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Introduction Prenatal alcohol exposure (PAE) impacts an estimated 5% or more children born in the USA and is associated with life-long neuropsychological deficits. Early identification is essential but access to diagnostic evaluation is limited. This study reports on the effectiveness of training child psychologists to identify and measure the salient physical features of PAE. Methods Children, 8–13 years, were divided into two groups: (1) children meeting criteria for PAE (n = 46) and (2) typically developing controls without PAE (TD; n = 36). Child psychologists were trained to reliability measure height, weight, occipital frontal circumference (OFC), and the characteristic facial features of FASD independent of knowledge of PAE history. Results Groups differed significantly on meeting the diagnostic criteria proposed by Hoyme et al. (Pediatrics, 138:e20154256, 2016) on height, OFC, upper vermillion border, philtrum, and palpebral fissure length. They did not differ on weight. All children in the alcohol exposed group could be classified as meeting criteria for an FASD whereas none in the unexposed group met criteria. Discussion This study demonstrated that child psychologists, blind to PAE history, could be reliably trained to assess the physical features of children with PAE. Because early diagnosis and intervention is of paramount importance, we propose that inclusive diagnostic criteria for FASD and the use of psychologists and other allied health professionals, trained to screen for the diagnosis, should be expanded in clinical practice.

In many patients, ostensible idiopathic attention deficit-hyperactivity disorder (ADHD) may actually stem from covert prenatal alcohol exposure (PAE), a treatment-relevant distinction. This study attempted a receiver-operator characteristic (ROC) classification of children with ADHD into those with PAE (ADHD+PAE) and those without (ADHD-PAE) using neurobehavioral instruments alongside magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) of supraventricular brain white matter. Neurobehavioral, MRS, and DTI endpoints had been suggested by prior findings. Participants included children aged 8-13 years, 23 with ADHD+PAE, 19 with familial ADHD-PAE, and 28 typically developing (TD) controls. With area-under-the-curve (AUC)0.90, the Conners 3 Parent Rating Scale Inattention (CIn) and Hyperactivity/Impulsivity (CHp) scores and the Behavioral Regulation Index (BRI) of the Behavior Rating Inventory of Executive Function (BRIEF2) excellently distinguished the clinical groups from TD, but not from each other (AUC 0.70). Combinations of MRS glutamate (Glu) and N-acetyl-compounds (NAA) and DTI mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) yielded "good" (AUC 0.80) discrimination. Neuroimaging combined with CIn and BRI achieved AUC 0.72 and AUC 0.84, respectively. But neuroimaging combined with CHp yielded 14 excellent combinations with AUC ≥ 0.90 (all p 0.0005), the best being Glu·AD·RD·CHp/(NAA·FA) (AUC 0.92, sensitivity 1.00, specificity 0.82, p 0.0005). Using Cho in lieu of Glu yielded AUC 0.83. White-matter microstructure and metabolism may assist efforts to discriminate ADHD etiologies and to detect PAE, beyond the ability of commonly used neurobehavioral measures alone.

Attention-deficit hyperactivity disorder (ADHD) is common in patients with (ADHD+PAE) and without (ADHD-PAE) prenatal alcohol exposure (PAE). Many patients diagnosed with idiopathic ADHD actually have covert PAE, a treatment-relevant distinction. To improve differential diagnosis, we sought to identify brain differences between ADHD+PAE and ADHD-PAE using neurobehavioral, magnetic resonance spectroscopy, and diffusion tensor imaging metrics that had shown promise in past research. Children 8–13 were recruited in three groups: 23 ADHD+PAE, 19 familial ADHD-PAE, and 28 typically developing controls (TD). Neurobehavioral instruments included the Conners 3 Parent Behavior Rating Scale and the Delis-Kaplan Executive Function System (D-KEFS). Two dimensional magnetic resonance spectroscopic imaging was acquired from supraventricular white matter to measure N-acetylaspartate compounds, glutamate, creatine + phosphocreatine (creatine), and choline-compounds (choline). Whole brain diffusion tensor imaging was acquired and used to to calculate fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity from the same superventricular white matter regions that produced magnetic resonance spectroscopy data. The Conners 3 Parent Hyperactivity/Impulsivity Score, glutamate, mean diffusivity, axial diffusivity, and radial diffusivity were all higher in ADHD+PAE than ADHD-PAE. Glutamate was lower in ADHD-PAE than TD. Within ADHD+PAE, inferior performance on the D-KEFS Tower Test correlated with higher neurometabolite levels. These findings suggest white matter differences between the PAE and familial etiologies of ADHD. Abnormalities detected by magnetic resonance spectroscopy and diffusion tensor imaging co-localize in supraventricular white matter and are relevant to executive function symptoms of ADHD.

Background Fetal Alcohol Spectrum Disorders (FASD) are a global health concern. Early intervention mitigates deficits, yet early diagnosis remains challenging. We examined whether children can be screened and meet diagnoses for FASD at 1.5 years compared to 5 years post-birth. Methods A population cohort of pregnant women in 24 neighborhoods (N = 1258) was recruited and 84.5 %–96 % were reassessed at two weeks post-birth, 0.5 years, 1.5 years, 3 years, and 5 years later. A two-step process was followed to diagnose FASD; first, a paraprofessional screened the children and then a physician evaluated the child. We evaluated FASD symptoms at 1.5 vs. 5 years. We also examined maternal differences in children receiving a positive FASD screening (n = 160) with those who received a negative FASD screening. Results Screening positive for FASD more than doubled from 1.5 years to 5 years (from 6.8 % to 14.8 %). About one quarter of children who screened positive and were evaluated by a physician, were diagnosed as having a FASD. However, half did not complete the 2nd stage screening. Compared to mothers of children with a negative FASD screening, mothers of children with a positive FASD screening were less likely to have a high school education and more likely to have lower incomes, have experienced interpersonal partner violence, and have a depressed mood. Mothers of children who did not follow up for a 2nd stage physician evaluation were more like to live in informal housing compared to those who followed-up (81.3 % vs. 62.5 %, p = 0.014). Conclusions We found that children can be screened and diagnosed for FASD at 1.5 and 5 years. As FASD characteristics develop over time, repeated screenings are necessary to identify all affected children and launch preventive interventions. Referrals for children to see a physician to confirm diagnosis and link children to care remains a challenge. Integration with the primary healthcare system might mitigate some of those difficulties.

