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Akkaya Hocagil T, Ryan LM, Cook RJ, Dang KD, Carter RC, Richardson GA, Day NL, Coles CD, Carmichael Olson H, Jacobson SW, Jacobson JL. Benchmark dose profiles for bivariate exposures. Risk Anal 2024. [PMID: 38651726 DOI: 10.1111/risa.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
While benchmark dose (BMD) methodology is well-established for settings with a single exposure, these methods cannot easily handle multidimensional exposures with nonlinear effects. We propose a framework for BMD analysis to characterize the joint effect of a two-dimensional exposure on a continuous outcome using a generalized additive model while adjusting for potential confounders via propensity scores. This leads to a dose-response surface which can be summarized in two dimensions by a contour plot in which combinations of exposures leading to the same expected effect are identified. In our motivating study of prenatal alcohol exposure, cognitive deficits in children are found to be associated with both the frequency of drinking as well as the amount of alcohol consumed on each drinking day during pregnancy. The general methodological framework is useful for a broad range of settings, including combinations of environmental stressors, such as chemical mixtures, and in explorations of the impact of dose rate rather than simply cumulative exposure on adverse outcomes.
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Affiliation(s)
- Tugba Akkaya Hocagil
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
- Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkiye
| | - Louise M Ryan
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Khue-Dung Dang
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Victoria, Australia
| | - R Colin Carter
- Division of Pediatric Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy L Day
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Washington, District of Columbia, USA
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Jacobson JL, Akkaya-Hocagil T, Jacobson SW, Coles CD, Richardson GA, Olson HC, Day NL, Carter RC, Dodge NC, Dang KD, Cook RJ, Ryan LM. A dose-response analysis of the effects of prenatal alcohol exposure on cognitive development. Alcohol Clin Exp Res (Hoboken) 2024; 48:623-639. [PMID: 38554140 DOI: 10.1111/acer.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Most studies of the effects of prenatal alcohol exposure (PAE) on cognitive function have assumed that the dose-response curve is linear. However, data from a few animal and human studies suggest that there may be an inflection point in the dose-response curve above which PAE effects are markedly stronger and that there may be differences associated with pattern of exposure, assessed in terms of alcohol dose per drinking occasion and drinking frequency. METHODS We performed second-order confirmatory factor analysis on data obtained at school age, adolescence, and early adulthood from 2227 participants in six US longitudinal cohorts to derive a composite measure of cognitive function. Regression models were constructed to examine effects of PAE on cognitive function, adjusted for propensity scores. Analyses based on a single predictor (absolute alcohol (AA)/day) were compared with analyses based on two predictors (dose/occasion and drinking frequency), using (1) linear models and (2) nonparametric general additive models (GAM) that allow for both linear and nonlinear effects. RESULTS The single-predictor GAM model showed virtually no nonlinearity in the effect of AA/day on cognitive function. However, the two-predictor GAM model revealed differential effects of maternal drinking pattern. Among offspring of infrequent drinkers, PAE effects on cognitive function were markedly stronger in those whose mothers drank more than ~3 drinks/occasion, and the effect of dose/occasion was strongest among the very frequent drinkers. Frequency of drinking did not appear to alter the PAE effect on cognitive function among participants born to mothers who limited their drinking to ~1 drink/occasion or less. CONCLUSIONS These findings suggest that linear models based on total AA/day are appropriate for assessing whether PAE affects a given cognitive outcome. However, examination of alcohol dose/occasion and drinking frequency is needed to fully characterize the impact of different levels of alcohol intake on cognitive impairment.
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Affiliation(s)
- Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tugba Akkaya-Hocagil
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gale A Richardson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nancy L Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - R Colin Carter
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
- Institute of Human Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Neil C Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Khue-Dung Dang
- School of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Louise M Ryan
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Melbourne, Parkville, Victoria, Australia
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Kautz-Turnbull C, Rockhold M, Handley ED, Olson HC, Petrenko C. Adverse childhood experiences in children with fetal alcohol spectrum disorders and their effects on behavior. Alcohol Clin Exp Res (Hoboken) 2023; 47:577-588. [PMID: 36811189 PMCID: PMC10050124 DOI: 10.1111/acer.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/12/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) have high rates of adverse childhood experiences (ACEs). ACEs are associated with a wide range of health outcomes including difficulty with behavior regulation, an important intervention target. However, the effect of ACEs on different areas of behavior has not been well characterized in children with disabilities. This study describes ACEs in children with FASD and how they impact behavior problems. METHODS A convenience sample of 87 caregivers of children (aged 3 to 12) with FASD participating in an intervention study reported on their children's ACEs using the ACEs Questionnaire and behavior problems on the Eyberg Child Behavior Inventory (ECBI). A theorized three-factor structure of the ECBI (Oppositional Behavior, Attention Problems, and Conduct Problems) was investigated. Data were analyzed using Pearson correlations and linear regression. RESULTS On average, caregivers endorsed 3.10 (SD = 2.99) ACEs experienced by their children. The two most frequently endorsed ACE risk factors were having lived with a household member with a mental health disorder, followed by having lived with a household member with a substance use disorder. Higher total ACEs score significantly predicted a greater overall frequency of child behavior (intensity scale), but not whether the caregiver perceived the behavior to be a problem (problem scale) on the ECBI. No other variable significantly predicted the frequency of children's disruptive behavior. Exploratory regressions indicated that a higher ACEs score significantly predicted greater Conduct Problems. Total ACEs score was not associated with Attention Problems or Oppositional Behavior. DISCUSSION Children with FASD are at risk for ACEs, and those with higher ACEs had a greater frequency of problem behavior on the ECBI, especially conduct problems. Findings emphasize the need for trauma-informed clinical care for children with FASD and increased accessibility of care. Future research should examine potential mechanisms that underlie the relationship between ACEs and behavior problems to optimally inform interventions.
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Affiliation(s)
- Carson Kautz-Turnbull
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Madeline Rockhold
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
| | - Heather Carmichael Olson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christie Petrenko
- Department of Psychology, Mt. Hope Family Center, University of Rochester, Rochester, New York, USA
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Hocagil TA, Ryan LM, Cook RJ, Jacobson SW, Richardson GA, Day NL, Coles CD, Olson HC, Jacobson JL. A hierarchical meta-analysis for settings involving multiple outcomes across multiple cohorts. Stat (Int Stat Inst) 2022; 11:e462. [PMID: 37841211 PMCID: PMC10569156 DOI: 10.1002/sta4.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022]
Abstract
Evidence from animal models and epidemiological studies has linked prenatal alcohol exposure (PAE) to a broad range of long-term cognitive and behavioural deficits. However, there is a paucity of evidence regarding the nature and levels of PAE associated with increased risk of clinically significant cognitive deficits. To derive robust and efficient estimates of the effects of PAE on cognitive function, we have developed a hierarchical meta-analysis approach to synthesize information regarding the effects of PAE on cognition, integrating data on multiple outcomes from six U.S. Iongitudinal cohort studies. A key assumption of standard methods of meta-analysis, effect sizes are independent, is violated when multiple intercorrelated outcomes are synthesized across studies. Our approach involves estimating the dose-response coefficients for each outcome and then pooling these correlated dose-response coefficients to obtain an estimated "global" effect of exposure on cognition. In the first stage, we use individual participant data to derive estimates of the effects of PAE by fitting regression models that adjust for potential confounding variables using propensity scores. The correlation matrix characterizing the dependence between the outcome-specific dose-response coefficients estimated within each cohort is then run, while accommodating incomplete information on some outcome. We also compare inferences based on the proposed approach to inferences based on a full multivariate analysis.
