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Felgueras N, López-Díaz JM, Garrote I. Effects of Developmental Timing on Cognitive and Behavioral Profiles in Fetal Alcohol Spectrum Disorder: Considerations for Education. Behav Sci (Basel) 2024; 14:431. [PMID: 38920763 PMCID: PMC11200952 DOI: 10.3390/bs14060431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Associations and families demand the need to raise awareness of the implications in the cognitive and behavioral development of children with Fetal Alcohol Spectrum Disorder (FASD) that affect their learning and school participation. This study aims to generate a profile of executive and behavioral functioning in children and adolescents diagnosed with FASD. A probabilistic sampling by clusters (associations for individuals with FASD) is applied. The sample is composed of 66 families from three associations. The BRIEF-2 and SENA tests were administered to assess executive and behavioral functioning domains. Data analysis found that the executive and behavioral functioning profile of individuals with FASD varies with age, with greater impairment in middle and late adolescence. Likewise, the domain of executive functioning most affected in any of the developmental stages is working memory. Finally, cognitive impairment in the executive functioning domains has a direct impact on the social and adaptive functioning of people with FASD.
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Affiliation(s)
- Nerea Felgueras
- High-Performance Research Group on Inclusive Education, People with Disabilities and Universal Accessibility (DIVERSIA), Department of Educational Sciences, Faculty of Education and Sport and Interdisciplinary Studies, King Juan Carlos University, 28933 Fuenlabrada, Spain;
| | - José María López-Díaz
- High-Performance Research Group on Inclusive Education, People with Disabilities and Universal Accessibility (DIVERSIA), Department of Educational Sciences, Faculty of Education and Sport and Interdisciplinary Studies, King Juan Carlos University, 28933 Fuenlabrada, Spain;
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Crichton A, Harris K, McGree JM, Nikles J, Anderson PJ, Williams K. Fetal alcohol spectrum disorder and attention deficit hyperactivity disorder stimulant trial in children: an N-of-1 pilot trial to compare stimulant to placebo (FASST): protocol. BMJ Open 2024; 14:e071266. [PMID: 38631835 PMCID: PMC11029357 DOI: 10.1136/bmjopen-2022-071266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/21/2023] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder caused by alcohol exposure during pregnancy. FASD is associated with neurodevelopmental deviations, and 50%-94% of children with FASD meet the Diagnostic and Statistical Manual of Mental Disorders-fifth edition diagnostic criteria for attention deficit hyperactivity disorder (ADHD). There is a paucity of evidence around medication efficacy for ADHD symptoms in children with FASD. This series of N-of-1 trials aims to provide pilot data on the feasibility of conducting N-of-1 trials in children with FASD and ADHD. METHODS AND ANALYSIS A pilot N-of-1 randomised trial design with 20 cycles of stimulant and placebo (four cycles of 2-week duration) for each child will be conducted (n=20) in Melbourne, Australia.Feasibility and tolerability will be assessed using recruitment and retention rates, protocol adherence, adverse events and parent ratings of side effects. Each child's treatment effect will be determined by analysing teacher ADHD ratings across stimulant and placebo conditions (Wilcoxon rank). N-of-1 data will be aggregated to provide an estimate of the cohort treatment effect as well as individual-level treatment effects. We will assess the sample size and number of cycles required for a future trial. Potential mediating factors will be explored to identify variables that might be associated with treatment response variability. ETHICS AND DISSEMINATION The study was approved by the Hospital and Health Service Human Research Ethics Committee (HREC/74678/MonH-2021-269029), Monash (protocol V6, 25 June 2023).Individual outcome data will be summarised and provided to participating carers and practitioners to enhance care. Group-level findings will be presented at a local workshop to engage stakeholders. Findings will be presented at national and international conferences and published in peer-reviewed journals. All results will be reported so that they can be used to inform prior information for future trials. TRIAL REGISTRATION NUMBER NCT04968522.
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Affiliation(s)
- Alison Crichton
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Katrina Harris
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Developmental and Community Paediatrics, Monash Health, Clayton, Victoria, Australia
| | - James M McGree
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jane Nikles
- University of Queensland Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Peter J Anderson
- Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
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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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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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Relationship Between Task-Based and Parent Report-Based Measures of Attention and Executive Function in Children with Fetal Alcohol Spectrum Disorders (FASD). JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2020; 6:176-188. [PMID: 33585167 DOI: 10.1007/s40817-020-00089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A majority of children with fetal alcohol spectrum disorders (FASD) have demonstrated attention and executive function deficits as measured by both parent report measures and performance on tasks requiring sustained levels of attention. However, prior studies have consistently reported a lack of association between parental report-based and task-based performance measures. The current study investigated whether changes in performance over time within-task (i.e., first-half versus second-half) better correspond to parental reports of executive function and temperament in children with FASD. Greater differences in split-half performance during a continuous performance task were found to be associated with higher parent-reported levels of behavioral regulation and inhibitory control. These findings suggest that within-task performance differences may more accurately reflect individual differences in executive function and temperament as measured by parental report and help to further inform the way in which cognitive processes are measured in children with FASD.
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Shinn JR, Jayawardena ADL, Patro A, Zuniga MG, Netterville JL. Teacher Prescreening for Hearing Loss in the Developing World. EAR, NOSE & THROAT JOURNAL 2019; 100:259S-262S. [PMID: 31608682 DOI: 10.1177/0145561319880388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of this prospective cohort study was to characterize the ability of teachers to identify schoolchildren at risk of hearing loss in order to maximize hearing screening efficiency in low-resource settings. At 4 semirural schools in Malindi, Kenya, preselected schoolchildren perceived as hearing impaired were compared to children thought to have normal hearing using portable audiometry. Eight of 127 children (54% male) failed hearing screening, all of who were identified by schoolteachers as having a high risk of hearing loss. Thus, for every 5 children prescreened by schoolteachers, an average of 1 child would be identified as having hearing loss. Overall, teacher prescreening had a 100% hearing loss identification rate and a 20% referral rate. In conclusion, in resource-limited settings, where universal hearing screening is challenging, teachers can effectively identify children with hearing loss for early intervention.
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Affiliation(s)
- Justin R Shinn
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Asitha D L Jayawardena
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ankita Patro
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Geraldine Zuniga
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - James L Netterville
- Department of Otolaryngology, 12328Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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