Prenatal alcohol-drinking is often measured with self-report, but it is unclear whether mothers give more accurate answers when asked while pregnant or some time after their pregnancy. There is also the question of whether to measure drinking in a dichotomous or continuous fashion. We sought to examine how the timing and scale of self-reports affected the content of reports. From a sample of 576 black mothers around Cape Town, South Africa, we compared prenatal reports of prenatal drinking with 5-year retrospective reports, and dichotomous metrics (drinking or abstinent) with continuous metrics (fluid ounces of absolute alcohol drunk per day). Amounts increased over the 5-year period, whereas dichotomous measures found mothers less likely to report drinking later. All four measures were weakly associated with birth weight, birth height, child head circumference soon after birth, and child intelligence at age 5. Furthermore, neither reporting time nor the scale of measurement were consistently related to the strengths of these associations. Our results point to problems with self-report, particularly with this population, but we recommend post-birth continuous measures as the best of the group for their flexibility and their consistency with previous research.

Background: An improved understanding of the neurodevelopmental differences between attention deficit hyperactivity disorder with and without prenatal alcohol exposure (ADHD + PAE and ADHD−PAE, respectively) is needed. Herein, we evaluated gyrification (cortical folding) in children with ADHD + PAE compared to that in children with familial ADHD−PAE and typically developing (TD) children. Methods: ADHD + PAE (n = 37), ADHD−PAE (n = 25), and TD children (n = 27), aged 8–13 years, were compared on facial morphological, neurobehavioral, and neuroimaging assessments. Local gyrification index (LGI) maps were compared between groups using general linear modelling. Relationships between LGI and clincobehavioral parameters in children with ADHD ± PAE were evaluated using multivariate partial least squares. Results: ADHD + PAE and ADHD−PAE groups showed significantly lower LGI (relative to TD) in numerous regions, overlapping in medial prefrontal, parietal, and temporo-occipital cortices (p < 0.001). However, LGI in left mid-dorsolateral prefrontal cortex was uniquely lower in the ADHD + PAE group (p < 0.001). Partial least squares analysis identified one significant latent variable (accounting for 59.3 % of the crossblock correlation, p < 0.001), reflecting a significant relationship between a profile of lower LGI in prefrontal (including left mid-dorsolateral), insular, cingulate, temporal, and parietal cortices and a clinicobehavioral profile of PAE, including a flat philtrum and upper vermillion border, lower IQ, poorer behavioral regulation scores, and greater hyperactivity/impulsivity. Conclusions: Children with ADHD + PAE uniquely demonstrate lower mid-dorsolateral LGI, with widespread lower LGI related to more severe facial dysmorphia and neurobehavioral impairments. These findings add insight into the brain bases of PAE symptoms, potentially informing more targeted ADHD treatments based on an objective differential diagnosis of ADHD + PAE vs. ADHD−PAE.

BACKGROUND. The teratogenic effects of prenatal alcohol exposure (PAE) have been extensively documented over the course of 45 years of research and psychiatric problems are pervasive in this population. In adults with PAE, suicidal risk is high but less is known about the suicidal risk in adolescents with Fetal Alcohol Spectrum Disorders (FASD). This study describes the prevalence of suicidal ideation and serious suicide attempts in a sample of 54 adolescents between the ages of 13 and 18 years with FASD. METHODS. Adolescents were diagnosed with FASD using the Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. The Children’s Interview for Psychiatric Syndromes was used to identify those adolescents who experienced suicidal ideation and/or who had made a serious suicide attempt in the last 12 months. RESULTS. The prevalence of suicidal behaviors in this sample was high with 35.2% of teens reporting incidences of suicidal ideation and 13.0% reporting at least one serious suicide attempt in the past year. This finding is in contrast to the 17.2% and 2.4% for ideation and serious attempts, respectively, reported in the general U.S. adolescent population. Alarmingly, 29.2% of males with FASD reported a serious suicide attempt which was 19 ½ times higher than national norms for males. No females reported attempts. Number of home placements and the presence of a depressive disorder contributed to study outcomes. CONCLUSIONS. Findings suggest the need for health practitioners to be aware of the significant risk for suicidality in this population, particularly in adolescent males, and to assess and treat this life threatening behavior.

Almost all pregnant women (98%) in 24 Cape Town neighborhoods were randomized by neighborhood to (1) the standard care (SC) condition (n = 12 neighborhoods; n = 594 pregnant women) or (2) the Philani Intervention Program (PIP) in which home visits by Community Health Workers (CHW) were conducted (n = 12 neighborhoods; n = 644 pregnant women). At 36months post-birth (84.6% follow-up), PIP mothers were significantly less depressed compared to the SC mothers. Children in PIP were significantly less likely to be stunted (24.3 vs 18.1%, p = 0.013), to have better vocabularies, and were less likely to be hospitalized than children in the SC condition. These data suggest home visits may need to continue for several years post-birth. Sustainable, scalable perinatal intervention models are needed in LMIC.