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Affiliation(s)
- Tugba Akkaya Hocagil
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Louise M Ryan
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Richard J. Cook
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Sandra W. Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, 48201, USA
| | - Gale A. Richardson
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
| | - Nancy L. Day
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, 30322, USA
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, 98195, USA
| | - Joseph L. Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, Michigan, 48201, USA
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Reid N, Crawford A, Petrenko C, Kable J, Olson HC. A Family-Directed Approach for Supporting Individuals with Fetal Alcohol Spectrum Disorders. Curr Dev Disord Rep 2022. [DOI: 10.1007/s40474-021-00241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Petrenko CLM, Kautz-Turnbull CC, Roth AR, Parr JE, Tapparello C, Demir U, Olson HC. Initial Feasibility of the "Families Moving Forward Connect" Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach. JMIR Form Res 2021; 5:e29687. [PMID: 34860661 PMCID: PMC8686405 DOI: 10.2196/29687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/20/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers’ stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions.
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Affiliation(s)
| | | | - Alicia Rose Roth
- Mt. Hope Family Center, University of Rochester, Rochester, NY, United States
| | | | - Cristiano Tapparello
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Utku Demir
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
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Jacobson JL, Akkaya-Hocagil T, Ryan LM, Dodge NC, Richardson GA, Olson HC, Coles CD, Day NL, Cook RJ, Jacobson SW. Effects of prenatal alcohol exposure on cognitive and behavioral development: Findings from a hierarchical meta-analysis of data from six prospective longitudinal U.S. cohorts. Alcohol Clin Exp Res 2021; 45:2040-2058. [PMID: 34342030 PMCID: PMC8602737 DOI: 10.1111/acer.14686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/13/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive and behavioral sequelae of prenatal alcohol exposure (PAE) continue to be prevalent in the United States and worldwide. Because these sequelae are also common in other neurodevelopmental disorders, researchers have attempted to identify a distinct neurobehavioral profile to facilitate the differential diagnosis of fetal alcohol spectrum disorders (FASD). We used an innovative, individual participant meta-analytic technique to combine data from six large U.S. longitudinal cohorts to provide a more comprehensive and reliable characterization of the neurobehavioral deficits seen in FASD than can be obtained from smaller samples. METHODS Meta-analyses were performed on data from 2236 participants to examine effects of PAE (measured as oz absolute alcohol/day (AA/day)) on IQ, four domains of cognition function (learning and memory, executive function, reading achievement, and math achievement), sustained attention, and behavior problems, after adjusting for potential confounders using propensity scores. RESULTS The effect sizes for IQ and the four domains of cognitive function were strikingly similar to one another and did not differ at school age, adolescence, or young adulthood. Effect sizes were smaller in the more middle-class Seattle cohort and larger in the three cohorts that obtained more detailed and comprehensive assessments of AA/day. PAE effect sizes were somewhat weaker for parent- and teacher-reported behavior problems and not significant for sustained attention. In a meta-analysis of five aspects of executive function, the strongest effect was on set-shifting. CONCLUSIONS The similarity in the effect sizes for the four domains of cognitive function suggests that PAE affects an underlying component or components of cognition involving learning and memory and executive function that are reflected in IQ and academic achievement scores. The weaker effects in the more middle-class cohort may reflect a more cognitively stimulating environment, a different maternal drinking pattern (lower alcohol dose/occasion), and/or better maternal prenatal nutrition. These findings identify two domains of cognition-learning/memory and set-shifting-that are particularly affected by PAE, and one, sustained attention, which is apparently spared.
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Affiliation(s)
- Joseph L. Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine
| | | | - Louise M. Ryan
- School of Mathematical and Physical Sciences, University of Technology Sydney
- ARC Centre of Excellence for Mathematical and Statistical Frontiers
| | - Neil C. Dodge
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine
| | | | | | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Nancy L. Day
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Richard J. Cook
- Department of Statistics and Actuarial Science, University of Waterloo
| | - Sandra W. Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine
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Olson HC, Sparrow J. A shift in perspective on secondary disabilities in fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2021; 45:916-921. [PMID: 33650705 DOI: 10.1111/acer.14586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Affiliation(s)
- Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.,Center on Child, Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Joanne Sparrow
- Center on Child, Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
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Pruner M, Jirikowic T, Yorkston K, Olson HC. The Best Possible Start: Perspectives of Parents of Children With or at High Risk for Fetal Alcohol Spectrum Disorders. Am J Occup Ther 2020. [DOI: 10.5014/ajot.2020.74s1-po9121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 03/28/20
This qualitative study explored the converging and diverging needs of biological and adoptive parents raising young children with or at risk for fetal alcohol spectrum disorders. Findings from this study advocate for early interventions that prioritize and promote social-emotional development of young children, are family-centered, and provide concrete assistance for family circumstances and parent well-being.
Primary Author and Speaker: Misty Pruner
Contributing Authors: Tracy Jirikowic, Kathryn Yorkston, Heather Carmichael Olson
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Petrenko CL, Parr J, Kautz C, Tapparello C, Olson HC. A Mobile Health Intervention for Fetal Alcohol Spectrum Disorders (Families Moving Forward Connect): Development and Qualitative Evaluation of Design and Functionalities. JMIR Mhealth Uhealth 2020; 8:e14721. [PMID: 32250274 PMCID: PMC7171567 DOI: 10.2196/14721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/27/2019] [Accepted: 01/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background Fetal alcohol spectrum disorders (FASD) affect approximately 2% to 5% of the US population. However, most families are unable to access FASD-informed interventions. Barriers to care include the lack of a knowledgeable and skilled workforce and family-level barriers such as limited financial resources, inability to access childcare, and stigma. As a result, families often try peer-to-peer and self-help support strategies. However, they often take these strategies from disparate sources, which have quite variable intervention quality and empirical support. Objective This study aimed to initiate systematic development and evaluation of a mobile health intervention (app) for caregivers raising children with FASD. Focus groups were conducted to elicit participant perspectives on app design and functionalities to inform further app development. Methods The app, called FMF Connect, was derived from the scientifically validated Families Moving Forward (FMF) Program, a clinician-delivered behavioral consultation intervention. FMF Connect was intended for caregiver self-delivery and included five main components: (1) Learning Modules, (2) Family Forum, (3) Library, (4) Notebook, and (5) Dashboard. Focus group methods were used to solicit perspectives from diverse families during the early stages of app development. Questions were asked about interface design, relevance of components and content, and perceived barriers and facilitators of use. A total of 25 caregivers participated in 7 focus groups across 5 US cities. Data were analyzed thematically. Results Focus group participants were generally enthusiastic about the app interface design and components. Four global positive impression themes emerged, including (1) ease of access, (2) how the app guides and organizes information, (3) connection to other users and information, and (4) ability to share some content with others. Themes arose not only in discussions relating to positive app features but also when participants were asked about motivators for app use. Participants related how these positive global themes could address some system-level barriers, such as limited access to services, feeling isolated, and increased advocacy needs related to the societal lack of FASD knowledge. Participants identified many positive features about individual app components and functionalities. They also communicated potential barriers to use and raised important concerns and considerations relating to several app components. These included recognizability of the app based on the logo, and the balance of following the planned intervention sequence versus obtaining immediate answers. Also mentioned were privacy and dynamics within the Family Forum. Conclusions FMF Connect is a promising novel intervention with potential to reach many families in need and reduce significant barriers to care, resulting in a broader public health impact. Study findings will guide further app development both in terms of content and technological advances to optimize intervention effects. FMF Connect app development provides useful directions for other apps aimed at changing parenting practices.
