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Vidal R, Vidal L, Lugo J, Ristol F, Domènec E, Casas T, Veiga A, Vico C, Ramos-Quiroga JA, Gómez-Barros N. Dog-Assisted Therapy vs Relaxation for Children and Adolescents with Fetal Alcohol Spectrum Disorder: A Randomized Controlled Study. J Autism Dev Disord 2024; 54:3133-3141. [PMID: 37340213 DOI: 10.1007/s10803-023-06023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/22/2023]
Abstract
The rationale of this study was to evaluate the efficacy of Dog-assisted Therapy (DAT) in children and adolescents with Fetal Alcohol Spectrum Disorder (FASD). We conducted a randomized controlled trial in a cohort of 71 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 38) or Relaxation Group (control group) (n = 33). Results revealed that participants who were assigned to the DAT group experienced significantly reduced externalizing symptoms (CBCL Externalizing Inattention: t (69) = 2.81, p = .007; d = 0.7); CBCL Opposition: t (69) = 2.54, p = .013; d = 0.6), reduced internalizing symptoms (CBCL Social problems: t (69) = 3.21, p = .002; d = 0.8) as well as improvements on social skills (SSIS-P Problem behavior: t (68) = 2.55, p = .013; d = 0.6), and quality of life (KidScreen Autonomy and Parents: t (51) = - 2.03, p = .047; d = 0.5) compared to the relaxation control group. The relaxation control group obtained significant differences between the pre- and post-treatment evaluation, diminishing withdraw symptoms (t (32) = 3.03, p = .005; d = 0.2). Results suggest that DAT and relaxation may be promising adjunctive treatments for children and adolescents with FASD.Clinical trial registration information: http://clinicaltrials.gov/ ; NCT04038164.
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Affiliation(s)
- Raquel Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Laura Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Jorge Lugo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Francesc Ristol
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | - Eva Domènec
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | - Teresa Casas
- Centre de Terapia Assistida Amb Cans (CTAC), Barcelona, Spain
| | | | | | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Gómez-Barros
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Biomedical Network Research Centre On Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Olivares-Costa M, Fabio MC, De la Fuente-Ortega E, Haeger PA, Pautassi R. New therapeutics for the prevention or amelioration of fetal alcohol spectrum disorders: a narrative review of the preclinical literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-22. [PMID: 39023419 DOI: 10.1080/00952990.2024.2361442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/26/2024] [Indexed: 07/20/2024]
Abstract
Background: Ethanol consumption during pregnancy induces enduring detrimental effects in the offspring, manifesting as a spectrum of symptoms collectively termed as Fetal Alcohol Spectrum Disorders (FASD). Presently, there is a scarcity of treatments for FASD.Objectives: To analyze current literature, emphasizing evidence derived from preclinical models, that could potentially inform therapeutic interventions for FASD.Methods: A narrative review was conducted focusing on four prospective treatments: nutritional supplements, antioxidants, anti-inflammatory compounds and environmental enrichment. The review also highlights innovative therapeutic strategies applied during early (e.g. folate administration, postnatal days 4-9) or late (e.g. NOX2 inhibitors given after weaning) postnatal stages that resulted in significant improvements in behavioral responses during adolescence (a critical period marked by the emergence of mental health issues in humans).Results: Our findings underscore the value of treatments centered around nutritional supplementation or environmental enrichment, aimed at mitigating oxidative stress and inflammation, implying shared mechanisms in FASD pathogenesis. Moreover, the review spotlights emerging evidence pertaining to the involvement of novel molecular components with potential pharmacological targets (such as NOX2, MCP1/CCR2, PPARJ, and PDE1).Conclusions: Preclinical studies have identified oxidative imbalance and neuroinflammation as relevant pathological mechanisms induced by prenatal ethanol exposure. The relevance of these mechanisms, which exhibit positive feedback loop mechanisms, appear to peak during early development and decreases in adulthood. These findings provide a framework for the future development of therapeutic avenues in the development of specific clinical treatments for FASD.
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Affiliation(s)
- Montserrat Olivares-Costa
- Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - María Carolina Fabio
- Instituto de Investigación Médica M. y M. Ferreyra, INIMEC-CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Coquimbo, Chile
| | - Erwin De la Fuente-Ortega
- Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - Paola A Haeger
- Departamento de Ciencias Biomédicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
- Millennium Nucleus of Neuroepigenetics and Plasticity (EpiNeuro), Santiago, Chile
| | - Ricardo Pautassi
- Instituto de Investigación Médica M. y M. Ferreyra, INIMEC-CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Coquimbo, Chile
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Hilly C, Wilson PH, Lucas B, McGuckian TB, Swanton R, Froude EH. Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1708-1733. [PMID: 37158227 DOI: 10.1080/09638288.2023.2207043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.
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Affiliation(s)
- Catherine Hilly
- School of Allied Health, Australian Catholic University, Canberra, Australia
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Barbara Lucas
- The John Walsh Centre for Rehabilitation Research, The University of Sydney
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ruth Swanton
- Occupational Therapy Department, Mercy University Hospital, Cork, Ireland
- Occupational Therapy Department, South Infirmary University Hospital, Cork, Ireland
| | - Elspeth H Froude
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Xia Y, Rebello V, Bodison SC, Jonker D, Steigelmann B, Donald KA, Charles W, Stein DJ, Ipser J, Ahmadi H, Kan E, Sowell ER, Narr KL, Joshi SH, Odendaal HJ, Uban KA. Contextualizing the impact of prenatal alcohol and tobacco exposure on neurodevelopment in a South African birth cohort: an analysis from the socioecological perspective. Front Integr Neurosci 2023; 17:1104788. [PMID: 37534335 PMCID: PMC10390790 DOI: 10.3389/fnint.2023.1104788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/19/2023] [Indexed: 08/04/2023] Open
Abstract
Background Alcohol and tobacco are known teratogens. Historically, more severe prenatal alcohol exposure (PAE) and prenatal tobacco exposure (PTE) have been examined as the principal predictor of neurodevelopmental alterations, with little incorporation of lower doses or ecological contextual factors that can also impact neurodevelopment, such as socioeconomic resources (SER) or adverse childhood experiences (ACEs). Here, a novel analytical approach informed by a socio-ecological perspective was used to examine the associations between SER, PAE and/or PTE, and ACEs, and their effects on neurodevelopment. Methods N = 313 mother-child dyads were recruited from a prospective birth cohort with maternal report of PAE and PTE, and cross-sectional structural brain neuroimaging of child acquired via 3T scanner at ages 8-11 years. In utero SER was measured by maternal education, household income, and home utility availability. The child's ACEs were measured by self-report assisted by the researcher. PAE was grouped into early exposure (<12 weeks), continued exposure (>=12 weeks), and no exposure controls. PTE was grouped into exposed and non-exposed controls. Results Greater access to SER during pregnancy was associated with fewer ACEs (maternal education: β = -0.293,p = 0.01; phone access: β = -0.968,p = 0.05). PTE partially mediated the association between SER and ACEs, where greater SER reduced the likelihood of PTE, which was positively associated with ACEs (β = 1.110,p = 0.01). SER was associated with alterations in superior frontal (β = -1336.036, q = 0.046), lateral orbitofrontal (β = -513.865, q = 0.046), caudal anterior cingulate volumes (β = -222.982, q = 0.046), with access to phone negatively associated with all three brain volumes. Access to water was positively associated with superior frontal volume (β=1569.527, q = 0.013). PTE was associated with smaller volumes of lateral orbitofrontal (β = -331.000, q = 0.033) and nucleus accumbens regions (β = -34.800, q = 0.033). Conclusion Research on neurodevelopment following community-levels of PAE and PTE should more regularly consider the ecological context to accelerate understanding of teratogenic outcomes. Further research is needed to replicate this novel conceptual approach with varying PAE and PTE patterns, to disentangle the interplay between dose, community-level and individual-level risk factors on neurodevelopment.
