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Andrew G. Addressing gaps and stigma appropriately in fetal alcohol spectrum disorder. Dev Med Child Neurol 2024; 66:683-684. [PMID: 37861240 DOI: 10.1111/dmcn.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
This commentary is on the scoping review by Wilson et al. on pages 702–712 of this issue.
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Affiliation(s)
- Gail Andrew
- Clinical Pediatrics, University of Alberta, Alberta, Canada
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Yadav KK, Chouhan N, Thubstan R, Norlha S, Hariharan J, Borwankar C, Chandra P, Dhar VK, Mankuzhyil N, Godambe S, Sharma M, Venugopal K, Singh KK, Bhatt N, Bhattacharyya S, Chanchalani K, Das MP, Ghosal B, Godiyal S, Khurana M, Kotwal SV, Koul MK, Kumar N, Kushwaha CP, Nand K, Pathania A, Sahayanathan S, Sarkar D, Tolamati A, Koul R, Rannot RC, Tickoo AK, Chitnis VR, Behere A, Padmini S, Manna A, Joy S, Nair PM, Jha KP, Moitra S, Neema S, Srivastava S, Punna M, Mohanan S, Sikder SS, Jain A, Banerjee S, . K, Deshpande J, Sanadhya V, Andrew G, Patil MB, Goyal VK, Gupta N, Balakrishna H, Agrawal A, Srivastava SP, Karn KN, Hadgali PI, Bhatt S, Mishra VK, Biswas PK, Gupta RK, Kumar A, Thul SG, Kalmady R, Sonvane DD, Kumar V, Gaur UK, Chattopadhyay J, Gupta SK, Kiran AR, Parulekar Y, Agrawal MK, Parmar RM, Reddy GR, Mayya YS, Pithawa CK. Commissioning of the MACE gamma-ray telescope at Hanle, Ladakh, India. CURR SCI INDIA 2022. [DOI: 10.18520/cs/v123/i12/1428-1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Hammond L, Joly V, Kapasi A, Kryska K, Andrew G, Oberlander TF, Pei J, Rasmussen C. Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder. Res Dev Disabil 2022; 131:104366. [PMID: 36279676 DOI: 10.1016/j.ridd.2022.104366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/08/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions. AIMS In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population. METHODS AND PROCEDURES Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity. OUTCOMES AND RESULTS Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior. CONCLUSIONS AND IMPLICATIONS Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.
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Affiliation(s)
- Leah Hammond
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Aamena Kapasi
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Kryska
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Tim F Oberlander
- Department of Pediatrics, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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Flannigan K, Kapasi A, Pei J, Murdoch I, Andrew G, Rasmussen C. Characterizing adverse childhood experiences among children and adolescents with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Child Abuse Negl 2021; 112:104888. [PMID: 33388606 DOI: 10.1016/j.chiabu.2020.104888] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure (PAE) face elevated rates of postnatal environmental adversity across the lifespan. OBJECTIVE We explored early adversity among children and adolescents with PAE. PARTICIPANTS AND SETTING Our sample included 333 children and adolescents with PAE assessed at a Canadian FASD diagnostic clinic, 66% of whom were diagnosed with FASD. METHODS Data were collected retrospectively via record review, and adversity was measured using the Adverse Childhood Experiences Questionnaire (ACE-Q). RESULTS Participants experienced high levels of adversity (mean ACE score of 3.4), which increased with age, mental health comorbidity, and number of living placements. Common ACEs included: not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (p < .001, ø = -0.18). There was no difference in total ACE scores between participants diagnosed with FASD versus those not diagnosed, but participants with FASD were less likely to live with both biological parents (p < .001, ø = .19) or to have been exposed to household mental health problems (p = .007, ø = -0.15). CONCLUSIONS Children and adolescents with PAE experience high rates of early adversity. Practice and policy initiatives are needed to improve early detection of ACEs among children with PAE, and of PAE among children with ACEs. Targeted supports are needed to strengthen the early caregiving environment and mitigate the risks of adversity to support healthy outcomes for individuals with PAE and FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada.
| | - Aamena Kapasi
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada; University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Isabel Murdoch
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton AB, T5G 0B7, Canada
| | - Carmen Rasmussen
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
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Duncan A, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Prioritizing a Research Agenda of Transitional Care Interventions for Childhood-Onset Disabilities. Front Pediatr 2021; 9:682078. [PMID: 34589448 PMCID: PMC8475648 DOI: 10.3389/fped.2021.682078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/11/2021] [Indexed: 01/20/2023] Open
Abstract
Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systematic review, on importance, impact, and feasibility. Seven of the 16 interventions categories received a mean score rating of ≥7 (out of 10) on all three rating categories. Participants then rank ordered the reduced list of seven interventions in order of priority and the top four ranked interventions advanced for further discussion at a consensus meeting. Using the Template for Intervention Description and Replication (TIDieR) checklist as a guide, the participants identified that a study of a peer system navigator was worthy of future evaluation. This study highlighted that transitional care interventions are complex and multifaceted. However, the presence of a peer to support system navigation, advocacy and individual and family education was considered the most ideal intervention addressing the current gap in care. Future research, which aims to engage patients and families in a co-design approach, is recommended to further develop this intervention.
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Affiliation(s)
- Andrea Duncan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, Toronto, ON, Canada
| | - Mark T Bayley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada.,Division of Physical Medicine, University of Toronto, Toronto, ON, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brian Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - C J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | | | - Laura Hartman
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Lennox Huang
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Shauna Kingsnorth
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Sinai Health System, Toronto, ON, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Alene Toulany
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Joanne Zee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Sarah E P Munce
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
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Levy BB, Song JZ, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Transitional Care Interventions for Youth With Disabilities: A Systematic Review. Pediatrics 2020; 146:peds.2020-0187. [PMID: 33046586 DOI: 10.1542/peds.2020-0187] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations. OBJECTIVE In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders. DATA SOURCES Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched. STUDY SELECTION In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years. DATA EXTRACTION Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment. RESULTS Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components. LIMITATIONS Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes. CONCLUSIONS Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.
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Affiliation(s)
- Ben B Levy
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jessica Z Song
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Mark T Bayley
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and.,Division of Physical Medicine, and
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Brian Chan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Cynthia J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | - Laura Hartman
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lennox Huang
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, and.,Family and Community Medicine, and.,North York General Hospital, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Rehabilitation Sciences Institute, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, and.,Sinai Health System, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, and.,Departments of Paediatrics.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alene Toulany
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Joanne Zee
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada; .,Institute of Health Policy, Management and Evaluation, and.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Kapasi A, Pei J, Kryska K, Joly V, Gill K, Thompson-Hodgetts S, McLachlan K, Andrew G, Rasmussen C. Exploring Self-Regulation Strategy Use in Adolescents with FASD. Journal of Occupational Therapy, Schools, & Early Intervention 2020. [DOI: 10.1080/19411243.2020.1822260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Aamena Kapasi
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Kathryn Kryska
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | - Kamaldeep Gill
- Department of Rehabilitation Sciences, University of British Colombia, Vancouver, Canada
| | | | | | - Gail Andrew
- Glenrose Rehabilitation Hospital Edmonton, PAE Clinic, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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McLachlan K, Zhou D, Little G, Rasmussen C, Pei J, Andrew G, Reynolds JN, Beaulieu C. Current Socioeconomic Status Correlates With Brain Volumes in Healthy Children and Adolescents but Not in Children With Prenatal Alcohol Exposure. Front Hum Neurosci 2020; 14:223. [PMID: 32714166 PMCID: PMC7344164 DOI: 10.3389/fnhum.2020.00223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
Individuals with prenatal alcohol exposure (PAE) exhibit neurological deficits associated with brain injury including smaller brain volumes. Additional risk factors such as lower socioeconomic status (SES) may also have an impact on brain development for this population. This study examined how brain volumes are related to SES in both neurotypically developing children and adolescents, and those with PAE. 3D T1-weighted MPRAGE images were acquired from 69 participants with PAE (13.0 ± 3.2 years, range 7.1–18.8 years, 49% female) and 70 neurotypical controls (12.4 ± 2.9 years, range 7.0–18.5 years, 60% female) from four scanning sites in Canada. SES scores calculated using Hollingshead’s Four-Factor Index of Social Status from current caregiver placement were not significantly different between groups, though more children with PAE had lower SES scores compared to controls. Psychometric data comprised 14 cognitive measures, including executive functioning, attention and working memory, memory, math/numerical ability, and word reading. All cognitive scores were significantly worse in children with PAE compared to controls, though SES was not correlated with cognitive scores in either group after correction for multiple comparisons. All 13 brain volumes were smaller in children with PAE compared to children in the control group. Higher SES was associated with larger hippocampus and amygdala volumes in controls, but there were no such associations in children with PAE. Direct evaluation of the interaction between SES and diagnostic group did not show a significant differential impact of SES on these structures. These findings support previous links between SES and brain volumes in neurotypically developing children, but the lack of such a relationship with SES in children with PAE may be due to the markedly smaller brain volumes resulting from the initial brain injury and postpartum brain development, regardless of later SES.