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Affiliation(s)
| | - Jennifer Parr
- Mt Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Carson Kautz
- Mt Hope Family Center, University of Rochester, Rochester, NY, United States
| | - Cristiano Tapparello
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, NY, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
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12
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Pruner M, Jirikowic T, Yorkston KM, Olson HC. The best possible start: A qualitative study on the experiences of parents of young children with or at risk for fetal alcohol spectrum disorders. Res Dev Disabil 2020; 97:103558. [PMID: 31884315 DOI: 10.1016/j.ridd.2019.103558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/19/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The developmental outcomes and life course trajectories of young children with or at-risk for fetal alcohol spectrum disorders (FASD) can be optimized when individual and family needs are identified early and met with family-centered early intervention (EI) services. However, little is known about access to and quality of EI services with this high-needs population. METHOD Twenty-five biological or adoptive parents of children with or at high risk for FASD, living in the greater area of Seattle, Washington participated in this qualitative study. Three focus groups were conducted using a semi-structured interview guide. Participants described their experience with EI, as well as other supports and challenges faced in their child's first three years of life. Interviews were audio recorded, transcribed verbatim and coded using phenomenological methods. Themes that were consistent across participant groups emerged from the data, as well as themes that showed differences among participant experiences. RESULTS Common EI supports and needs between biological and adoptive parent groups were identified. In addition, perspectives and needs unique to each parent group were revealed. Themes were identified and organized into three categories: (1) child needs; (2) parent needs and priorities; and (3) EI capacity. When parents talked about their child's cognitive, physical, communication or adaptive development, they all discussed how EI was meeting those needs. In contrast, when parents expressed concern for their child's social-emotional development, a description of how EI was supporting these needs was missing from the conversation. Parents appreciated when EI providers were truthful, provided anticipatory guidance, and connected them with supports for their own social-emotional well-being. Yet there were unmet needs for respite care, and parents expressed that support for basic needs related to child or family survival was not consistently recognized as a top priority for families. This high-risk group of young children and their parents also encountered a multitude of transitions in their child's early years and later. Parents wanted more support navigating these transitions as they entered or moved through different systems of care. CONCLUSIONS Parents appreciated and endorsed the importance of EI with its provision of individualized, family-centered supports and resources. Examination of the gaps and unmet needs that are common and distinct underscore the importance of an FASD-informed approach to EI. Study findings provide insight into areas for which EI enhancements could be developed in order to tailor supports for the complex needs of this diverse population of children and parents.
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Affiliation(s)
- Misty Pruner
- School of Medicine, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA, 98195, USA.
| | - Tracy Jirikowic
- School of Medicine, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA, 98195, USA.
| | - Kathryn M Yorkston
- School of Medicine, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA, 98195, USA.
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13
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Abstract
Intra-individual variability (IIV) is defined as systematic within-person variation in performance either across test sessions (e.g., test/retest performance on the same task) or in one session (e.g., variations in performance on multiple trials of a single task). Higher levels of IIV have been noted as a characteristic of neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD), but IIV is yet to be investigated in fetal alcohol spectrum disorder (FASD). FASD is a term used to describe a range of conditions resulting from prenatal exposure to alcohol. As part of a comprehensive neuropsychological battery, four study groups (1. fetal alcohol syndrome/partial fetal alcohol syndrome; 2. static encephalopathy/alcohol exposed; 3. neurobehavioral disorder/alcohol exposed as diagnosed using the University of Washington FASD 4-Digit Code; 4. typically-developing (TD) age-matched children with no prenatal alcohol exposure) were administered measures of motor response and inhibitory control, attention, and adaptive behavior. The results indicate increased levels of IIV in those with FASD compared to the TD controls. It was found that IIV uniquely contributes to predicting adaptive behavior above and beyond attention, while attention partially mediates the relationship between IIV and adaptive behavior. This is the first study to the authors' knowledge to show the presence of increased IIV in children with FASD. It additionally provides evidence that IIV measures some inherent variability in performance independent of poor attention in children with FASD.
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Affiliation(s)
- Sheliza Ali
- a Department of Psychology , University of Victoria , Canada
| | | | | | - Heather Carmichael Olson
- b Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine , Seattle , WA , USA
- c Seattle Children's Research Institute , Seattle , WA , USA
| | - Susan J Astley
- d Department of Epidemiology , University of Washington School of Public Health , Seattle , WA , USA
- e Department of Pediatrics , University of Washington School of Medicine , Seattle , WA , USA
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14
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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: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Hanlon-Dearman A, Chen ML, Olson HC. Understanding and managing sleep disruption in children with fetal alcohol spectrum disorder. Biochem Cell Biol 2017; 96:267-274. [PMID: 28977761 DOI: 10.1139/bcb-2017-0064] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Accumulating evidence has revealed high rates of sleep disruption among children with fetal alcohol spectrum disorder (FASD). Multiple animal and clinical studies have found a clear association between sleep problems and prenatal alcohol exposure, and recent research is beginning to characterize the types and extent of sleep disruption in FASD. Nevertheless, sleep disruption in children with FASD often goes unrecognized or is treated without referring to an evidence base. Children's disrupted sleep interferes with parental sleep and increases caregiver burden, which is of particular importance for families raising children with FASD, a group with very high levels of caregiving stress. The literature supporting an association between sleep problems and deficits in emotional, behavioral, and cognitive function in children is compelling, but needs further investigation in children with FASD. This paper will review the current state of knowledge on sleep in FASD and recommend a rational approach to sleep interventions for affected children and their families.
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Affiliation(s)
- Ana Hanlon-Dearman
- a Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada.,b Manitoba FASD Centre, Winnipeg, MB R3E 3G1, Canada
| | - Maida Lynn Chen
- c Department of Pediatrics, Pulmonary and Sleep Medicine Division, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Heather Carmichael Olson
- d Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.,e Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA 98101, USA
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16
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Fitzpatrick JP, Latimer J, Olson HC, Carter M, Oscar J, Lucas BR, Doney R, Salter C, Try J, Hawkes G, Fitzpatrick E, Hand M, Watkins RE, Tsang TW, Bower C, Ferreira ML, Boulton J, Elliott EJ. Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities. Res Dev Disabil 2017; 65:114-126. [PMID: 28499185 DOI: 10.1016/j.ridd.2017.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/23/2017] [Accepted: 04/01/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Despite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). AIMS This study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. METHODS AND PROCEDURES Children born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. OUTCOMES AND RESULTS Neurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0-279.0). CONCLUSIONS AND IMPLICATIONS Neurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.
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Affiliation(s)
- James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - Heather Carmichael Olson
- The University of Washington School of Medicine, Seattle, Washington, USA; Seattle Children's Research Institute, Seattle, Washington, USA.