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Affiliation(s)
- Yingjing Xia
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Vida Rebello
- Public Health, University of California, Irvine, Irvine, CA, United States
| | - Stefanie C. Bodison
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Deborah Jonker
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Kirsten A. Donald
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Weslin Charles
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Jonathan Ipser
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hedyeh Ahmadi
- University Statistical Consulting, LLC, Irvine, CA, United States
| | - Eric Kan
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Katherine L. Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shantanu H. Joshi
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hein J. Odendaal
- Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Kristina A. Uban
- Public Health, University of California, Irvine, Irvine, CA, United States
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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, CLINICAL & EXPERIMENTAL RESEARCH 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] [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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Osterlund Oltmanns JR, Schaeffer EA, Goncalves Garcia M, Donaldson TN, Acosta G, Sanchez LM, Davies S, Savage DD, Wallace DG, Clark BJ. Sexually dimorphic organization of open field behavior following moderate prenatal alcohol exposure. Alcohol Clin Exp Res 2022; 46:861-875. [PMID: 35315075 PMCID: PMC9117438 DOI: 10.1111/acer.14813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can produce deficits in a wide range of cognitive functions but is especially detrimental to behaviors requiring accurate spatial information processing. In open field environments, spatial behavior is organized such that animals establish "home bases" marked by long stops focused around one location. Progressions away from the home base are circuitous and slow, while progressions directed toward the home base are non-circuitous and fast. The impact of PAE on the organization of open field behavior has not been experimentally investigated. METHODS In the present study, adult female and male rats with moderate PAE or saccharin exposure locomoted a circular high walled open field for 30 minutes under lighted conditions. RESULTS The findings indicate that PAE and sex influence the organization of open field behavior. Consistent with previous literature, PAE rats exhibited greater locomotion in the open field. Novel findings from the current study indicate that PAE and sex also impact open field measures specific to spatial orientation. While all rats established a home base on the periphery of the open field, PAE rats, particularly males, exhibited significantly less clustered home base stopping with smaller changes in heading between stops. PAE also impaired progression measures specific to distance estimation, while sex alone impacted progression measures specific to direction estimation. CONCLUSIONS These findings support the conclusion that adult male rats have an increased susceptibility to the effects of PAE on the organization of open field behavior.
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Affiliation(s)
| | - Ericka A Schaeffer
- Department of Psychology, Northern Illinois University, Dekalb, Illinois, USA
| | | | - Tia N Donaldson
- Department of Psychology, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Gabriela Acosta
- Department of Psychology, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Lilliana M Sanchez
- Department of Psychology, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Suzy Davies
- Department of Neurosciences, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Daniel D Savage
- Department of Psychology, The University of New Mexico, Albuquerque, New Mexico, USA.,Department of Neurosciences, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Douglas G Wallace
- Department of Psychology, Northern Illinois University, Dekalb, Illinois, USA
| | - Benjamin J Clark
- Department of Psychology, The University of New Mexico, Albuquerque, New Mexico, USA.,Department of Neurosciences, The University of New Mexico, Albuquerque, New Mexico, USA
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Brown J, Jonason A, Asp E, McGinn V, Carter MN, Spiller V, Jozan A. Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers. BEHAVIORAL SCIENCES & THE LAW 2022; 40:46-86. [PMID: 34689366 DOI: 10.1002/bsl.2540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.
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Affiliation(s)
- Jerrod Brown
- Pathways Counseling Center, Inc., St. Paul, Minnesota, USA
- Concordia University, St. Paul, Minnesota, USA
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Alec Jonason
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
| | - Erik Asp
- Department of Psychology, Hamline University, St. Paul, Minnesota, USA
- Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, Minnesota, USA
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Valerie McGinn
- The FASD Centre, Auckland, New Zealand
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Megan N Carter
- University of Washington, Seattle, Washington, USA
- Department of Social and Health Services, Special Commitment Center, Steilacoom, Washington, USA
| | | | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
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Reid N, Crawford A, Petrenko C, Kable J, Olson HC. A Family-Directed Approach for Supporting Individuals with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-021-00241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ordenewitz LK, Weinmann T, Schlüter JA, Moder JE, Jung J, Kerber K, Greif-Kohistani N, Heinen F, Landgraf MN. Evidence-based interventions for children and adolescents with fetal alcohol spectrum disorders - A systematic review. Eur J Paediatr Neurol 2021; 33:50-60. [PMID: 34058625 DOI: 10.1016/j.ejpn.2021.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Brain function deficits cause strong negative impacts for the everyday lives of children and adolescents with fetal alcohol spectrum disorders (FASD). Therefore, evidence-based intervention programs that are specifically designed for patients with FASD are needed but still scarce. The aim of the presented article is a systematic literature review of evidence-based intervention strategies for children and adolescents with FASD. MATERIALS AND METHODS A comprehensive systematic literature search was conducted in several relevant databases to identify randomized-controlled intervention studies for children and adolescents with FASD. RESULTS We identified 25 randomized-controlled studies regarding interventions in FASD. Overall, evidence indicating that some therapeutic interventions are effective in children and adolescents with FASD was found. Even though evidence-based interventions rarely lead to improvements of performance into a "normal range", those measures can alleviate negative consequences of prenatal alcohol exposure and relieve daily burdens. CONCLUSION There are only a few randomized-controlled trials regarding therapy research for children and adolescents with FASD. Their results indicate that especially the combination of parent and child sessions present a promising approach for the treatment of FASD. Positive treatment effects of interventions seem to be domain specific, except for interventions regarding self-regulation or social interaction.
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Affiliation(s)
- Lisa K Ordenewitz
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Julia A Schlüter
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Judith E Moder
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Jessica Jung
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Kerber
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Naschla Greif-Kohistani
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, German FASD Competence Center Bavaria, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
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Pei J, Poth C, Tremblay M, Walker M. An Integrative Systems Approach to Enhancing Service Delivery for Individuals with Complex Needs. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2021. [DOI: 10.1007/s40474-021-00223-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
There are a lack of system-wide integrative services for individuals with complex needs and a corresponding demand for advancing cross-disciplinary practices in community settings. This demand is especially acute for individuals with fetal alcohol spectrum disorder (FASD) and a gap we have sought to address.
