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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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2
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Glass L, Moore EM, Mattson SN. Current considerations for fetal alcohol spectrum disorders: identification to intervention. Curr Opin Psychiatry 2023; 36:249-256. [PMID: 36939372 PMCID: PMC10079626 DOI: 10.1097/yco.0000000000000862] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent findings regarding the prevalence, public health impact, clinical presentation, intervention access and conceptualization of fetal alcohol spectrum disorders (FASDs). Despite ongoing work in prevention and identification of this population, the rates of drinking during pregnancy have increased and significant gaps remain in diagnosis and intervention. RECENT FINDINGS Prenatal alcohol exposure is the most common preventable cause of developmental disability in the world. Research has focused on improving diagnostic clarity, utilizing technology and neuroimaging to facilitate identification, engaging broader stakeholders (including self-advocates) to inform understanding and needs, and increasing access to effective interventions. There is an emerging focus on developmental trajectories and experiences in young and middle adulthood. Public policy advocacy has also made great strides in recent years. SUMMARY Increases in public awareness, greater concordance of diagnostic schema, leveraged use of novel technology, and the development of targeted interventions within a holistic, strengths-based conceptualization are important considerations for this population.
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Affiliation(s)
- Leila Glass
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
- University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, USA
| | - Eileen M. Moore
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Sarah N. Mattson
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
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3
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Marcellus L, Badry D. Infants, children, and youth in foster care with prenatal substance exposure: a synthesis of two scoping reviews. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 69:265-290. [PMID: 37025340 PMCID: PMC10071944 DOI: 10.1080/20473869.2021.1945890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Infants, children, and youth in foster care have frequently experienced prenatal substance exposure (PSE), neglect, and maltreatment as well as disruptions in their relationships with families. They also have great capacity for overcoming early adversities. In this synthesis of two previously conducted scoping reviews, we aimed to identify and describe literature that identifies a range of interventions that support the health and development of this population. Methods: This review integrates and extends two previously conducted scoping reviews, one focusing on infants and one focusing on children and youth, to synthesize themes across these developmental stages. The Joanna Briggs Institute scoping review methodology was employed for the current and previous reviews. A three-step search strategy identified published studies in the English language from January 2006 to February 2020. Results: One-hundred and fifty-three sources were included in this review. Four themes were identified: (1) early screening, diagnosis, and intervention; (2) providing theoretically grounded care; (3) supporting parents and foster care providers; and (4) intersectoral collaboration. Conclusion:Infants, children, and youth with PSE are overrepresented in foster care. Child welfare system planning should take a multi-sectoral approach to addressing the cumulative needs of this population and their care providers over developmental ages and stages. Although research remains limited, early screening, diagnosis, and developmentally and fetal alcohol spectrum disorder-informed intersectoral interventions are critical for optimizing outcomes.
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Affiliation(s)
| | - Dorothy Badry
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Correspondence to: Dorothy Badry, Faculty of Social Work, University of Calgary, Calgary, AB, Canada.
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4
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Mattson JT, Thorne JC, Kover ST. [Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD). Child Neuropsychol 2022; 28:853-877. [PMID: 34978272 PMCID: PMC10686097 DOI: 10.1080/09297049.2021.2023122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.
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Affiliation(s)
- Julia T. Mattson
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - John C. Thorne
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
| | - Sara T. Kover
- Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
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5
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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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6
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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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7
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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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8
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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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9
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Adebiyi BO, Mukumbang FC, Erasmus C. The Distribution of Available Prevention and Management Interventions for Fetal Alcohol Spectrum Disorder (2007 to 2017): Implications for Collaborative Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122244. [PMID: 31242673 PMCID: PMC6617245 DOI: 10.3390/ijerph16122244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The aim of the scoping review is to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. We searched some selected databases with predefined terms. Framework and narrative approaches were used to synthesize and report on the findings. Thirty-two prevention intervention studies and 41 management interventions studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.
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Affiliation(s)
- Babatope O Adebiyi
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 8001, South Africa.
| | - Charlene Erasmus
- Child and Family Studies, University of the Western Cape, Cape Town 8001, South Africa.
