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Vidal R, Vidal L, Lugo J, Ristol F, Domènec E, Casas T, Veiga A, Vico C, Ramos-Quiroga JA, Gómez-Barros N. Dog-Assisted Therapy vs Relaxation for Children and Adolescents with Fetal Alcohol Spectrum Disorder: A Randomized Controlled Study. J Autism Dev Disord 2024; 54:3133-3141. [PMID: 37340213 DOI: 10.1007/s10803-023-06023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/22/2023]
Abstract
The rationale of this study was to evaluate the efficacy of Dog-assisted Therapy (DAT) in children and adolescents with Fetal Alcohol Spectrum Disorder (FASD). We conducted a randomized controlled trial in a cohort of 71 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 38) or Relaxation Group (control group) (n = 33). Results revealed that participants who were assigned to the DAT group experienced significantly reduced externalizing symptoms (CBCL Externalizing Inattention: t (69) = 2.81, p = .007; d = 0.7); CBCL Opposition: t (69) = 2.54, p = .013; d = 0.6), reduced internalizing symptoms (CBCL Social problems: t (69) = 3.21, p = .002; d = 0.8) as well as improvements on social skills (SSIS-P Problem behavior: t (68) = 2.55, p = .013; d = 0.6), and quality of life (KidScreen Autonomy and Parents: t (51) = - 2.03, p = .047; d = 0.5) compared to the relaxation control group. The relaxation control group obtained significant differences between the pre- and post-treatment evaluation, diminishing withdraw symptoms (t (32) = 3.03, p = .005; d = 0.2). Results suggest that DAT and relaxation may be promising adjunctive treatments for children and adolescents with FASD.Clinical trial registration information: http://clinicaltrials.gov/ ; NCT04038164.
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Affiliation(s)
- Raquel Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Laura Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jorge Lugo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Francesc Ristol
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | - Eva Domènec
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | - Teresa Casas
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | | | | | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Gómez-Barros
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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2
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Hilly C, Wilson PH, Lucas B, McGuckian TB, Swanton R, Froude EH. Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1708-1733. [PMID: 37158227 DOI: 10.1080/09638288.2023.2207043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.
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Affiliation(s)
- Catherine Hilly
- School of Allied Health, Australian Catholic University, Canberra, Australia
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Barbara Lucas
- The John Walsh Centre for Rehabilitation Research, The University of Sydney
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ruth Swanton
- Occupational Therapy Department, Mercy University Hospital, Cork, Ireland
- Occupational Therapy Department, South Infirmary University Hospital, Cork, Ireland
| | - Elspeth H Froude
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Hennessy A, Nichols ES, Al-Saoud S, Brossard-Racine M, Duerden EG. Identifying cognitive profiles in children with neurodevelopmental disorders using online cognitive testing. Clin Child Psychol Psychiatry 2024; 29:591-607. [PMID: 38282296 PMCID: PMC10945998 DOI: 10.1177/13591045241228889] [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] [Indexed: 01/30/2024]
Abstract
Children with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) tend to exhibit similar deficits in attention and memory ability. Early screening of cognitive deficits in children with NDDs, particularly in preschool children, is fundamental to improving cognitive and academic outcomes. In order to determine cognitive profiles in children with ASD and ADHD, we developed accessible audiovisual instructions for an online battery of 13 cognitive tests. Children ages 4-16 who were diagnosed with ADHD (n = 83), or ASD (n = 37), or who were typically developing children (TD) (n = 86) were recruited. Data were analyzed using a stepwise Discriminant Analysis to determine which cognitive tasks were the strongest discriminators between the diagnostic groups. Results revealed four tasks reflective of working memory, reasoning, and attentional processes, which correctly classified approximately 53-60% of each group. The ADHD group had lower scores on attentional tasks compared to TD, while ASD group had lower scores on reasoning tasks compared to the TD children, and made more attempts across all four tasks. The results from this study stress the need for cognitive screening assessments that include domain-specific items to improve the characterization of executive function deficits and promote academic achievement in all children with NDDs.
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Affiliation(s)
- Abagail Hennessy
- Applied Psychology, Faculty of Education, Western University, Canada
| | - Emily S Nichols
- Applied Psychology, Faculty of Education, Western University, Canada
- Western Institute for Neuroscience, Western University, Canada
| | - Sarah Al-Saoud
- Applied Psychology, Faculty of Education, Western University, Canada
| | | | - Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, Canada
- Western Institute for Neuroscience, Western University, Canada
- Neuroscience, Schulich School of Medicine and Dentistry, Western University, Canada
- Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
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4
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Champagne M, McCrossin J, Pei J, Reynolds JN. A tornado in the family: fetal alcohol spectrum disorder and aggression during childhood and adolescence: a scoping review. Front Neurosci 2023; 17:1176695. [PMID: 37415615 PMCID: PMC10320198 DOI: 10.3389/fnins.2023.1176695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/09/2023] [Indexed: 07/08/2023] Open
Abstract
Background Aggression exhibited by children and youth with Fetal Alcohol Spectrum Disorder (FASD) toward family members is a major cause of stress and anxiety for caregivers, but relatively little attention has been directed toward designing interventions specific to this phenomenon. In light of the serious negative impact of this issue for families, a scoping review was undertaken to summarize the evidence available on psychosocial interventions that may mitigate the frequency and severity of aggression exhibited by children and youth with FASD toward family members. Methods This review was designed using PRISMA-SCR and JBI scoping review guidelines. Three databases were searched in August 2021: EMBASE, PsychINFO, and Medline. Results A total of 1,061 studies were imported for screening with only five studies meeting full eligibility criteria. None of the interventions were aimed at specifically targeting aggression and instead reported on broader constructs of externalizing behaviors such as hyperactivity. The interventions were limited to school-aged children. Studies reported primarily on child outcomes while only one reported on family related outcomes. Conclusion Following from this review of the literature, we argue that aggression is a related but separate construct from other behavioral problems most frequently targeted by parenting interventions. Given the often dire consequence of aggression displayed by children and youth with FASD and the limited number of studies, there is an urgent need for research on how to support families to manage this specific type of behavior in this population.
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Affiliation(s)
- Maude Champagne
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | | | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - James N. Reynolds
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Mah JW, Gill H, Doherty M. Feasibility and Efficacy of the Alert Program® for Children with Attention-Deficit/Hyperactivity Disorder. Clin Child Psychol Psychiatry 2023:13591045231162680. [PMID: 37015349 DOI: 10.1177/13591045231162680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
This study explored the feasibility and initial efficacy of a sensorimotor intervention to improve symptoms of attention-deficit/hyperactivity disorder (ADHD). Twenty-seven children (ages 8-12 years) with ADHD and their parents participated in an 8-week group intervention based on The Alert Program® for Self-Regulation (AP). Families were taught to recognize child arousal states and to use sensorimotor strategies to manage levels of alertness. Parent and teacher reports of child attention symptoms were collected at baseline, before and after intervention. Objective ratings of child problem behaviours and use of sensorimotor strategies during computerized tasks of visual and auditory attention were also coded before and after intervention. Parents and children endorsed high acceptability and satisfaction for the AP treatment. Parental ratings indicated increased knowledge and use of sensorimotor strategies, and decreased child ADHD symptoms at home from pre-AP to post-AP. However, no significant changes in child outcomes were reported by teachers. Unexpectedly, observed child problem behaviours during the visual attention task increased from pre-AP to post-AP. The AP was received positively by parents and children with improvements in regulation strategies and child attention at home, but more work needs to be done to generalize the effects to school and other peer settings.
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Affiliation(s)
| | - Harleen Gill
- 512469BC Children's Hospital Research Institute, Vancouver, CA
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6
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Kuschick D, Kuck J, Pachanov A, Geene R. Health promotion for families with parental alcohol addiction: a systematic review. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01845-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Abstract
Aim
Alcohol-related illnesses represent a major burden and challenge to families and pose health risks for all involved. Therefore, health promotion attempts need to focus on these vulnerable families and identify effective interventions. A systematic review was conducted of approaches to health promotion and prevention and their effectiveness for families with addiction concerns. The review focused on parental alcohol dependency.
Subject and methods
A systematic search of relevant databases was conducted, followed by a multistep screening process and a narrative synthesis of results.
Results
A total of 20 studies were included that evaluated 14 intervention programmes. The main target group was children with any form of fetal alcohol spectrum disorders and their caregivers. The study sample was dominated by behavioural approaches. The evidence base was heterogeneous. There was limited evidence of the effectiveness of combined counselling and coaching interventions that aimed to strengthen psychosocial resources.