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Affiliation(s)
- Kaitlyn McLachlan
- Department of Psychology, College of Social & Applied Human Sciences, University of Guelph, Guelph, ON, Canada
| | - Dongming Zhou
- Department of Zoology, Kunming Medical University, Kunming, Yunnan, China.,Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Graham Little
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital PAE Clinic, Edmonton, AB, Canada
| | - James N Reynolds
- Department of Biomedical and Molecular Sciences, School of Medicine, Faculty of Health Sciences, Queens University, Kingston, ON, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Berrigan P, Andrew G, Reynolds JN, Zwicker JD. The cost-effectiveness of screening tools used in the diagnosis of fetal alcohol spectrum disorder: a modelled analysis. BMC Public Health 2019; 19:1746. [PMID: 31881876 PMCID: PMC6935188 DOI: 10.1186/s12889-019-8110-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. METHODS The screenings tools evaluated were chosen from Children's Healthcare Canada's National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. Costs reflect 2017 Canadian dollars and the perspective is the public healthcare system. RESULTS Both screening tools evaluated resulted in reduced costs and fewer diagnosed years of life than a no screening strategy in which all children suspected of FASD receive diagnostic testing. The model predicts that screening newborns with meconium testing results in a reduced cost of $89,186 per 100 individuals screened and 38 fewer diagnosed years of life by age 18, corresponding to an incremental cost-effectiveness ratio (ICER) of $2359. Screening children with the NST resulted in a reduced cost of $183,895 per 100 individuals screened and 77 fewer diagnosed years of life by age 18, corresponding to an ICER of $2390. CONCLUSION Findings suggest that screening is associated with less use of healthcare recourses but also fewer years of life with an FASD diagnosis over a no screening strategy. Since diagnosis can be key to children receiving timely and appropriate health and educational services, cost-savings must be weighed against the fewer years of life with a diagnosis associated with screening.
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Affiliation(s)
- Patrick Berrigan
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.
| | - Gail Andrew
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 5th Floor, 11405 - 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.,Glenrose FASD Clinic, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta, T5G 0B7, Canada
| | - James N Reynolds
- Department of Biomedical and Molecular Sciences, Queen's University, Botterell Hall, Room 563, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, 906 8th Avenue SW, 5th Floor, Calgary, Alberta, T2P 1H9, Canada.,Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Samuel S, Dimitropoulos G, Schraeder K, Klarenbach S, Nettel-Aguirre A, Guilcher G, Pacaud D, Pinzon J, Lang E, Andrew G, Zwaigenbaum L, Scott S, McBrien K, Hamiwka L, Mackie A. Pragmatic trial evaluating the effectiveness of a patient navigator to decrease emergency room utilisation in transition age youth with chronic conditions: the Transition Navigator Trial protocol. BMJ Open 2019; 9:e034309. [PMID: 31826899 PMCID: PMC6924868 DOI: 10.1136/bmjopen-2019-034309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transition to adult care is a challenging and complex process for youth with special healthcare needs. We aim to compare effectiveness of a patient navigator service in reducing emergency room (ER) use among adolescents with chronic health conditions transitioning to adult care. METHODS AND ANALYSIS Pragmatic randomised controlled trial parallel group design comparing ER visit rates between patients with access to a personalised navigator intervention compared with usual care. Unit of randomisation is the patient. Treatment assignment will not be blinded. Embedded qualitative study to understand navigator's role and cost analysis attributable to the intervention will be performed. Patients aged 16-21 years, followed within a chronic disease clinic, expected to be transferred to adult care within 12 months and residing in Alberta during study period will be recruited from three tertiary care paediatric hospitals. Sample size will be 300 in each arm. Navigator intervention over 24 months is designed to assist participants in four domains: transition preparation, health system brokering, socioeconomic determinants of health and self-management. Primary outcome is ER visit rate during observation period. Secondary outcomes are ambulatory and inpatient care utilisation measures, as well as Transition Readiness Assessment Questionnaire score, and Short-Form Health Survey 12 (SF-12) score at 6 and 18 months post-randomisation. Poisson regression will compare rates of ER/urgent care visits between navigator and control participants, using intention to treat principle. Cost analysis of the intervention will be conducted. Thematic analysis will be used to identify perceptions of stakeholders regarding the role of navigators. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Calgary Conjoint Health Research Ethics Board (REB #162561) and the University of Alberta Health Research Ethics Board (Pro00077325). Our team is composed of diverse stakeholders who are committed to improving transition of care who will assist with dissemination of results. TRIAL REGISTRATION NUMBER NCT03342495.
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Affiliation(s)
- Susan Samuel
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Kyleigh Schraeder
- Alberta Children's Hospital Research Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Greg Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Daniele Pacaud
- Section of Endocrinology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jorge Pinzon
- Section of Adolescent Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Autism Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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11
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Dimitropoulos G, Morgan-Maver E, Allemang B, Schraeder K, Scott SD, Pinzon J, Andrew G, Guilcher G, Hamiwka L, Lang E, McBrien K, Nettel-Aguirre A, Pacaud D, Zwaigenbaum L, Mackie A, Samuel S. Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care. BMC Health Serv Res 2019; 19:390. [PMID: 31208417 PMCID: PMC6580652 DOI: 10.1186/s12913-019-4227-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. METHODS Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. RESULTS A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. CONCLUSIONS The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
| | | | - Brooke Allemang
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Kyleigh Schraeder
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Jorge Pinzon
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Gregory Guilcher
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Daniele Pacaud
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Diabetes and Endocrinology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Andrew Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
- Division of Cardiology, Stollery Children’s Hospital, Edmonton, Alberta Canada
| | - Susan Samuel
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
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12
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McLachlan K, McNeil A, Pei J, Brain U, Andrew G, Oberlander TF. Prevalence and characteristics of adults with fetal alcohol spectrum disorder in corrections: a Canadian case ascertainment study. BMC Public Health 2019; 19:43. [PMID: 30626356 PMCID: PMC6325737 DOI: 10.1186/s12889-018-6292-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a Northern Canadian correctional population. METHODS Using an active case ascertainment approach we recruited a representative sample of 80 justice-involved adults (ages 18-40, 85% male) over an 18-month period from 2013 to 2015. Participants completed interdisciplinary clinical assessments comprising medical and psychological evaluations that adhered to the 2005 Canadian FASD Diagnostic Guidelines. RESULTS We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2% with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment. CONCLUSIONS Findings showed disproportionately high estimated FASD prevalence in this representative sample compared to general population estimates in both Canada and the U.S. (2-5%), underscoring the need for improved FASD screening and diagnosis in correctional settings, and education for clinicians working in the justice context. Strengthened health prevention and intervention efforts to support the needs of individuals with FASD outside the criminal justice context are needed.
