Principal Investigator: Philip A. May, Ph.D.
The long-term objective of this proposal is to determine if there is a unique neurobehavioral profile in children exposed to alcohol prenatally. Even though a large body of literature on cognitive-emotional functioning in alcohol-exposed children exists, it is unknown if there is a signature neurobehavioral profile in children with fetal alcohol syndrome (FAS) spectrum disorder. Specific aims of the current investigation are: 1. to assess cognitive-emotional functioning in children diagnosed with FAS spectrum disorder from a community in South Africa and a number of American Indian reservations in the Northern Plains States. A core test battery designed by the NIAAA-supported Consortium of International Collaborative Research on Fetal Alcohol Spectrum Disorder will be utilized in this international study; 2. to test a specific statistical model of neurocognitive functioning (radex model) with the aim of further elucidating cognitive dysfunction in alcohol-affected children. The health relatedness of the project is that the identification of neurobehavioral profile in children with prenatal alcohol exposure will tremendously help clinician diagnose children with FAS spectrum disorder, specifically those alcohol-exposed children without evidence of dysmorphia. Identification of a profile of strengths and weaknesses of cognitive-emotional functioning is also essential for developing evidence-based interventions for children with FAS spectrum disorder. Specifically, clinicians will be able to design programs that capitalize on strengths to address weaknesses in cognitive emotional functioning of these children. The research design of the proposed project involves a comparison of test performance of alcohol-affected children with that of typically developing children matched for age, sex, SES, and ethnicity. Participants in South Africa will be 100 children previously diagnosed as having FAS by an international team of dysmorphologists and 100 case controls. The American Indian sample will be made of volunteers from 50 children diagnosed with a FAS spectrum disorder through the University of New Mexico FAS Epidemiology Research Project. Case controls (n=50) will be selected from the same communities. The test battery will be comprised of tests designed to measure general cognitive ability, attention, executive functioning, language, visual perception, memory, motor skills and emotional functioning. The data gathered through the core test battery will combined with those collected by other participants in the international collaborative project (e.g. Russia, Finland, Italy, and other various sites in the US) to create a large data base. It is expected that this international collaborative project afford a rare opportunity to researchers to answer many questions pertaining to cognitive-emotional functioning of alcohol-affected children and to design evidence-based interventions.
Educational Intervention
Despite ongoing efforts to prevent maternal drinking during pregnancy, prenatal alcohol exposure continues to be the leading non-genetic cause of mental retardation. As the result of ongoing epidemiological studies in South Africa since 1999, the prevalence of fetal alcohol syndrome (FAS) in the Western Cape Region of South Africa has been found to range from 46 per 1000 to 75 per thousand among school children ages 5 to 9 years. These are the highest recorded rates in any general community in the world and are many times higher than prevalence estimates for the United States. Even though the need for developing intervention programs for alcohol-affected children has long been recognized, no systematic outcome studies of such intervention programs exist. Therefore, the current project aims to test the efficacy of three intervention methods in the remediation of specific behavioral and learning problems in alcohol-affected children in the Western Cape Province of South Africa. The specific aims of the multi-method study are: 1) To determine the degree to which cognitive control therapy improves academic skills and behavior in alcohol-exposed children; 2) To determine the degree to which family interventions improve academic skills and behavior of alcohol-exposed children; 3) To determine the degree to which specific linguistic and literacy training programs improve academic skills and behavior of alcohol-exposed children; 4) To determine the degree to which environmental modifications in the classroom (e.g. limited class size and structured teaching) improve academic skills and behavior in alcohol-exposed children; 5) To determine the degree to which combinations of above methods improve academic skills and behavior in alcohol-exposed children; 6) To assess the effects of 3 mediating variables (self-efficacy, attention, meta-cognitive skills) and 3 moderating variables (child's IQ, life stress, maternal education) on therapeutic outcomes.
Eighty children, ages 7 to 9 will be recruited through an epidemiological study currently being conducted in the Western Region of South Africa. Twenty children will be randomly assigned to one of four groups, three treatment groups (cognitive control therapy, family support, and linguistic and literacy training) and one control group consisting of both alcohol-exposed and typically developing children. During the first phase of the project, all treatment and control-group children will be administered a comprehensive battery of tests consisting of a neuropsychological test battery, tests of academic achievement, selected speech/language tests, and a functional behavior assessment. The pre-testing will serve the following two distinct purposes: 1) to provide pretest data for each child in the research cohort and, 2) to identify current educational and behavioral issues for each child in the study. Following the pre-testing, each of the three proposed intervention methods will be administered once a week with children in each study group over a period of 18 months. In addition, each child in the study will be observed by a blinded observer 4 times in the prescribed time of intervention. After the 18- month intervention trial, the same testing battery will be administered as post-intervention measures. The pre-test and post-test performance of the children will be analyzed.