Recent Findings
We present findings from a literature scan to guide service delivery for individuals and families affected by FASD and other complex needs: four overarching guiding principles for policy decision-makers, seven guiding practices for organizations, and 23 guiding practices for service providers.
Summary
These identified principles and practices bridge diverse perspectives, with potential for their implementation to provide consistent, evidence-based services to underserved populations with complex needs.
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11
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Flannigan K, Coons-Harding KD, Anderson T, Wolfson L, Campbell A, Mela M, Pei J. A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:2401-2430. [PMID: 33119894 PMCID: PMC7839542 DOI: 10.1111/acer.14490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2020] [Indexed: 12/25/2022]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well‐being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.
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Affiliation(s)
- Katherine Flannigan
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Kelly D Coons-Harding
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, (KDC-H), Laurentian University, Sudbury, Ontario, Canada
| | - Tara Anderson
- (TA), Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lindsay Wolfson
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,(LW), Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Alanna Campbell
- (AC), Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mansfield Mela
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Psychiatry, College of Medicine, (MM), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jacqueline Pei
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Educational Psychology, (JP), University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, (JP), University of Alberta, Edmonton, Alberta, Canada
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12
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Passmore HM, Mutch RC, Watkins R, Burns S, Hall G, Urquhart J, Carapetis J, Bower C. Reframe the Behaviour: Evaluation of a training intervention to increase capacity in managing detained youth with fetal alcohol spectrum disorder and neurodevelopmental impairments. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 28:382-407. [PMID: 35530127 PMCID: PMC9067986 DOI: 10.1080/13218719.2020.1780643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The first study to investigate the prevalence of fetal alcohol spectrum disorder (FASD) within an Australian juvenile detention centre has identified the highest known prevalence of FASD among a justice-involved population worldwide. However, there has been limited investigation into the capacity of the custodial workforce to identify and manage young people in Australian detention centres with FASD or other neurodevelopmental impairment (NDI), and no published interventions aiming to develop environments appropriate for those with FASD in justice settings. Using the Template for Intervention Description and Replication checklist, this study describes the conception, implementation and evaluation of a training intervention aiming to upskill the custodial workforce in the management of youth with FASD and NDI; 117 staff participated in the intervention, and 109 completed pre- and post-intervention surveys. Improvements were seen across almost all knowledge and attitude items, and the intervention was considered highly necessary, appropriate and valuable by the workforce.
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Affiliation(s)
- Hayley M. Passmore
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Raewyn C. Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
- Department of Health Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sharyn Burns
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Guy Hall
- School of Law, Murdoch University, Perth, WA, Australia
| | | | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Perth Children’s Hospital, Perth, WA, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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13
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Vidal R, Vidal L, Ristol F, Domènec E, Segú M, Vico C, Gomez-Barros N, Ramos-Quiroga JA. Dog-Assisted Therapy for Children and Adolescents With Fetal Alcohol Spectrum Disorders a Randomized Controlled Pilot Study. Front Psychol 2020; 11:1080. [PMID: 32528389 PMCID: PMC7264372 DOI: 10.3389/fpsyg.2020.01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Objective The rationale of this study was to evaluate the efficacy of dog-assisted therapy (DAT) combined with pharmacological treatment in children and adolescents with fetal alcohol spectrum disorder (FASD). Method We conducted a randomized, rater-blinded, controlled pilot trial in a cohort of 33 children and adolescents with FASD. Participants were randomly assigned either to DAT group (n = 17) or Treatment as Usual (TAU control group) (n = 16). Results Of the initial 39 participants enrolled, 33 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the DAT group experienced significantly improvements on social skills (SSIS-P social skills: p = 0.02, d = 0.8), reductions on externalizing symptoms (CBCL externalizing: p = 0.03; d = 0.56), and lower scores on FASD severity (CGI-S clinician: p = 0.001, d = 0.5). Conclusion DAT is a promising adjunctive treatment for children and adolescents with FASD. Clinical Trial Registration Dog-assisted therapy for children and adolescents with fetal alcohol spectrum disorders: a randomized controlled pilot study; http://clinicaltrials.gov/, identifier NCT04038164.
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Affiliation(s)
- Raquel Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Vidal
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain
| | | | - Eva Domènec
- Centre de Terapia Assistida amb Cans, Barcelona, Spain
| | | | | | - Núria Gomez-Barros
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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14
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Kapasi A, Makela ML, Flannigan K, Joly V, Pei JR. Understanding employment success in adults with Fetal Alcohol Spectrum Disorder. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Aamena Kapasi
- University of Alberta, Edmonton, AB, Canada
- Canada FASD Research Network, Vancouver, BC, Canada
| | | | | | | | - Jacqueline R. Pei
- University of Alberta, Edmonton, AB, Canada
- Canada FASD Research Network, Vancouver, BC, Canada
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15
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Reversal of neurobehavioral teratogenicity in animal models and human: Three decades of progress. Brain Res Bull 2019; 150:328-342. [DOI: 10.1016/j.brainresbull.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
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16
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Abstract
Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.
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17
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Doyle LR, Moore EM, Coles CD, Kable JA, Sowell ER, Wozniak JR, Jones KL, Riley EP, Mattson SN. Executive Functioning Correlates With Communication Ability in Youth With Histories of Heavy Prenatal Alcohol Exposure. J Int Neuropsychol Soc 2018; 24:1026-1037. [PMID: 30322415 PMCID: PMC6237635 DOI: 10.1017/s1355617718000772] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. METHODS Subjects (ages 10-16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales - Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. RESULTS Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. CONCLUSIONS Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026-1037).
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Affiliation(s)
- Lauren R. Doyle
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Eileen M. Moore
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Department of Pediatrics, Emory University School of Medicine
| | - Julie A. Kable
- Department of Pediatrics, Emory University School of Medicine
| | - Elizabeth R. Sowell
- Department of Pediatrics, Keck School of Medicine, University of Southern California
| | | | - Kenneth L. Jones
- Department of Pediatrics, University of California, San Diego School of Medicine
| | - Edward P. Riley
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
| | - Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University
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18
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Abstract
The internal validity of the proposed Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) was evaluated in children diagnosed with either Fetal Alcohol Syndrome (FAS) or partial FAS who were 3-10 years of age and had enrolled in a math intervention study. Symptoms were coded as present or absent using assessments conducted in the study, including standardized measures of neurocognitive and behavioral functioning, parent interview, and direct observations of the child. The number of endorsed ND-PAE symptoms was not related to environmental factors but was moderately related to the child's age. ND-PAE symptoms were highly consistent and this did not vary by age. Evidence suggested the ND-PAE adaptive symptoms may be too restrictive and only one symptom from this domain may be sufficient. Impulsiveness was not related to an endorsement of the ND-PAE disorder but research is needed with other clinical groups to establish the discriminative validity of this symptom.