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Affiliation(s)
- K McLachlan
- Department of Psychology, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - A McNeil
- Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - J Pei
- Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - U Brain
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - G Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - T F Oberlander
- Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Omololu A, Andrew G, Onukak A, Shwe D, Akude C, Gomerep S, Shehu NY. Yellow fever childhood immunization coverage in jos north local government area, North Central Nigeria: 2015 – 2017. Niger J Med 2019. [DOI: 10.4103/1115-2613.278625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Kully-Martens K, Pei J, Kable J, Coles CD, Andrew G, Rasmussen C. Mathematics intervention for children with fetal alcohol spectrum disorder: A replication and extension of the math interactive learning experience (MILE) program. Res Dev Disabil 2018; 78:55-65. [PMID: 29775869 DOI: 10.1016/j.ridd.2018.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/16/2018] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders (FASD) experience deficits in behavior, cognition, and academic functioning resulting from prenatal alcohol exposure (PAE). Although receiving intervention for developmental disabilities is a strong protective factor against negative outcomes in FASD, intervention research in this population is in its infancy. AIMS The purpose of this study was to replicate and extend a mathematics intervention, the Math Interactive Learning Experience (MILE) program, which was developed in the USA specifically for children with FASD. METHODS Twenty-eight Canadian children aged 4-10 years with confirmed PAE or an FASD diagnosis were assigned to either the MILE intervention or a contrast intervention. RESULTS Following a relatively brief, individualized, one-on-one intervention, children in the MILE group demonstrated significantly greater changes in math achievement compared to the contrast group. Significant changes in other cognitive functions were not observed. Older age, lower IQ, and confirmed PAE but no FASD diagnosis were associated with greater math achievement change in the MILE group. CONCLUSIONS The replication and extension of the math intervention appears to have significant, positive impact on mathematics achievement scores of children with PAE and FASD.
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Affiliation(s)
- Katrina Kully-Martens
- Department of Educational Psychology, 6-102 Education North, University of Alberta, Edmonton, AB, T6G 2G5, Canada.
| | - Jacqueline Pei
- Department of Educational Psychology, 6-102 Education North, University of Alberta, Edmonton, AB, T6G 2G5, Canada
| | - Julie Kable
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, E213C Glenrose Rehabilitation Hospital, 10230-111 Ave, Edmonton, AB, T5G 0B7, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, E213C Glenrose Rehabilitation Hospital, 10230-111 Ave, Edmonton, AB, T5G 0B7, Canada
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15
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Flannigan K, Gill K, Pei J, Andrew G, Rajani H, McFarlane A, O’Riordan T, Symes B, Rasmussen C. Deferred diagnosis in children assessed for fetal alcohol spectrum disorder. Applied Neuropsychology: Child 2018; 8:213-222. [DOI: 10.1080/21622965.2018.1427094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Kamaldeep Gill
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hasu Rajani
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Audrey McFarlane
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, Alberta, Canada
| | - Teresa O’Riordan
- Yellowhead Tribal Community Corrections Society, Edmonton, Alberta, Canada
| | - Brent Symes
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Zhou D, Rasmussen C, Pei J, Andrew G, Reynolds JN, Beaulieu C. Preserved cortical asymmetry despite thinner cortex in children and adolescents with prenatal alcohol exposure and associated conditions. Hum Brain Mapp 2017; 39:72-88. [PMID: 28960637 DOI: 10.1002/hbm.23818] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prenatal alcohol exposure (PAE) is associated with reduced overall brain volume. Although this has been reported consistently across studies, the status of cortical thickness after PAE is more variable. The cortex is asymmetric in typical controls, but it is unclear whether the left and right counter parts of the cortical gray matter are unevenly influenced in postpartum brain development after PAE. Brain MRI was acquired in a newly recruited sample of 157 participants (PAE: N = 78, 5.5-18.9 years, 40 females and controls: N = 79, 5.8-18.5 years, 44 females) across four Canadian sites in the NeuroDevNet project. The PAE group had other confounds such as psychiatric co-morbidity, different living environment, and so on, not present in the control group. In agreement with previous studies, the volumes of all brain structures were reduced in PAE compared to controls, including gray and white matter of cerebrum and cerebellum, and all deep gray matter including the hippocampus, amygdala, thalamus, caudate, putamen, and pallidum. The PAE group showed reductions in global and regional cortical thickness, while the pattern and degree of cortical thickness asymmetry were preserved in PAE participants with the greatest rightward asymmetry in the lateral parietal lobe and the greatest leftward asymmetry in the lateral frontal cortex. This persistent asymmetry reflects that the homologous left and right cortical regions followed typical relative developmental patterns in the PAE group despite being thinner bilaterally than controls. Hum Brain Mapp 39:72-88, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dongming Zhou
- Environment and Health Research Centre, Southwest China Eco-development Academy, Southwest Forestry University, Kunming, Yunnan, China.,Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jacqueline Pei
- Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital FASD Clinic, Edmonton, Alberta, Canada
| | - James N Reynolds
- Biomedical and Molecular Sciences, Queens University, Kingston, Ontario, Canada
| | - Christian Beaulieu
- Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Treit S, Chen Z, Zhou D, Baugh L, Rasmussen C, Andrew G, Pei J, Beaulieu C. Sexual dimorphism of volume reduction but not cognitive deficit in fetal alcohol spectrum disorders: A combined diffusion tensor imaging, cortical thickness and brain volume study. Neuroimage Clin 2017; 15:284-297. [PMID: 28560153 PMCID: PMC5440763 DOI: 10.1016/j.nicl.2017.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/17/2017] [Accepted: 05/08/2017] [Indexed: 02/08/2023]
Abstract
Quantitative magnetic resonance imaging (MRI) has revealed abnormalities in brain volumes, cortical thickness and white matter microstructure in fetal alcohol spectrum disorders (FASD); however, no study has reported all three measures within the same cohort to assess the relative magnitude of deficits, and few studies have examined sex differences. Participants with FASD (n = 70; 30 females; 5-32 years) and healthy controls (n = 74; 35 females; 5-32 years) underwent cognitive testing and MRI to assess cortical thickness, regional brain volumes and fractional anisotropy (FA)/mean diffusivity (MD) of white matter tracts. A significant effect of group, age-by-group, or sex-by-group was found for 9/9 volumes, 7/39 cortical thickness regions, 3/9 white matter tracts, and 9/10 cognitive tests, indicating group differences that in some cases differ by age or sex. Volume reductions for several structures were larger in males than females, despite similar deficits of cognition in both sexes. Correlations between brain structure and cognitive scores were found in females of both groups, but were notably absent in males. Correlations within a given MRI modality (e.g. total brain volume and caudate volume) were prevalent in both the control and FASD groups, and were more numerous than correlations between measurement types (e.g. volumes and diffusion tensor imaging) in either cohort. This multi-modal MRI study finds widespread differences of brain structure in participants with prenatal alcohol exposure, and to a greater extent in males than females which may suggest attenuation of the expected process of sexual dimorphism of brain structure during typical development.
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Affiliation(s)
- Sarah Treit
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G-2R3, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Zhang Chen
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Dongming Zhou
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Lauren Baugh
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Carmen Rasmussen
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G-2R3, Canada; Department of Pediatrics, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G-2R3, Canada; FASD Diagnostic Clinic, Glenrose Rehabilitation Hospital, Edmonton, AB T6G-0B7, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB T6G-2R3, Canada
| | - Christian Beaulieu
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB T6G-2R3, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G-2R3, Canada.
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18
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Pei J, Baugh L, Andrew G, Rasmussen C. Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders. Res Dev Disabil 2017; 60:176-186. [PMID: 27987413 DOI: 10.1016/j.ridd.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/26/2016] [Accepted: 11/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorders (FASD) and prenatal alcohol exposure (PAE) experience multiple difficulties requiring various interventions. Researchers have called for investigation into service use with respect to clinically recommended interventions. AIMS To examine intervention recommendations for children with FASD/PAE and subsequent access to these recommended interventions. METHODS AND PROCEDURES Intervention recommendations following FASD assessment were examined for children (1-17 years). Recommendations were compared according to diagnostic status and demographic and environmental variables. Subsequent access to several interventions was examined for 45 participants. OUTCOMES AND RESULTS A variety of recommendations were given. Children with FASD received more recommendations overall and received more education, anticipatory guidance, family support, and safety recommendations than undiagnosed children with PAE. Undiagnosed children received more mental health and reassessment recommendations. Older children received fewer family support and developmental therapy recommendations but more mental health recommendations than younger age groups. Many families accessed modified school programming, developmental therapy, psychiatry, child counseling, and parent support as recommended. CONCLUSIONS AND IMPLICATIONS Children with FASD and PAE have extensive needs and should receive individualized recommendations. An assessment is valuable even without an FASD diagnosis. Areas of high/low service access may provide insight into accessibility and perceived importance of interventions. WHAT THIS PAPER ADDS This study responds to important research questions regarding the intervention needs of individuals with FASD. It is novel in its exploration of intervention recommendations given to children prenatally exposed to alcohol without an FASD diagnosis (rather than only children with FASD) and in its examination of post-assessment service use patterns specifically in relation to clinical recommendations.