Conclusion
The robustness of the results is limited by the moderate methodological quality of the studies. Because of the search strategy, which focused on studies with outcomes for parents with alcohol dependence, and the systematic review methodology, almost all studies reviewed featured behavioural prevention interventions. Very few studies provided specific information on the effectiveness of interventions for alcohol-dependent parents with a focus on environmental changes. The selected approach provided a limited mapping of the field of interest. However, these review findings provide the foundation for an evidence-based approach to health promotion for families with parental alcohol dependence.
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Curran WC, Danbrook MC. Capturing invisibility: child welfare social worker's interventions and assessment planning in presentations of fetal alcohol spectrum disorder(s). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-01-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Purpose
Child welfare services (CWSs) globally continue to absorb high rates of children living with or suspected of fetal alcohol spectrum disorder (FASD). Such high prevalence rates render CWS with major ethical and moral dilemmas of meeting complex needs. Currently, many jurisdictions are challenged by diagnostic capacity and cost implications of formal FASD diagnosis. This paper aims to recommend a screening protocol to address management gap between FASD initial presentation and formal diagnosis.
Design/methodology/approach
This is a follow-up paper from a grounded-theory study of a sample (N = 18) of child welfare social workers (CWSWs), allied health professionals and foster parents. A stepwise protocol was developed through systematical interpretation of the final data.
Findings
The application of a five-step screening protocol would greatly support CWSW in meeting the needs of children with suspected FASD. This CWSWs-led assessment model incorporates a clinical evaluation to exclude neurodevelopmental conditions caused by known genetic disorders, followed by behavioral and neurocognitive psychosocial assessments.
Research limitations/implications
This study had several limitations. Firstly, as a specific social work-based sample, it is not necessarily representative of the wider population of social workers globally due to different cultural responses to FASD in CWSs. The transferability of findings will have to be considered due to cultural variations concerning FASD.
Practical implications
By offering a management and nonlabeling approach, this five-step screening protocol offers a delineated pathway for CWSW and addresses the major professional frustrations while seeking to plan safe care for a child suspected of having FASD.
Social implications
The research offers a pragmatic low-cost to society to alleviate the mounting social and monetary implications of FASD. A large percentage of children impacted by prenatal alcohol exposure do not qualify under formal clinical diagnostic guidelines. Leaving these children without intervention is problematic. The recommendation of this study addresses this critical gap in services. The primary aim is to alleviate the burden on this cohort of vulnerable children by offering nonlabeling neurodevelopmental screening.
Originality/value
The direct implications of FASD and how it impacts CWS are well documented. However, few studies focus on the critical interface of FASD and the role of CWSW responsible for planning their safe care. This paper offers a novel pragmatic and functional multistep protocol to aid CWSW in this complex area of practice.
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Rau JMH, Sundermann B, Pfleiderer B, Dehghan-Nayyeri M, Garde S, Weglage J, Feldmann R. Inhibitory control in young adult women with fetal alcohol syndrome: Findings from a pilot functional magnetic resonance imaging study. Alcohol Clin Exp Res 2023; 47:600-612. [PMID: 36807201 DOI: 10.1111/acer.15025] [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: 08/23/2022] [Revised: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Executive dysfunction, especially impaired inhibitory control, is a common finding in individuals with fetal alcohol syndrome (FAS). Previous research has mostly focused on neural correlates of inhibitory deficits in children and adolescents. We investigated inhibitory functions and underlying cerebral activation patterns in young adult women with FAS. METHODS Task performance and functional magnetic resonance imaging (fMRI) data were acquired during a Go/NoGo (GNG) inhibition task in 19 young adult women with FAS and 19 healthy female control subjects. Whole-brain activation and task performance analyses were supplemented by region of interest (ROI) analyses of fMRI data within a predefined cognitive control network (CCN). RESULTS Task performance did not differ significantly between groups on errors of commission, associated with inhibitory control. Similarly, overall activation within the preselected ROIs did not differ significantly between groups for the main inhibitory contrast NoGo > Go. However, whole-brain analyses revealed activation differences in the FAS group when compared to controls under inhibitory conditions. This included hyperactivations in the left inferior frontal, superior temporal, and supramarginal gyri in the FAS group. Likewise, lateralization tendencies toward right-hemispheric ROIs were weaker in FAS subjects. In contrast to comparable inhibitory performance, attention-related errors of omission were significantly higher in the FAS group. Correspondingly, FAS subjects had lower activity in attention-related temporal and parietal areas. CONCLUSIONS The known alterations of inhibitory functions associated with prenatal alcohol exposure in children and adolescents were not seen in this adult sample. However, differential brain activity was observed, reflecting potential compensatory mechanisms. Secondary results suggest that there is impaired attentional control in young adult women with FAS.
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Affiliation(s)
- Johanna M H Rau
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany.,Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Benedikt Sundermann
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany.,Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Medical Campus, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany.,Otto Creutzfeldt Center for Cognitive and Behavioral Neuroscience, Münster, Germany
| | - Mahboobeh Dehghan-Nayyeri
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stefan Garde
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany
| | - Josef Weglage
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Reinhold Feldmann
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
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Marcellus L, Badry D. Infants, children, and youth in foster care with prenatal substance exposure: a synthesis of two scoping reviews. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:265-290. [PMID: 37025340 PMCID: PMC10071944 DOI: 10.1080/20473869.2021.1945890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Infants, children, and youth in foster care have frequently experienced prenatal substance exposure (PSE), neglect, and maltreatment as well as disruptions in their relationships with families. They also have great capacity for overcoming early adversities. In this synthesis of two previously conducted scoping reviews, we aimed to identify and describe literature that identifies a range of interventions that support the health and development of this population. Methods: This review integrates and extends two previously conducted scoping reviews, one focusing on infants and one focusing on children and youth, to synthesize themes across these developmental stages. The Joanna Briggs Institute scoping review methodology was employed for the current and previous reviews. A three-step search strategy identified published studies in the English language from January 2006 to February 2020. Results: One-hundred and fifty-three sources were included in this review. Four themes were identified: (1) early screening, diagnosis, and intervention; (2) providing theoretically grounded care; (3) supporting parents and foster care providers; and (4) intersectoral collaboration. Conclusion:Infants, children, and youth with PSE are overrepresented in foster care. Child welfare system planning should take a multi-sectoral approach to addressing the cumulative needs of this population and their care providers over developmental ages and stages. Although research remains limited, early screening, diagnosis, and developmentally and fetal alcohol spectrum disorder-informed intersectoral interventions are critical for optimizing outcomes.
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Affiliation(s)
| | - Dorothy Badry
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Correspondence to: Dorothy Badry, Faculty of Social Work, University of Calgary, Calgary, AB, Canada.
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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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11
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Mattson JT, Thorne JC, Kover ST. [Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD). Child Neuropsychol 2022; 28:853-877. [PMID: 34978272 PMCID: PMC10686097 DOI: 10.1080/09297049.2021.2023122] [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: 05/04/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.
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Affiliation(s)
- Julia T. Mattson
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - John C. Thorne
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
| | - Sara T. Kover
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
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12
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Fuglestad AJ, Miller NC, Fink BA, Boys CJ, Eckerle JK, Georgieff MK, Wozniak JR. Neurophysiological correlates of memory change in children with fetal alcohol spectrum disorders treated with choline. Front Psychol 2022; 13:936019. [PMID: 36225707 PMCID: PMC9548619 DOI: 10.3389/fpsyg.2022.936019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Prenatal and early postnatal choline supplementation reduces cognitive and behavioral deficits in animal models of Fetal Alcohol Spectrum Disorder (FASD). In a previously published 9-month clinical trial of choline supplementation in children with FASD, we reported that postnatal choline was associated with improved performance on a hippocampal-dependent recognition memory task. The current paper describes the neurophysiological correlates of that memory performance for trial completers. Methods Children with FASD (N = 24) who were enrolled in a clinical trial of choline supplementation were followed for 9 months. Delayed recall on a 9-step elicited imitation task (EI) served as the behavioral measure of recognition memory. Neurophysiological correlates of memory were assessed via event-related potentials (ERP). Results Delayed recall on EI was correlated with two ERP components commonly associated with recognition memory in young children: middle latency negative component (Nc amplitude; range: r = -0.41 to r = -0.44) and positive slow wave (PSW area under the curve; range: r = -0.45 to r = -0.63). No significant ERP differences were observed between the choline and placebo groups at the conclusion of the trial. Conclusion Although the small sample size limits the ability to draw clear conclusions about the treatment effect of choline on ERP, the results suggest a relationship between memory performance and underlying neurophysiological status in FASD. This trial was registered.