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia.
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia; University of Notre Dame, Broome, Australia.
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, Australia.
| | - Claire Salter
- Derby Allied Health Service, Western Australian Country Health Services, Derby, Australia.
| | - Julianne Try
- Department of Education and Early Childhood Development, Government of Victoria, Australia.
| | - Genevieve Hawkes
- Derby Allied Health Service, Western Australian Country Health Services, Derby, Australia.
| | - Emily Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | | | - Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Manuela L Ferreira
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
| | - John Boulton
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Sydney Medical School, University of Sydney, Australia.
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17
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Petrenko CLM, Pandolfino ME, Quamma J, Carmichael Olson H. Emotional Understanding in School-Aged Children with Fetal Alcohol Spectrum Disorders: A Promising Target for Intervention. J Popul Ther Clin Pharmacol 2017; 24:e21-e31. [PMID: 28594481 DOI: 10.22374/1710-6222.24.2.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) are at high risk for secondary conditions, including mental health difficulties. Data on both children with typical development and other clinical conditions suggest that limited emotional understanding (EU) raises risk for psychopathology, but little is known about EU in FASD. OBJECTIVES To determine if EU is a reasonable treatment target for children with FASD. METHODS 56 children (6-13 years) with FASD completed the Kusche Affective Interview-Revised, a verbal interview measure of EU. RESULTS Children showed striking delays in EU (2-5 years delay) relative to published normative data, despite mean IQ (IQ=94.56) within normal limits. Individual variability was considerable even after accounting for age and verbal IQ. CONCLUSIONS Despite variability in individual differences, treatments targeting EU may benefit children with FASD as components within a comprehensive, tailored intervention focused on child self-regulation and caregiver behavior management.
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Affiliation(s)
| | | | - Julie Quamma
- University of Washington, Department of Psychology, Seattle, WA, USA
| | - Heather Carmichael Olson
- University of Washington, School of Medicine, Department of Psychiatry and Behavioral Sciences and Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, WA, USA
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18
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Lucas BR, Latimer J, Fitzpatrick JP, Doney R, Watkins RE, Tsang TW, Jirikowic T, Carmichael Olson H, Oscar J, Carter M, Elliott EJ. Soft neurological signs and prenatal alcohol exposure: a population-based study in remote Australia. Dev Med Child Neurol 2016; 58:861-7. [PMID: 26991727 DOI: 10.1111/dmcn.13071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Abstract
AIM To identify soft neurological signs (SNS) in a population-based study of children living in remote Aboriginal communities in the Fitzroy Valley, Western Australia, born between 2002 and 2003 and explore the relationship between SNS, prenatal alcohol exposure (PAE), and fetal alcohol spectrum disorders (FASD). METHOD The presence of SNS was assessed using the Quick Neurological Screening Test, 2nd edition (QNST-2), which has a total maximum score of 140. Higher scores indicated more SNS. 'Severe discrepancy' was defined as scores less than or equal to the fifth centile while 'moderate discrepancy' represented scores from the sixth to the 24th centile. Children were assigned FASD diagnoses using modified Canadian FASD diagnostic guidelines. RESULTS A total of 108 of 134 (80.6%) eligible children (mean age 8y 9mo, SD=6mo, 53% male) were assessed. The median QNST-2 Total Score for all participants was within the normal category (19.0, range 4-66). However, the median QNST-2 Total Score was higher in children with than without (1) PAE (r=0.2, p=0.045) and (2) FASD (r=0.3, p=0.004). Half (8/16) of children scoring 'moderate discrepancy' and all (2/2) children scoring 'severe discrepancy' had at least three domains of central nervous system impairment. INTERPRETATION SNS were more common in children with PAE or FASD, consistent with the known neurotoxic effect of PAE. The QNST-2 is a useful screen for subtle neurological dysfunction indicating the need for more comprehensive assessment in children with PAE or FASD.
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Affiliation(s)
- Barbara R Lucas
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Heather Carmichael Olson
- Seattle Children's Research Institute and University of Washington School of Medicine, Seattle, WA, USA
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, WA, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, WA, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
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Olson HC. A Renewed Call to Action: The Need for Systematic Research on Interventions for FASD. Alcohol Clin Exp Res 2016; 40:1817-21. [PMID: 27453398 DOI: 10.1111/acer.13150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
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20
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Streissguth AP, Barr HM, Bookstein FL, Sampson PD, Olson HC. The Long-Term Neurocognitive Consequences of Prenatal Alcohol Exposure: A 14-Year Study. Psychol Sci 2016. [DOI: 10.1111/1467-9280.00131] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prenatal alcohol exposure, at doses not generally associated with maternal alcohol problems, produces a broad array of neurocognitive deficits in offspring even in the absence of effects on growth and morphology. This report presents a summary of neurobehavioral, growth, and morphology findings from long-term follow-up of a birth cohort of 500 from a population-based study that has revealed attention, memory, and information processing deficits from birth through 14 years. Also observed (from school age through 14 years) have been problems with antisocial and delinquent behaviors, and classroom learning and behaviors; some of these problems may be secondary to earlier neurocognitive disabilities. Continuing research in behavioral and neurobehavioral teratology provides important opportunities for the neurosciences and for improved health of future generations.
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Affiliation(s)
- Ann P. Streissguth
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Helen M. Barr
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | | | - Paul D. Sampson
- Department of Statistics, University of Washington School of Arts and Sciences
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Abstract
Fourteen-year-old adolescents' behavior on a spatial-visual reasoning task was associated with self-report of their mothers' alcohol consumption during pregnancy, 15 years earlier The task was arranged so that it was possible to evaluate the examinees' tendency to respond rapidly and less accurately, or slowly and more accurately The greater the mother's reported drinking, the faster and less accurately the adolescent responded The decrement in visual-spatial reasoning related to alcohol appears to be linked to a tendency toward impulsive responding
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Kable JA, O'Connor MJ, Olson HC, Paley B, Mattson SN, Anderson SM, Riley EP. Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis. Child Psychiatry Hum Dev 2016. [PMID: 26202432 DOI: 10.1007/s10578-015-0566-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.
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Affiliation(s)
- Julie A Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, 30329, USA.
| | - Mary J O'Connor
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Blair Paley
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah N Mattson
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, CA, 92120, USA
| | - Sally M Anderson
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MA, USA
| | - Edward P Riley
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, CA, 92120, USA
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Tsang TW, Lucas BR, Carmichael Olson H, Pinto RZ, Elliott EJ. Prenatal Alcohol Exposure, FASD, and Child Behavior: A Meta-analysis. Pediatrics 2016; 137:e20152542. [PMID: 26908693 DOI: 10.1542/peds.2015-2542] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) are associated with behavioral difficulties, although there are no published systematic reviews that summarize and critique the literature. OBJECTIVE To describe the behavioral characteristics of children with PAE and/or FASD, assessed using the Achenbach System of Empirically Based Assessments (ASEBA) for school-aged children with parent, teacher, and youth (self-report) forms. DATA SOURCES Electronic literature databases, reference lists, hand-searches. STUDY SELECTION peer-reviewed observational studies. DATA EXTRACTION Study appraisal and data extraction were undertaken by 2 independent assessors. Meta-analyses were performed for parent-rated Internalizing, Externalizing, and Total problems scales. All other ASEBA scales were summarized qualitatively. RESULTS Included were 23 articles; 16 were used in meta-analyses. Pooled results showed higher Total (mean difference 12.1, 95% confidence interval [95% CI] 7.7-16.5), Internalizing (6.3, 95% CI 3.1-9.5), and Externalizing problems scores (12.5, 95% CI 7.9-17.0) in FASD than No FASD; and greater odds of scoring in the "Clinical" range in FASD. Pooled results demonstrated higher problem scores in children with PAE (P > .05). Qualitative summaries of other scales from parents, teachers, and self-report show poorer behavior ratings in children with FASD and PAE on composite Problem and Competence scores and many Syndrome subscales. LIMITATIONS Findings were restricted to behaviors assessed using the ASEBA. The published literature was limited, often with only 1 study reporting on a particular scale. CONCLUSIONS Meta-analysis reveals that FASD and PAE are associated with problematic behavior in many, but not all domains. This clearly affects families, and should be considered in clinical practice by providers.