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Affiliation(s)
- Jacqueline Pei
- Department of Educational Psychology, University of Alberta, 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Lauren Baugh
- Department of Educational Psychology, University of Alberta, 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, 3rd Floor, Edmonton, AB T6G 1C9, Canada; Glenrose Rehabilitation Hospital, 10230 111 Avenue Northwest, Edmonton, AB T5G 0B7, Canada.
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, 3rd Floor, Edmonton, AB T6G 1C9, Canada.
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Abstract
Researchers have reported benefits of working memory training in various populations, however, the training gains in preterm population is still inadequately studied. This study aimed to investigate the transfer and lasting effects of an online working memory training program on a group of preterm children aged between 4 and 6 years (mean gestational age = 28.3 weeks; mean birth weight = 1153 grams). Children were asked to perform the Cogmed JM at home for approximately 15 minutes a day, 5 days a week for 5 weeks. Their nontrained working memory and attention were assessed pre-training, post-training, and at 5-week follow-up. Parent ratings on children's executive functions were obtained at the three time points. Results revealed that significant improvements in verbal working memory was emerging in preterm children at 5-week follow-up, while significant gains in visuospatial working memory was found post-training and at 5-week follow-up in age-matched term-born children. These results indicated that working memory training has benefits on preterm children; however, the gains are different from those observed in term-born children. No significant differences in attention and parent-rated EF were found in either group across time. The possible explanations for the training benefits observed in preterm children were discussed.
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Affiliation(s)
- Clara S C Lee
- a Educational Psychology, University of Alberta , Edmonton , Alberta , Canada
| | - Jacqueline Pei
- a Educational Psychology, University of Alberta , Edmonton , Alberta , Canada
| | - Gail Andrew
- b Glenrose Rehabilitation Hospital , Edmonton , Alberta , Canada
| | - Kimberly A Kerns
- c Psychology, University of Victoria , Victoria , British Colombia , Canada
| | - Carmen Rasmussen
- d Glenrose Rehabilitation Hospital, Pediatrics , Edmonton , Alberta , Canada
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Treit S, Zhou D, Chudley AE, Andrew G, Rasmussen C, Nikkel SM, Samdup D, Hanlon-Dearman A, Loock C, Beaulieu C. Relationships between Head Circumference, Brain Volume and Cognition in Children with Prenatal Alcohol Exposure. PLoS One 2016; 11:e0150370. [PMID: 26928125 PMCID: PMC4771159 DOI: 10.1371/journal.pone.0150370] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Head circumference is used together with other measures as a proxy for central nervous system damage in the diagnosis of fetal alcohol spectrum disorders, yet the relationship between head circumference and brain volume has not been investigated in this population. The objective of this study is to characterize the relationship between head circumference, brain volume and cognitive performance in a large sample of children with prenatal alcohol exposure (n = 144) and healthy controls (n = 145), aged 5-19 years. All participants underwent magnetic resonance imaging to yield brain volumes and head circumference, normalized to control for age and sex. Mean head circumference, brain volume, and cognitive scores were significantly reduced in the prenatal alcohol exposure group relative to controls, albeit with considerable overlap between groups. Males with prenatal alcohol exposure had reductions in all three measures, whereas females with prenatal alcohol exposure had reduced brain volumes and cognitive scores, but no difference in head circumference relative to controls. Microcephaly (defined here as head circumference ≤ 3rd percentile) occurred more often in prenatal alcohol exposed participants than controls, but 90% of the exposed sample had head circumferences above this clinical cutoff indicating that head circumference is not a sensitive marker of prenatal alcohol exposure. Normalized head circumference and brain volume were positively correlated in both groups, and subjects with very low head circumference typically had below-average brain volumes. Conversely, over half of the subjects with very low brain volumes had normal head circumferences, which may stem from differential effects of alcohol on the skeletal and nervous systems. There were no significant correlations between head circumference and any cognitive score. These findings confirm group-level reductions in head circumference and increased rates of microcephaly in children with prenatal alcohol exposure, but raise concerns about the predictive value of this metric at an individual-subject level.
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Affiliation(s)
- Sarah Treit
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Dongming Zhou
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Albert E. Chudley
- Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- FASD Diagnostic Clinic, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah M. Nikkel
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawa Samdup
- Department of Pediatrics, Queens University, Kingston, Ontario, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Loock
- Department of Pediatrics, University of British Columbia and Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Christian Beaulieu
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Zhou D, Rasmussen C, Pei J, Andrew G, Reynolds J, Beaulieu C. ISDN2014_0383: Thinner cortex and reduced brain volumes in children and adolescents with prenatal alcohol exposure. Int J Dev Neurosci 2015. [DOI: 10.1016/j.ijdevneu.2015.04.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Dongming Zhou
- Biomedical EngineeringUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Jacqueline Pei
- Educational PsychologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital FASD ClinicEdmontonAlbertaCanada
| | - James Reynolds
- Biomedical and Molecular SciencesQueens UniversityKingstonOntarioCanada
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McLachlan K, Pei J, Kully‐Martens K, Paolozza A, Oberlander TF, Loock C, Andrew G, Reynolds J, Rasmussen C. ISDN2014_0204: Performance‐ and questionnaire‐based tools for the evaluation of executive function in children and adolescents with fetal alcohol spectrum disorder. Int J Dev Neurosci 2015. [DOI: 10.1016/j.ijdevneu.2015.04.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kaitlyn McLachlan
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
- Department of PediatricsUniversity of British ColumbiaVancouverBCCanada
| | - Jacqueline Pei
- Department of Educational PsychologyUniversity of AlbertaEdmontonABCanada
| | | | | | - Tim F. Oberlander
- Department of PediatricsUniversity of British ColumbiaVancouverBCCanada
| | - Christine Loock
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gail Andrew
- Glenrose Rehabilitation HospitalEdmontonABCanada
| | - James Reynolds
- Centre for Neuroscience StudiesQueens UniversityKingstonONCanada
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Treit S, Zhou D, Andrew G, Chudley A, Beaulieu C. ISDN2014_0283: Is head circumference an accurate proxy for brain volume in individuals with fetal alcohol spectrum disorders? Int J Dev Neurosci 2015. [DOI: 10.1016/j.ijdevneu.2015.04.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Sarah Treit
- Centre for NeuroscienceUniversity of AlbertaCanada
| | - Dongming Zhou
- Department of Biomedical EngineeringUniversity of AlbertaCanada
| | - Gail Andrew
- FASD Diagnostic ClinicGlenrose Rehabilitation HospitalCanada
| | - Albert Chudley
- Departments of Pediatrics and Child HealthBiochemistry and Medical GeneticsUniversity of ManitobaCanada
| | - Christian Beaulieu
- Centre for NeuroscienceUniversity of AlbertaCanada
- Department of Biomedical EngineeringUniversity of AlbertaCanada
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Vander Pluym JH, O'Sullivan J, Andrew G, Bolduc FV. Genomic characterization of chromosome 8 pericentric trisomy. Clin Case Rep 2015; 3:570-7. [PMID: 26273445 PMCID: PMC4527799 DOI: 10.1002/ccr3.234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/29/2015] [Indexed: 11/10/2022] Open
Abstract
We present a patient with trisomy 8p11.21q11.21 associated with language, gross motor, fine motor, and cognitive delay. Furthermore, using array-based comparative genomic hybridization, we identify the specific genes duplicated in our patient.
