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Pruner M, Jirikowic T, Baylor C, Astley Hemingway SJ. Developmental, sensory and behavioral outcomes among infants and toddlers with prenatal alcohol exposure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 146:104671. [PMID: 38262190 DOI: 10.1016/j.ridd.2024.104671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/17/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can disrupt children's neurodevelopment and exert lasting influences on overall child well-being and family functioning. A comprehensive exploration of developmental outcomes in infants/toddlers with PAE seen for a diagnosis on the fetal alcohol spectrum can inform early identification and intervention. AIMS To describe the prevalence and patterns of neurodevelopment, sensory processing, and emotional and behavioral functioning in a clinical sample of infants/toddlers with PAE. METHODS In this retrospective analysis, clinical data from 125 infants/toddlers with PAE, aged 2-42 months, assessed at the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network clinic were analyzed. RESULTS Seventy-four to 87% of infants/toddlers demonstrated delayed development in one or more domains of the Bayley Scales of Infant and Toddler Development (n = 125). Adverse developmental outcomes were significantly correlated with PAE and/or postnatal risk factors. All 93 infants/toddlers with a complete Infant/Toddler Sensory Profile obtained definite difference scores in at least one quadrant/section. Over half of infant/toddlers with a completed Child Behavior Checklist/1½- 5 had total problem scores in the borderline or clinical range. CONCLUSIONS Findings suggest that several domains of child functioning may be vulnerable to the teratogenic impact of PAE, and that these delays are evident in the first years of life. Early screening, ongoing monitoring and comprehensive assessment is needed to facilitate earlier identification and guide clinical intervention.
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Affiliation(s)
- Misty Pruner
- University of Washington, Institute on Human Development and Disability, 1701 NE Columbia Rd, Box 357920, Seattle, WA 98195, USA.
| | - Tracy Jirikowic
- University of Washington, Department of Rehabilitation Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
| | - Carolyn Baylor
- University of Washington, Department of Rehabilitation Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
| | - Susan J Astley Hemingway
- University of Washington, Department of Epidemiology, 3980 15th Ave NE, Box 351619, Seattle, WA 98195, USA; University of Washington, School of Medicine, Department of Pediatrics, 1959 NE Pacific Street, Box 356340, Seattle, WA 98195, USA
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Aguilar-Rivera M, Kable JA, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers C, Coleman TP. Wireless Heart Sensor for Capturing Cardiac Orienting Response for Prediction of Neurodevelopmental Delay in Infants. SENSORS (BASEL, SWITZERLAND) 2022; 22:9140. [PMID: 36501842 PMCID: PMC9739526 DOI: 10.3390/s22239140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Early identification of infants at risk of neurodevelopmental delay is an essential public health aim. Such a diagnosis allows early interventions for infants that maximally take advantage of the neural plasticity in the developing brain. Using standardized physiological developmental tests, such as the assessment of neurophysiological response to environmental events using cardiac orienting responses (CORs), is a promising and effective approach for early recognition of neurodevelopmental delay. Previous CORs have been collected on children using large bulky equipment that would not be feasible for widespread screening in routine clinical visits. We developed a portable wireless electrocardiogram (ECG) system along with a custom application for IOS tablets that, in tandem, can extract CORs with sufficient physiologic and timing accuracy to reflect the well-characterized ECG response to both auditory and visual stimuli. The sensor described here serves as an initial step in determining the extent to which COR tools are cost-effective for the early screening of children to determine who is at risk of developing neurocognitive deficits and may benefit from early interventions. We demonstrated that our approach, based on a wireless heartbeat sensor system and a custom mobile application for stimulus display and data recording, is sufficient to capture CORs from infants. The COR monitoring approach described here with mobile technology is an example of a desired standardized physiologic assessment that is a cost-and-time efficient, scalable method for early recognition of neurodevelopmental delay.
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Affiliation(s)
- Marcelo Aguilar-Rivera
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Julie A. Kable
- Departments of Psychiatry and Behavioral Science and Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Post-Graduate Extension Program, Rivne Regional Medical Diagnostic Center, Lviv National Medical University, 79010 Lviv, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Post-Graduate Extension Program, Rivne Regional Medical Diagnostic Center, Lviv National Medical University, 79010 Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Khmelnytsky City Perinatal Center, 29008 Khmelnytskyi, Ukraine
| | - Iryna Dubchak
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Khmelnytsky City Perinatal Center, 29008 Khmelnytskyi, Ukraine
| | | | | | - Christina Chambers
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Todd P. Coleman
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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Coles CD, Kable JA, Granovska IV, Pashtepa AO, Wertelecki W, Chambers CD. Measurement of neurodevelopmental effects of prenatal alcohol exposure in Ukrainian preschool children. Child Neuropsychol 2021; 27:1088-1103. [PMID: 33982636 DOI: 10.1080/09297049.2021.1919298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.