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Affiliation(s)
- Anita J. Fuglestad
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Neely C. Miller
- Masonic Institute for the Developing Brain, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Birgit A. Fink
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Christopher J. Boys
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Judith K. Eckerle
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Michael K. Georgieff
- Masonic Institute for the Developing Brain, University of Minnesota Twin Cities, Minneapolis, MN, United States,Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Jeffrey R. Wozniak
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, United States,*Correspondence: Jeffrey R. Wozniak,
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13
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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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14
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Bottom RT, Kozanian OO, Rohac DJ, Erickson MA, Huffman KJ. Transgenerational Effects of Prenatal Ethanol Exposure in Prepubescent Mice. Front Cell Dev Biol 2022; 10:812429. [PMID: 35386207 PMCID: PMC8978834 DOI: 10.3389/fcell.2022.812429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/28/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Fetal alcohol spectrum disorders (FASD) represent a leading cause of non-genetic neuropathologies. Recent preclinical evidence from suggests that prenatal ethanol exposure (PrEE), like other environmental exposures, may have a significant, transgenerational impact on the offspring of directly exposed animals, including altered neocortical development at birth and behavior in peri-pubescent mice. How these adverse behavioral outcomes are manifested within the brain at the time of behavioral disruption remains unknown. Methods: A transgenerational mouse model of FASD was used to generate up to a third filial generation of offspring to study. Using a multi-modal battery of behavioral assays, we assessed motor coordination/function, sensorimotor processing, risk-taking behavior, and depressive-like behavior in postnatal day (P) 20 pre-pubescent mice. Additionally, sensory neocortical area connectivity using dye tracing, neocortical gene expression using in situ RNA hybridization, and spine density of spiny stellate cells in the somatosensory cortex using Golgi-Cox staining were examined in mice at P20. Results: We found that PrEE induces behavioral abnormalities including abnormal sensorimotor processing, increased risk-taking behavior, and increased depressive-like behaviors that extend to the F3 generation in 20-day old mice. Assessment of both somatosensory and visual cortical connectivity, as well as cortical RZRβ expression in pre-pubescent mice yielded no significant differences among any experimental generations. In contrast, only directly-exposed F1 mice displayed altered cortical expression of Id2 and decreased spine density among layer IV spiny stellate cells in somatosensory cortex at this pre-pubescent, post weaning age. Conclusion: Our results suggest that robust, clinically-relevant behavioral abnormalities are passed transgenerationally to the offspring of mice directly exposed to prenatal ethanol. Additionally, in contrast to our previous findings in the newborn PrEE mouse, a lack of transgenerational findings within the brain at this later age illuminates the critical need for future studies to attempt to discover the link between neurological function and the described behavioral changes. Overall, our study suggests that multi-generational effects of PrEE may have a substantial impact on human behavior as well as health and well-being and that these effects likely extend beyond early childhood.
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Affiliation(s)
- Riley T Bottom
- Interdepartmental Neuroscience Program, University of California, Riverside, Riverside, CA, United States
| | - Olga O Kozanian
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - David J Rohac
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Michael A Erickson
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Kelly J Huffman
- Interdepartmental Neuroscience Program, University of California, Riverside, Riverside, CA, United States.,Department of Psychology, University of California, Riverside, Riverside, CA, United States
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15
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Brown J, Jonason A, Asp E, McGinn V, Carter MN, Spiller V, Jozan A. Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers. BEHAVIORAL SCIENCES & THE LAW 2022; 40:46-86. [PMID: 34689366 DOI: 10.1002/bsl.2540] [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: 04/08/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.
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Affiliation(s)
- Jerrod Brown
- Pathways Counseling Center, Inc., St. Paul, Minnesota, USA
- Concordia University, St. Paul, Minnesota, USA
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Alec Jonason
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
| | - Erik Asp
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Valerie McGinn
- The FASD Centre, Auckland, New Zealand
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Megan N Carter
- University of Washington, Seattle, Washington, USA
- Department of Social and Health Services, Special Commitment Center, Steilacoom, Washington, USA
| | | | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
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16
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Louw JG, van Heerden A, Olivier L, Lambrechts T, Broodryk M, Bunge L, Vosloo M, Tomlinson M. Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study. JMIR Form Res 2021; 5:e20658. [PMID: 34255647 PMCID: PMC8285745 DOI: 10.2196/20658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/27/2020] [Accepted: 03/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low–socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low–socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID) RR2-10.2196/14489
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.,Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Pietermaritzburg, South Africa.,Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand/Medical Research Council, Johannesburg, South Africa
| | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Tersius Lambrechts
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Mandi Broodryk
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Liska Bunge
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Martlé Vosloo
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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17
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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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18
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Gardiner E, Hutchison SM, McLachlan K, Rasmussen C, Pei J, Mâsse LC, Oberlander TF, Reynolds JN. Behavior regulation skills are associated with adaptive functioning in children and adolescents with prenatal alcohol exposure. APPLIED NEUROPSYCHOLOGY-CHILD 2021; 11:691-701. [PMID: 34155949 DOI: 10.1080/21622965.2021.1936528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children with prenatal alcohol exposure (PAE) experience a range of adverse outcomes that impact multiple domains of functioning, including cognitive, physical, mental health, behavioral, social-emotional, communication, and learning. To inform tailored clinical intervention, the current study examined the relation between caregiver-reported cognitive skills (executive function; EF) and adaptive functioning. The study conducted a secondary analyses of data provided by caregivers of 87 children and adolescents (aged 5-18 years, M = 11.7; 52% male) with confirmed PAE, including a subset (n = 70) with Fetal Alcohol Spectrum Disorder (FASD), who reported on their child's EF (Behavior Rating Inventory of Executive Function) and adaptive function (Adaptive Behavior Assessment System, 2nd Edition) skills. Findings from the current study showed that caregivers reported significantly poorer EF and adaptive functioning skills for children with PAE as compared to normative samples. Poorer behavior regulation skills were associated with all aspects of adaptive functioning (i.e., practical, conceptual, and social skills). Specifically, shifting skills emerged as the best predictor of adaptive functioning among children with PAE. These results highlight the possibility that targeting particular EF domains among individuals with PAE may benefit behavior regulation, which may also extend to adaptive skills. This highlights the need to develop EF interventions for children and adolescents who have been prenatally exposed to alcohol.
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Affiliation(s)
- Emily Gardiner
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Sarah M Hutchison
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Alberta, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - James N Reynolds
- Centre for Neuroscience Studies, Queens University, Kingston, Canada
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19
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Lindinger NM, Jacobson JL, Warton CMR, Malcolm-Smith S, Molteno CD, Dodge NC, Robertson F, Meintjes EM, Jacobson SW. Fetal Alcohol Exposure Alters BOLD Activation Patterns in Brain Regions Mediating the Interpretation of Facial Affect. Alcohol Clin Exp Res 2021; 45:140-152. [PMID: 33220071 DOI: 10.1111/acer.14519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although deficits in the interpretation of affective facial expressions have been described clinically and in behavioral studies of fetal alcohol spectrum disorders (FASD), effects of prenatal alcohol exposure on the neural networks that mediate affective appraisal have not previously been examined. METHODS We administered a nonverbal event-related fMRI affective appraisal paradigm to 64 children (mean age = 12.5 years; 18 with fetal alcohol syndrome (FAS) or partial FAS (PFAS), 18 nonsyndromal heavily exposed (HE), and 28 controls). Happy, sad, angry, fearful, and neutral faces and pixelated control images were presented sequentially in a randomized order. The child indicated whether the currently displayed face showed the same or different affect as the previous one. RESULTS Data from whole-brain analyses showed that all groups activated the appropriate face processing neural networks. Region of interest analyses indicated that, compared to HE and control children, the FAS/PFAS group exhibited greater blood oxygenation level-dependent (BOLD) signal changes when processing neutral faces than pixelated images in 2 regions that form part of the visual sensory social brain network, which plays an important role in the initial processing of facial affect. By contrast, BOLD signal when processing angry faces was weaker for the FAS/PFAS group in a region involved in the processing of facial identity and facial expressions and in a region involved in the recognition and selection of behavioral responses to aggressive behavior. CONCLUSIONS These findings of greater BOLD signal in the FAS/PFAS group in response to neutral faces suggest less efficient neural processing of more difficult to interpret emotions, and the weaker BOLD response to angry faces suggests altered processing of angry stimuli. Although behavioral performance did not differ in this relatively simple affective appraisal task, these data suggest that in children with FAS and PFAS, the appraisal of neutral affect and anger is likely to be more effortful in more challenging and dynamic social contexts.