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Affiliation(s)
- Juliana H Vander Pluym
- Division of Pediatric Neuroscience, Stollery Children Hospital, University of Alberta Edmonton, Alberta, Canada
| | - Julia O'Sullivan
- Division of Pediatric Neuroscience, Stollery Children Hospital, University of Alberta Edmonton, Alberta, Canada
| | - Gail Andrew
- Division of Neurodevelopmental and Neuromotor Pediatrics, University of Alberta Edmonton, Alberta, Canada
| | - Francois V Bolduc
- Division of Pediatric Neuroscience, Stollery Children Hospital, University of Alberta Edmonton, Alberta, Canada ; Neuroscience and Mental Health Institute, University of Alberta Edmonton, Alberta, Canada
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Bell E, Andrew G, Di Pietro N, Chudley AE, N. Reynolds J, Racine E. It’s a Shame! Stigma Against Fetal Alcohol Spectrum Disorder: Examining the Ethical Implications for Public Health Practices and Policies. Public Health Ethics 2015. [DOI: 10.1093/phe/phv012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Hanlon-Dearman A, Green CR, Andrew G, LeBlanc N, Cook JL. Anticipatory guidance for children and adolescents with Fetal Alcohol Spectrum Disorder (FASD): practice points for primary health care providers. J Popul Ther Clin Pharmacol 2015; 22:e27-e56. [PMID: 25599159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of effects that can occur in an individual who was prenatally exposed to alcohol and includes an array of complex neurodevelopmental and physical findings. OBJECTIVES To give primary healthcare providers (PHCP) evidence-based recommendations for supporting and managing the symptoms of FASD after patients have received a diagnosis. MethodsPrimary health recommendations for the management of children and adolescents with FASD were developed based on expert clinical judgment and supported by evidence-based research, where appropriate. The format was adapted from other health supervision practice guidelines as developed by the American Academy of Pediatrics. Clinical practice "Points" for the PHCP are highlighted. A reference table of anticipatory recommendations by age is presented. RESULTS In most cases, the initial screening and referral for diagnosis will be made by the PHCP, and they will be responsible for ongoing management. It is anticipated that these recommendations will provide the PHCP with evidence to support the longitudinal health care of children and adolescents with FASD and their families as they transition throughout all developmental stages. CONCLUSION There is a pressing need for the involvement of PHCP in the active care of children and adolescents with FASD and their families over the lifespan. PHCP are trained in screening, prevention, and management of health needs, and are in the position to coordinate sub-specialty referrals as needed. Engaging PHCP will provide a truly integrated care system for individuals with FASD and their families.
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LaFrance MA, McLachlan K, Nash K, Andrew G, Loock C, Oberlander TF, Koren G, Rasmussen C. Evaluation of the neurobehavioral screening tool in children with fetal alcohol spectrum disorders (FASD). J Popul Ther Clin Pharmacol 2014; 21:e197-e210. [PMID: 24897061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND There is a growing need for validated tools to screen children at risk of fetal alcohol spectrum disorders (FASD). The Neurobehavioral Screening Tool (NST) is one of several promising screening measures for FASD, though further evidence is needed to establish the tool's psychometric utility. OBJECTIVE To assess the predictive accuracy of the NST among children with an FASD diagnosis, with prenatal alcohol exposure (PAE) but no FASD diagnosis, and typically developing controls. METHOD The NST was completed by caregivers of children ages 6 to 17, including 48 with FASD, 22 with PAE, and 32 typically developing non-exposed controls. Predictive accuracy coefficients were calculated using Nash et al. (2006) criteria, and compared against controls. An alternative scoring scheme was also investigated to determine optimum referral thresholds using item-level total scores. RESULTS The NST yielded 62.5% sensitivity for participants with FASD and 50% for PAE. Specificity values were 100% with no typically developing control scoring positive. Within the FASD group there was a trend for higher sensitivity among adolescents aged 12 to17 (70.8%) compared with children aged 6 to 11 years (54.2%), p = 0.23. CONCLUSION The findings support a growing body of literature evidencing psychometric promise for the clinical utility of the NST as an FASD screening tool, though further research on possible age-effects is warranted. The availability of a validated clinical screening tool for FASD, such as the NST, would aid in accurately screening a large number of children and lead to a timelier diagnostic referral.
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Treit S, Zhou D, Lebel C, Rasmussen C, Andrew G, Beaulieu C. Longitudinal MRI reveals impaired cortical thinning in children and adolescents prenatally exposed to alcohol. Hum Brain Mapp 2014; 35:4892-903. [PMID: 24700453 DOI: 10.1002/hbm.22520] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 12/12/2022] Open
Abstract
Brain imaging studies suggest that cortical thickness decreases during childhood and adolescence, in concert with underlying structural and synaptic changes required for cognitive maturation and regional specialization of function. Abnormalities of this protracted developmental process may provide key insights into the cognitive and behavioral deficits that emerge in individuals with fetal alcohol spectrum disorders (FASD). Several studies have demonstrated cortical thickness differences in children and adolescents who were prenatally exposed to alcohol, though all have been cross sectional, limiting conclusions about cortical development with age. In this study, we analyze serially collected T1 -weighted MRI from 11 children with FASD and 21 controls, scanned twice each ∼2 to 4 years apart. Mixed-models analysis of cortical thickness measurements revealed age-by-group interactions in cortical thinning, with FASD participants undergoing less developmental thinning than controls across many regions of the cortex, particularly in medial frontal and parietal areas. These results provide further longitudinal evidence in humans that prenatal alcohol exposure is associated with altered patterns of brain development that persist during childhood and adolescence.
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Affiliation(s)
- Sarah Treit
- Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Racine E, Bell E, Yan A, Andrew G, Bell LE, Clarke M, Dubljevic V, Goldowitz D, Janvier A, McLachlan K, Muhajarine N, Nicholas D, Oskoui M, Rasmussen C, Rasmussen LA, Roberts W, Shevell M, Wade L, Yager JY. Ethics challenges of transition from paediatric to adult health care services for young adults with neurodevelopmental disabilities. Paediatr Child Health 2014; 19:65-8. [PMID: 24596475 DOI: 10.1093/pch/19.2.65] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Racine
- Neuroethics Research Unit; ; Département de médecine, Université de Montréal; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Emily Bell
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | | | - Gail Andrew
- Neurodevelopmental/Neuromotor Division, Department of Pediatrics, University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Lorraine E Bell
- Department of Pediatrics, Division of Nephrology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec
| | - Margaret Clarke
- Departments of Pediatrics/Psychiatry, Alberta Children's Hospital, Calgary, Alberta
| | - Veljko Dubljevic
- Neuroethics Research Unit; ; Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Quebec
| | - Dan Goldowitz
- NeuroDevNet, Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia
| | - Annie Janvier
- Division of Neonatology and Clinical Ethics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Lisa Anne Rasmussen
- Departments of Pediatrics and Neurology, McGill University, Montreal Children's Hospital, Montreal, Quebec
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | | | - Lucie Wade
- Ethics Program Office, Jewish General Hospital, Montreal, Quebec
| | - Jerome Y Yager
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Paolozza A, Rasmussen C, Pei J, Hanlon-Dearman A, Nikkel SM, Andrew G, McFarlane A, Samdup D, Reynolds JN. Working memory and visuospatial deficits correlate with oculomotor control in children with fetal alcohol spectrum disorder. Behav Brain Res 2014; 263:70-9. [PMID: 24486257 DOI: 10.1016/j.bbr.2014.01.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 11/28/2022]
Abstract
Previous studies have demonstrated that children with Fetal Alcohol Spectrum Disorder (FASD) exhibit deficits in measures of eye movement control that probe aspects of visuospatial processing and working memory. The goal of the present study was to examine, in a large cohort of children with FASD, prenatal alcohol exposure (PAE) but not FASD, and typically developing control children, the relationship between performance in eye movement tasks and standardized psychometric tests that assess visuospatial processing and working memory. Participants for this dataset were drawn from a large, multi-site investigation, and included children and adolescents aged 5-17 years diagnosed with an FASD (n=71), those with PAE but no clinical FASD diagnosis (n=20), and typically developing controls (n=111). Participants completed a neurobehavioral test battery and a series of saccadic eye movement tasks. The FASD group performed worse than controls on the psychometric and eye movement measures of working memory and visuospatial skills. Within the FASD group, digit recall, block recall, and animal sorting were negatively correlated with sequence errors on the memory-guided task, and arrows was negatively correlated with prosaccade endpoint error. There were no significant correlations in the control group. These data suggest that psychometric tests and eye movement control tasks may assess similar domains of cognitive function, and these assessment tools may be measuring overlapping brain regions damaged due to prenatal alcohol exposure. The results of this study demonstrate that eye movement control tasks directly relate to outcome measures obtained with psychometric tests and are able to assess multiple domains of cognition simultaneously, thereby allowing for an efficient and accurate assessment.