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19
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Petrelli B, Weinberg J, Hicks GG. Effects of prenatal alcohol exposure (PAE): insights into FASD using mouse models of PAE. Biochem Cell Biol 2018; 96:131-147. [PMID: 29370535 PMCID: PMC5991836 DOI: 10.1139/bcb-2017-0280] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The potential impact of prenatal alcohol exposure (PAE) varies considerably among exposed individuals, with some displaying serious alcohol-related effects and many others showing few or no overt signs of fetal alcohol spectrum disorder (FASD). In animal models, variables such as nutrition, genetic background, health, other drugs, and stress, as well as dosage, duration, and gestational timing of exposure to alcohol can all be controlled in a way that is not possible in a clinical situation. In this review we examine mouse models of PAE and focus on those with demonstrated craniofacial malformations, abnormal brain development, or behavioral phenotypes that may be considered FASD-like outcomes. Analysis of these data should provide a valuable tool for researchers wishing to choose the PAE model best suited to their research questions or to investigate established PAE models for FASD comorbidities. It should also allow recognition of patterns linking gestational timing, dosage, and duration of PAE, such as recognizing that binge alcohol exposure(s) during early gestation can lead to severe FASD outcomes. Identified patterns could be particularly insightful and lead to a better understanding of the molecular mechanisms underlying FASD.
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Affiliation(s)
- Berardino Petrelli
- Department of Biochemistry & Medical Genetics; Regenerative Medicine Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, Faculty of Medicine, Life Sciences Institute, University of British Columbia, UBC Institute of Mental Health, Vancouver, British Columbia, Canada
| | - Geoffrey G. Hicks
- Department of Biochemistry & Medical Genetics; Regenerative Medicine Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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20
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Cook JL, Green CR, Lilley C, Psych R, Anderson S, Baldwin ME, Chudley AE, Conry J, LeBlanc N, Loock CA, Mallon B, McFarlane A, Temple V, Psych C. Response to "A critique for the new Canadian FASD diagnostic Guidelines". JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:83-87. [PMID: 29662519 PMCID: PMC5896521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada (SOGC), University of Ottawa, Ottawa, Ontario
- Canada FASD Research Network, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada (SOGC), University of Ottawa, Ottawa, Ontario
- Canada FASD Research Network, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario
| | - Christine Lilley
- The Society of Obstetricians and Gynaecologists of Canada (SOGC), University of Ottawa, Ottawa, Ontario
- Canada FASD Research Network, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario
- Compass Clinic, Vancouver, British Columbia
- National Institutes of Health, Bethesda, Maryland, USA
- Fetal Alcohol Spectrum Disorders Clinic, Child Development Services, Alberta Children's Hospital, Calgary, Alberta
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
- Emerita University of British Columbia, Vancouver, British Columbia
- Dr. Georges-L.-Dumont University Hospital Centre, Moncton, New Brunswick
- FASD Centre of Excellence, Université de Moncton and Université de Sherbrooke, Moncton, New Brunswick
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta
- Lakeland Centre for FASD, Cold Lake, Alberta
- Surrey Place Centre, Toronto, Ontario
| | - R Psych
- Compass Clinic, Vancouver, British Columbia
| | | | - Mary Ellen Baldwin
- Fetal Alcohol Spectrum Disorders Clinic, Child Development Services, Alberta Children's Hospital, Calgary, Alberta
| | - Albert E Chudley
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Julianne Conry
- Emerita University of British Columbia, Vancouver, British Columbia
| | - Nicole LeBlanc
- Dr. Georges-L.-Dumont University Hospital Centre, Moncton, New Brunswick
- FASD Centre of Excellence, Université de Moncton and Université de Sherbrooke, Moncton, New Brunswick
| | - Christine A Loock
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Bernadene Mallon
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta
| | | | - Valerie Temple
- The Society of Obstetricians and Gynaecologists of Canada (SOGC), University of Ottawa, Ottawa, Ontario
- Canada FASD Research Network, Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario
- Compass Clinic, Vancouver, British Columbia
- National Institutes of Health, Bethesda, Maryland, USA
- Fetal Alcohol Spectrum Disorders Clinic, Child Development Services, Alberta Children's Hospital, Calgary, Alberta
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
- Emerita University of British Columbia, Vancouver, British Columbia
- Dr. Georges-L.-Dumont University Hospital Centre, Moncton, New Brunswick
- FASD Centre of Excellence, Université de Moncton and Université de Sherbrooke, Moncton, New Brunswick
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta
- Lakeland Centre for FASD, Cold Lake, Alberta
- Surrey Place Centre, Toronto, Ontario
| | - C Psych
- Surrey Place Centre, Toronto, Ontario
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21
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Keightley M, Agnihotri S, Subramaniapillai S, Gray J, Keresztesi J, Colantonio A, Polatajko HJ, Cameron D, Wiseman-Hakes C. Investigating a theatre-based intervention for Indigenous youth with fetal alcohol spectrum disorder: Exploration d'une intervention basée sur le théâtre auprès de jeunes Autochtones atteints du syndrome d'alcoolisme fœtal. The Canadian Journal of Occupational Therapy 2018; 85:128-136. [PMID: 29463135 DOI: 10.1177/0008417417719722] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Theatre-based interventions use artistic media to facilitate social and emotional awareness and have therapeutic benefits for persons with developmental disabilities and mental health problems. The role of these interventions with Indigenous youth who have emotional, behavioural, and cognitive sequelae related to fetal alcohol spectrum disorder (FASD) has not been explored. PURPOSE The purpose of this study was to explore the experiences and acceptability of a theatre-based approach for facilitating social communication and engagement in youth with FASD. METHOD Participants were three Indigenous youth with FASD. A qualitative exploration of the experiences and acceptability of the intervention was conducted via focus groups held 2 weeks post-program participation with the participants, their caregivers, and program facilitators. The transcripts were analyzed using an inductive thematic approach. FINDINGS Our results identified perceived postintervention improvements in participants' development of self-esteem, social skills, and emotional awareness. IMPLICATIONS A theatre-based arts intervention has the potential to support improvements in social skills for youth with FASD.
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22
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Howes OD, Rogdaki M, Findon JL, Wichers RH, Charman T, King BH, Loth E, McAlonan GM, McCracken JT, Parr JR, Povey C, Santosh P, Wallace S, Simonoff E, Murphy DG. Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol 2018; 32:3-29. [PMID: 29237331 PMCID: PMC5805024 DOI: 10.1177/0269881117741766] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.