BACKGROUND Attention deficit-hyperactivity disorder (ADHD) is common in fetal alcohol spectrum disorders (FASD) but also in patients without prenatal alcohol exposure (PAE). Many patients diagnosed with idiopathic ADHD may actually have ADHD and covert PAE, a treatment-relevant distinction. METHODS We compared proton magnetic resonance spectroscopic imaging (MRSI; N = 44) and diffusion tensor imaging (DTI; N = 46) of the anterior corona radiata (ACR)-a key fiber tract in models of ADHD-at 1.5 T in children with ADHD with PAE (ADHD+PAE), children with ADHD without PAE (ADHD-PAE), children without ADHD with PAE (non-ADHD+PAE), and children with neither ADHD nor PAE (non-ADHD-PAE, i.e., typically developing controls). Levels of choline-compounds (Cho) were the main MRSI endpoint, given interest in dietary choline for FASD; the main DTI endpoint was fractional anisotropy (FA), as ACR FA may reflect ADHD-relevant executive control functions. RESULTS For ACR Cho, there was an ADHD-by-PAE interaction (p = 0.038) whereby ACR Cho was 26.7% lower in ADHD+PAE than in ADHD-PAE children (p

Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.

Overwhelming evidence on the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities, which are characterized by physical, cognitive, and behavioral impairments. Importantly, individuals with PAE are particularly vulnerable to mental health problems. This review summarizes the current literature on the underlying mechanisms of PAE vulnerability, including epigenetic, genetic, and environmental risk factors that predispose individuals with PAE to psychiatric illness. The studies cited are from animal and human research and include a developmental perspective. Research on the mental health problems suffered by individuals with fetal alcohol spectrum disorders (FASDs) throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability.

OBJECTIVE: To evaluate the effect of home visits by community health workers (CHWs) on maternal and infant well being from pregnancy through the first 6 months of life for women living with HIV (WLH) and all neighborhood mothers. DESIGN AND METHODS: In a cluster randomized controlled trial in Cape Town townships neighborhoods were randomized within matched pairs to either standard care comprehensive healthcare at clinics (n=12 neighborhoods; n=169 WLH; n=594 total mothers); or Philani Intervention Program home visits by CHWs in addition to standard care (PIP; n=12 neighborhoods; n=185 WLH; n=644 total mothers). Participants were assessed during pregnancy (2% refusal) and reassessed at 1 week (92%) and 6 months (88%) postbirth. We analyzed PIPs effect on 28 measures of maternal and infant well being among WLH and among all mothers using random effects regression models. For each group PIPs overall effectiveness was evaluated using a binomial test for correlated outcomes. RESULTS: Significant overall benefits were found in PIP compared to standard care among WLH and among all participants. Secondarily compared to standard care PIP WLH were more likely to complete tasks to prevent vertical transmission use one feeding method for 6 months avoid birth-related medical complications and have infants with healthy height-for-age measurements. Among all mothers compared to standard care PIP mothers were more likely to use condoms consistently breastfeed exclusively for 6 months and have infants with healthy height-for-age measurements. CONCLUSION: PIP is a model for countries facing significant reductions in HIV funding whose families face multiple health risks.

Background Project Step Up proposed to reduce alcohol consumption and alcohol-related negative outcomes in adolescents with fetal alcohol spectrum disorders (FASD). Methods The 54 participants (30 females, 24 males) were assigned to either Project Step Up Intervention (SUI) or Control conditions and were assessed prior to intervention, immediately following intervention, and at 3-month follow-up. Adolescents in the SUI condition participated in a 6-week, 60-minute group intervention that provided alcohol education and promoted adaptive responses to alcohol-related social pressures. Caregivers attended concurrent but separate sessions on the effects of prenatal alcohol exposure on the brain and how to handle parenting challenges associated with alcohol use in teens with FASD. Results Thirty-three percent (n = 18) of adolescents were classified as light/moderate drinkers, and 67% (n = 36) were abstinent/infrequent drinkers based on their lifetime drinking histories. Results revealed a significant decrease in self-reported alcohol risk and in alcohol-related negative behaviors (Cohen's d = 1.08 and 0.99) in light/moderate drinkers in the SUI compared to the Control group. These results were partially sustained at 3-month follow-up. Furthermore, adolescents in the abstinent/infrequent group exhibited no increase in alcohol-related outcomes suggesting that the group intervention used in this study was not iatrogenic. Conclusions The success of this treatment development study provides preliminary support for effective treatment of adolescents with FASD to prevent or reduce alcohol use and its negative consequences in this high risk population.

Exposure to alcoholin uterocan cause birth defects, including face and brain abnormalities, and is the most common preventable cause of intellectual disabilities. Here we use structural magnetic resonance imaging to measure cortical volume change longitudinally in a cohort of human children and youth with prenatal alcohol exposure (PAE) and a group of unexposed control subjects, demonstrating that the normal processes of brain maturation are disrupted in individuals whose mothers drank heavily during pregnancy. Trajectories of cortical volume change within children and youth with PAE differed from those of unexposed control subjects in posterior brain regions, particularly in the parietal cortex. In these areas, control children appear to show a particularly plastic cortex with a prolonged pattern of cortical volume increases followed by equally vigorous volume loss during adolescence, while the alcohol-exposed participants showed primarily volume loss, demonstrating decreased plasticity. Furthermore, smaller volume changes between scans were associated with lower intelligence and worse facial morphology in both groups, and were related to the amount of PAE during each trimester of pregnancy in the exposed group. This demonstrates that measures of IQ and facial dysmorphology predict, to some degree, the structural brain development that occurs in subsequent years. These results are encouraging in that interventions aimed at altering “experience” over time may improve brain trajectories in individuals with heavy PAE and possibly other neurodevelopmental disorders.