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10
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O'Connor MJ, Portnoff LC, Lebsack-Coleman M, Dipple KM. Suicide risk in adolescents with fetal alcohol spectrum disorders. Birth Defects Res 2019; 111:822-828. [PMID: 30677250 DOI: 10.1002/bdr2.1465] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The teratogenic effects of prenatal alcohol exposure (PAE) have been extensively documented over the course of 45 years of research and psychiatric problems are pervasive in this population. In adults with PAE, suicidal risk is high but less is known about the suicidal risk in adolescents with fetal alcohol spectrum disorders (FASD). This study describes the prevalence of suicidal ideation and serious suicide attempts in a sample of 54 adolescents between the ages of 13 and 18 years with FASD. METHODS Adolescents were diagnosed with FASD using the Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. The Children's Interview for Psychiatric Syndromes was used to identify those adolescents who experienced suicidal ideation and/or who had made a serious suicide attempt in the last 12 months. RESULTS The prevalence of suicidal behaviors in this sample was high with 35.2% of teens reporting incidences of suicidal ideation and 13.0% reporting at least one serious suicide attempt in the past year. This finding is in contrast to the 17.2% and 2.4% for ideation and serious attempts, respectively, reported in the general U.S. adolescent population. Alarmingly, 29.2% of males with FASD reported a serious suicide attempt which was 19½ times higher than national norms for males. No females reported attempts. Number of home placements and the presence of a depressive disorder contributed to study outcomes. CONCLUSIONS Findings demonstrate the significant risk for suicidality in this population, particularly adolescent males, and the need to assess and treat this life threatening behavior.
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Affiliation(s)
- Mary J O'Connor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Larissa C Portnoff
- Department of Psychology, Teachers College, Columbia University, New York City, New York
| | - Michael Lebsack-Coleman
- Department of Applied Social Psychology, Claremont Graduate University, Claremont, California
| | - Katrina M Dipple
- Department of Genetics, University of Washington, Seattle Children's Hospital, Seattle, Washington
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11
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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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12
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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: 36] [Impact Index Per Article: 5.1] [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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13
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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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14
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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: 42] [Impact Index Per Article: 5.3] [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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15
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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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16
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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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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: 81] [Impact Index Per Article: 10.1] [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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Løhaugen GCC, Flak MM, Gerstner T, Sundberg C, Lerdal B, Skranes J. Establishment of the South-Eastern Norway Regional Health Authority Resource Center for Children with Prenatal Alcohol/Drug Exposure. Subst Abuse 2015; 9:67-75. [PMID: 26692762 PMCID: PMC4671549 DOI: 10.4137/sart.s23542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
This paper presents a new initiative in the South-Eastern Health Region of Norway to establish a regional resource center focusing on services for children and adolescents aged 2–18 years with prenatal exposure to alcohol or other drugs. In Norway, the prevalence of fetal alcohol spectrum (FAS) is not known but has been estimated to be between 1 and 2 children per 1000 births, while the prevalence of prenatal exposure to illicit drugs is unknown. The resource center is the first of its kind in Scandinavia and will have three main objectives: (1) provide hospital staff, community health and child welfare personnel, and special educators with information, educational courses, and seminars focused on the identification, diagnosis, and treatment of children with a history of prenatal alcohol/drug exposure; (2) provide specialized health services, such as diagnostic services and intervention planning, for children referred from hospitals in the South-Eastern Health Region of Norway; and (3) initiate multicenter studies focusing on the diagnostic process and evaluation of interventions.
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Affiliation(s)
- Gro C C Løhaugen
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Department of Laboratory Medicine, Children's and Women's Health (LBK), Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway
| | - Marianne Møretrø Flak
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Addiction Unit (ARA-K), Sørlandet Sykehus HF, Kristiansand, Norway
| | - Thorsten Gerstner
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway
| | - Cato Sundberg
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway
| | - Bjørn Lerdal
- Department of Child Neurology and Rehabilitation (HABU-K), Sørlandet Hospital HF, HABU, Kristiansand, Norway
| | - Jon Skranes
- Department of Child Neurology and Rehabilitation (HABU-A), Sørlandet Hospital HF, HABU, Arendal, Norway. ; Department of Laboratory Medicine, Children's and Women's Health (LBK), Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway
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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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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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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: 19] [Impact Index Per Article: 2.1] [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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Olson HC. Advancing Recognition of Fetal Alcohol Spectrum Disorders: the Proposed DSM-5 Diagnosis of “Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)”. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2015. [DOI: 10.1007/s40474-015-0056-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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O’Connor MJ. Mental Health Outcomes Associated with Prenatal Alcohol Exposure: Genetic and Environmental Factors. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2014. [DOI: 10.1007/s40474-014-0021-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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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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