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Affiliation(s)
- Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington
| | - Rafael Z Pinto
- Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Sao Paulo, Brazil
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; The George Institute for Global Health, and The Sydney Children's Hospital Networks (Westmead), Westmead, New South Wales, Australia; The Australian Paediatric Surveillance Unit, Kids' Research Institute, Westmead, New South Wales, Australia
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Olson HC. Advancing Recognition of Fetal Alcohol Spectrum Disorders: the Proposed DSM-5 Diagnosis of “Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)”. Curr Dev Disord Rep 2015. [DOI: 10.1007/s40474-015-0056-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Fitzpatrick JP, Latimer J, Carter M, Oscar J, Ferreira ML, Carmichael Olson H, Lucas BR, Doney R, Salter C, Try J, Hawkes G, Fitzpatrick E, Hand M, Watkins RE, Martiniuk ALC, Bower C, Boulton J, Elliott EJ. Prevalence of fetal alcohol syndrome in a population-based sample of children living in remote Australia: the Lililwan Project. J Paediatr Child Health 2015; 51:450-7. [PMID: 25594247 DOI: 10.1111/jpc.12814] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/28/2022]
Abstract
AIM Aboriginal leaders concerned about high rates of alcohol use in pregnancy invited researchers to determine the prevalence of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (pFAS) in their communities. METHODS Population-based prevalence study using active case ascertainment in children born in 2002/2003 and living in the Fitzroy Valley, in Western Australia (April 2010-November 2011) (n = 134). Socio-demographic and antenatal data, including alcohol use in pregnancy, were collected by interview with 127/134 (95%) consenting parents/care givers. Maternal/child medical records were reviewed. Interdisciplinary assessments were conducted for 108/134 (81%) children. FAS/pFAS prevalence was determined using modified Canadian diagnostic guidelines. RESULTS In 127 pregnancies, alcohol was used in 55%. FAS or pFAS was diagnosed in 13/108 children, a prevalence of 120 per 1000 (95% confidence interval 70-196). Prenatal alcohol exposure was confirmed for all children with FAS/pFAS, 80% in the first trimester and 50% throughout pregnancy. Ten of 13 mothers had Alcohol Use Disorders Identification Test scores and all drank at a high-risk level. Of children with FAS/pFAS, 69% had microcephaly, 85% had weight deficiency and all had facial dysmorphology and central nervous system abnormality/impairment in three to eight domains. CONCLUSIONS The population prevalence of FAS/pFAS in remote Aboriginal communities of the Fitzroy Valley is the highest reported in Australia and similar to that reported in high-risk populations internationally. Results are likely to be generalisable to other age groups in the Fitzroy Valley and other remote Australian communities with high-risk alcohol use during pregnancy. Prevention of FAS/pFAS is an urgent public health challenge.
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Affiliation(s)
- James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia; Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia; Poche Centre for Indigenous Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Duval-White CJ, Jirikowic T, Rios D, Deitz J, Olson HC. Functional handwriting performance in school-age children with fetal alcohol spectrum disorders. Am J Occup Ther 2014; 67:534-42. [PMID: 23968791 DOI: 10.5014/ajot.2013.008243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Handwriting is a critical skill for school success. Children with fetal alcohol spectrum disorders (FASD) often present with fine motor and visual-motor impairments that can affect handwriting performance, yet handwriting skills have not been systematically investigated in this clinical group. This study aimed to comprehensively describe handwriting skills in 20 school-age children with FASD. Children were tested with the Process Assessment of the Learner, 2nd Edition (PAL-II), and the Visuomotor Precision subtest of NEPSY, a developmental neuropsychological assessment. Participants performed below average on PAL-II measures of handwriting legibility and speed and on NEPSY visual-motor precision tasks. In contrast, PAL-II measures of sensorimotor skills were broadly within the average range. Results provide evidence of functional handwriting challenges for children with FASD and suggest diminished visual-motor skills and increased difficulty as task complexity increases. Future research is needed to further describe the prevalence and nature of handwriting challenges in this population.
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Abstract
STUDY OBJECTIVES Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. METHODS Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. RESULTS Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. CONCLUSIONS Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.
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Affiliation(s)
- Maida Lynn Chen
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Jirikowic T, Olson HC, Astley S. Parenting Stress and Sensory Processing: Children with Fetal Alcohol Spectrum Disorders. OTJR: Occupation, Participation and Health 2012. [DOI: 10.3928/15394492-20120203-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sensory processing differences are reported in a high proportion of children with fetal alcohol spectrum disorders (FASD), but how these problems impact caregiver burden has not been investigated. Linear regression was used to examine the association between parenting stress and problems in sensory processing, along with other child and family characteristics, among 52 children aged 5 to 12 years with FASD. Participants also had clinically significant problem behaviors. Higher levels of child-related parenting stress were moderately correlated with more parent-reported sensory processing problems ( r = −.60). Regression findings revealed that parent-reported problems in children's behavior regulation, an aspect of executive function, and sensory processing deficits were the strongest predictors of child-related parenting stress, together accounting for 62% of variance. Children's sensory processing deficits and executive function impairments affect the parent—child system and should be central considerations when developing family-centered supports for children with FASD.