Various abnormalities in frontal and striatal regions have been reported in children with prenatal alcohol and/or methamphetamine exposure. In a recent fMRI study, we observed a correlation between accuracy on a working-memory task and functional activation in the putamen in children with prenatal methamphetamine and polydrug exposure. Because the putamen is part of the corticostriatal motor loop whereas the caudate is involved in the executive loop, we hypothesized that a loss of segregation between distinct corticostriatal networks may occur in these participants. The current study was designed to test this hypothesis using functional connectivity MRI. We examined 50 children ranging in age from 7 to 15, including 19 with prenatal methamphetamine exposure (15 of whom had concomitant prenatal alcohol exposure), 13 with prenatal exposure to alcohol but not methamphetamine, and 18 unexposed controls. We measured the coupling between blood oxygenation level dependent (BOLD) fluctuations during a working-memory task in four striatal seed regions and those in the rest of the brain. We found that the putamen seeds showed increased connectivity with frontal brain regions involved in executive functions while the caudate seeds showed decreased connectivity with some of these regions in both groups of exposed subjects compared to controls. These findings suggest that localized brain abnormalities resulting from prenatal exposure to alcohol and/or methamphetamine lead to a partial rewiring of corticostriatal networks. These results represent important progress in the field, and could have substantial clinical significance in helping devise more targeted treatments and remediation strategies designed to better serve the needs of this population.

Background Structural abnormalities of the corpus callosum (CC), such as reduced size and increased shape variability, have been documented in individuals with fetal alcohol spectrum disorders (FASD). However, the regional specificity of altered CC structure, which may point to the timing of neurodevelopmental disturbances and/or relate to specific functional impairments, is unclear. Further, associations between facial dysmorphology and callosal structure remain undetermined.

Pregnant mothers in South African townships face multiple health risks for themselves and their babies. Existing clinic-based services face barriers to access, utilization, and human resource capacities. Home visiting by community health workers (CHW) can mitigate such barriers. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting intervention program for maternal and child nutrition by integrating content and activities to address HIV, alcohol, and mental health. Pregnant Mothers at Risk (MAR) for HIV, alcohol, and/or nutrition problems in 24 neighborhoods in townships in Cape Town, South Africa (n = 1,239) were randomly assigned by neighborhood to an intervention (Philani Plus (+), N = 12 neighborhoods; n = 645 MAR) or a standard-care control condition of neighborhood clinic-based services (N = 12 neighborhoods; n = 594 MAR). Positive peer deviant "Mentor Mother" CHWs are recruited from the township neighborhoods and trained to deliver four antenatal and four postnatal home visits that address HIV, alcohol, nutrition, depression, health care regimens for the family, caretaking and bonding, and securing government-provided child grants. The MAR and their babies are being monitored during pregnancy, 1 week post-birth, and 6 and 18 months later. Among the 1,239 MAR recruited: 26% were HIV-positive; 27% used alcohol during pregnancy; 17% previously had low-birthweight babies; 23% had at least one chronic condition (10% hypertension, 5% asthma, 2% diabetes); 93% had recent sexual partners with 10% known to be HIV+; and 17% had clinically significant prenatal depression and 42% had borderline depression. This paper presents the intervention protocol and baseline sample characteristics for the "Philani Plus (+)" CHW home-visiting intervention trial.

Background: Children with prenatal alcohol exposure (PAE) have significant social skills deficits and are often treated in community mental health settings. However, it remains unclear whether these children can be effectively treated using manualized, evidence-based interventions that have been designed for more general mental health populations. Methods: To shed light on this issue, the effectiveness of Children’s Friendship Training (CFT) versus Standard of Care (SOC) was assessed for 85 children ages 6 to 12 years with and without PAE in a community mental health center. Results: Children participating in CFT showed significantly improved knowledge of appropriate social skills, improved self-concept, and improvements in parent-reported social skills compared to children in the SOC condition. Moreover, results revealed that within the CFT condition, children with PAE performed as well as children without PAE. Findings indicated that CFT, an evidence-based social skills intervention, yielded greater gains than a community SOC social skills intervention and was equally effective for children with PAE as for those without PAE. Conclusions: Results suggest that children with PAE can benefit from treatments initiated in community settings in which therapists are trained to understand their unique developmental needs, and that they can be successfully integrated into treatment protocols that include children without PAE.

South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASDs) in the world. The purpose of this study was to identify high risk factors associated with drinking alcohol prior to pregnancy recognition in 24 neighborhoods in the Cape Flats outside Cape Town, South Africa. An interviewer assessed risk among 619 pregnant Black/African women between the ages of 18 and 41 years. Logistic regression analyses explored factors associated with drinking alcohol post conception but prior to pregnancy recognition. Forced multiple logistic regression analysis revealed that drinking prior to pregnancy recognition was associated with being younger, single, having better living conditions, smoking, having a longer gestation prior to pregnancy recognition, having a greater number of sexual partners, and a higher incidence of intimate partner violence. Depressive symptoms tended to be higher among alcohol users. These risk factors were consistent with other research on the characteristics of South African women having children with a diagnosis of Fetal Alcohol Spectrum Disorders and/or of non pregnant women at high risk for an alcohol-exposed pregnancy. These findings highlight the need for women of child-bearing age to be routinely screened for alcohol use and its associated risk factors. Intervention efforts could be integrated into health initiatives already present in South Africa including the prevention and treatment of HIV/AIDS, tuberculosis, and malnutrition. Preconception care is particularly important since pregnancy recognition often occurs several weeks to months following conception and could be implemented by South African community health workers. These endeavors should facilitate national goals of healthier pregnancies and the elimination of FASDs in South Africa.