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Affiliation(s)
- Oliver D Howes
- 1 MRC London Institute of Medical Sciences, London, UK
- 2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Rogdaki
- 1 MRC London Institute of Medical Sciences, London, UK
| | - James L Findon
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Robert H Wichers
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Tony Charman
- 4 Department of Psychology, King's College London, London UK
| | - Bryan H King
- 5 Department of Psychiatry, University of California at San Francisco, San Francisco, USA
| | - Eva Loth
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Gráinne M McAlonan
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - James T McCracken
- 8 Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, USA
| | - Jeremy R Parr
- 9 Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carol Povey
- 10 The National Autistic Society, London, UK
| | - Paramala Santosh
- 11 Department of Child Psychiatry, King's College London, London, UK
| | | | - Emily Simonoff
- 13 Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Declan G Murphy
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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23
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Embryonic alcohol exposure leading to social avoidance and altered anxiety responses in adult zebrafish. Behav Brain Res 2017; 352:62-69. [PMID: 28882694 DOI: 10.1016/j.bbr.2017.08.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 12/25/2022]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) is a syndrome characterized by neurological and behavioral impairments. A recently discovered hallmark of FASD is impaired social behavior. Avoidance of social interaction typical of FASD may be the result of increased anxiety. Previously, the zebrafish was successfully used to model embryonic alcohol induced social abnormalities. Here, we analyzed both anxiety and social responses using a zebrafish FASD model, in adult fish. We exposed zebrafish embryos to low concentrations of ethanol (0.1%; 0.25%; 0.5% and 1% v/v) for 2h at, 24h post-fertilization, to mimic the most prevalent milder FASD cases, and investigated the ensuing alterations in adult, 4-month-old, zebrafish. We studied social interaction in the social preference task and anxiety in the novel tank task. We observed an ethanol dose dependent reduction of time spend in the conspecific zone compared to control, corroborating prior findings. We also found significant changes in the novel tank (e.g. increased bottom dwell time, increased distance to top) suggesting elevated anxiety to control, but we also found, using an anxiolytic drug buspirone, that reduction of anxiety is associated with reduced shoaling. Our results confirm that embryonic alcohol exposure disrupts social behavior, and also show that its effects on anxiety related phenotypes may be genotype, alcohol administration method, experimental procedure and test-context dependent.
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24
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Petrenko CLM, Pandolfino ME, Robinson LK. Findings from the Families on Track Intervention Pilot Trial for Children with Fetal Alcohol Spectrum Disorders and Their Families. Alcohol Clin Exp Res 2017; 41:1340-1351. [PMID: 28440861 DOI: 10.1111/acer.13408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/19/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders (FASD) are at high risk for costly, debilitating mental health problems and secondary conditions, such as school disruption, trouble with the law, and substance use. The study objective was to pilot a multicomponent intervention designed to prevent secondary conditions in children with FASD and improve family adaptation. METHODS Thirty children with FASD or prenatal alcohol exposure (PAE) (ages 4 to 8) and their primary caregivers were enrolled. Families were randomized to either the Families on Track Integrated Preventive Intervention or an active control of neuropsychological assessment and personalized community referrals. The 30-week intervention integrates scientifically validated bimonthly, in-home parent behavioral consultation, and weekly child skills groups. Outcomes measured at baseline and follow-up postintervention included intervention satisfaction, child emotional and behavioral functioning, child self-esteem, caregiver knowledge of FASD and advocacy, caregiver attitudes, use of targeted parenting practices, perceived family needs met, social support, and self-care. Data analysis emphasized calculation of effect sizes and was supplemented with analysis of variance techniques. RESULTS Analyses indicated that families participating in the intervention reported high program satisfaction. Relative to comparison group outcomes, the intervention was associated with medium-to-large effects for child emotion regulation, self-esteem, and anxiety. Medium-sized improvements in disruptive behavior were observed for both groups. Medium and large effects were seen for important caregiver outcomes: knowledge of FASD and advocacy, attributions of behavior, use of antecedent strategies, parenting efficacy, family needs met, social support, and self-care. CONCLUSIONS This pilot study yielded promising findings from the multicomponent Families on Track Integrated Preventive Intervention for child and caregiver outcomes. An important next step is to complete a randomized control trial of the Families on Track Program with a larger sample fully representative of this underserved clinical population with built-in study of implementation parameters.
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Affiliation(s)
| | - Mary E Pandolfino
- Mt. Hope Family Center , University of Rochester, Rochester, New York
| | - Luther K Robinson
- Women and Children's Hospital of Buffalo , University at Buffalo, Buffalo, New York
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Brown JM, Haun J, Zapf PA, Brown NN. Fetal Alcohol Spectrum Disorders (FASD) and competency to stand trial (CST): Suggestions for a 'best practices' approach to forensic evaluation. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:19-27. [PMID: 28502700 DOI: 10.1016/j.ijlp.2017.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/25/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Fetal Alcohol Spectrum Disorders (FASD), an umbrella term for neurodevelopmental conditions caused by prenatal alcohol exposure, is overrepresented in the U.S. juvenile and adult criminal justice systems. The brain damage in FASD manifests in a combination of cognitive and adaptive impairments that potentially reduce ability to function adequately during the criminal justice process, including capacity to stand trial (CST). Despite the high risk of arrest and conviction in this population, relatively little research guides CST assessment for defendants who have or may have FASD. Therefore, the purpose of this article is to describe how FASD may affect CST and suggest ways forensic professionals might modify assessment protocols to address possible effects of FASD-associated impairments on adjudicative capacity.
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Affiliation(s)
- Jerrod M Brown
- Concordia University, St. Paul, MN, USA; Pathways Counseling Center, St. Paul, MN, USA; The American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA.
| | - Jeffrey Haun
- University of Minnesota, Minneapolis, MN, USA; State Operated Forensic Services, St. Peter, MN, USA
| | - Patricia A Zapf
- John Jay College of Criminal Justice, The City University of New York, NYC, NY, USA; Consolidated Continuing Education and Professional Training, FL, USA
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Landgraf MN, Giese RM, Heinen F. Fetale Alkoholspektrumstörungen – Diagnose, neuropsychologische Testung und symptomorientierte Förderung. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:104-117. [DOI: 10.1024/1422-4917/a000444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Laut den aktuellen Studien zur Gesundheit in Deutschland (GEDA) haben knapp 20 % der schwangeren Frauen einen „moderaten Alkoholkonsum“ und knapp 8 % einen riskanten Alkoholkonsum. 12 % der Schwangeren geben ein Rauschtrinken (≥ 5 Getränke pro Gelegenheit) seltener als einmal pro Monat, knapp 4 % jeden Monat und 0.1 % mindestens jede Woche an. Zurückhaltende, strenge Schätzungen ergeben, dass ca. 1 % aller Kinder intrauterin durch Alkohol geschädigt werden. Extrapoliert aus dieser Schätzung bedeutet dies, dass in Deutschland ca. 0.8 Millionen Menschen, davon 130 000 Kinder, mit einer Fetalen Alkoholspektrumstörung (FASD) leben. Die Mehrzahl der betroffenen Kinder werden nicht oder erst spät richtig diagnostiziert. Professionelle Helfer im Gesundheits- und Sozialsystem sind bislang über die Symptome und die notwendige Diagnostik der FASD nur unzureichend informiert. Ziel dieses Übersichtsartikels ist die Erläuterung der ärztlichen und psychologischen diagnostischen Möglichkeiten und Notwendigkeiten bei Kindern und Jugendlichen mit FASD. Eine frühzeitige Diagnose und ein konstantes förderndes und gewaltfreies Umfeld sind als wichtigste protektive Faktoren für den Langzeit-Outcome von Menschen mit FASD identifiziert worden.