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Fitzpatrick JP, Elliott EJ, Latimer J, Carter M, Oscar J, Ferreira M, Olson HC, Lucas B, Doney R, Salter C, Peadon E, Hawkes G, Hand M. The Lililwan Project: study protocol for a population-based active case ascertainment study of the prevalence of fetal alcohol spectrum disorders (FASD) in remote Australian Aboriginal communities. BMJ Open 2012; 2:bmjopen-2012-000968. [PMID: 22556161 PMCID: PMC3346942 DOI: 10.1136/bmjopen-2012-000968] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Anecdotal reports suggest that high-risk drinking in pregnancy is common in some remote Australian communities. Alcohol is teratogenic and may cause a range of lifelong conditions termed 'fetal alcohol spectrum disorders' (FASD). Australia has few diagnostic services for FASD, and prevalence of these neurodevelopmental disorders remains unknown. In 2009, Aboriginal leaders in the remote Fitzroy Valley in North Western Australia identified FASD as a community priority and initiated the Lililwani Project in partnership with leading research organisations. This project will establish the prevalence of FASD and other health and developmental problems in school-aged children residing in the Fitzroy Valley, providing data to inform FASD prevention and management. METHODS AND ANALYSIS This is a population-based active case ascertainment study of all children born in 2002 and 2003 and residing in the Fitzroy Valley. Participants will be identified from the Fitzroy Valley Population Project and Communicare databases. Parents/carers will be interviewed using a standardised diagnostic questionnaire modified for local language and cultural requirements to determine the demographics, antenatal exposures, birth outcomes, education and psychosocial status of each child. A comprehensive interdisciplinary health and neurodevelopmental assessment will be performed using tests and operational definitions adapted for the local context. Internationally recognised diagnostic criteria will be applied to determine FASD prevalence. Relationships between pregnancy exposures and early life trauma, neurodevelopmental, health and education outcomes will be evaluated using regression analysis. Results will be reported according to STROBE guidelines for observational studies. ETHICS AND DISSEMINATION Ethics approval has been granted by the University of Sydney Human Research Ethics Committee, the Western Australian Aboriginal Health Information and Ethics Committee, the Western Australian Country Health Service Board Research Ethics Committee and the Kimberley Aboriginal Health Planning Forum Research Sub-committee. Results will be disseminated widely through peer-reviewed manuscripts, reports, conference presentations and the media.
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Affiliation(s)
- James P Fitzpatrick
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Elizabeth J Elliott
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- The Sydney Children's Hospital Network (Westmead), Westmead, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia
- University of Notre Dame, Broome, Australia
| | - Manuela Ferreira
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Barbara Lucas
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Robyn Doney
- School of Public Health, Curtin University of Technology, Perth, Australia
| | | | - Elizabeth Peadon
- Sydney Medical School, University of Sydney, Sydney, Australia
- The Sydney Children's Hospital Network (Westmead), Westmead, Australia
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Astley SJ, Aylward EH, Olson HC, Kerns K, Brooks A, Coggins TE, Davies J, Dorn S, Gendler B, Jirikowic T, Kraegel P, Maravilla K, Richards T. Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2009; 33:1671-89. [PMID: 19572986 PMCID: PMC4170878 DOI: 10.1111/j.1530-0277.2009.01004.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. METHODS A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately. RESULTS Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction. CONCLUSIONS Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.
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Affiliation(s)
- Susan J Astley
- Department of Epidemiology, University of Washington, Seattle, Washington 98195-7920, USA.
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Astley SJ, Olson HC, Kerns K, Brooks A, Aylward EH, Coggins TE, Davies J, Dorn S, Gendler B, Jirikowic T, Kraegel P, Maravilla K, Richards T. Neuropyschological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Can J Clin Pharmacol 2009; 16:e178-e201. [PMID: 19329824 PMCID: PMC4188550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Clinical and research advancements in the field of fetal alcohol spectrum disorders (FASD) require accurate and valid identification of FASD clinical subgroups. OBJECTIVES A comprehensive neuropsychological battery, coupled with magnetic resonance imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified across the spectrum, and distinguish diagnostic subclassifications within the spectrum. The neuropsychological outcomes of the comprehensive neuroimaging study are presented here. METHODS The study groups included: 1) FAS/Partial FAS; 2) Static Encephalopathy/Alcohol Exposed (SE/AE); 3) Neurobehavioral Disorder/Alcohol Exposed (ND/AE) as diagnosed by an interdisciplinary team using the FASD 4-Digit Code; and 4) healthy peers with no prenatal alcohol. A standardized neuropsychological battery was administered to each child and their primary caregiver by a psychologist. RESULTS Use of the 4-Digit Code produced three clinically and statistically distinct FASD clinical subgroups. The three subgroups (ND/AE, SE/AE and FAS/PFAS) reflected a linear continuum of increasing neuropsychological impairment and physical abnormality, representing the full continuum of FASD. Behavioral and psychiatric disorders were comparably prevalent across the three FASD groups, and significantly more prevalent than among the Controls. All three FASD subgroups had comparably high levels of prenatal alcohol exposure. CONCLUSIONS Although ND/AE, SE/AE, and FAS/PFAS are distinct FASD subgroups, these groups are not distinguishable solely by their neuropsychological profiles. While all children within a group shared the same magnitude of neuropsychological impairment, the patterns of impairment showed considerable individual variability. MRI, MRS and fMRI further distinguished these FASD subgroups.
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Affiliation(s)
- Susan J Astley
- Department of Epidemiology, University of Washington, Seattle, USA.
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Astley SJ, Aylward EH, Olson HC, Kerns K, Brooks A, Coggins TE, Davies J, Dorn S, Gendler B, Jirikowic T, Kraegel P, Maravilla K, Richards T. Functional magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. J Neurodev Disord 2009; 1:61-80. [PMID: 21547622 PMCID: PMC3164017 DOI: 10.1007/s11689-009-9004-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 01/23/2009] [Indexed: 11/26/2022] Open
Abstract
A comprehensive neuropsychological/psychiatric, MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The four study groups included: 1. FAS/Partial FAS; 2. Static Encephalopathy/Alcohol Exposed (SE/AE); 3. Neurobehavioral Disorder/Alcohol Exposed (ND/AE); and 4. healthy peers with no prenatal alcohol exposure. fMRI outcomes are reported here. The neuropsychological/psychiatric, MRI, and MRS outcomes are reported separately. fMRI was used to assess activation in seven brain regions during performance of N-back working memory tasks. Children across the full spectrum of FASD exhibited significant working memory deficits and altered activation patterns in brain regions that are known to be involved in working memory. These results demonstrate the potential research and diagnostic value of this non-invasive MR tool in the field of FASD.
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Affiliation(s)
- Susan J Astley
- Department of Epidemiology, Center on Human Development and Disability, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA,
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Affiliation(s)
- Heather Carmichael Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
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Jirikowic T, Kartin D, Olson HC. Children with fetal alcohol spectrum disorders: a descriptive profile of adaptive function. Can J Occup Ther 2008; 75:238-48. [PMID: 18975670 DOI: 10.1177/000841740807500411] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) demonstrate neurobehavioral impairments that affect function and participation. Adaptive behavior deficits have been documented; however, specific functional profiles are less well described. PURPOSE This study compared caregiver-reported adaptive and maladaptive behaviors between a clinic-referred sample of 25 five- through eight-year-old children with FASD and a sample of 23 children with typical development. FINDINGS Children with FASD were rated significantly lower on the Scales of Independent Behavior-Revised in social interaction and communication, personal-living skills, and community-living skills and significantly higher on maladaptive behavior scales. Exploratory contrasts revealed strengths and needs within specific functional domains, along with the need for more support and supervision than peers with typical development to perform day-to-day adaptive skills and manage behavior. IMPLICATIONS Children with FASD and their caregivers need support for daily activities involving personal and social performance. Awareness of specific strengths and needs can guide interventions that promote function and participation.
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Affiliation(s)
- Tracy Jirikowic
- University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network, Department of Rehabilitation Medicine, School of Medicine, Seattle, WA 98195-6490, USA.