Here we investigate the effects of prenatal exposure to methamphetamine (MA) on local brain volume using magnetic resonance imaging. Because many who use MA during pregnancy also use alcohol, a known teratogen, we examined whether local brain volumes differed among 61 children (ages 5–15 years), 21 with prenatal MA exposure, 18 with concomitant prenatal alcohol exposure (the MAA group), 13 with heavy prenatal alcohol but not MA exposure (ALC group), and 27 unexposed controls. Volume reductions were observed in both exposure groups relative to controls in striatal and thalamic regions bilaterally and in right prefrontal and left occipitoparietal cortices. Striatal volume reductions were more severe in the MAA group than in the ALC group, and, within the MAA group, a negative correlation between full-scale intelligence quotient (FSIQ) scores and caudate volume was observed. Limbic structures, including the anterior and posterior cingulate, the inferior frontal gyrus (IFG), and ventral and lateral temporal lobes bilaterally, were increased in volume in both exposure groups. Furthermore, cingulate and right IFG volume increases were more pronounced in the MAA than ALC group. Discriminant function analyses using local volume measurements and FSIQ were used to predict group membership, yielding factor scores that correctly classified 72% of participants in jackknife analyses. These findings suggest that striatal and limbic structures, known to be sites of neurotoxicity in adult MA abusers, may be more vulnerable to prenatal MA exposure than alcohol exposure and that more severe striatal damage is associated with more severe cognitive deficit.

This study evaluated the neural basis of verbal working memory (WM) function in a group of 20 children and adolescents with fetal alcohol spectrum disorders (FASDs) and 20 typically developing comparison participants using functional magnetic resonance imaging (fMRI). Both groups showed prominent activation in the frontal-parietal-cerebellar network known to be important for verbal WM. Despite equivalent behavioral performance between groups, alcohol-exposed individuals showed increased activation relative to typically developing individuals in left dorsal frontal and left inferior parietal cortices, and bilateral posterior temporal regions during verbal WM. These effects remained even when group differences on IQ were statistically controlled. This pattern of increased activation coupled with equivalent behavioral performance between groups suggests that individuals with FASD recruit a more extensive network of brain regions during verbal WM relative to typically developing individuals. These findings may suggest that frontal-parietal processing during verbal WM is less efficient in alcohol-exposed individuals.

The effects of prenatal exposure to methamphetamine on neurocognitive skills are not well understood. Chang and colleagues documented lower scores on measures of verbal memory, spatial memory, attention, and visual motor integration in methamphetamine-exposed children compared to unexposed participants (1). However, the largest reported sample of prenatal MA exposure reported that 49% of participating methamphetamine users also used alcohol during pregnancy, and only 10% used methamphetamine alone (2). These high rates of co-exposure to alcohol during pregnancy render it difficult to separate effects of methamphetamine exposure from alcohol exposure. Heavy prenatal alcohol exposure is known to detrimentally affect verbal memory (3). Verbal memory encompasses learning and recall of verbal information from long-term storage. Verbal learning is an important cognitive skill because it underlies basic academic skills such as vocabulary acquisition. The verbal nature of classroom instruction implicates that deficits in verbal learning may detrimentally influence achievement in other areas such as math and science. Three independent research groups have shown that children with prenatal exposure to alcohol perform more poorly on both immediate and delayed recall of verbal information compared to unexposed participants (4-6). All three studies concluded that problems of verbal memory were specific to encoding or learning of new information, and retention of information was not different between exposed and unexposed groups after accounting for initial encoding differences (4-6). Consistent with these behavioral findings, we have recently shown that unexposed control subjects activate left medial temporal structures important for verbal memory more than children with prenatal alcohol exposure during a verbal memory task using functional magnetic resonance imaging (fMRI) (7). Examination of prenatal methamphetamine exposure presents significant challenges given that a significant number of individuals with methamphetamine exposure have concomitant alcohol exposure. For this reason, we have recently attempted to address the specificity of methamphetamine exposure on neurocognitive performance by comparing a methamphetamine plus alcohol-exposed group of children to an alcohol-exposed only group and an unexposed control group. Both exposed groups performed more poorly than the unexposed control group on measures of verbal memory; however, there was no difference between our methamphetamine plus alcohol-exposed and our alcohol exposure only groups (8). These behavioral data suggested that decreased verbal memory performance in children exposed to both methamphetamine and alcohol may be due to the effects of alcohol rather than to the effects of methamphetamine. A limitation with behavioral performance data is that they cannot reveal whether neurocognitive systems engaged to achieve task completion are similar in children with different exposure histories. A similar level of performance can be achieved via engagement of different neurocognitive systems. For example, Brown and colleagues showed that children and adults engage different brain regions on word generation tasks despite equivalent levels of performance (9). Among atypically developing populations (e.g., dyslexia), different patterns of activation between the studied population and normally developing controls have been interpreted as effortful compensatory mechanisms and/or functional disruptions in the studied population (10, 11). To date, no studies have evaluated the effects of prenatal methamphetamine exposure on brain activation patterns. In the present exploratory study, we asked whether children with histories of prenatal exposure to methamphetamine plus alcohol engaged different neurocognitive systems during a verbal memory task in comparison to unexposed controls and children with exposure to alcohol only. The alcohol-exposed group is a necessary control given that the majority of our methamphetamine-exposed participants also have concomitant alcohol exposure. The term Fetal Alcohol Spectrum Disorders (FASD) has been proposed to capture the continuum of effects attributable to prenatal alcohol exposure (12, 13). We followed the Washington diagnostic system (12), under which the FASD umbrella term includes Fetal Alcohol Syndrome (FAS) and Partial Fetal Alcohol Syndrome (PFAS) on the more severe end of the spectrum where facial dysmorphology is prominent. Those who do not meet criteria for FAS or PFAS have less prominent facial dysmorphology and physical evidence of brain damage, and have been referred to as Alcohol-Related Neurobehavioral Disorder (ARND). Individuals in the ARND category also show impaired cognitive performance across multiple domains, suggesting that alcohol teratogenesis on brain development exists in the absence of facial dysmorphology (14). In order to minimize the possibility that heavy alcohol exposure effects may mask more subtle effects of methamphetamine exposure, we excluded from both the methamphetamine-exposed and the alcohol-exposed only groups those who met criteria for FAS and PFAS, the most severe manifestations of prenatal alcohol exposure. If methamphetamine has a specific effect on the development of the verbal memory system or interacts with alcohol in influencing the development of this system, then the methamphetamine-exposed children are expected to show a different pattern of activation during our verbal memory task compared to both the unexposed and the alcohol-exposed only groups.

