was found for any of the syntheses of indirect measures of EF. Based on pre-post single-group designs, there was evidence for small to medium sized improvements in EF based on direct measures (cognitive flexibility, verbal working memory and visual working memory) and indirect measures (behavioural regulation, shifting, inhibition and meta-cognition). However, these results must be interpreted with caution due to high risk of bias. Authors' Conclusions This review found limited and uncertain evidence for the effectiveness of interventions for improving executive functioning in children with FASD across 8 direct and 13 indirect measures of EF. The findings are limited by the small number of high-quality studies that could be synthesised by meta-analysis and the very small sample sizes for the included studies.
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Affiliation(s)
- Joseph Lee Betts
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
| | - Elizabeth Eggins
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
| | | | - Doug Shelton
- Child Development ServiceGold Coast Hospital and Health ServiceSouthportAustralia
| | - Haydn Till
- Child Development Service, Gold Coast Hospital and Health ServiceSouthportAustralia
| | - Paul Harnett
- School of Criminology and Criminal JusticeGriffith UniversityMount GravattAustralia
| | - Sharon Dawe
- School of Applied PsychologyGriffith UniversityBrisbaneAustralia
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Shmueli M, Ben-Shachar MS, Jacobson JL, Meintjes EM, Molteno CD, Jacobson SW, Berger A. Magnitude comparison and automaticity in number processing in adolescents with prenatal alcohol exposure: An event-related potentials study. Alcohol Clin Exp Res 2022; 46:961-978. [PMID: 35373355 DOI: 10.1111/acer.14823] [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: 03/18/2021] [Revised: 02/17/2022] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders may exhibit a distinct pattern of dysmorphic facial features, growth restriction, and cognitive deficits, particularly in arithmetic. Magnitude comparison, a fundamental element of numerical cognition, is modulated by the numerical distance effect, with numbers closer in value more difficult to compare than those further apart, and by the automaticity of the association of numerical values with their symbolic representations (Arabic numerals). METHODS We examined event-related potentials acquired during the Numerical Stroop numerical and physical tasks administered to 24 alcohol-exposed adolescents (eight fetal alcohol syndrome (FAS), eight partial FAS (PFAS), eight heavily exposed (HE) nonsyndromal) and 23 typically developing (TD), same- age controls. The distance effect was assessed on the numerical task to examine differences in reaction time (RT) and accuracy when two numbers are close in value (e.g., 1 vs. 2) compared to when the numbers are less close (e.g., 1 vs. 6). Automaticity was assessed in the physical task by examining the degree to which RT and accuracy are reduced when the relative physical size of two numerals is incongruent with their numerical values (e.g., 1 vs. 6). RESULTS Adolescents in all four groups performed behaviorally as expected on these relatively simple magnitude comparison tasks, but accuracy was poorer and RT was slower on both tasks in the FAS and PFAS than the HE and TD groups. At the neurophysiological level, in the numerical task, a higher level of prenatal alcohol exposure was associated with smaller P2p amplitude. In the physical task, only the TD and nonsyndromal HE groups exhibited the expected smaller P300 amplitude in the incongruent than the congruent condition. CONCLUSIONS These findings suggest that magnitude comparison in alcohol-exposed individuals may be mediated by recruitment of alternative neural pathways that are likely to be inefficient when number processing becomes more challenging.
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Affiliation(s)
- Michael Shmueli
- Department of Psychology, Faculty of Humanities and Social Sciences and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mattan S Ben-Shachar
- Department of Psychology, Faculty of Humanities and Social Sciences and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ernesta M Meintjes
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrea Berger
- Department of Psychology, Faculty of Humanities and Social Sciences and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Toward a Strengths-Based Cognitive Profile of Children with Fetal Alcohol Spectrum Disorders: Implications for Intervention. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-022-00245-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ordenewitz LK, Weinmann T, Schlüter JA, Moder JE, Jung J, Kerber K, Greif-Kohistani N, Heinen F, Landgraf MN. Evidence-based interventions for children and adolescents with fetal alcohol spectrum disorders - A systematic review. Eur J Paediatr Neurol 2021; 33:50-60. [PMID: 34058625 DOI: 10.1016/j.ejpn.2021.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Brain function deficits cause strong negative impacts for the everyday lives of children and adolescents with fetal alcohol spectrum disorders (FASD). Therefore, evidence-based intervention programs that are specifically designed for patients with FASD are needed but still scarce. The aim of the presented article is a systematic literature review of evidence-based intervention strategies for children and adolescents with FASD. MATERIALS AND METHODS A comprehensive systematic literature search was conducted in several relevant databases to identify randomized-controlled intervention studies for children and adolescents with FASD. RESULTS We identified 25 randomized-controlled studies regarding interventions in FASD. Overall, evidence indicating that some therapeutic interventions are effective in children and adolescents with FASD was found. Even though evidence-based interventions rarely lead to improvements of performance into a "normal range", those measures can alleviate negative consequences of prenatal alcohol exposure and relieve daily burdens. CONCLUSION There are only a few randomized-controlled trials regarding therapy research for children and adolescents with FASD. Their results indicate that especially the combination of parent and child sessions present a promising approach for the treatment of FASD. Positive treatment effects of interventions seem to be domain specific, except for interventions regarding self-regulation or social interaction.