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Affiliation(s)
- Mirjam N. Landgraf
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, iSPZ Hauner, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München
| | - Renate M. Giese
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, iSPZ Hauner, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München
| | - Florian Heinen
- Abteilung für Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, iSPZ Hauner, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München
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Gerlai R. Animated images in the analysis of zebrafish behavior. Curr Zool 2017; 63:35-44. [PMID: 29491961 PMCID: PMC5804150 DOI: 10.1093/cz/zow077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/22/2016] [Indexed: 12/16/2022] Open
Abstract
This invited review is based upon a recent oral paper I presented at the Virtual Reality Symposium of the 34th International Ethological Conference (2015, Cairns, Australia), and as such it describes studies conducted mainly in my own laboratory. It reviews how we utilized visual stimuli for inducing behavioral responses in the zebrafish with a focus on shoaling, group forming behavior. The zebrafish is gaining increasing popularity in neuroscience. With this interest, its behavior is also more frequently studied. One of the many advantages of the zebrafish over traditional laboratory rodents is that this species is diurnal, and it relies heavily upon its visual system. Thus, similarly to our own species, zebrafish respond to visual stimuli in a robust and easily quantifiable manner. For the past decade, we have been exploring how to use such visual stimuli, and have developed numerous paradigms with which we can induce and quantify a variety of behavioral responses, including shoaling. This review summarizes some of these studies, and discusses questions including whether one should use live fish as stimulus, whether and how one could present animated (moving images) of fish, and how one could optimize a range of stimulus presentation parameters to elicit the most robust responses in zebrafish. Although the zebrafish is a relative newcomer in ethology and behavioral neuroscience, and although many of our findings only represent the first steps in this research, our results suggest that the behavioral analysis of the zebrafish will have an important place in biomedical research.
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Affiliation(s)
- Robert Gerlai
- Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road North, Rm CCT4004, Mississauga, Ontario, Canada L5L 1C6
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28
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Abstract
This grand rounds manuscript reviews important considerations in developing case conceptualizations for individuals with a history of prenatal alcohol exposure. This case study provides an introduction to fetal alcohol spectrum disorders, diagnostic issues, a detailed description of the individual's history, presenting symptoms, neuropsychological test results, and an integrated summary. We describe a 9-year old girl diagnosed with a fetal alcohol spectrum disorder (FASD): Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). This patient is a composite of a prototypical child who participated as part of a research project at the Center for Behavioral Teratology who was subsequently seen at an outpatient child psychiatry facility.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
| | - Sarah N Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
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Petrenko CLM, Alto ME. Interventions in fetal alcohol spectrum disorders: An international perspective. Eur J Med Genet 2017; 60:79-91. [PMID: 27742482 PMCID: PMC5205562 DOI: 10.1016/j.ejmg.2016.10.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 10/03/2016] [Accepted: 10/11/2016] [Indexed: 12/21/2022]
Abstract
Fetal alcohol spectrum disorders (FASD) are present across countries and cultures, with prevalence rates threatening to rise in the coming years. In order to support children and families with FASD around the world, researchers must work to disseminate and implement evidence-based interventions. However, each cultural context presents unique elements and barriers to the implementation process. This review considers the challenges of addressing FASD in an international context. It summarizes existing FASD interventions that have empirical support in the domains of parenting and education, attention and self-regulation, adaptive functioning, and nutrition and medication. It then outlines cultural barriers pertaining to FASD that may impede the implementation process and makes suggestions for using purveyors as cultural liaisons between researchers and local stakeholders. The review concludes with recommendations for moving forward with international dissemination and implementation of FASD interventions.
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Neuropsychological Aspects of Prevention and Intervention for FASD in the USA. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2016. [DOI: 10.1007/s40817-016-0024-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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31
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Stevens SA, Clairman H, Nash K, Rovet J. Social perception in children with fetal alcohol spectrum disorder. Child Neuropsychol 2016; 23:980-993. [DOI: 10.1080/09297049.2016.1246657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sara A. Stevens
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Hayyah Clairman
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kelly Nash
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Human Development and Applied Psychology, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Rovet
- Neurosciences and Mental Health Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Hagan JF, Balachova T, Bertrand J, Chasnoff I, Dang E, Fernandez-Baca D, Kable J, Kosofsky B, Senturias YN, Singh N, Sloane M, Weitzman C, Zubler J. Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. Pediatrics 2016; 138:e20151553. [PMID: 27677572 PMCID: PMC5477054 DOI: 10.1542/peds.2015-1553] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/24/2022] Open
Abstract
Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.
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Affiliation(s)
- Joseph F Hagan
- University of Vermont College of Medicine, Burlington, Vermont;
| | - Tatiana Balachova
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Elizabeth Dang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Natasha Singh
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Sloane
- Western Michigan University, Portage, Michigan; and
| | | | - Jennifer Zubler
- Centers for Disease Control and Prevention, Atlanta, Georgia
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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] [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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34
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O'Connor MJ, Quattlebaum J, Castañeda M, Dipple KM. Alcohol Intervention for Adolescents with Fetal Alcohol Spectrum Disorders: Project Step Up, a Treatment Development Study. Alcohol Clin Exp Res 2016; 40:1744-51. [DOI: 10.1111/acer.13111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Mary J. O'Connor
- Department of Psychiatry and Biobehavioral Sciences; Semel Institute for Neuroscience and Human Behavior; University of California, Los Angeles (UCLA); Los Angeles California
| | - Justin Quattlebaum
- Department of Psychiatry and Biobehavioral Sciences; Semel Institute for Neuroscience and Human Behavior; University of California, Los Angeles (UCLA); Los Angeles California
| | - Marleen Castañeda
- Department of Psychiatry and Biobehavioral Sciences; Semel Institute for Neuroscience and Human Behavior; University of California, Los Angeles (UCLA); Los Angeles California
| | - Katrina M. Dipple
- Departments of Human Genetics and Pediatrics; David Geffen School of Medicine at UCLA; Los Angeles California
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35
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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: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [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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36
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Reid N, Dawe S, Shelton D, Harnett P, Warner J, Armstrong E, LeGros K, O'Callaghan F. Systematic Review of Fetal Alcohol Spectrum Disorder Interventions Across the Life Span. Alcohol Clin Exp Res 2015; 39:2283-95. [DOI: 10.1111/acer.12903] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/09/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Natasha Reid
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| | - Sharon Dawe
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
- Australian Centre for Child Protection; University of South Australia; Adelaide South Australia Australia
| | - Douglas Shelton
- Community Child Health; Gold Coast Hospital & Health Service; Gold Coast Queensland Australia
| | - Paul Harnett
- School of Psychology; University of Queensland; Brisbane Queensland Australia
| | - Judith Warner
- Community Child Health; Gold Coast Hospital & Health Service; Gold Coast Queensland Australia
| | - Eleanor Armstrong
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
| | - Kim LeGros
- Community Child Health; Gold Coast Hospital & Health Service; Gold Coast Queensland Australia
| | - Frances O'Callaghan
- School of Applied Psychology; Menzies Health Institute Queensland; Griffith University; Gold Coast Queensland Australia
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37
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Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Wertelecki W, Pedersen TL, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on information processing skills in Ukrainian infants. Alcohol 2015; 49:647-56. [PMID: 26493109 PMCID: PMC4636447 DOI: 10.1016/j.alcohol.2015.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) was explored in a clinical trial conducted in Ukraine. Cardiac orienting responses (ORs) during a habituation/dishabituation learning paradigm were obtained from 6 to 12 month-olds to assess neurophysiological encoding and memory. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to a group (No study-provided supplements, multivitamin/mineral supplement, or multivitamin/mineral supplement plus choline supplement). Heart rate was collected for 30 s prior to stimulus onset and 12 s post-stimulus onset. Difference values (∆HR) for the first 3 trials of each condition were aggregated for analysis. Gestational blood samples were collected to assess maternal nutritional status and changes as a function of the intervention. Choline supplementation resulted in a greater ∆HR on the visual habituation trials for all infants and for the infants with no PAE on the dishabituation trials. The latency of the response was reduced in both conditions for all infants whose mothers received choline supplementation. Change in gestational choline level was positively related to ∆HR during habituation trials and levels of one choline metabolite, dimethylglycine (DMG), predicted ∆HR during habituation trials and latency of responses. A trend was found between DMG and ∆HR on the dishabituation trials and latency of the response. Supplementation did not affect ORs to auditory stimuli. Choline supplementation when administered together with routinely recommended multivitamin/mineral prenatal supplements during pregnancy may provide a beneficial impact to basic learning mechanisms involved in encoding and memory of environmental events in alcohol-exposed pregnancies as well as non- or low alcohol-exposed pregnancies. Changes in maternal nutrient status suggested that one mechanism by which choline supplementation may positively impact brain development is through prevention of fetal alcohol-related depletion of DMG, a metabolic nutrient that can protect against overproduction of glycine, during critical periods of neurogenesis.