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Affiliation(s)
- Nadine M Lindinger
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychology, (NML, SMS), Faculty of Humanities, University of Cape Town, Cape Town, South Africa
| | - Joseph L Jacobson
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, (JLJ, NCD, SWJ), Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Psychiatry and Mental Health, (JLJ, CDM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher M R Warton
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Susan Malcolm-Smith
- Department of Psychology, (NML, SMS), Faculty of Humanities, University of Cape Town, Cape Town, South Africa
| | - Christopher D Molteno
- Department of Psychiatry and Mental Health, (JLJ, CDM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, (JLJ, NCD, SWJ), Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Frances Robertson
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Biomedical Engineering Research Centre (BMERC), (FR, EMM), Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre (CUBIC), (FR, EMM), Cape Town, South Africa
| | - Ernesta M Meintjes
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Biomedical Engineering Research Centre (BMERC), (FR, EMM), Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre (CUBIC), (FR, EMM), Cape Town, South Africa
| | - Sandra W Jacobson
- From the, Department of Human Biology, (NML, JLJ, CMRW, FR, EMM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Behavioral Neurosciences, (JLJ, NCD, SWJ), Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Psychiatry and Mental Health, (JLJ, CDM, SWJ), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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20
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Cao Y, Huang T, Huang J, Xie X, Wang Y. Effects and Moderators of Computer-Based Training on Children's Executive Functions: A Systematic Review and Meta-Analysis. Front Psychol 2020; 11:580329. [PMID: 33324291 PMCID: PMC7726355 DOI: 10.3389/fpsyg.2020.580329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/06/2020] [Indexed: 01/04/2023] Open
Abstract
Computer-based training has attracted increasing attention from researchers in recent years. Several studies have found that computer-based training resulted in improved executive functions (EFs) in adults. However, it remains controversial whether children can benefit from computer-based training and what moderator could influence the training effects. The focus of the present meta-analysis was to examine the effects of computer-based training on EFs in children: working memory, cognitive flexibility, and inhibitory control. A thorough search of published work yielded a sample of 36 studies with 216 effect sizes. The results indicated that computer-based training showed moderate training effects on improving EFs in children (g = 0.35, k = 36, p < 0.001), while training effects of working memory were significantly higher. Furthermore, we found near-transfer effects were marginally significantly higher than far-transfer effects. The standard training method was significantly more effective than training with game elements. In computer-based training, typically developing children had significantly better training effects than atypically developing children. Some additional factors, such as the number of training sessions and age, also modulated the training effects. In conclusion, the present study investigated the effects and moderators of computer-based training for children's EFs. The results provided evidence that computer-based training (especially standard training) may serve as an efficient way to improve EFs in children (especially typically developing individuals). We also discussed some directions for future computer-based training studies.
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Affiliation(s)
- Yifei Cao
- School of Psychology, Northeast Normal University, Changchun, China
| | - Ting Huang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Jipeng Huang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Xiaochun Xie
- School of Psychology, Northeast Normal University, Changchun, China
| | - Yuan Wang
- School of Psychology, Northeast Normal University, Changchun, China
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21
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Flannigan K, Coons-Harding KD, Anderson T, Wolfson L, Campbell A, Mela M, Pei J. A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:2401-2430. [PMID: 33119894 PMCID: PMC7839542 DOI: 10.1111/acer.14490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2020] [Indexed: 12/25/2022]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well‐being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.
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Affiliation(s)
- Katherine Flannigan
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Kelly D Coons-Harding
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, (KDC-H), Laurentian University, Sudbury, Ontario, Canada
| | - Tara Anderson
- (TA), Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lindsay Wolfson
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,(LW), Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Alanna Campbell
- (AC), Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mansfield Mela
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Psychiatry, College of Medicine, (MM), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jacqueline Pei
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Educational Psychology, (JP), University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, (JP), University of Alberta, Edmonton, Alberta, Canada
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22
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Waddell J, Hill E, Tang S, Jiang L, Xu S, Mooney SM. Choline Plus Working Memory Training Improves Prenatal Alcohol-Induced Deficits in Cognitive Flexibility and Functional Connectivity in Adulthood in Rats. Nutrients 2020; 12:E3513. [PMID: 33202683 PMCID: PMC7696837 DOI: 10.3390/nu12113513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/28/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is the leading known cause of intellectual disability, and may manifest as deficits in cognitive function, including working memory. Working memory capacity and accuracy increases during adolescence when neurons in the prefrontal cortex undergo refinement. Rats exposed to low doses of ethanol prenatally show deficits in working memory during adolescence, and in cognitive flexibility in young adulthood. The cholinergic system plays a crucial role in learning and memory processes. Here we report that the combination of choline and training on a working memory task during adolescence significantly improved cognitive flexibility (performance on an attentional set shifting task) in young adulthood: 92% of all females and 81% of control males formed an attentional set, but only 36% of ethanol-exposed males did. Resting state functional magnetic resonance imaging showed that functional connectivity among brain regions was different between the sexes, and was altered by prenatal ethanol exposure and by choline + training. Connectivity, particularly between prefrontal cortex and striatum, was also different in males that formed a set compared with those that did not. Together, these findings indicate that prenatal exposure to low doses of ethanol has persistent effects on brain functional connectivity and behavior, that these effects are sex-dependent, and that an adolescent intervention could mitigate some of the effects of prenatal ethanol exposure.
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Affiliation(s)
- Jaylyn Waddell
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (E.H.); (S.M.M.)
| | - Elizabeth Hill
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (E.H.); (S.M.M.)
| | - Shiyu Tang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.T.); (L.J.); (S.X.)
| | - Li Jiang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.T.); (L.J.); (S.X.)
| | - Su Xu
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (S.T.); (L.J.); (S.X.)
| | - Sandra M. Mooney
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (E.H.); (S.M.M.)
- Department of Nutrition, Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC 28081, USA
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23
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Kapasi A, Pei J, Kryska K, Joly V, Gill K, Thompson-Hodgetts S, McLachlan K, Andrew G, Rasmussen C. Exploring Self-Regulation Strategy Use in Adolescents with FASD. JOURNAL OF OCCUPATIONAL THERAPY, SCHOOLS, & EARLY INTERVENTION 2020. [DOI: 10.1080/19411243.2020.1822260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aamena Kapasi
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Kathryn Kryska
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Kamaldeep Gill
- Department of Rehabilitation Sciences, University of British Colombia, Vancouver, Canada
| | | | | | - Gail Andrew
- Glenrose Rehabilitation Hospital Edmonton, PAE Clinic, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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24
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Passmore HM, Mutch RC, Watkins R, Burns S, Hall G, Urquhart J, Carapetis J, Bower C. Reframe the Behaviour: Evaluation of a training intervention to increase capacity in managing detained youth with fetal alcohol spectrum disorder and neurodevelopmental impairments. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 28:382-407. [PMID: 35530127 PMCID: PMC9067986 DOI: 10.1080/13218719.2020.1780643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The first study to investigate the prevalence of fetal alcohol spectrum disorder (FASD) within an Australian juvenile detention centre has identified the highest known prevalence of FASD among a justice-involved population worldwide. However, there has been limited investigation into the capacity of the custodial workforce to identify and manage young people in Australian detention centres with FASD or other neurodevelopmental impairment (NDI), and no published interventions aiming to develop environments appropriate for those with FASD in justice settings. Using the Template for Intervention Description and Replication checklist, this study describes the conception, implementation and evaluation of a training intervention aiming to upskill the custodial workforce in the management of youth with FASD and NDI; 117 staff participated in the intervention, and 109 completed pre- and post-intervention surveys. Improvements were seen across almost all knowledge and attitude items, and the intervention was considered highly necessary, appropriate and valuable by the workforce.
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Affiliation(s)
- Hayley M. Passmore
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Raewyn C. Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Health Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sharyn Burns
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Guy Hall
- School of Law, Murdoch University, Perth, WA, Australia
| | | | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Perth Children’s Hospital, Perth, WA, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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25
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Wagner B, Latimer J, Adams E, Carmichael Olson H, Symons M, Mazzucchelli TG, Jirikowic T, Watkins R, Cross D, Carapetis J, Boulton J, Wright E, McRae T, Carter M, Fitzpatrick JP. School-based intervention to address self-regulation and executive functioning in children attending primary schools in remote Australian Aboriginal communities. PLoS One 2020; 15:e0234895. [PMID: 32579567 PMCID: PMC7314028 DOI: 10.1371/journal.pone.0234895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children's executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children's behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children's executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children's exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.