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Affiliation(s)
- Claire D Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Iryna V Granovska
- OMNet, Rivne, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Ala O Pashtepa
- OMNet, Rivne, Ukraine.,Khmelnitsky Perinatal Center, Khmelnitsky, Ukraine
| | - Wladimir Wertelecki
- OMNet, Rivne, Ukraine.,Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
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- Collaborative Initiative for Fetal Alcohol Spectrum Disorders
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Kable JA, Coles CD, Jones KL, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers CD. Infant Cardiac Orienting Responses Predict Later FASD in the Preschool Period. Alcohol Clin Exp Res 2021; 45:386-394. [PMID: 33277942 PMCID: PMC7887046 DOI: 10.1111/acer.14525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) has been identified as one of the leading preventable causes of developmental disabilities, but early identification of those impacted has been challenging. This study evaluated the use of infant cardiac orienting responses (CORs), which assess neurophysiological encoding of environmental events and are sensitive to the impact of PAE, to predict later fetal alcohol spectrum disorder (FASD) status. METHODS Mother-infant dyads from Ukraine were recruited during pregnancy based on the mother's use of alcohol. Participants (n = 120) were then seen at 6 and 12 months when CORs were collected and in the preschool period when they were categorized as having (i) fetal alcohol syndrome (FAS), (ii) partial FAS (pFAS), (iii) alcohol-related neurodevelopmental disorder (ARND), (iv) PAE and no diagnosis, or (v) no PAE and no diagnosis. To assess CORs, stimuli (auditory tones and pictures) were presented using a fixed-trial habituation/dishabituation paradigm. Heart rate (HR) responses were aggregated across the first 3 habituation and dishabituation trials and converted to z-scores relative to the sample's mean response at each second by stimuli. Z-scores greater than 1 were then counted by condition (habituation or dishabituation) to compute a total risk index. RESULTS Significant group differences were found on total deviation scores of the CORs elicited from visual but not auditory stimuli. Those categorized as pFAS/FAS had significantly higher total deviation scores than did those categorized as ARND or as having no alcohol-related diagnosis with or without a history of PAE. Receiver operating characteristic curve analysis of the visual response yielded an area under the curve value of 0.765 for predicting to pFAS/FAS status. CONCLUSIONS A score reflecting total deviation from typical HR during CORs elicited using visual stimuli in infancy may be useful in identifying individuals who need early intervention as a result of their PAE.
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Affiliation(s)
- Julie A Kable
- From the Department of Psychiatry and Behavioral Science (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
- Department of and Pediatrics (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claire D Coles
- From the Department of Psychiatry and Behavioral Science (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
- Department of and Pediatrics (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth L Jones
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health (KLJ, ChDC), University of California San Diego, La Jolla, California, USA
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Rivne Regional Medical Diagnostic Center (LY, YK), Rivne, Ukraine
- Lviv National Medical University (LY), Lviv, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Rivne Regional Medical Diagnostic Center (LY, YK), Rivne, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Iryna Dubchak
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Diana Akhmedzhanova
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Wladimir Wertelecki
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
| | - Christina D Chambers
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health (KLJ, ChDC), University of California San Diego, La Jolla, California, USA
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Singer LT, Chambers C, Coles C, Kable J. Fifty Years of Research on Prenatal Substances: Lessons Learned for the Opioid Epidemic. ADVERSITY AND RESILIENCE SCIENCE 2020; 1:223-234. [PMID: 34316723 PMCID: PMC8312986 DOI: 10.1007/s42844-020-00021-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 01/31/2023]
Abstract
Current efforts to design research on developmental effects of prenatal opioid exposure can benefit from knowledge gained from 50 years of studies of fetal alcohol and prenatal drug exposures such as cocaine. Scientific advances in neurobiology, developmental psychopathology, infant assessments, genetics, and imaging support the principles of developmental neurotoxicology that guide research in prenatal exposures. Important to research design is accurate assessment of amount, frequency, and timing of exposure which benefits from accurate self-report and biomarkers of exposure. Identifying and control of pre- and postnatal factors that impact development are difficult and dependent on appropriate research design and selection of comparison groups and measurement of confounding, mediating, and moderating variables. Polysubstance exposure has increased due to the number of prescribed and nonprescribed substances used by pregnant women and varying combinations of drugs may have differential effects on the outcome. Multiple experimental and clinical assessments of infant behavior have been developed but predicting outcome before 18-24 months of age remains difficult. With some exceptions, prenatal substance exposure effect sizes have been small, and cognitive and behavioral effects tend to be specific rather than global. Studies require large sample sizes, adequate retention, and support for social services in at-risk samples. The ethical and legal contexts and stigma associated with drug/alcohol use disorder should be considered in order to prevent harm to families in research programs. Recognition of the pervasive use of addictive substances in this nation should lead to broad scientific efforts to understand how substances affect child outcomes and to initiate prevention and intervention where needed.
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Affiliation(s)
- Lynn T. Singer
- School of Medicine, Case Western Reserve University, WG49, Cleveland, OH 44106-7001, USA
| | - Christina Chambers
- Health Sciences, University of California, San Diego, San Diego, CA, USA
| | - Claire Coles
- Psychiatry and Behavioral Sciences and Pediatrics, Emory University, Atlanta, GA, USA
| | - Julie Kable
- Psychiatry and Behavioral Sciences and Pediatrics, Emory University, Atlanta, GA, USA
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Reid N, Petrenko CLM. Applying a Developmental Framework to the Self-Regulatory Difficulties of Young Children with Prenatal Alcohol Exposure: A Review. Alcohol Clin Exp Res 2018; 42:987-1005. [PMID: 29672859 DOI: 10.1111/acer.13756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/08/2018] [Indexed: 12/31/2022]
Abstract
Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self-regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self-regulation for this population. The application of a multilevel theoretical framework that describes the development of self-regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self-regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self-regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE.
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Affiliation(s)
- Natasha Reid
- Centre for Child Health Research, University of Queensland, Brisbane, Queensland
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Jacobson SW, Jacobson JL. Cardiac Orienting Response as an Early Indicator of Impairment in Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2017; 41:262-265. [PMID: 28029171 PMCID: PMC5272827 DOI: 10.1111/acer.13287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences , Wayne State University School of Medicine, Detroit, Michigan
- Departments of Human Biology and of Psychiatry and Mental Health , University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Joseph L Jacobson
- Department of Psychiatry and Behavioral Neurosciences , Wayne State University School of Medicine, Detroit, Michigan
- Departments of Human Biology and of Psychiatry and Mental Health , University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
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