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Affiliation(s)
- J A Kable
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA.
| | - C D Coles
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA
| | - C L Keen
- Department of Nutrition, University of California, Davis, USA
| | - J Y Uriu-Adams
- Department of Nutrition, University of California, Davis, USA
| | - K L Jones
- Department of Pediatrics, University of California, San Diego, USA
| | - L Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - Y Kulikovsky
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - W Wertelecki
- Department of Pediatrics, University of California, San Diego, USA; Department of Medical Genetics, University of South Alabama, USA
| | - T L Pedersen
- United States Department of Agriculture, Agricultural Research Service (ARS), Western Human Nutrition Research Center, Davis, CA, USA
| | - C D Chambers
- Department of Pediatrics, University of California, San Diego, USA; Department of Family Medicine and Public Health, University of California, San Diego, USA
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38
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Petrenko CLM. Positive Behavioral Interventions and Family Support for Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015; 2:199-209. [PMID: 26380802 PMCID: PMC4569135 DOI: 10.1007/s40474-015-0052-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although the scientific community has recognized the effects of prenatal alcohol exposure on development for over 40 years, the empirical study of positive behavioral interventions and family support programs for people with fetal alcohol spectrum disorders (FASD) has only just emerged over the last 10 to 15 years. In this time, dedicated researchers have developed innovative programs that have generally produced large effects and have been acceptable to children with FASD and their families. This body of work demonstrates that children with FASD can benefit from interventions that are appropriately tailored to their neurodevelopmental disabilities. Despite this progress, much work lies ahead to meet the significant needs of people with FASD. This review evaluates available sources of information, including theoretical and Lived Experience models, empirical evidence on existing programs, and best practice guidelines, to guide future research priorities and clinical practice. Three priorities for future intervention research are offered.
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40
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Fernandes Y, Rampersad M, Gerlai AR. Impairment of social behaviour persists two years after embryonic alcohol exposure in zebrafish: A model of fetal alcohol spectrum disorders. Behav Brain Res 2015; 292:102-108. [PMID: 26097005 DOI: 10.1016/j.bbr.2015.05.060] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/23/2015] [Accepted: 05/29/2015] [Indexed: 12/19/2022]
Abstract
Zebrafish naturally form social groups called shoals. Previously, we have shown that submerging zebrafish eggs into low concentrations of alcohol (0.00, 0.25, 0.50, 0.75 and 1.00 vol/vol% external bath concentration) during development (24h post-fertilization) for two hours resulted in impaired shoaling response in seven month old young adult zebrafish. Here we investigate whether this embryonic alcohol exposure induced behavioural deficit persists to older age. Zebrafish embryos were exposed either to fresh system water (control) or to 1% alcohol for two hours, 24h after fertilization, and were raised in a high-density tank system. Social behaviour was tested by presenting the experimental fish with a computer animated group of zebrafish images, while automated tracking software measured their behaviour. Control fish were found to respond strongly to animated conspecific images by reducing their distanceand remaining close to the images during image presentation, embryonic alcohol treated fish did not. Our results suggest that the impaired shoaling response of the alcohol exposed fish was not due to altered motor function or visual perception, but likely to a central nervous system alteration affecting social behaviour itself. We found the effects of embryonic alcohol exposure on social behaviour not to diminish with age, a result that demonstrates the deleterious and potentially life-long consequences of exposure to even small amount of alcohol during embryonic development in vertebrates.
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Affiliation(s)
| | | | - And Robert Gerlai
- Department of Psychology, University of Toronto.,Department of Cell and System Biology, University of Toronto
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41
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Gerlai R. Embryonic alcohol exposure: Towards the development of a zebrafish model of fetal alcohol spectrum disorders. Dev Psychobiol 2015; 57:787-98. [DOI: 10.1002/dev.21318] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/08/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Robert Gerlai
- Department of Psychology; University of Toronto Mississsauga; 3359 Mississauga Road North Mississauga Ontario L5L 1C6 Canada
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42
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Improving the Social Skills of Children with HFASD: An Intervention Study. J Autism Dev Disord 2015; 45:2961-80. [DOI: 10.1007/s10803-015-2459-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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43
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Abstract
"Fetal alcohol spectrum disorders" is a nondiagnostic umbrella term encompassing the wide variations in clinical presentation among individuals that are prenatally exposed to alcohol. This article discusses brain development and central nervous system abnormalities and reviews prevention and interventions for these neurologic manifestations.
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Affiliation(s)
- Elizabeth L Roszel
- Elizabeth L. Roszel is a primary care PNP at Suncoast Community Health Center, Wimauma, Fla
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44
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Abstract
Children with fetal alcohol spectrum disorders (FASD) show sociobehavioral impairments; however, the social cognitive profile contributing to these impairments is poorly understood. This study compared social perspective taking and empathy in children with FASD versus typically developing controls (TDC). Thirty-seven children with FASD and 21 TDC participated. Measures included parent-rated CBCL and SSIS, and NEPSY-II Theory of Mind, Test of Social Cognition and Index of Empathy. Parents rated the FASD group higher than TDC on indices of behavior problems and lower on indices of social skills and empathy. Children with FASD scored significantly below TDC on tasks requiring complex social cognition. The majority of correlations between social cognition and parent-ratings were not significant in FASD and TDC, with the exception of a negative correlation between self-reported empathy and parent-rated behavior difficulties in TDC. FASD subgroup analyses revealed lower theory of mind and empathy scores among children with ARND than pFAS/FAS. With regard to sex, males with FASD were rated as having more behavior difficulties than females, whereas TDC females obtained higher empathy ratings than males. In both groups, females scored higher on theory of mind and empathy indices. On theory of mind tasks, older children with FASD performed below younger, whereas younger TDC children performed more poorly than older. Children with FASD show reduced functioning on indices of sociobehavioral and social cognition, and the effects are influenced by sex and age. These findings provide insight into the clinical and social profile of children with FASD.