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Affiliation(s)
- Angelina Paolozza
- Centre for Neuroscience Studies, Queens University, Kingston, ON, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jacqueline Pei
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Sarah M Nikkel
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | | | - Dawa Samdup
- Centre for Neuroscience Studies, Queens University, Kingston, ON, Canada
| | - James N Reynolds
- Centre for Neuroscience Studies, Queens University, Kingston, ON, Canada.
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Paolozza A, Rasmussen C, Pei J, Hanlon-Dearman A, Nikkel SM, Andrew G, McFarlane A, Samdup D, Reynolds JN. Deficits in response inhibition correlate with oculomotor control in children with fetal alcohol spectrum disorder and prenatal alcohol exposure. Behav Brain Res 2013; 259:97-105. [PMID: 24185031 DOI: 10.1016/j.bbr.2013.10.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/15/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
Abstract
Children with fetal alcohol spectrum disorder (FASD) or prenatal alcohol exposure (PAE) frequently exhibit impairment on tasks measuring inhibition. The objective of this study was to determine if a performance-based relationship exists between psychometric tests and eye movement tasks in children with FASD. Participants for this dataset were aged 5-17 years and included those diagnosed with an FASD (n=72), those with PAE but no clinical FASD diagnosis (n=21), and typically developing controls (n=139). Participants completed a neurobehavioral test battery, which included the NEPSY-II subtests of auditory attention, response set, and inhibition. Each participant completed a series of saccadic eye movement tasks, which included the antisaccade and memory-guided tasks. Both the FASD and the PAE groups performed worse than controls on the subtest measures of attention and inhibition. Compared with controls, the FASD group made more errors on the antisaccade and memory-guided tasks. Among the combined FASD/PAE group, inhibition and switching errors were negatively correlated with direction errors on the antisaccade task but not on the memory-guided task. There were no significant correlations in the control group. These data suggests that response inhibition deficits in children with FASD/PAE are associated with difficulty controlling saccadic eye movements which may point to overlapping brain regions damaged by prenatal alcohol exposure. The results of this study demonstrate that eye movement control tasks directly relate to outcome measures obtained with psychometric tests that are used during FASD diagnosis, and may therefore help with early identification of children who would benefit from a multidisciplinary diagnostic assessment.
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Rasmussen C, Tamana S, Baugh L, Andrew G, Tough S, Zwaigenbaum L. Neuropsychological impairments on the NEPSY-II among children with FASD. Child Neuropsychol 2012; 19:337-49. [PMID: 22384972 DOI: 10.1080/09297049.2012.658768] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND We examined the pattern of neuropsychological impairments of children with FASD (compared to controls) on NEPSY-II measures of attention and executive functioning, language, memory, visuospatial processing, and social perception. METHODS Participants included 32 children with FASD and 30 typically developing control children, ranging in age from 6 to 16 years. Children were tested on the following subtests of the NEPSY-II: Attention and Executive Functioning (animal sorting, auditory attention/response set, and inhibition), Language (comprehension of instructions and speeded naming), Memory (memory for names/delayed memory for names), Visual-Spatial Processing (arrows), and Social Perception (theory of mind). Groups were compared using MANOVA. RESULTS Children with FASD were impaired relative to controls on the following subtests: animal sorting, response set, inhibition (naming and switching conditions), comprehension of instructions, speeded naming, and memory for names total and delayed, but group differences were not significant on auditory attention, inhibition (inhibition condition), arrows, and theory of mind. Among the FASD group, IQ scores were not correlated with performance on the NEPSY-II subtests, and there were no significant differences between those with and without comorbid ADHD. CONCLUSIONS The NEPSY-II is an effective and useful tool for measuring a variety of neuropsychological impairments among children with FASD. Children with FASD displayed a pattern of results with impairments (relative to controls) on measures of executive functioning (set shifting, concept formation, and inhibition), language, and memory, and relative strengths on measures of basic attention, visual spatial processing, and social perception.
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Affiliation(s)
- Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
BACKGROUND The goal of this study was to examine social skills deficits among children with and without prenatal alcohol exposure (PAE) who were both referred to a respite programme. METHODS Thirty-seven children with PAE and 23 non-exposed children (aged 3 to 8 years) were evaluated on the Social Skills Rating System (SSRS) by their caregivers and respite workers. RESULTS As compared with the non-exposed children, those with PAE showed more deficits on caregiver ratings of responsibility, hyperactivity, internalizing problems and overall social skills, as well as respite worker ratings of hyperactivity. The social skills among the PAE group were not related to home placement variables. Among both groups, caregivers rated social skills lower than respite workers, and among the PAE group, girls tended to display more social skills deficits than boys. CONCLUSIONS The SSRS is useful in identifying unique social skills deficits among children with PAE.
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Affiliation(s)
- C Rasmussen
- Section of Pediatric Neurosciences, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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Zhou D, Lebel C, Lepage C, Rasmussen C, Evans A, Wyper K, Pei J, Andrew G, Massey A, Massey D, Beaulieu C. Developmental cortical thinning in fetal alcohol spectrum disorders. Neuroimage 2011; 58:16-25. [PMID: 21704711 DOI: 10.1016/j.neuroimage.2011.06.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/08/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022] Open
Abstract
Regional cortical thickness was evaluated using CIVET processing of 3D T1-weighted images (i) to compare the variation in cortical thickness between 33 participants with fetal alcohol spectrum disorders (FASD) aged 6-30 years (mean age 12.3 years) versus 33 age/sex/hand-matched controls, and (ii) to examine developmental changes in cortical thickness with age from children to young adults in both groups. Significant cortical thinning was found in the participants with FASD in large areas of the bilateral middle frontal lobe, pre- and post- central areas, lateral and inferior temporal and occipital lobes compared to controls. No significant cortical thickness increases were observed for the FASD group. Cortical thinning with age in a linear model was observed in both groups, but the locations were different for each group. FASD participants showed thinning with age in the left middle frontal, bilateral precentral, bilateral precuneus and paracingulate, left inferior occipital and bilateral fusiform gyri; while controls showed decreases with age in the bilateral middle frontal gyrus, right inferior frontal gyrus, bilateral precuneus gyrus, and bilateral occipital gyrus. A battery of cognitive assessments of memory, attention, motor, and verbal abilities was conducted with many of the FASD participants, but no significant correlations were found between these cognitive scores and regional cortical thickness. Non-invasive measurements of cortical thickness in children to young adults with FASD have identified both key regions of cortex that may be more deleteriously affected by prenatal alcohol exposure as well as cortical changes with age that differ from normal developmental thinning.