This article describes the use of fetal alcohol spectrum disorders (FASDs) as a theme to connect the learning of basic neurosciences with clinical applications across the age span within a systems-based, integrated curricular structure that emphasizes problem-based learning.In collaboration with the Centers for Disease Control and Prevention (CDC) and the National Organization on Fetal Alcohol Syndrome, the Western Regional Training Center for Fetal Alcohol Exposure at UCLA developed and integrated educational materials on FASDs into the curriculum for first-year medical students.Quantitative and qualitative evaluations suggested materials were effective in enhancing student knowledge and skills related to FASDs, as well as embryology, brain development, substance abuse, developmental psychopathology, and medical ethics.The use of a unifying theme integrating basic science and clinical information and skills is effective for medical student training in the prevention and treatment of common medical problems.

Since the identification of fetal alcohol syndrome (FAS) over 35 years ago, mounting evidence about the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities that are characterized by physical, cognitive, and behavioral impairments. These disabilities include a continuum of developmental disorders known as fetal alcohol spectrum disorders (FASDs). Longitudinal studies suggest that individuals with FASDs are at a greatly increased risk for adverse long-term outcomes, including mental health problems and poor social adjustment. This review summarizes the existing literature on mental health outcomes for individuals with PAE across the lifespan, including findings in infancy and early childhood, middle childhood, and adolescence and early adulthood. Research on the psychiatric disabilities suffered by individuals with FASDs throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability since early identification and treatment have been demonstrated to be protective against more serious secondary disabilities. It is hoped that with greater awareness of the mental health problems experienced by individuals with FASDs, these individuals can receive appropriate and early treatment resulting in more adaptive and rewarding lives.

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs.

SUMMARY Several measures of self-concept and self-esteem were applied to a sample of 15 ‘mainstreamed’ upper-middle-class, cerebral-palsied children aged between four and eight years, and to 15 matched controls. Over-all self-concept scores were similar for both groups, although they tended to be lower for the handicapped group. Teachers rated the handicapped children as having lower self-esteem than the controls in the classroom, but behavioral ratings by parents of their own children at home revealed no group differences in self-esteem. These tentative findings, supplemented by interview data, support the hypothesis that children with cerebral palsy begin to regard themselves as different as early as four years of age. However, these self-views and their potentially negative effects on self-esteem do not appear to crystallize until the children are in the primary grades at school. RESUME Image de soi chez de jeunes IMC Plusieurs mesures de l'image de soit et d'auto-valorisation ont ete effectuees sur un groupe de 15 IMC, bien representatifs, de classe moyenne superieure, âges de quatre a huit ans et chez un groupe controle apparie. Globalement, les scores d'image de soi etaient identiques pour les deux groupes, quoiqu'avec une tendance aetre plus bas pour le groupe handicape. Les enseignants classaient les enfants handicapes avec une auto-evaluation plus basse que les controles dans de cadre de la classe mais les appreciations comportementales faites par les parents sur leurs propres enfants a la maison ne revelaient pas de difference d'auto-valorisation entre les groupes. Ces donnees favorisent une hypothese selon laquelle les enfants IMC commencent a se considerer comme differents des l'age de quatre ans. Cependant, ces auto-appreciations et leurs effets negatifs potentiels sur l'auto-valoristion ne paraissent pas se cristalliser tant que les enfants sont dans les classes les plus elementaires. ZUSAMMENFASSUNG Selbstwertgefuhl beijungen Kindern mit Cerebralparese Bei 15 voll in der Gesellschaft integrierten Kindern mit Cerebralparese aus der Ober- bis Mittelschicht im Alter zwischen vier und acht Jahren und bei 15 entsprechenden Kontrollen wurden mehrere Masstabe fur Selbstwertgeful und Selbsteinschatzung angelegt. Im allgemeinen war das Selbstwertgefuhl bei beiden Gruppen gleich, jedoch neigten die Kinder mit Cerebralparese dazu, sich etwas geringer einzuschatzen. Nach dem Urteil der Lehrer hatten die behinderten Kinder ein geringeres Selbstwertgefuhl innerhalb der Klassengemeinschaft als die Kontrollen, die Angaben der Eltern dagegen uber ihre eigenen Kinder zu Hause ergaben keine Gruppenunterschiede. Diese vorlaufigen Befunde unterstutzen die Hypothese, das Kinder mit Cerebralparese bereits mit vier Jahren anfangen, sich als anders zu betrachten. Diese Selbstbetrachtungen und ihre potentiell negativen Auswirkungen auf das Selbstwertgefuhl kristallisieren sich jedoch erst mit Beginn der ersten Schuljahre heraus. RESUMEN Concepto de si mismos en ninos con paralisis cerebral Se aplicaron diversas mediciones de ‘concepto de si mismo’ y de ‘autoestima’ a una muestra de ninos con paralisis cerebral de clase media alta, de cuatro a ocho anos de edad, lo mismo que a 15 controles homologos. Los puntajes de autoconcepto eran similares en ambos grupos, aunque tendian a ser mas bajos en el grupo minusvalido. Los maestros consideraban a los minusvalidos como poseedores de una autoestima en la clase menor que los controles, pero segun los padres al valorar el comportamiento de su ninos en casa no habia diferencias de autoestima en ambos grupos. Estos hallazgos orientativos apoyan la hipotesis de que los ninos con paralisis cerebral empiezan a considerarse a si mismos como diferentes ya a los cuatro anos de edad. Sin embargo estos autoconceptos y sus efectos potencialmente negativos sobre la autoestima parece que no cristalizan hasta que el nino no esta en los primeros grados de la escuela.

