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Garavelis KN, Hayes N, Rose TA, Maloney M, Liddle K, Moritz K, Gullo M, Gullo HL, McMah R, Heussler H, Reid N. Exploring the experience of service users following attendance at a student-led interprofessional neurodevelopmental clinic. Disabil Rehabil 2024; 46:1298-1308. [PMID: 37029616 DOI: 10.1080/09638288.2023.2193430] [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: 09/25/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The aim of the current study was to understand service users' experiences at a recently established student-led interprofessional neurodevelopmental clinic for children and adolescents with suspected or confirmed prenatal alcohol exposure. METHOD Semi-structured interviews were completed at 3-months post-clinic attendance with 10 service users: eight parents/caregivers and two youth workers/case managers. Interview data were analysed thematically using NVivo12. RESULTS Four main themes were developed: (1) clinic attendance seen as a positive event; (2) validation, clarification, and relief, but also challenges post-assessment; (3) need for further support and importance of advocacy; and (4) drawing on lived experiences for future service improvements. CONCLUSIONS The current study demonstrated that service users reported benefits from tailored services delivered by student practitioners that were validating, supportive, and holistic. Findings from the current study can inform the development and implementation of future innovative service delivery models for individuals with suspected or confirmed prenatal alcohol exposure.
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Affiliation(s)
- Khari Nicola Garavelis
- Child Health Research Centre, The University of Queensland, Brisbane, South Brisbane, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, Brisbane, South Brisbane, Australia
| | - Tanya A Rose
- The University of Queensland, Brisbane, Australia
| | - Maree Maloney
- Child Health Research Centre, The University of Queensland, Brisbane, South Brisbane, Australia
| | - Karen Liddle
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Karen Moritz
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Matthew Gullo
- National Centre for Youth Substance Abuse Research, The University of Queensland, Saint Lucia, Australia
| | - Hannah L Gullo
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, St Lucia Campus, Brisbane, Australia
| | - Rebeccah McMah
- School of Health and Rehabilitation Sciences, The University of Queensland, Therapies Annexe, St Lucia Campus, Brisbane, Australia
| | - Helen Heussler
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Natasha Reid
- Child Health Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Pervin Z, Pinner J, Flynn L, Cerros CM, Williams ME, Hill DE, Stephen JM. School-aged children diagnosed with an FASD exhibit visuo-cortical network disturbance: A magnetoencephalography (MEG) study. Alcohol 2022; 99:59-69. [PMID: 34915151 PMCID: PMC9113084 DOI: 10.1016/j.alcohol.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
Children with prenatal alcohol exposure (PAE) often suffer from cognitive and neurobehavioral dysfunction throughout their lives, which may rise to a level of concern such that children receive a diagnosis under the fetal alcohol spectrum disorders (FASD) umbrella. Magnetoencephalography (MEG) contributes direct insight into neural processing and functional connectivity measures with temporal precision to understand cortical processing disorders that manifest during development. The impairment of perception may become more consequential among school-aged children with an FASD in the process of intellectual functioning and behavioral maturation. Fifty participants with the age range of 8-13 years participated in our study following parental informed consent and child assent. For each participant, visual responses were recorded using magnetoencephalography (MEG) while performing a prosaccade task with central stimuli (fovea centralis) and peripheral stimuli (left and right of central) presented on a screen, requiring participants to shift their gaze to the stimuli. After source analysis using minimum norm estimation (MNE), we investigated visual responses from each participant by measuring the latency and amplitude of visual evoked fields. Delayed peak latency of the visual response was identified in the primary visual area (calcarine fissure) and visual association areas (v2, v3) in young children with an FASD for both stimulus types (central and peripheral). But the difference in visual response latency was only statistically significant (p ≤ 0.01) for the peripheral (right) stimulus. We also observed reduced amplitude (p ≤ 0.006) of visual evoked response in children with an FASD for the central stimulus type in both primary and visual association areas. Multiple visual areas show impairment in children with an FASD, with visual delay and conduction disturbance more prominent in response to peripheral stimuli. Children with an FASD also exhibit significantly reduced amplitude of neural activation to central stimuli. These sensory deficits may lead to slow cognitive processing speed through continued intra-cortical network disturbance in children with an FASD.
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Affiliation(s)
- Zinia Pervin
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA.,Department of Biomedical Engineering, University of New Mexico, Albuquerque, NM 87131, USA
| | - John Pinner
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA
| | - Lucinda Flynn
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA
| | - Cassandra M. Cerros
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Mareth E. Williams
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Dina E. Hill
- Health Sciences Center, School of Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Julia M. Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, Albuquerque, NM 87106, USA.,Corresponding author Julia M. Stephen, Ph.D., MEG Core Director, Prof. of Translational Neuroscience, The Mind Research Network, Pete & Nancy Domenici hall, 1101 Yale Blvd. NE, Albuquerque, New Mexico 87106, Tel: (505)-504-1053.
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The Association Between Performance-Based Measures and Caregiver Ratings of Executive Functioning Among Children with Prenatal Alcohol Exposure. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-021-00115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Coles CD, Kable JA, Granovska IV, Pashtepa AO, Wertelecki W, Chambers CD. Measurement of neurodevelopmental effects of prenatal alcohol exposure in Ukrainian preschool children. Child Neuropsychol 2021; 27:1088-1103. [PMID: 33982636 DOI: 10.1080/09297049.2021.1919298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.