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Affiliation(s)
- Dongming Zhou
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Nardelli A, Lebel C, Rasmussen C, Andrew G, Beaulieu C. Extensive deep gray matter volume reductions in children and adolescents with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2011; 35:1404-17. [PMID: 21575012 DOI: 10.1111/j.1530-0277.2011.01476.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The link between the numerous cognitive, motor, and behavioral difficulties of individuals with fetal alcohol spectrum disorders (FASD) and underlying specific structural brain injuries can be investigated using high-resolution imaging. Differential sensitivity of the brain's "relay" stations, namely the deep gray matter structures, may play a key factor given their multifaceted role in brain function. The purpose of our study was to analyze differences in deep gray matter volumes of children and adolescents with FASD relative to age/sex-matched controls and to examine whether any volume differences were consistent across the age range of neurodevelopment. METHODS Children and adolescents (N = 28, 6 to 17 years) diagnosed with FASD and 56 age- and sex-matched healthy controls (i.e., 2 matched controls per FASD subject) underwent 3-dimensional T1-weighted MRI scans that were used for the automated volume measurement (FreeSurfer) of the intracranial space, total white matter, cortical gray matter, and 6 deep gray matter structures, namely the hippocampus, amygdala, thalamus, caudate, putamen, and globus pallidus, with left and right measured separately. Volumes were compared between FASD and controls, as well as changes with age. RESULTS Significant reductions of volume in FASD were observed for the intracranial vault (7.6%), total white matter (8.6%), total cortical gray matter (7.8%), and total deep gray matter (13.1%). All 6 deep gray matter structures showed significant volume reductions bilaterally with the caudate (approximately 16%) and globus pallidus (approximately 18%) being most affected. The hippocampus, thalamus, and globus pallidus showed reductions in all 3 age subgroups (6 to 9, 10 to 13, and 14 to 17 years) but the caudate and putamen had smaller volumes for FASD only within the 2 youngest subgroups; the amygdala was only smaller for FASD in the 2 oldest subgroups. CONCLUSIONS Significant, but variable, volume reductions throughout the deep gray matter are observed over a wide age range of 6 to 17 years in FASD.
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Affiliation(s)
- Alexa Nardelli
- Centre for Neuroscience, University of Alberta, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
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Huntingford FA, Andrew G, Mackenzie S, Morera D, Coyle SM, Pilarczyk M, Kadri S. Coping strategies in a strongly schooling fish, the common carp Cyprinus carpio. J Fish Biol 2010; 76:1576-1591. [PMID: 20557617 DOI: 10.1111/j.1095-8649.2010.02582.x] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Individual common carp Cyprinus carpio were screened repeatedly for risk taking (rate of exploration of a novel, potentially dangerous environment) and for competitive ability (success in gaining access to a spatially restricted food source). Marked differences in behaviour were evident, and significant consistency in individual responses across trials was found for both risk taking and competitive ability. In addition, there was a significant positive relationship between individual performance in these two contexts, with fish that explored more quickly in the novel environment tending to be among the first to gain access to restricted food. In two follow-up studies, resting metabolic rate, blood lactate and glucose and the expression of the cortisol receptor gene in the head kidney and brain were compared in fish from the two extremes of the risk-taking spectrum. Mass-specific metabolic rate was significantly higher in risk-taking than in risk-avoiding fish, while plasma lactate and glucose concentrations and expression of the cortisol receptor gene were lower. It was concluded that a behavioural syndrome based on boldness and aggression exists in C. carpio, as it does in many other animals, and that this is associated with differences in metabolic and stress physiology (down to the genomic level) similar to those described in animals with different coping strategies.
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Affiliation(s)
- F A Huntingford
- Fish Biology Group, Division of Ecology & Evolutionary Biology, Faculty of Biomedical & Life Sciences, Glasgow G12 8QQ, UK.
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Rasmussen C, Benz J, Pei J, Andrew G, Schuller G, Abele-Webster L, Alton C, Lord L. The impact of an ADHD co-morbidity on the diagnosis of FASD. Can J Clin Pharmacol 2010; 17:e165-e176. [PMID: 20395649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Many children with Fetal Alcohol Spectrum Disorders (FASD) also have co-morbid ADHD. The goal of this study was to examine the impact of having a co-morbid ADHD diagnosis on FASD diagnostic results. We compared children with FASD to those with FASD and co-morbid ADHD across the neurobehavioral domains recommended by the Canadian Guidelines in the diagnosis of FASD. METHODS We retrospectively analyzed data from 52 children, aged 4 to 17 years, diagnosed with an FASD at a hospital FASD clinic. Thirty-three of these children had a co-morbid diagnosis of ADHD and 19 did not. Children with FASD and those with FASD and co-morbid ADHD were compared on the following neurobehavioral domains: sensory/motor, cognition, communication, academic achievement, memory, executive functioning, attention, and adaptive behavior. RESULTS Children with FASD and ADHD performed significantly worse than those without ADHD on attention but better on academic achievement. No other group differences were significant. CONCLUSIONS Having an ADHD co-morbidity had little effect on the FASD diagnosis. The results of this project will inform the diagnostic process for FASD and have implications for standardizing diagnostic processes across clinics.
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Bell SH, Stade B, Reynolds JN, Rasmussen C, Andrew G, Hwang PA, Carlen PL. The remarkably high prevalence of epilepsy and seizure history in fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2010; 34:1084-9. [PMID: 20374205 DOI: 10.1111/j.1530-0277.2010.01184.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is the umbrella term that describes the range of adverse developmental outcomes that may occur in the offspring of mothers who drink alcohol during pregnancy. FASD is associated with several comorbidities including epilepsy. The objective of the study was to evaluate the prevalence of epilepsy or a history of seizures in subjects with FASD and the contribution of relevant risk factors. METHODS A retrospective chart review was conducted on all active charts (N = 1063) at two FASD clinics. After exclusion of subjects without a confirmed diagnosis, a total of 425 subjects between the ages of 2-49 were included in the analysis. The relationships between FASD diagnosis and other risk factors for co-occurrence of epilepsy or a seizure disorder (e.g., extent of exposure to alcohol and other drugs, type of birth, and trauma) were examined using chi-square and multivariate multinomial logistic regression. RESULTS Twenty-five (5.9%) individuals in the study population had a confirmed diagnosis of epilepsy, and 50 (11.8%) had at least one documented seizure episode, yielding an overall prevalence of 17.7% in this population. Importantly, a history of epilepsy or seizures was not different across the three diagnostic subgroups. In those subjects with available maternal drinking histories, first trimester exposure or drinking throughout all three trimesters were the predominant forms of fetal exposure. None of the other risk factors were associated with a greater prevalence of epilepsy or seizures. CONCLUSIONS There is a remarkably high prevalence of epilepsy/seizures in the FASD population.
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Affiliation(s)
- Stephanie H Bell
- Department of Pharmacology and Toxicology, and Centre for Neuroscience Studies, Queens University, Kingston, ON, Canada
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Lebel C, Rasmussen C, Wyper K, Andrew G, Beaulieu C. Brain Microstructure Is Related to Math Ability in Children With Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2010; 34:354-63. [PMID: 19930234 DOI: 10.1111/j.1530-0277.2009.01097.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Catherine Lebel
- Department of Biomedical Engineering, University of Alberta, Alberta, Canada
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Carlen P, Bell S, Reynolds J, Stade B, Hwang P, Rasmussen C, Andrew G. FP38-WE-04 The high prevalence of epilepsy and seizures in the fetal alcohol spectrum disorder. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE The goal of this study was to examine whether children with foetal alcohol spectrum disorders (FASD) show the same developmental transition from visual to verbal memory strategies as in non-FASD children and whether this transition was related to executive functioning and vocabulary skills. METHODS Younger (5-6 years) and older (8-10 years) children with FASD and non-FASD children were tested on a picture memory task. RESULTS Among both age groups, the non-FASD children performed better than those with FASD. Younger children with FASD appeared to use a visual approach, whereas older children with FASD appeared to use a verbal approach. However, among the non-FASD group both age groups appeared to use a verbal approach. Among the FASD group, the transition from a visual to verbal approach was correlated with executive functioning skills. IMPLICATIONS Strategies for classroom approaches as well as strategy training are discussed.
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Benz J, Rasmussen C, Andrew G. Diagnosing fetal alcohol spectrum disorder: History, challenges and future directions. Paediatr Child Health 2009; 14:231-7. [PMID: 20357921 PMCID: PMC2690536 DOI: 10.1093/pch/14.4.231] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2008] [Indexed: 02/04/2023] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is one of the most common preventable causes of developmental disability, and is currently one of the most pressing public health concerns in Canada. FASD refers to the range of physical, mental, behavioural and learning disabilities that an individual may acquire as a result of maternal alcohol consumption. In the present paper, the history of the diagnostic approach to alcohol-related disorders over the past 35 years is reviewed. Research supporting the importance of early diagnosis for the long-term outcomes and management of individuals with FASD is presented, and challenges that have plagued efforts to efficiently diagnose individuals with FASD are discussed. Finally, the study reviews the future directions and implications regarding current diagnostic strategies.