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Affiliation(s)
- Bree Wagner
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Jane Latimer
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emma Adams
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Heather Carmichael Olson
- Seattle Children’s Research Institute, Seattle, Washington, United States of America
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Martyn Symons
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Trevor G. Mazzucchelli
- Child and Family Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
- Brain, Behaviour and Mental Health Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Rochelle Watkins
- National Health and Medical Research Council FASD Research Australia Centre of Research Excellence, Perth, Western Australia, Australia
| | - Donna Cross
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Health Promotion and Education Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- CoLab–Collaborate for Kids, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children’s Hospital, Perth, Western Australia, Australia
| | - John Boulton
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Edie Wright
- Western Australian Department of Education Kimberley Education Region, Broome, Western Australia, Australia
| | - Tracy McRae
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Western Australia, Australia
| | - James P. Fitzpatrick
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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26
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Crawford A, Te Nahu Rongomaiwahine Rāua Ko Kahungunu LTH, Peterson ER, McGinn V, Robertshaw K, Tippett L. [Formula: see text] Cognitive and social/emotional influences on adaptive functioning in children with FASD: Clinical and cultural considerations. Child Neuropsychol 2020; 26:1112-1144. [PMID: 32519571 DOI: 10.1080/09297049.2020.1771296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Fetal Alcohol Spectrum Disorder (FASD) is one of the leading causes of intellectual disability and learning difficulties around the world. Children with FASD often have extremely low adaptive behavior due to the severity of brain impairment, however there is limited understanding as to the important predictors of adaptive behavior. In a study of 39 children with FASD and 29 comparison children, we found that social cognition (specifically recognizing emotions) was the only significant independent predictor of teacher-rated adaptive functioning even after including IQ, executive functioning, and adverse childhood experiences into the model. In this current study, Māori (Indigenous people of Aotearoa New Zealand) were overrepresented; therefore, the research was supported by a strong partnership with Te Wāhanga Hauora Māori (Māori Health Service). Aotearoa New Zealand's colonized history is recognized and findings are discussed with regard to both the psychological literature and a Te Ao Māori worldview.
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Affiliation(s)
- Andi Crawford
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand.,Child Development Service, Hawke's Bay District Health Board , Hawke's Bay, New Zealand
| | | | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand
| | - Valerie McGinn
- Honorary Senior Research Fellow, School of Population Health, The University of Auckland , Auckland, New Zealand
| | - Kate Robertshaw
- Child Development Service, Hawke's Bay District Health Board , Hawke's Bay, New Zealand
| | - Lynette Tippett
- School of Psychology, University of Auckland, Science Centre , Auckland, New Zealand.,The Center of Brain Research, University of Auckland , New Zealand
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27
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Vidal R, Vidal L, Ristol F, Domènec E, Segú M, Vico C, Gomez-Barros N, Ramos-Quiroga JA. Dog-Assisted Therapy for Children and Adolescents With Fetal Alcohol Spectrum Disorders a Randomized Controlled Pilot Study. Front Psychol 2020; 11:1080. [PMID: 32528389 PMCID: PMC7264372 DOI: 10.3389/fpsyg.2020.01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Objective The rationale of this study was to evaluate the efficacy of dog-assisted therapy (DAT) combined with pharmacological treatment in children and adolescents with fetal alcohol spectrum disorder (FASD). Method We conducted a randomized, rater-blinded, controlled pilot trial in a cohort of 33 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 17) or Treatment as Usual (TAU control group) (n = 16). Results Of the initial 39 participants enrolled, 33 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the DAT group experienced significantly improvements on social skills (SSIS-P social skills: p = 0.02, d = 0.8), reductions on externalizing symptoms (CBCL externalizing: p = 0.03; d = 0.56), and lower scores on FASD severity (CGI-S clinician: p = 0.001, d = 0.5). Conclusion DAT is a promising adjunctive treatment for children and adolescents with FASD. Clinical Trial Registration Dog-assisted therapy for children and adolescents with fetal alcohol spectrum disorders: a randomized controlled pilot study; http://clinicaltrials.gov/, identifier NCT04038164.
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Affiliation(s)
- Raquel Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | - Eva Domènec
- Centre de Terapia Assistida amb Cans, Barcelona, Spain
| | | | | | - Núria Gomez-Barros
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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28
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Aghaie CI, Hausknecht KA, Wang R, Dezfuli PH, Haj-Dahmane S, Kane CJM, Sigurdson WJ, Shen RY. Prenatal Ethanol Exposure and Postnatal Environmental Intervention Alter Dopaminergic Neuron and Microglia Morphology in the Ventral Tegmental Area During Adulthood. Alcohol Clin Exp Res 2020; 44:435-444. [PMID: 31872887 DOI: 10.1111/acer.14275] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/13/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prenatal ethanol exposure (PE) impairs midbrain dopaminergic (DA) neuron function, which might contribute to various cognitive and behavioral deficits, including attention deficits and increased addiction risk, often observed in individuals with fetal alcohol spectrum disorders. Currently, the underlying mechanisms for PE-induced deficits are unclear. PE could lead to neuroinflammation by activating microglia, which play an important role in synaptic function. In the present study, we investigated PE effects on microglial activation and DA neuron density and morphology in the ventral tegmental area (VTA). Since postnatal environmental enrichment can reduce neuroinflammation and ameliorate several PE-induced behavioral deficits, we examined if a postnatal environmental intervention strategy using neonatal handling and postweaning complex housing could reverse PE effects on VTA DA neurons and microglia. METHODS Pregnant rats received 0 or 6 g/kg/d ethanol by 2 intragastric intubations on gestation days 8 to 20. After birth, rats were reared in the standard laboratory or enriched condition. Male adult rats (8 to 12 weeks old) were used for immunocytochemistry. RESULTS The results showed that PE decreased VTA DA neuron body size in standardly housed rats. Moreover, there was a significant decrease in numbers of VTA microglial branches and junctions in PE rats, suggesting morphological activation of microglia and possible neuroinflammation. The PE effects on microglia were normalized by postnatal environmental intervention, which also decreased the numbers of microglial branches and junctions in control animals, possibly via reduced stress. CONCLUSIONS Our findings show an association between PE-induced morphological activation of microglia and impaired DA neuron morphology in the VTA. Importantly, postnatal environmental intervention rescues possible PE-induced microglial activation. These data support that environmental intervention can be effective in ameliorating cognitive and behavioral deficits associated with VTA DA neuron dysfunctions, such as attention deficits and increased addiction risk.
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Affiliation(s)
- Claudia I Aghaie
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York
| | - Kathryn A Hausknecht
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York
| | - Ruixiang Wang
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York
| | | | - Samir Haj-Dahmane
- Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York
| | - Cynthia J M Kane
- Department of Neurobiology and Developmental Sciences, College of Medicine, the University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wade J Sigurdson
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York
| | - Roh-Yu Shen
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, New York.,Department of Pharmacology and Toxicology, University at Buffalo, Buffalo, New York
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29
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Louw JG, Olivier L, Skeen S, van Heerden A, Tomlinson M. Evaluation of a Custom-Developed Computer Game to Improve Executive Functioning in 4- to 6-Year-Old Children Exposed to Alcohol in Utero: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e14489. [PMID: 31596247 PMCID: PMC6806122 DOI: 10.2196/14489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/28/2022] Open
Abstract
Background Fetal alcohol spectrum disorder (FASD) is one of the most common causes of preventable intellectual disability, and the key associated deficits are in executive function (EF). Aspects of EF can be improved using cognitive training interventions. The highest prevalence of FASD globally (at a rate of 135.1 per 1000) has been found in a South African population in the Western Cape province. There is a shortage of specialized health service personnel, and there are limited remedial services. Computer-based cognitive training, if age and culturally appropriate, could be an effective way to provide the interventions with minimal need for skilled personnel and other resources. The Foundation for Alcohol Related Research has developed such a program for the South African context. Objective This protocol aimed to evaluate whether it is feasible to use computerized cognitive training in a resource-poor context to improve cognitive function in children exposed to alcohol in utero. Methods We are conducting a randomized controlled trial in the Saldanha Bay Municipal area, evaluating a custom-developed cognitive training program to improve the cognitive function of children aged between 4 and 6 years who were exposed to alcohol in the prenatal stage. Participants will be recruited from local Early Childhood Development centers. Community workers will interview biological mothers to identify alcohol-exposed pregnancies. Alcohol-exposed children will be randomized into an intervention or a control group of 40 participants each using block randomization. A group of 40 children not exposed to alcohol will be included in a normative group using individual randomization. The intervention group will play the game for 6 months (40 sessions). Normative and control groups will receive no intervention. Neurodevelopmental assessments will be done at baseline and upon completion of the study with all participants. Results The intervention has started, and all baseline assessments have been done at the time of submission. Conclusions This study will provide insight into whether computerized cognitive training is viable and effective in the South African context. It has the potential to provide a means of intervention globally and in other resource-poor context and expand the knowledge base regarding executive functioning and FASD. This paper presents the research protocol and intervention design of the study. Trial Registration ISRCTN Registry ISRCTN17244156; http://www.isrctn.com/ISRCTN17244156. International Registered Report Identifier (IRRID) DERR1-10.2196/14489
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Affiliation(s)
- Jacobus Gidion Louw