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Affiliation(s)
- Claire D Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Iryna V Granovska
- OMNet, Rivne, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Ala O Pashtepa
- OMNet, Rivne, Ukraine.,Khmelnitsky Perinatal Center, Khmelnitsky, Ukraine
| | - Wladimir Wertelecki
- OMNet, Rivne, Ukraine.,Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
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- Collaborative Initiative for Fetal Alcohol Spectrum Disorders
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Taylor NM, Enns LN. Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings. Child Neuropsychol 2018; 25:507-527. [PMID: 29996711 DOI: 10.1080/09297049.2018.1495187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Diagnostic assessment in Fetal Alcohol Spectrum Disorder (FASD) is informed by multidisciplinary assessment incorporating objective (i.e., test measures) and subjective means, such as parent and teacher behavior ratings. The purpose of this study was to extend our previous neuropsychological test findings by identifying parent and teacher ratings of academic achievement, attention, executive functioning, and adaptive functioning as predictors of an FASD diagnosis. The charts of 315 children and adolescents with prenatal alcohol exposure (PAE) who underwent assessment for FASD were retrospectively reviewed. Direct logistic regressions analyzed the contribution of different ratings on the likelihood of an FASD diagnosis. The results suggest that a number of rating measures do contribute toward accurately differentiating those with FASD from within a PAE population, including teacher ratings of learning problems, inattention, and adaptive skills. The classification accuracy for each regression was clinically significant (59.1-70.8%). Children with worse ratings on these variables are approximately 1.5 to 2 times more likely to receive an FASD diagnosis. Only teacher ratings (not parent) significantly contributed to whether a diagnosis was made, suggesting that teacher observational rating scales are a critical component of an FASD assessment. Together with our previous research examining neuropsychological evaluation and FASD diagnostic assessment, this study helps to further guide decisions to streamline care in multidisciplinary assessment and intervention planning.
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Affiliation(s)
- Nicole M Taylor
- a Department of Clinical Health Psychology , University of Manitoba , Winnipeg , MB , Canada.,b Manitoba FASD Centre , SSCY Centre , Winnipeg , MB , Canada
| | - Leah N Enns
- a Department of Clinical Health Psychology , University of Manitoba , Winnipeg , MB , Canada.,b Manitoba FASD Centre , SSCY Centre , Winnipeg , MB , Canada
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Taylor NM, Enns LN. Age-related differences in neuropsychological assessment of fetal alcohol spectrum disorder: a cross-sectional study. Biochem Cell Biol 2017; 96:252-259. [PMID: 28796950 DOI: 10.1139/bcb-2017-0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study examined 6 key areas of neuropsychological functioning (cognitive, academic, attention, executive function, adaptive skills) comparing adolescents and school-age children with prenatal alcohol exposure (PAE). The aims were: (i) to examine which neuropsychological measures were predictive of an FASD diagnosis in adolescents and school-age children with PAE, and (ii) to compare the neuropsychological performance of adolescents and children diagnosed with FASD. Hierarchical logistic regressions determined that the Full-Scale IQ, Verbal Comprehension and Perceptual Reasoning indices, basic reading and math skills, adaptive functioning at school, and components of executive functioning (dependent on age) improved the probability of an accurate FASD diagnosis in both groups: 9.1% to 19.2% for adolescents and 10.9% to 19.4% for school-age children (61.5%-80.9% correct classifications overall). For the age comparison analyses (ANOVAs/MANOVAs), a significant difference was observed in the cognitive domain, as well as with basic math skills (trend) in the sample diagnosed with FASD, with lower scores observed for adolescents across these measures. These findings provide further evidence for age differences in neuropsychological assessment as well as increased neuropsychological difficulties in adolescence by comparison with childhood with FASD. Longitudinal studies will be needed to make further inferences about developmental changes in neuropsychological functioning in FASD.
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Affiliation(s)
- Nicole M Taylor
- a Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada.,b Manitoba FASD Centre, SSCY Centre, 1155 Notre Dame Avenue, Winnipeg, MB R3E 3G1, Canada
| | - Leah N Enns
- a Department of Clinical Health Psychology, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, MB R3E 3N4, Canada.,b Manitoba FASD Centre, SSCY Centre, 1155 Notre Dame Avenue, Winnipeg, MB R3E 3G1, Canada
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Lange S, Rovet J, Rehm J, Popova S. Neurodevelopmental profile of Fetal Alcohol Spectrum Disorder: A systematic review. BMC Psychol 2017. [PMID: 28645298 PMCID: PMC5481937 DOI: 10.1186/s40359-017-0191-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background In an effort to improve the screening and diagnosis of individuals with Fetal Alcohol Spectrum Disorder (FASD), research has focused on the identification of a unique neurodevelopmental profile characteristic of this population. The objective of this review was to identify any existing neurodevelopmental profiles of FASD and review their classification function in order to identify gaps and limitations of the current literature. Methods A systematic search for studies published up to the end of December 2016 reporting an identified neurodevelopmental profile of FASD was conducted using multiple electronic bibliographic databases. The search was not limited geographically or by language of publication. Original research published in a peer-reviewed journal that involved the evaluation of the classification function of an identified neurodevelopmental profile of FASD was included. Results Two approaches have been taken to determine the pathognomonic neurodevelopmental features of FASD, namely the utilization of i) behavioral observations/ratings by parents/caregivers and ii) subtest scores from standardized test batteries assessing a variety of neurodevelopmental domains. Both approaches show some promise, with the former approach (which is dominated by research on the Neurobehavioral Screening Tool) having good sensitivity (63% to 98%), but varying specificity (42% to 100%), and the latter approach having good specificity (72% to 96%), but varying sensitivity (60% to 88%). Conclusions The current review revealed that research in this area remains limited and a definitive neurodevelopmental profile of FASD has not been established. However, the identification of a neurodevelopmental profile will aid in the accurate identification of individuals with FASD, by adding to the armamentarium of clinicians. The full review protocol is available in PROSPERO (http://www.crd.york.ac.uk/PROSPERO/); registration number CRD42016039326; registered 20 May 2016.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health , Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Joanne Rovet
- Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health , Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health , Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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