Brain structural abnormalities and neurocognitive dysfunction have been observed in individuals with fetal alcohol spectrum disorders (FASDs). Little is known about how white matter integrity is related to these functional and morphological deficits. We used a combination of diffusion tensor and T1-weighted magnetic resonance imaging to evaluate white matter integrity in individuals with FASDs and related these findings to neurocognitive deficits. Seventeen children and adolescents with FASDs were compared with 19 typically developing age-and gender-matched controls. Lower fractional anisotropy (FA) was observed in individuals with FASDs relative to controls in the right lateral temporal lobe and bilaterally in the lateral aspects of the splenium of the corpus callosum. White matter density was also lower in some, but not all regions in which FA was lower. FA abnormalities were confirmed to be in areas of white matter inpost hocregion of interest analyses, further supporting that less myelin or disorganized fiber tracts are associated with heavy prenatal alcohol exposure. Significant correlations between performance on a test of visuomotor integration and FA in bilateral splenium, but not temporal regions were observed within the FASD group. Correlations between the visuomotor task and FA within the splenium were not significant within the control group, and were not significant for measures of reading ability. This suggests that this region of white matter is particularly susceptible to damage from prenatal alcohol exposure and that disruption of splenial fibers in this group is associated with poorer visuomotor integration.

Prenatal exposure to alcohol is a leading preventable cause of birth defects and developmental disabilities. Individuals exposed to alcohol during fetal development can have physical, mental, behavioral, and learning disabilities, with lifelong implications. These conditions are known as fetal alcohol spectrum disorders (FASDs). Health care professionals play a crucial role in identifying women at risk for an alcohol-exposed pregnancy and in identifying the effects of prenatal alcohol exposure among individuals. The Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities has funded four universities as FASD Regional Training Centers (RTCs). The RTCs, in collaboration with the CDC and the National Organization on Fetal Alcohol Syndrome, are developing, implementing, and evaluating educational curricula for medical and allied health students and practitioners and seeking to have the curricula incorporated into training programs at each grantee's ...

Previous research attests to the marked impairments in social functioning exhibited by children with Fetal Alcohol Spectrum Disorders (FASD), suggesting that such children are in need of social skills intervention. Recently, an existing evidence-based manualized behavioral treatment for improving children's friendships was implemented and demonstrated to be effective with children aged 6–12, diagnosed with FASD. In the present report, we describe methods for adapting this behavioral intervention in line with the specific cognitive and behavioral deficits seen in children with FASD and other developmental disabilities to enhance treatment efficacy.

South Africa has the highest prevalence of Fetal Alcohol Spectrum Disorders (FASD) in the world yet many women have no access to clinic care or to physicians in their communities. The shortage of physicians trained in the diagnosis of FASD is even more severe. Thus there is a need to train community workers to assist in the delivery of health care.This study reports on the effectiveness of training community workers to screen for a possible diagnosis of a FASD.Community workers in Cape Town, South Africa were trained to screen for FASD in 139, 18-month-old toddlers with prenatal alcohol exposure (PAE). Children were assessed according to the salient characteristics of individuals with PAE using height, weight, head circumference (OFC), philtrum, and lip measurements according to criteria set forth by the Institute of Medicine. Screen-positive children were referred for diagnostic assessment to a pediatrician reliably trained in the diagnosis of FASD.Of the screen-positive children, 93% received an FASD diagnosis suggesting that the screening procedure was highly sensitive. Diagnoses included 15% with fetal alcohol syndrome (FAS), 23% with Partial FAS, and 62% with Alcohol Related Neurodevelopmental Disorder (ARND, provisional).The use of community workers to screen for FASD represents a promising approach to effective diagnosis of children affected by PAE in areas lacking adequate medical resources.

This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the child"s executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

OBJECTIVES. Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics. METHODS. This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included. RESULTS. Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy. CONCLUSIONS. The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.

Fetal alcohol spectrum disorders (FASDs) are among the leading preventable causes of developmental disorders in the United States; however, recognition and prevention of these conditions cannot be achieved without informed and educated health providers. This commentary addresses the importance of recognition and prevention of FASDs through the use of well-established standardized practices of diagnosis, screening, and brief alcohol reduction counseling. It is hoped that more knowledge on currently available procedures will encourage their use in the provision of routine health care to all women of childbearing age.

Objective: To report a case of a child with bipolar disorder found to have an unbalanced translocation involving the long arm of chromosome 8, a region that has been previously implicated in genome-wide linkage scans. Case report: A 7-year-old boy with a complex psychiatric symptom presentation including attention deficits, distractibility, impulsivity, pressured speech, sleep disturbance, aggressive behavior, and hypersexuality diagnosed with bipolar disorder. He also showed evidence of borderline intellectual and adaptive functioning and had mild dysmorphic features with a duplication of distal 8q that arose as an unbalanced chromosomal translocation due to a maternal 15p;8q insertion. Conclusion: This finding of an unbalanced translocation provides further evidence to support previous linkage studies of a potential causative gene on 8q for bipolar disorder.