- Foundation for Alcohol Related Research, Cape Town, South Africa.,Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.,Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leana Olivier
- Foundation for Alcohol Related Research, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alastair van Heerden
- Human and Social Development, Human Sciences Research Council, Pietermaritzburg, South Africa.,MRC/WITS Developmental Pathways for Health Research Unit Department of Paediatrics, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
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30
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Wagner B, Cross D, Adams E, Symons M, Mazzucchelli TG, Watkins R, Wright E, Latimer J, Carapetis J, Boulton J, Fitzpatrick JP. RE-AIM evaluation of a teacher-delivered programme to improve the self-regulation of children attending Australian Aboriginal community primary schools. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1672991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Bree Wagner
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Donna Cross
- Health Promotion and Education Research Team, Co-Lab – Collaborate for Kids, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Emma Adams
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Martyn Symons
- National Health and Medical Research Council FASD Research, Australia Centre of Research Excellence, Perth, Australia
| | - Trevor G. Mazzucchelli
- Child and Family Research Group and Brain, Behaviour and Mental Health Research Group, School of Psychology, Curtin University, Perth, Australia
| | - Rochelle Watkins
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Edie Wright
- Department of Education Western Australia, Kimberley Education Region, Broome, Australia
| | - Jane Latimer
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Perth Children’s Hospital, Perth, Australia
| | - John Boulton
- The University of Newcastle, Newcastle, Australia
| | - James P. Fitzpatrick
- Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
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31
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Petrenko CLM, Demeusy EM, Alto ME. Six-Month Follow-up of the Families on Track Intervention Pilot Trial for Children With Fetal Alcohol Spectrum Disorders and Their Families. Alcohol Clin Exp Res 2019; 43:2242-2254. [PMID: 31408192 DOI: 10.1111/acer.14180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND When the primary disabilities associated with fetal alcohol spectrum disorders (FASD) are not well supported, individuals are at higher risk for mental health problems and other secondary conditions. The Families on Track (FOT) intervention was designed to prevent secondary conditions and improve family functioning in children with FASD. Promising results from a pilot study demonstrated positive effects on child and caregiver outcomes immediately following the intervention. The objective of this study was to examine the sustainability of these effects 6 months postintervention. METHODS Thirty children (ages 4 to 8) with prenatal alcohol exposure and their caregivers were enrolled in the original study. Families were randomized to the FOT intervention or an active comparison group that provided comprehensive assessment and individualized feedback. The intervention integrated a positive parenting curriculum and a child skills group. Families were assessed at baseline, postintervention, and 6-month follow-up visits. Follow-up data were available for 24 families on child and caregiver outcomes. Data were analyzed using effect size calculations and analysis-of-variance techniques. RESULTS Relative to the comparison group, intervention families showed continued gains in parenting efficacy and maintained prior improvements in FASD knowledge over the follow-up period. Although intervention families reported a decrease in their needs being met over the follow-up period, they continued to report their needs being met to greater extent than those in the comparison group. Consistent with postintervention outcomes, children in both groups exhibited similar decreases in child disruptive behavior 6 months following the intervention. Unfortunately, positive gains seen at postintervention for child self-esteem and emotion regulation were attenuated at follow-up. CONCLUSIONS This pilot study yielded promising effects on important areas of caregiver functioning. However, the intervention's impact on child functioning waned over time, suggesting the need for sustained or alternate child intervention.
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Affiliation(s)
| | | | - Michelle E Alto
- Mt. Hope Family Center, University of Rochester, Rochester, New York
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32
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Adebiyi BO, Mukumbang FC, Erasmus C. The Distribution of Available Prevention and Management Interventions for Fetal Alcohol Spectrum Disorder (2007 to 2017): Implications for Collaborative Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122244. [PMID: 31242673 PMCID: PMC6617245 DOI: 10.3390/ijerph16122244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The aim of the scoping review is to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. We searched some selected databases with predefined terms. Framework and narrative approaches were used to synthesize and report on the findings. Thirty-two prevention intervention studies and 41 management interventions studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Charlene Erasmus
- Child and Family Studies, University of the Western Cape, Cape Town 8001, South Africa.
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Betts J, Dawe S, Eggins E, Shelton D, Till H, Harnett P, Chandler‐Mather N. PROTOCOL: Interventions for improving executive functions in children with Fetal Alcohol Spectrum Disorder: Systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1009. [PMID: 37131471 PMCID: PMC8533799 DOI: 10.1002/cl2.1009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Joseph Betts
- School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
| | - Sharon Dawe
- School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
| | - Elizabeth Eggins
- School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
| | - Doug Shelton
- Gold Coast University HospitalSouthportAustralia
| | - Haydn Till
- Gold Coast Hospital and Health ServiceSouthportAustralia
| | - Paul Harnett
- School of Applied PsychologyGriffith UniversityBrisbaneQueenslandAustralia
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Doyle LR, Moore EM, Coles CD, Kable JA, Sowell ER, Wozniak JR, Jones KL, Riley EP, Mattson SN. Executive Functioning Correlates With Communication Ability in Youth With Histories of Heavy Prenatal Alcohol Exposure. J Int Neuropsychol Soc 2018; 24:1026-1037. [PMID: 30322415 PMCID: PMC6237635 DOI: 10.1017/s1355617718000772] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. METHODS Subjects (ages 10-16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales - Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. RESULTS Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. CONCLUSIONS Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026-1037).
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Affiliation(s)
- Lauren R. Doyle
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Eileen M. Moore
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Pediatrics, Emory University School of Medicine
| | - Julie A. Kable
- Department of Pediatrics, Emory University School of Medicine
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, University of Southern California
| | | | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
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Khoury JE, Jamieson B, Milligan K. Risk for Childhood Internalizing and Externalizing Behavior Problems in the Context of Prenatal Alcohol Exposure: A Meta-Analysis and Comprehensive Examination of Moderators. Alcohol Clin Exp Res 2018; 42:1358-1377. [PMID: 29852057 DOI: 10.1111/acer.13805] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long-lasting impacts on children, adolescents, and their families. The present meta-analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta-analysis included 65 studies comparing children and adolescents with PAE to non- or light-exposed controls and attention-deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (d = 0.71, medium effect) and externalizing (d = 0.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE.
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Affiliation(s)
| | | | - Karen Milligan
- Department of Psychology, Ryerson University, Toronto, Canada
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Reid N, Petrenko CLM. Applying a Developmental Framework to the Self-Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2018; 42:987-1005. [PMID: 29672859 DOI: 10.1111/acer.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022]
Abstract
Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self-regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self-regulation for this population. The application of a multilevel theoretical framework that describes the development of self-regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self-regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self-regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE.
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Affiliation(s)
- Natasha Reid
- Centre for Child Health Research, University of Queensland, Brisbane, Queensland
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37
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Wagner B, Fitzpatrick JP, Mazzucchelli TG, Symons M, Carmichael Olson H, Jirikowic T, Cross D, Wright E, Adams E, Carter M, Bruce K, Latimer J. Study protocol for a self-controlled cluster randomised trial of the Alert Program to improve self-regulation and executive function in Australian Aboriginal children with fetal alcohol spectrum disorder. BMJ Open 2018; 8:e021462. [PMID: 29581212 PMCID: PMC5875644 DOI: 10.1136/bmjopen-2017-021462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION While research highlights the benefits of early diagnosis and intervention for children with fetal alcohol spectrum disorders (FASD), there are limited data documenting effective interventions for Australian children living in remote communities. METHODS AND ANALYSIS This self-controlled cluster randomised trial is evaluating the effectiveness of an 8-week Alert Program school curriculum for improving self-regulation and executive function in children living in remote Australian Aboriginal communities. Children in grades 1-6 attending any of the eight participating schools across the Fitzroy Valley in remote North-West Australia (N ≈ 363) were invited to participate. Each school was assigned to one of four clusters with clusters randomly assigned to receive the intervention at one of four time points. Clusters two, three and four had extended control conditions where students received regular schooling before later receiving the intervention. Trained classroom teachers delivered the Alert Program to students in discrete, weekly, 1-hour lessons. Student outcomes were assessed at three time points. For the intervention condition, data collection occurred 2 weeks immediately before and after the intervention, with a follow-up 8 weeks later. For control conditions in clusters two to four, the control data collection matched that of the data collection for the intervention condition in the preceding cluster. The primary outcome is change in self-regulation. FASD diagnoses will be determined via medical record review after the completion of data collection. The results will be analysed using generalised linear mixed modelling and reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Western Australia (WA) (RA/4/1/7234), WA Aboriginal Health Ethics Committee (601) and WA Country Health Service (2015:04). The Kimberley Aboriginal Health Planning Forum Research Sub-Committee and WA Department of Education also provided approval. The results will be disseminated through peer-reviewed journals, conference presentations, the media and at forums. TRIAL REGISTRATION NUMBER ACTRN12615000733572; Pre-results.