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Affiliation(s)
- Jennifer Benz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Lebel C, Rasmussen C, Wyper K, Walker L, Andrew G, Yager J, Beaulieu C. Brain diffusion abnormalities in children with fetal alcohol spectrum disorder. Alcohol Clin Exp Res 2008; 32:1732-40. [PMID: 18671811 DOI: 10.1111/j.1530-0277.2008.00750.x] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with fetal alcohol spectrum disorder (FASD) have a variety of cognitive, behavioral, and neurological impairments, including structural brain damage. Despite the importance of white matter connections for proper brain function, little is known about how these connections, and the deep gray matter structures that act as relay stations, are affected in children with FASD. The purpose of this study was to use diffusion tensor imaging, an advanced magnetic resonance imaging technique, to examine microstructural differences of white and deep gray matter in children with FASD. METHODS Subjects were 24 children aged 5-13 years previously diagnosed with FASD and 95 healthy children over the same age range. Diffusion tractography was used to delineate 10 major white matter tracts in each individual, and region-of-interest analysis was used to assess 4 deep gray matter structures. Fractional anisotropy, an indicator of white matter integrity, and mean diffusivity, a measure of the average water diffusion, were assessed in all 14 brain structures. RESULTS Diffusion tensor imaging revealed significant differences of diffusion parameters in several areas of the brain, including the genu and splenium of the corpus callosum, cingulum, corticospinal tracts, inferior fronto-occipital fasciculus, inferior and superior longitudinal fasciculi, globus pallidus, putamen, and thalamus. Reduced white and gray matter volumes, as well as total brain volume, were observed in the FASD group. CONCLUSIONS These results demonstrate diffusion abnormalities in FASD beyond the corpus callosum and suggest that several specific white matter regions, particularly commissural and temporal connections, and deep gray matter areas of the brain are sensitive to prenatal alcohol exposure.
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Affiliation(s)
- Catherine Lebel
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Rasmussen C, Andrew G, Zwaigenbaum L, Tough S. Neurobehavioural outcomes of children with fetal alcohol spectrum disorders: A Canadian perspective. Paediatr Child Health 2008; 13:185-91. [PMID: 19252695 PMCID: PMC2529423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2007] [Indexed: 05/27/2023] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is one of the most common preventable causes of developmental disability and is currently one of the most pressing public health concerns in Canada. FASD refers to the range of physical, mental, behavioural and learning disabilities that an individual may acquire as a result of maternal alcohol consumption. Prenatal exposure to alcohol leads to numerous primary and secondary disabilities in affected children, which can result in poor long-term outcomes. The present paper reviews previous research on the neurobehavioural outcomes of children with FASD, particularly in terms of behavioural, mental health and adaptive outcomes. The role of risk and protective factors on these outcomes and the impact of FASD on the family are also examined. Finally, future directions and implications regarding outcomes research among children with FASD, particularly within a Canadian context, are discussed.
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Affiliation(s)
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton
| | | | - Suzanne Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta
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Loomes C, Rasmussen C, Pei J, Manji S, Andrew G. The effect of rehearsal training on working memory span of children with fetal alcohol spectrum disorder. Res Dev Disabil 2008; 29:113-24. [PMID: 17317098 DOI: 10.1016/j.ridd.2007.01.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 01/05/2007] [Accepted: 01/19/2007] [Indexed: 05/14/2023]
Abstract
A key area of weakness in individuals with fetal alcohol spectrum disorder (FASD) is working memory, thus the goal of this study was to determine whether teaching children (aged 4-11) with FASD verbal rehearsal would increase their memory. Rehearsal training has been effective in other populations with working memory difficulties, so we hypothesized that children with FASD would also benefit from rehearsal training. Children were divided into an Experimental group, who received rehearsal training and a Control group, who did not receive training. All children were tested on digit span tasks over three sessions: a pretest (baseline) and then post-test 1 and post-test 2 (where only the Experimental group received rehearsal training). The Experimental group showed a significant increase in performance across session but the Control group did not. Children in the Experimental group performed significantly higher than the Control group on post-test 2 but not on the pretest or post-test 1. More children in the Experimental group showed behavioral evidence and self-report of rehearsal after training. Rehearsal training was successful at increasing the memory for numbers among children with FASD and may help to ameliorate working memory difficulties in FASD, ultimately supporting academic and developmental growth of children with FASD.
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Affiliation(s)
- Carly Loomes
- Department of Pediatrics, University of Alberta, 137 Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, Alberta, Canada T5G 0B7
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Abstract
OBJECTIVES The lie-telling abilities of children with fetal alcohol spectrum disorder (FASD) (aged 4-8 years) were tested using a temptation resistance paradigm. METHODS Children were told not to peek at a forbidden toy while left alone in a room. Later children were asked if they peeked at the toy as well as follow-up questions to see if they could conceal their peeking behavior and maintain their lie in subsequent verbal statements. RESULTS Approximately 78% of the children peeked at the toy. However, 94% of the FASD children lied about peeking, a rate that is much higher than the non-FASD control group (72%). As age increased, FASD children were better at concealing their lies and maintaining semantic leakage control than non-FASD children. CONCLUSIONS This is the first study to specifically test lying in children with FASD and has implications for remediation and understanding secondary disabilities in these children, which will lead to further research in this area.
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Affiliation(s)
- Carmen Rasmussen
- Department of Pediatrics, University of Alberta, 137 Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada T5G 0B7.
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Abstract
The preoperative concerns of patients undergoing total knee or hip arthroplasty were evaluated in a cross-sectional study of 370 patients. Patients completed a questionnaire on 29 concerns, each rated on a scale of 1 (not concerned) to 4 (very concerned). Short Form 12 and Oxford hip or knee scores were also calculated. The results showed that the greatest concern for patients was cancellation of the surgery. This was followed by failure of the surgery to reduce pain, loss of a limb, and joint infection. Concerns regarding scar problems, nursing care, and preoperative tests were the lowest. Women showed statistically significant greater concerns in 9 areas. Younger patients (age, <65) showed increased concerns in 8 areas. Patients who had previously undergone joint arthroplasty were less concerned than those who had not undergone previous lower limb joint arthroplasty for 6 responses. They showed increased concern in 2 areas, nursing care and hospital food. Those undergoing total hip arthroplasty were more concerned about dislocation, dressing, and returning to work (all, P<.05). This study provides useful information for the preoperative counseling of patients and the production of preoperative literature.
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Affiliation(s)
- M Moran
- Department of Orthopaedic Surgery, North Manchester General Hospital, Manchester, United Kingdom
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Andrew G, Horne K, Reynolds M, Schuller G, Abele-Webster L. Defining The Brain Dysfunction in Fetal Alcohol Spectrum Disorder. Paediatr Child Health 2003. [DOI: 10.1093/pch/8.suppl_b.48b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moran M, Khan A, Sochart DH, Andrew G. Expect the best, prepare for the worst: surgeon and patient expectation of the outcome of primary total hip and knee replacement. Ann R Coll Surg Engl 2003; 85:204-6. [PMID: 12831497 PMCID: PMC1964367 DOI: 10.1308/003588403321661415] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A cross-sectional study of 100 surgeons and 370 patients awaiting primary total hip or knee replacement was carried out. Oxford hip or knee score questionnaires were sent to the surgeons and patients. They were asked to predict the level of symptoms expected 6 months following surgery. The Oxford scores derive a value of 12-60, with a greater score indicating worsening symptoms. The mean pre-operative score was 45.12 for the hip patients and 42.96 for the knee patients, and the patients expected this to drop to 23.70 and 25.66, respectively, 6 months' postoperatively. This was a significant difference for both groups. The surgeons expected the patients to have a mean postoperative score of 20.91 for the hip group and 22.19 for the knee group. The surgeons' scores were significantly lower than those from the patients. There was a significant difference between the patients' and surgeons' expectations of the results of total knee and hip replacement surgery. The surgeons expected better results than the patients. We believe that this is the first study that directly compares surgeon and patient expectations of lower limb arthroplasty.
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Affiliation(s)
- M Moran
- Department of Orthopaedic Surgery, North Manchester General Hospital, Manchester, UK.
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