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Affiliation(s)
- Lisa K Ordenewitz
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Julia A Schlüter
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Judith E Moder
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Jessica Jung
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Kerber
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Naschla Greif-Kohistani
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
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McDougall S, Finlay-Jones A, Arney F, Gordon A. A qualitative examination of the cognitive and behavioural challenges experienced by children with fetal alcohol spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103683. [PMID: 32521433 DOI: 10.1016/j.ridd.2020.103683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION At present it is unclear whether there is a consistent behavioural phenotype for children with Fetal Alcohol Spectrum Disorder (FASD) that can support screening efforts. There has been a dearth of qualitative studies exploring the behavioural phenotype from the perspective of caregivers raising children with FASD. The current study explores the cognitive and behavioural difficulties and impairments experienced by children with FASD aged between four and 12 years from the perspective of caregivers. METHODS Fourteen caregivers of children with FASD participated in telephone interviews. Caregivers were recruited until data saturation occurred. Thematic analysis was undertaken on the transcribed interviews, using NVivo 12. RESULTS Three over-arching themes were identified that consisted of subthemes 1) Self-regulation; behavioural, emotional, and attention; 2) Cognitive abilities; academic abilities and learning and memory; and 3) Adaptive functioning; social skills, communication and language skills, motor skills, and sleep concerns. Multiple subthemes were consistently identified across participants. A further two cross-cutting themes were identified; children behaving young for their age, and inconsistency in behaviour and strategies. DISCUSSION Despite the lack of a consistent behavioural phenotype for FASD, the findings suggest consistency between caregivers in their reports of the difficulties experienced by children with FASD. The implications for early identification and screening tool development are discussed.
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Affiliation(s)
- Stewart McDougall
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia.
| | - Amy Finlay-Jones
- Fetal Alcohol Spectrum Disorders Centre for Research Excellence, Telethon Kids Institute, WA, 6009, Australia
| | - Fiona Arney
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia
| | - Andrea Gordon
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia
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Clinical presentation, diagnosis, and management of fetal alcohol spectrum disorder. Lancet Neurol 2019; 18:760-770. [PMID: 31160204 DOI: 10.1016/s1474-4422(19)30150-4] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/21/2022]
Abstract
Although prenatal alcohol exposure causes craniofacial anomalies, growth retardation, neurological abnormalities, cognitive impairment, and birth defects, fetal alcohol spectrum disorder is underdiagnosed. Global prevalence of fetal alcohol spectrum disorder is 0·77%, with a higher prevalence of 2-5% in Europe and North America, highlighting the need for increased diagnosis and treatment. However, diagnosis remains challenging because of the poor reliability of self-reported maternal drinking histories, an absence of sensitive biomarkers, and the infrequency of diagnostic dysmorphic facial features among individuals with fetal alcohol spectrum disorder. Different diagnostic systems and disagreements over criteria have slowed progress in the diagnosis and management of the disorder. Neuroimaging shows abnormalities in brain structure, cortical development, white matter microstructure, and functional connectivity in individuals with fetal alcohol spectrum disorder. These abnormalities modify developmental trajectories and are associated with deficits in cognition, executive function, memory, vision, hearing, motor skills, behaviour, and social adaptation. Promising trials of nutritional interventions and cognitive rehabilitation therapies are underway, with the aim of treating cognitive deficits in fetal alcohol spectrum disorders.
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