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Affiliation(s)
- Bree Wagner
- Alcohol and Pregnancy and FASD Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - James P Fitzpatrick
- Alcohol and Pregnancy and FASD Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Trevor G Mazzucchelli
- Child and Family Research Group and Brain, Behaviour and Mental Health Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Martyn Symons
- FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Heather Carmichael Olson
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tracy Jirikowic
- Division of Occupational Therapy, University of Washington School of Medicine, Children's Research Institute, Seattle, Washington, USA
| | - Donna Cross
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Edie Wright
- Western Australian Department of Education, Kimberley Education Region, Broome, Australia
| | - Emma Adams
- Alcohol and Pregnancy and FASD Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Kaashifah Bruce
- Alcohol and Pregnancy and FASD Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jane Latimer
- Musculoskeletal Health Sydney, Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
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Pfeiffer B, Clark GF, Arbesman M. Effectiveness of Cognitive and Occupation-Based Interventions for Children With Challenges in Sensory Processing and Integration: A Systematic Review. Am J Occup Ther 2017; 72:7201190020p1-7201190020p9. [PMID: 29280712 DOI: 10.5014/ajot.2018.028233] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review examines the evidence for the effectiveness of cognitive and occupation-based interventions to improve self-regulation in children and youth who have challenges in processing and integrating sensory information. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided the methodology. Five studies identified through a comprehensive database search met the inclusion criteria and were separated into categories of cognitive and occupation-based interventions. Articles that did not specifically measure sensory integration (SI) or processing challenges were omitted. Synthesis of the articles suggests that self-regulation (e.g., sensory processing, emotional regulation, executive functioning, social function) improved with cognitive and occupation-based interventions. Because the number of studies that measured sensory processing or SI challenges was limited, researchers are encouraged to include these measures in future research to understand the impact of a broader range of cognitive and occupation-based interventions.
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Affiliation(s)
- Beth Pfeiffer
- Beth Pfeiffer, PhD, OTR/L, BCP, FAOTA, is Associate Professor, Department of Rehabilitation Sciences, Temple University, Philadelphia, PA;
| | - Gloria Frolek Clark
- Gloria Frolek Clark, PhD, OTR/L, BCP, SCSS, FAOTA, is Occupational Therapist, Private Practice, Adel, IA
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Methodology Consultant, Evidence-Based Practice Project, American Occupational Therapy Association, Bethesda, MD; Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC; and President, ArbesIdeas, Inc., Williamsville, NY
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Nash K, Stevens S, Clairman H, Rovet J. Preliminary Findings that a Targeted Intervention Leads to Altered Brain Function in Children with Fetal Alcohol Spectrum Disorder. Brain Sci 2017; 8:brainsci8010007. [PMID: 29283403 PMCID: PMC5789338 DOI: 10.3390/brainsci8010007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 11/16/2022] Open
Abstract
Children with fetal alcohol spectrum disorder (FASD) exhibit behavioral dysregulation, executive dysfunction, and atypical function in associated brain regions. Previous research shows early intervention mitigates these outcomes but corresponding brain changes were not studied. Given the Alert® Program for Self-Regulation improves behavioral regulation and executive function in children with FASD, we asked if this therapy also improves their neural functioning in associated regions. Twenty-one children with FASD aged 8–12 years were randomized to the Alert®-treatment (TXT; n = 10) or waitlist-control (WL; n = 11) conditions. They were assessed with a Go-NoGo functional magnetic resonance imaging (fMRI) paradigm before and after training or the wait-out period. Groups initially performed equivalently and showed no fMRI differences. At post-test, TXT outperformed WL on NoGo trials while fMRI in uncorrected results with a small-volume correction showed less activation in prefrontal, temporal, and cingulate regions. Groups also demonstrated different patterns of change over time reflecting reduced signal at post-test in selective prefrontal and parietal regions in TXT and increased in WL. In light of previous evidence indicating TXT at post-test perform similar to non-exposed children on the Go-NoGo fMRI paradigm, our findings suggest Alert® does improve functional integrity in the neural circuitry for behavioral regulation in children with FASD.
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Affiliation(s)
- Kelly Nash
- Psychiatry Department, The Hospital for Sick Children, Toronto, ON M5G1X8, Canada.
| | - Sara Stevens
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G1R8, Canada.
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON M4G1R8, Canada.
| | - Hayyah Clairman
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON M5G1A0, Canada.
| | - Joanne Rovet
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON M5G1A0, Canada.
- Department of Pediatrics, University of Toronto, Toronto, ON M5G1X8, Canada.
- Psychology Department, University of Toronto, Toronto, ON M5S3G3, Canada.
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Fetal alcohol spectrum disorders: Zebrafish in the analysis of the milder and more prevalent form of the disease. Behav Brain Res 2017; 352:125-132. [PMID: 28988969 DOI: 10.1016/j.bbr.2017.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 02/08/2023]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) represent a large unmet medical need. Exposure of the developing human embryo to alcohol can lead to life-long suffering. Despite the well documented deleterious effects of alcohol on the developing fetus, pregnant women continue to drink alcohol, and FASD remains the leading cause of preventable mental retardation and other behavioral abnormalities. Particularly prevalent are the milder forms of the disease cluster, representing children who do not show obvious physical signs and who may be undiagnosed or misdiagnosed. To develop treatment and diagnostic tools, researchers have turned to animal models. The zebrafish is becoming one of the leading biomedical research organisms that may facilitate discovery of the biological mechanisms underlying this disease and the identification of biomarkers that may be used for diagnosis. Here we review the latest advances of this field, mostly focussing on the discoveries made in our own laboratory and others with zebrafish employed to analyze the effects of moderate to low level of exposure to alcohol. We argue that the zebrafish represents unique advantages, and adding information obtained with this species to the mix of other animal models will significantly increase translational relevance of animal biomedical research for the analysis of human FASD.
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Choline and Working Memory Training Improve Cognitive Deficits Caused by Prenatal Exposure to Ethanol. Nutrients 2017; 9:nu9101080. [PMID: 28961168 PMCID: PMC5691697 DOI: 10.3390/nu9101080] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023] Open
Abstract
Prenatal ethanol exposure is associated with deficits in executive function such as working memory, reversal learning and attentional set shifting in humans and animals. These behaviors are dependent on normal structure and function in cholinergic brain regions. Supplementation with choline can improve many behaviors in rodent models of fetal alcohol spectrum disorders and also improves working memory function in normal rats. We tested the hypothesis that supplementation with choline in the postnatal period will improve working memory during adolescence in normal and ethanol-exposed animals, and that working memory engagement during adolescence will transfer to other cognitive domains and have lasting effects on executive function in adulthood. Male and female offspring of rats fed an ethanol-containing liquid diet (ET; 3% v/v) or control dams given a non-ethanol liquid diet (CT) were injected with choline (Cho; 100 mg/kg) or saline (Sal) once per day from postnatal day (P) 16–P30. Animals were trained/tested on a working memory test in adolescence and then underwent attentional set shifting and reversal learning in young adulthood. In adolescence, ET rats required more training to reach criterion than CT-Sal. Choline improved working memory performance for both CT and ET animals. In young adulthood, ET animals also performed poorly on the set shifting and reversal tasks. Deficits were more robust in ET male rats than female ET rats, but Cho improved performance in both sexes. ET male rats given a combination of Cho and working memory training in adolescence required significantly fewer trials to achieve criterion than any other ET group, suggesting that early interventions can cause a persistent improvement.
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Prefrontal cortical responses in children with prenatal alcohol-related neurodevelopmental impairment: A functional near-infrared spectroscopy study. Clin Neurophysiol 2017; 128:2099-2109. [PMID: 28914230 DOI: 10.1016/j.clinph.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 07/06/2017] [Accepted: 08/13/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Disruption in the neural activation of the prefrontal cortex (PFC) in modulating arousal was explored in children with heavy prenatal alcohol exposure (PAE), who have known neurobehavioral impairment. METHODS During a task that elicits frustration, functional near-infrared spectroscopy (fNIRS) was used to measure PFC activation, specifically levels of oxygenated (HBO) and deoxygenated (HBR) hemoglobin, in children with PAE (n=18) relative to typically developing Controls (n=12) and a Clinical Contrast group with other neurodevelopmental or behavioral problems (n=14). RESULTS Children with PAE had less activation during conditions with positive emotional arousal, as indicated by lower levels of HBO in the medial areas of the PFC and higher levels of HBR in all areas of the PFC sampled relative to both other groups. Children in the Control group demonstrated greater differentiation of PFC activity than did children with PAE. Children in the Clinical Contrast group demonstrated the greatest differences in PFC activity between valences of task conditions. CONCLUSIONS Specific patterns of PFC activation differentiated children with PAE from typically developing children and children with other clinical problems. SIGNIFICANCE FNIRS assessments of PFC activity provide new insights regarding the mechanisms of commonly seen neurobehavioral dysfunction in children with PAE.