The long-term objective of this proposal is to determine if there is a unique neurobehavioral profile in children exposed to alcohol prenatally. Even though a large body of literature on cognitive-emotional functioning in alcohol-exposed children exists, it is unknown if there is a signature neurobehavioral profile in children with fetal alcohol syndrome (FAS) spectrum disorder. Specific aims of the current investigation are: 1. to assess cognitive-emotional functioning in children diagnosed with FAS spectrum disorder from a community in South Africa and a number of American Indian reservations in the Northern Plains States. A core test battery designed by the NIAAA-supported Consortium of International Collaborative Research on Fetal Alcohol Spectrum Disorder will be utilized in this international study; 2. to test a specific statistical model of neurocognitive functioning (radex model) with the aim of further elucidating cognitive dysfunction in alcohol-affected children. The health relatedness of the project is that the identification of neurobehavioral profile in children with prenatal alcohol exposure will tremendously help clinician diagnose children with FAS spectrum disorder, specifically those alcohol-exposed children without evidence of dysmorphia. Identification of a profile of strengths and weaknesses of cognitive-emotional functioning is also essential for developing evidence-based interventions for children with FAS spectrum disorder. Specifically, clinicians will be able to design programs that capitalize on strengths to address weaknesses in cognitive emotional functioning of these children. The research design of the proposed project involves a comparison of test performance of alcohol-affected children with that of typically developing children matched for age, sex, SES, and ethnicity. Participants in South Africa will be 100 children previously diagnosed as having FAS by an international team of dysmorphologists and 100 case controls. The American Indian sample will be made of volunteers from 50 children diagnosed with a FAS spectrum disorder through the University of New Mexico FAS Epidemiology Research Project. Case controls (n=50) will be selected from the same communities. The test battery will be comprised of tests designed to measure general cognitive ability, attention, executive functioning, language, visual perception, memory, motor skills and emotional functioning. The data gathered through the core test battery will combined with those collected by other participants in the international collaborative project (e.g. Russia, Finland, Italy, and other various sites in the US) to create a large data base. It is expected that this international collaborative project afford a rare opportunity to researchers to answer many questions pertaining to cognitive-emotional functioning of alcohol-affected children and to design evidence-based interventions.
Educational Intervention
Despite ongoing efforts to prevent maternal drinking during pregnancy, prenatal alcohol exposure continues to be the leading non-genetic cause of mental retardation. As the result of ongoing epidemiological studies in South Africa since 1999, the prevalence of fetal alcohol syndrome (FAS) in the Western Cape Region of South Africa has been found to range from 46 per 1000 to 75 per thousand among school children ages 5 to 9 years. These are the highest recorded rates in any general community in the world and are many times higher than prevalence estimates for the United States. Even though the need for developing intervention programs for alcohol-affected children has long been recognized, no systematic outcome studies of such intervention programs exist. Therefore, the current project aims to test the efficacy of three intervention methods in the remediation of specific behavioral and learning problems in alcohol-affected children in the Western Cape Province of South Africa. The specific aims of the multi-method study are: 1) To determine the degree to which cognitive control therapy improves academic skills and behavior in alcohol-exposed children; 2) To determine the degree to which family interventions improve academic skills and behavior of alcohol-exposed children; 3) To determine the degree to which specific linguistic and literacy training programs improve academic skills and behavior of alcohol-exposed children; 4) To determine the degree to which environmental modifications in the classroom (e.g. limited class size and structured teaching) improve academic skills and behavior in alcohol-exposed children; 5) To determine the degree to which combinations of above methods improve academic skills and behavior in alcohol-exposed children; 6) To assess the effects of 3 mediating variables (self-efficacy, attention, meta-cognitive skills) and 3 moderating variables (child's IQ, life stress, maternal education) on therapeutic outcomes.
Eighty children, ages 7 to 9 will be recruited through an epidemiological study currently being conducted in the Western Region of South Africa. Twenty children will be randomly assigned to one of four groups, three treatment groups (cognitive control therapy, family support, and linguistic and literacy training) and one control group consisting of both alcohol-exposed and typically developing children. During the first phase of the project, all treatment and control-group children will be administered a comprehensive battery of tests consisting of a neuropsychological test battery, tests of academic achievement, selected speech/language tests, and a functional behavior assessment. The pre-testing will serve the following two distinct purposes: 1) to provide pretest data for each child in the research cohort and, 2) to identify current educational and behavioral issues for each child in the study. Following the pre-testing, each of the three proposed intervention methods will be administered once a week with children in each study group over a period of 18 months. In addition, each child in the study will be observed by a blinded observer 4 times in the prescribed time of intervention. After the 18- month intervention trial, the same testing battery will be administered as post-intervention measures. The pre-test and post-test performance of the children will be analyzed.