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45
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Abstract
Prenatal alcohol exposure (PAE) is one of the most prevalent and modifiable risk factors for somatic, behavioral, and neurological abnormalities. Affected individuals exhibit a wide range of such features referred to as fetal alcohol spectrum disorders (FASD). These are characterized by a more or less specific pattern of minor facial dysmorphic features, growth deficiency and central nervous system symptoms. Nevertheless, whereas the diagnosis of the full-blown fetal alcohol syndrome does not pose a major challenge, only a tentative diagnosis of FASD can be reached if only mild features are present and/or maternal alcohol consumption during pregnancy cannot be verified. The respective disorders have lifelong implications. The teratogenic mechanisms induced by PAE can lead to various additional somatic findings and structural abnormalities of cerebrum and cerebellum. At the functional level, cognition, motor coordination, attention, language development, executive functions, memory, social perception and emotion processing are impaired to a variable extent. The long-term development is characterized by disruption and failure in many domains; an age-adequate independency is frequently not achieved. In addition to primary prevention, individual therapeutic interventions and tertiary prevention are warranted; provision of extensive education to affected subjects and their caregivers is crucial. Protective environments are often required to prevent negative consequences such as delinquency, indebtedness or experience of physical/sexual abuse.
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46
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Nash K, Stevens S, Greenbaum R, Weiner J, Koren G, Rovet J. Improving executive functioning in children with fetal alcohol spectrum disorders. Child Neuropsychol 2014; 21:191-209. [PMID: 25010354 DOI: 10.1080/09297049.2014.889110] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An extensive body of literature has documented executive function (EF) impairments in children with fetal alcohol spectrum disorders (FASD); however, few studies have aimed specifically at improving EF. One treatment program that shows promise for children with FASD is the Alert Program for Self-Regulation®, which is a 12-week treatment specifically designed to target self-regulation, a component of EF. The present study sought to examine if Alert would produce improvements in self-regulation that would generalize to other aspects of EF, behavior, and social skills in children with FASD. Twenty-five children aged 8-12 years diagnosed with an FASD were assigned in alternating sequence to either an immediate treatment (TXT) or a delayed treatment control (DTC) group. Both groups received a comprehensive evaluation of EF at baseline and upon completing therapy (TXT), or after a 12- to 14-week interval from baseline (DTC). Parents also completed questionnaires assessing EF and behavior at both time points. For the TXT group only, parent questionnaires were readministered at 6-month follow-up. At the 12-week follow-up, the TXT group displayed significant improvements in inhibitory control and social cognition. Parents of children in the TXT group reported improved behavioral and emotional regulation, as well as reduced externalizing behavior problems. These behavioral improvements along with further improved parent-rated inhibitory control was maintained at the 6-month follow-up. The EF disabilities in children with FASD can be remediated through a targeted treatment approach aimed at facilitating self-regulation skills.
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Affiliation(s)
- Kelly Nash
- a The Hospital for Sick Children, Neuroscience and Mental Health , Toronto , Ontario , Canada
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47
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Kodituwakku P, Kodituwakku E. Cognitive and Behavioral Profiles of Children with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0022-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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48
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Senturias Y, Burns B. Managing children and adolescents with fetal alcohol spectrum disorders in the medical home. Curr Probl Pediatr Adolesc Health Care 2014; 44:96-101. [PMID: 24810412 DOI: 10.1016/j.cppeds.2013.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Yasmin Senturias
- Developmental-Behavioral Pediatrics Program, Levine Children׳s Hospital, Charlotte, NC; Developmental and Behavioral Pediatrics of the Carolinas-Charlotte, Carolinas Healthcare System, Charlotte, NC; Department of Pediatrics, University of North Carolina, Charlotte, NC
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Koren G, Zelner I, Nash K, Koren G. Foetal alcohol spectrum disorder: identifying the neurobehavioural phenotype and effective interventions. Curr Opin Psychiatry 2014; 27:98-104. [PMID: 24445400 DOI: 10.1097/yco.0000000000000038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Since the first description of the foetal damage of alcohol in 1967, numerous studies have outlined different aspects of neurodevelopmental dysfunction, adversely affecting the lives of children worldwide. Although the cause of the syndrome is sorted out, the pathogenesis of brain damage is far from being clear. In contrast to children exhibiting the full facial dysmorphology, who are relatively easy to diagnose, in those presenting only with alcohol-related neurodevelopmental damage diagnosis is much more challenging due to poor specificity of the brain dysfunction. Hence, identifying the neurodevelopmental phenotype of foetal alcohol spectrum disorder (FASD) is a major challenge. RECENT FINDINGS Recently, a behavioural phenotype of FASD has been described and validated using items from the Child Behaviour Checklist. This tool has high sensitivity and specificity in separating children with FASD from those with ADHD and from healthy controls. In parallel, a number of intervention studies show promise in improving the abilities of children and adolescents with the syndrome to cope with daily tasks and improve their quality of life. SUMMARY The neurobehavioural screening test can facilitate screening for FASD and is an official screening tool in the FASD toolkit of the Public Health Agency of Canada. Promising new interventions may attenuate the long-term outcome of these children.
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Affiliation(s)
- Gideon Koren
- aMotherisk Program, Division of Clinical Pharmacology-Toxicology, Department of Pediatrics bDepartment of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
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Glass L, Ware AL, Mattson SN. Neurobehavioral, neurologic, and neuroimaging characteristics of fetal alcohol spectrum disorders. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:435-462. [PMID: 25307589 DOI: 10.1016/b978-0-444-62619-6.00025-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Alcohol consumption during pregnancy can have deleterious consequences for the fetus, including changes in central nervous system development leading to permanent neurologic alterations and cognitive and behavioral deficits. Individuals affected by prenatal alcohol exposure, including those with and without fetal alcohol syndrome, are identified under the umbrella of fetal alcohol spectrum disorders (FASD). While studies of humans and animal models confirm that even low to moderate levels of exposure can have detrimental effects, critical doses of such exposure have yet to be specified and the most clinically significant and consistent consequences occur following heavy exposure. These consequences are pervasive, devastating, and can result in long-term dysfunction. This chapter summarizes the neurobehavioral, neurologic, and neuroimaging characteristics of FASD, focusing primarily on clinical research of individuals with histories of heavy prenatal alcohol exposure, although studies of lower levels of exposure, particularly prospective, longitudinal studies, will be discussed where relevant.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Ashley L Ware
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Sarah N Mattson
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA.
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