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Jirikowic T, Olson HC, Kartin D. Sensory processing, school performance, and adaptive behavior of young school-age children with fetal alcohol spectrum disorders. Phys Occup Ther Pediatr 2008; 28:117-36. [PMID: 18846892 DOI: 10.1080/01942630802031800] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study described sensory processing behaviors and sensory-motor abilities in children with fetal alcohol spectrum disorders (FASD) and explored their relationship to home and school function. A clinic-referred sample of 25 children with FASD, ages 5 to 8 years, was compared with 26 children with typical development, balanced for age, gender, and race/ethnicity, on standardized tests examining sensory processing, sensory-motor performance, school performance, and adaptive behavior. Children with FASD scored significantly more poorly on sensory processing, sensory-motor, adaptive, and academic achievement measures, and demonstrated more problem behaviors at home and school. Correlations were significant between measures of sensory processing and sensory-motor performance, adaptive behavior, and some aspects of academic performance. Sensory processing and related foundational sensory-motor impairments should be considered when determining the developmental needs of children with FASD. These impairments may co-occur with and contribute, at least in part, to decreased adaptive and school function.
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Affiliation(s)
- Tracy Jirikowic
- University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network (FAS DPN), WA, USA.
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Thorne JC, Coggins TE, Carmichael Olson H, Astley SJ. Exploring the utility of narrative analysis in diagnostic decision making: picture-bound reference, elaboration, and fetal alcohol spectrum disorders. J Speech Lang Hear Res 2007; 50:459-74. [PMID: 17463241 DOI: 10.1044/1092-4388(2007/032)] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate classification accuracy and clinical feasibility of a narrative analysis tool for identifying children with a fetal alcohol spectrum disorder (FASD). METHOD Picture-elicited narratives generated by 16 age-matched pairs of school-aged children (FASD vs. typical development [TD]) were coded for semantic elaboration and reference strategy by judges who were unaware of age, gender, and group membership of the participants. Receiver operating characteristic (ROC) curves were used to examine the classification accuracy of the resulting set of narrative measures for making 2 classifications: (a) for the 16 children diagnosed with FASD, low performance (n = 7) versus average performance (n = 9) on a standardized expressive language task and (b) FASD (n = 16) versus TD (n = 16). RESULTS Combining the rates of semantic elaboration and pragmatically inappropriate reference perfectly matched a classification based on performance on the standardized language task. More importantly, the rate of ambiguous nominal reference was highly accurate in classifying children with an FASD regardless of their performance on the standardized language task (area under the ROC curve = .863, confidence interval = .736-.991). CONCLUSION Results support further study of the diagnostic utility of narrative analysis using discourse level measures of elaboration and children's strategic use of reference.
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Affiliation(s)
- John C Thorne
- Department of Speech and Hearing Sciences, University of Washington, 1417 N.E. 42nd Street, Seattle, WA 98105-6246, USA.
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Bonthius DJ, Olson HC, Thomas JD. Proceedings of the 2006 annual meeting of the Fetal Alcohol Spectrum Disorders Study Group. Alcohol 2006; 40:61-5. [PMID: 17157721 PMCID: PMC1865502 DOI: 10.1016/j.alcohol.2006.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 09/08/2006] [Indexed: 10/23/2022]
Abstract
This article describes the proceedings of the 2006 Annual Meeting of the Fetal Alcohol Spectrum Disorders Study Group (FASDSG), which was held in Baltimore, Maryland on June 24, 2006. The meeting was held in conjunction with the annual meeting of the Research Society on Alcoholism and was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism. The 2005-2006 FASDSG officers, Daniel J. Bonthius (President), Heather Carmichael Olson (Vice-President), and Jennifer Thomas (Secretary-Treasurer), organized the meeting. Nationally prominent speakers delivered plenary lectures on topics of newborn screening, ethics, and neuroscience. Selected members of the FASDSG provided brief scientific data (FASt) reports, describing new research findings. Representatives from national agencies involved in fetal alcohol syndrome (FAS) research, treatment, and prevention provided updates regarding priorities, funding, and agency activities. Presentations were also made by the 2006 Student Merit Award recipient and by the 2006 Rosett Award recipient. The meeting served as a forum for clinicians, neuroscientists, psychologists, social scientists, and other professionals to discuss recent advances in FAS research and to identify the most important gaps in the understanding of alcohol-induced teratology.
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Affiliation(s)
- Daniel J Bonthius
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA.
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Carmichael Olson H, O'Connor MJ, Fitzgerald HE. Lessons learned from study of the developmental impact of parental alcohol use. Infant Ment Health J 2001. [DOI: 10.1002/imhj.1001] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The effect of prenatal cocaine exposure on the motor development of full-term infants was examined in a prospective study, controlling for maternal characteristics and exposure to other substances. Intrauterine cocaine exposure was determined at birth by maternal self-report and was verified by hair analysis. At 4 months, 120 cocaine-exposed (COC) and 186 non-cocaine-exposed (NON-COC) infants were assessed by blinded examiners using a standard evaluation of neuromotor function, the Movement Assessment of Infants (MAI). Relative to NON-COC infants, COC infants had significantly higher full-scale MAI total risk scores after adjusting for covariates (p = .05). Infants exposed through the third trimester of pregnancy (n = 48) had higher MAI scores for both total risk (p = .02) and Volitional Movement (p = .01), and when compared with infants exposed only within the first two trimesters (n = 72), they had significantly more deficits in Volitional Movement (p = .03). Although MAI scores for the majority of exposed infants were within the normal range, infants exposed through the third trimester were at significantly increased risk for motor dysfunction (relative risk = 1.6; 95% confidence interval = 1.1, 2.8). Intrauterine cocaine exposure had an adverse effect on infant motor development after the neonatal period; this association was related to the timing and duration of gestational exposure. Further study is needed to evaluate the long-term clinical implications of neuromotor abnormalities in prenatally exposed infants.
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Affiliation(s)
- M W Swanson
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195-7920, USA.
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Abstract
Although research methodology in study of the effects of prenatal cocaine exposure has markedly Improved as this complex field has matured, there remain vexing methodological difficulties. Comparing findings across different cohort studies is challenging because of variations in how samples are described or because important sample characteristics are not documented. A few studies of prenatal poly-drug exposure with problems in sample design continue to be published, the implications of sample design for research questions need consideration, and sample attrition is a continuing problem. This paper explains these problems, and suggests some practical solutions. Examples are drawn from the current literature and the authors' experience with the Seattle Cocaine and Pregnancy Study, an early cohort study of cocaine effects.
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Abstract
This study examines the treatment, maternal and infant outcomes of pregnant adolescents (16-19 years) enrolled in an adult perinatal chemical dependency treatment program. Twenty-one adolescent subjects were compared to 323 adult women (mean age, 27.4 years) after enrollment into a randomized treatment trial consisting of intensive outpatient or short-term residential conditions. The results show a similar treatment retention rate. Adolescents differed from adult women on marital status, drugs of choice (alcohol, marijuana vs. opiates and cocaine) and method of administration, with no injection drug users in the adolescent cohort. Tobacco use was high (> 85%) in both groups. Obstetric, maternal, and infant outcomes to 1 year were comparable. Older adolescents who are chemically dependent and pregnant have treatment needs similar to adult women and can benefit from programs designed to treat older women. Recruitment difficulties for adolescents in need of treatment is discussed.