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Petrenko CLM, Pandolfino ME, Robinson LK. Findings from the Families on Track Intervention Pilot Trial for Children with Fetal Alcohol Spectrum Disorders and Their Families. Alcohol Clin Exp Res 2017; 41:1340-1351. [PMID: 28440861 DOI: 10.1111/acer.13408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders (FASD) are at high risk for costly, debilitating mental health problems and secondary conditions, such as school disruption, trouble with the law, and substance use. The study objective was to pilot a multicomponent intervention designed to prevent secondary conditions in children with FASD and improve family adaptation. METHODS Thirty children with FASD or prenatal alcohol exposure (PAE) (ages 4 to 8) and their primary caregivers were enrolled. Families were randomized to either the Families on Track Integrated Preventive Intervention or an active control of neuropsychological assessment and personalized community referrals. The 30-week intervention integrates scientifically validated bimonthly, in-home parent behavioral consultation, and weekly child skills groups. Outcomes measured at baseline and follow-up postintervention included intervention satisfaction, child emotional and behavioral functioning, child self-esteem, caregiver knowledge of FASD and advocacy, caregiver attitudes, use of targeted parenting practices, perceived family needs met, social support, and self-care. Data analysis emphasized calculation of effect sizes and was supplemented with analysis of variance techniques. RESULTS Analyses indicated that families participating in the intervention reported high program satisfaction. Relative to comparison group outcomes, the intervention was associated with medium-to-large effects for child emotion regulation, self-esteem, and anxiety. Medium-sized improvements in disruptive behavior were observed for both groups. Medium and large effects were seen for important caregiver outcomes: knowledge of FASD and advocacy, attributions of behavior, use of antecedent strategies, parenting efficacy, family needs met, social support, and self-care. CONCLUSIONS This pilot study yielded promising findings from the multicomponent Families on Track Integrated Preventive Intervention for child and caregiver outcomes. An important next step is to complete a randomized control trial of the Families on Track Program with a larger sample fully representative of this underserved clinical population with built-in study of implementation parameters.
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Affiliation(s)
| | - Mary E Pandolfino
- Mt. Hope Family Center , University of Rochester, Rochester, New York
| | - Luther K Robinson
- Women and Children's Hospital of Buffalo , University at Buffalo, Buffalo, New York
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Abstract
This grand rounds manuscript reviews important considerations in developing case conceptualizations for individuals with a history of prenatal alcohol exposure. This case study provides an introduction to fetal alcohol spectrum disorders, diagnostic issues, a detailed description of the individual's history, presenting symptoms, neuropsychological test results, and an integrated summary. We describe a 9-year old girl diagnosed with a fetal alcohol spectrum disorder (FASD): Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). This patient is a composite of a prototypical child who participated as part of a research project at the Center for Behavioral Teratology who was subsequently seen at an outpatient child psychiatry facility.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
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Petrenko CLM, Alto ME. Interventions in fetal alcohol spectrum disorders: An international perspective. Eur J Med Genet 2017; 60:79-91. [PMID: 27742482 PMCID: PMC5205562 DOI: 10.1016/j.ejmg.2016.10.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 12/21/2022]
Abstract
Fetal alcohol spectrum disorders (FASD) are present across countries and cultures, with prevalence rates threatening to rise in the coming years. In order to support children and families with FASD around the world, researchers must work to disseminate and implement evidence-based interventions. However, each cultural context presents unique elements and barriers to the implementation process. This review considers the challenges of addressing FASD in an international context. It summarizes existing FASD interventions that have empirical support in the domains of parenting and education, attention and self-regulation, adaptive functioning, and nutrition and medication. It then outlines cultural barriers pertaining to FASD that may impede the implementation process and makes suggestions for using purveyors as cultural liaisons between researchers and local stakeholders. The review concludes with recommendations for moving forward with international dissemination and implementation of FASD interventions.
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Wagner B, Fitzpatrick J, Symons M, Jirikowic T, Cross D, Latimer J. The development of a culturally appropriate school based intervention for Australian Aboriginal children living in remote communities: A formative evaluation of the Alert Program ® intervention. Aust Occup Ther J 2016; 64:243-252. [PMID: 27966224 DOI: 10.1111/1440-1630.12352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Although previous research has demonstrated the benefits of targeting self-regulation in non-Aboriginal children, it is unclear whether such programs would be effective for Aboriginal children attending school in remote communities. Some of these children have been diagnosed with a fetal alcohol spectrum disorder (FASD) impairing their ability to self-regulate. The aim of this article is to describe a three phase formative process to develop and pilot a curriculum version of the Alert Program® , a promising intervention for improving self-regulation that could be used in remote community schools. This modified version of the program will be subsequently tested in a cluster randomised controlled trial. METHODS A mixed methods approach was used. RESULTS Modifications to the Alert Program® , its delivery and evaluation were made after community and stakeholder consultation facilitated by a senior Aboriginal community researcher. Changes to lesson plans and program resources were made to reflect the remote community context, classroom environment and the challenging behaviours of children. Standardised study outcome measures were modified by removing several questions that had little relevance to the lives of children in remote communities. Program training for school staff was reduced in length to reduce staff burden. CONCLUSIONS This study identified aspects of the Alert Program® training, delivery and measures for evaluation that need modification before their use in assessing the efficacy of the Alert Program® in remote Aboriginal community primary schools.
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Affiliation(s)
- Bree Wagner
- Telethon Kids Institute, The University of Western Australia, Australia
| | - James Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Martyn Symons
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Donna Cross
- Faculty of Medicine, Dentistry and Health Science, Telethon Kids Institute, The University of Western Australia, Australia.,Edith Cowan University, Perth, Western Australia, Australia
| | - Jane Latimer
- The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia
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Stevens SA, Clairman H, Nash K, Rovet J. Social perception in children with fetal alcohol spectrum disorder. Child Neuropsychol 2016; 23:980-993. [DOI: 10.1080/09297049.2016.1246657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sara A. Stevens
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Hayyah Clairman
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kelly Nash
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Rovet
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Pei J, Tremblay M, McNeil A, Poole N, McFarlane A. Neuropsychological Aspects of Prevention and Intervention for FASD in Canada. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2016. [DOI: 10.1007/s40817-016-0020-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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du Plooy CP, Malcolm-Smith S, Adnams CM, Stein DJ, Donald KA. The Effects of Prenatal Alcohol Exposure on Episodic Memory Functioning: A Systematic Review: Table 1. Arch Clin Neuropsychol 2016; 31:710-726. [DOI: 10.1093/arclin/acw067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 01/04/2023] Open
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Gupta KK, Gupta VK, Shirasaka T. An Update on Fetal Alcohol Syndrome-Pathogenesis, Risks, and Treatment. Alcohol Clin Exp Res 2016; 40:1594-602. [PMID: 27375266 DOI: 10.1111/acer.13135] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
Abstract
Alcohol is a well-established teratogen that can cause variable physical and behavioral effects on the fetus. The most severe condition in this spectrum of diseases is known as fetal alcohol syndrome (FAS). The differences in maternal and fetal enzymes, in terms of abundance and efficiency, in addition to reduced elimination, allow for alcohol to have a prolonged effect on the fetus. This can act as a teratogen through numerous methods including reactive oxygen species (generated as by products of CYP2E1), decreased endogenous antioxidant levels, mitochondrial damage, lipid peroxidation, disrupted neuronal cell-cell adhesion, placental vasoconstriction, and inhibition of cofactors required for fetal growth and development. More recently, alcohol has also been shown to have epigenetic effects. Increased fetal exposure to alcohol and sustained alcohol intake during any trimester of pregnancy is associated with an increased risk of FAS. Other risk factors include genetic influences, maternal characteristics, for example, lower socioeconomic statuses and smoking, and paternal chronic alcohol use. The treatment options for FAS have recently started to be explored although none are currently approved clinically. These include prenatal antioxidant administration food supplements, folic acid, choline, neuroactive peptides, and neurotrophic growth factors. Tackling the wider impacts of FAS, such as comorbidities, and the family system have been shown to improve the quality of life of FAS patients. This review aimed to focus on the pathogenesis, especially mechanisms of alcohol teratogenicity, and risks of developing FAS. Recent developments in potential management strategies, including prenatal interventions, are discussed.
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Affiliation(s)
| | - Vinay K Gupta
- School of Medicine, University of Birmingham, Birmingham, UK
| | - Tomohiro Shirasaka
- Department of Neuropsychiatry, School of Medicine, Sapporo Medical University, Sapporo, Japan
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