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Affiliation(s)
- J A Farrow
- Division of Adolescent Medicine, University of Washington, Seattle 98195-7920, USA
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Olson HC, Feldman JJ, Streissguth AP, Sampson PD, Bookstein FL. Neuropsychological Deficits in Adolescents with Fetal Alcohol Syndrome: Clinical Findings. Alcohol Clin Exp Res 1998. [DOI: 10.1111/j.1530-0277.1998.tb05909.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Olson HC, Feldman JJ, Streissguth AP, Sampson PD, Bookstein FL. Neuropsychological deficits in adolescents with fetal alcohol syndrome: clinical findings. Alcohol Clin Exp Res 1998; 22:1998-2012. [PMID: 9884144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Understanding the nature of cognitive deficits among adolescent patients with fetal alcohol syndrome (FAS) can direct future research on assessment and intervention. In an exploratory study, nine nonretarded teenagers with FAS were administered tests of IQ and adaptive behavior, and neuropsychological tests presumed sensitive to alcohol effects. Their performance was compared with psychometric norms and to data from a sample of 174 adolescents with minimal or no prenatal alcohol exposure. These nonretarded FAS patients commonly showed behavior problems, decreased social competence, and poor school performance. Neuropsychological testing revealed significant deficits, although no one neuropsychological profile characterized all patients and not all tests revealed problems. Relatively intact performance was observed in procedural memory, some measures of reaction time, and some reading measures. Deficits were seen on attentional and memory tasks tapping visual-spatial skills, short-term auditory attention and memory, declarative learning, and cognitive flexibility and planning. Difficulties in processing speed and accuracy were also seen. Comparison with a subgroup of 52 nonalcohol-exposed or minimally alcohol-exposed adolescents with a similar range of IQ scores demonstrated that deficits among these FAS patients were not fully explained by a general lowering of IQ.
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Affiliation(s)
- H C Olson
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA
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Olson HC, Streissguth AP, Sampson PD, Barr HM, Bookstein FL, Thiede K. Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence. J Am Acad Child Adolesc Psychiatry 1997; 36:1187-94. [PMID: 9291719 DOI: 10.1097/00004583-199709000-00010] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the association of moderate levels of prenatal alcohol exposure with learning and behavior in early adolescence. METHOD A population-based cohort of 464 children were followed longitudinally from birth to age 14 years. Alcohol exposure was assessed via in-depth maternal self-report in the fifth month of pregnancy. At age 14, learning and behavior were assessed with multiple measures, tapping parent, teenager, and psychologist viewpoints, drawn from adolescent laboratory examination and parent phone interview. The underlying pattern of association between prenatal alcohol and adolescent outcome was detected using partial least-squares statistical techniques; confounding factors were dealt with by regression methods. RESULTS Analyses revealed a statistically significant, subtle relationship between greater prenatal alcohol use and increased behavior/learning difficulties during adolescence, even after accounting for other developmental influences. "Binge" maternal drinking and exposure early in pregnancy were associated with a profile of adolescent antisocial behavior, school problems, and self-perceived learning difficulties. CONCLUSIONS Fetal alcohol exposure (even at "social drinking" levels) is associated with developmental difficulties in adolescence that are consistent with problems seen earlier in life. Clinicians should understand the potential role prenatal alcohol exposure plays in behavioral and cognitive problems.
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Affiliation(s)
- H C Olson
- School of Medicine, University of Washington, Seattle, USA
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Olson HC, Toth-Sadjadi S, Hanna E. Substance-abusing women and their young infants: Early child outcome and sources of vulnerability. Infant Behav Dev 1996. [DOI: 10.1016/s0163-6383(96)90427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Streissguth AP, Barr HM, Olson HC, Sampson PD, Bookstein FL, Burgess DM. Drinking during pregnancy decreases word attack and arithmetic scores on standardized tests: adolescent data from a population-based prospective study. Alcohol Clin Exp Res 1994; 18:248-54. [PMID: 8048722 DOI: 10.1111/j.1530-0277.1994.tb00009.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Women (1529) were interviewed in midpregnancy, and a cohort of their children has been examined at various ages. The two standardized tests presented herein are part of a large battery of tests administered when the children were 14 years old. "Word Attack" (n = 462) measures phonological processing on a task involving the reading of pseudowords in nontimed performance. "Arithmetic" (n = 191) measures auditorily processed mental computations in timed performance. Scores on both tests were associated with prenatal alcohol exposure in a dose-dependent fashion. These effects were robust when considered in relation to a wide variety of potentially confounding variables, such as prenatal exposure to tobacco and other drugs, sociodemographic characteristics, and traumatic postnatal events. A variety of alcohol scores were related to these two performance measures, but those involving a massing of drinks on a given occasion had the strongest association. The higher the average number of drinks/occasion, the poorer the offspring performance on tasks thought to underlie numerical problem solving and reading proficiency. Earlier reports of prenatal, alcohol-related neurobehavioral deficits in childhood have now been extended into adolescence.
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Affiliation(s)
- A P Streissguth
- Department of Psychiatry, University of Washington, Seattle 98195
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Streissguth AP, Sampson PD, Olson HC, Bookstein FL, Barr HM, Scott M, Feldman J, Mirsky AF. Maternal drinking during pregnancy: attention and short-term memory in 14-year-old offspring--a longitudinal prospective study. Alcohol Clin Exp Res 1994; 18:202-18. [PMID: 8198221 DOI: 10.1111/j.1530-0277.1994.tb00904.x] [Citation(s) in RCA: 263] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A large and compelling experimental literature has documented the adverse impact of prenatal alcohol exposure on the developing brain of the offspring. This is the first report of adolescent attention/memory performance and its relationship with prenatal alcohol exposure in a population-based, longitudinal, prospective study (n = 462) involving substantial covariate control and "blind" examiners. Prenatal alcohol exposure was significantly related to attention/memory deficits in a dose-dependent fashion. A latent variable reflecting 13 measures of maternal drinking was correlated 0.26 with a latent variable representing 52 scores from 6 tests measuring various components of attention and short-term memory performance. The number of drinks/occasion was the strongest alcohol predictor. Fluctuating attentional states, problems with response inhibition, and spatial learning showed the strongest association with prenatal alcohol exposure. A latent variable reflecting the pattern of attention/memory deficits observed at 14 years correlated 0.67 with a composite pattern of deficits previously detected on neurobehavioral tests administered during the first 7 years of life. The 14-year attention/memory deficits observed in the present study appear to be the adolescent sequelae of deficits observed earlier in development. As is usual in such studies, not all exposed offspring showed deficits.
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Abstract
Psychrotrophic bacteria were isolated from 227 pasteurized milk samples which had a shelf life in excess of 20 days at 7.2 C. Of 700 cultures isolated, 135 were resistant to heating at 72 C for 16 sec and were able to re-establish growth at 7.2 C. Thirty-five cultures, representing 15 different types were subjected to detailed examination to determine their actions on refrigerated milk, growth temperatures, thermal resistance at various temperatures, and their identities. The spore-forming genus Bacillus occured most frequently. The non-sporing types were assigned to the genera Arthrobacter , Microbacterium , Streptococcus , and Corynebacterium .
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Affiliation(s)
- C J Washam
- Department of Dairy Science, Oklahoma State University, Stillwater, Oklahoma 74074
| | - H C Olson
- Department of Dairy Science, Oklahoma State University, Stillwater, Oklahoma 74074
| | - E R Vedamuthu
- Department of Dairy Science, Oklahoma State University, Stillwater, Oklahoma 74074
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