Objective: This study examined the extent to which preg- nant women participating in the Special Supplemental Nutrition Pro- gram for Women, Infants, and Children (WIC) were counseled by their health care providers to stop drinking alcohol during pregnancy. A sec- ond purpose was to identify characteristics associated with alcohol con- sumption postrecognition of pregnancy. Method: The sample consisted of 279 women who continued to drink after learning they were preg- nant. Measures of provider advice on alcohol consumption, demographic characteristics, caffeine intake, smoking, other drug use, alcohol risk (using the TWEAK scale), and depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D) were collected. Re- sults: Sixty-two percent of women had significantly high TWEAK scores, and 60% scored within the clinical range for depression (CES- D ≥ 16). Sixty percent of sample women had been advised by their care providers not to drink alcohol during pregnancy. Women who were most likely to receive advice were black non-Hispanic and Hispanic, were Spanish speaking, were less educated, were on public assistance, and had a higher number of alcohol-related risk behaviors. Advanced age, public assistance, caffeine use, smoking, and elevated TWEAK and CES- D scores predicted elevations in alcohol consumption rates. Conclu- sions: Although advice to stop drinking during pregnancy was provided to 60% of this sample, women continued to drink following pregnancy recognition, with alcohol consumption rates highly associated with sociodemographic and psychological factors, namely maternal depres- sion. Because elevations in alcohol consumption during pregnancy are associated with poorer developmental outcomes for children, further ef- forts are needed to better address social and mental health factors that influence consumption. (J. Stud. Alcohol 67: 22-31, 2006)

Alcohol use among women of childbearing age is prevalent in the United States, with approximately 1 in 5 nonpregnant women reporting binge drinking (5 or more drinks on any one occasion) and 1 in 25 pregnant women reporting binge drinking. Alcohol use during pregnancy results in a spectrum of adverse outcomes known as fetal alcohol spectrum disorders. Fetal alcohol syndrome (FAS) is one of these disorders. Fetal alcohol syndrome is characterized by specific facial abnormalities and significant impairments in neurodevelopment and physical growth. Early identification of children with FAS has been shown to enhance their long-term outcomes. In an effort to improve clinical recognition of children with this condition, Centers for Disease Control and Prevention (CDC) was directed by Congress in 2002 to lead the development of uniform diagnostic criteria for FAS and other prenatal alcohol-related conditions. The purpose of this commentary is to provide clinicians a summary of the report released by CDC describing the current diagnostic criteria for FAS. In addition, advancements have been made in screening and brief interventions for alcohol use disorders in women who have the potential to make significant strides in the prevention of FAS spectrum disorders. Knowledge of the diagnostic criteria for FAS can lead to increased identification of the syndrome in infants and children and the provision of appropriate medical and support services. Screening for and intervening with women at risk for an alcohol-exposed pregnancy can prevent FAS and other fetal alcohol spectrum disorders.

Objective. This study examined linkages between prenatal exposure to alcohol, current maternal alcohol use, child externalizing behavior, and maternal stress in a sample of 4- to 6-year-old children and their mothers. Design. Questionnaires, interviews, and behavioral observations were used to assess study variables in 42 mother - child dyads. Results. Current maternal alcohol use did not relate to children's behavior problems. However, children with higher levels of prenatal exposure to alcohol exhibited more externalizing behavior. In turn, higher levels of child externalizing behavior were associated with increased maternal stress. An alternative model, in which maternal stress was assumed to relate to less supportive mother - child interactions and higher levels of current maternal alcohol consumption, which in turn were expected to relate to higher rates of child externalizing behavior, did not fit the data. Conclusions. The impact of prenatal alcohol exposure likely extends to caregivers. Interventi...

Background This study examined the association between prenatal alcohol exposure and attachment behavior in 4- and 5-year-old children. Prenatal alcohol exposure was hypothesized to be associated with insecure attachment behavior of the child toward the mother. It was also hypothesized that children with heavier prenatal alcohol exposure would exhibit higher levels of negative affect as well as poorer coping skills. The quality of maternal support in interaction with the child was predicted to mediate prenatal exposure effects. Methods Participants were 42 mother-child dyads, the majority of whom came from poverty backgrounds in which the mother was a single parent. Attachment security was measured using the Attachment Q-Set. Results Results revealed that prenatal alcohol exposure was highly related to attachment insecurity. Eighty percent of children who were exposed to alcohol during gestation were insecure, whereas 36% of unexposed children were insecure. Prenatal alcohol exposure also predicted child negative affect, which was related to lower levels of maternal emotional support of the child. However, when the mothers of the prenatally exposed children provided high levels of support, these children evidenced better coping skills and more secure attachment relations. Conclusions Although prenatal alcohol exposure was found to relate to higher levels of insecure attachment, children of mothers who provided them with emotional support were more able to deal with frustration. These children also exhibited higher levels of attachment security. Thus, the mother's supportive presence may mediate the association between prenatal alcohol exposure and the child's security of attachment.

BackgroundInterventions are needed to reduce poor perinatal health. We trained community health workers (CHWs) as home visitors to address maternal/infant risks.MethodsIn a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1) the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women), or 2) a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme), in addition to clinic care (n = 12 neighbourhoods; n = 644 women). Participants were assessed during pregnancy (2% refusal) and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received.ResultsBenefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008); nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014), have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045), height-for-age measurements (OR = 1.13, p

South African children's long-term health and well-being is jeopardized during their mothers' pregnancies by the intersecting epidemics of HIV, alcohol use, low birth weight (LBW

Background : Several studies show impairments in the social and adaptive behaviors of children prenatally exposed to alcohol. However, there remains limited consensus on whether the alcohol exposure directly affects social functioning or whether its effect is mediated by deficits in IQ. In addition, no studies have investigated whether deficits in social functioning are significantly more pronounced in children prenatally exposed to alcohol than in children referred to psychiatric treatment who were not prenatally exposed. We explored the effect of alcohol exposure on social and adaptive functioning and explored whether or not social and adaptive functioning are significantly more impaired in children prenatally exposed to alcohol than in a clinical sample of children. Methods: A sample of 33 alcohol-exposed children was compared with a sample of 33 clinic-referred nonexposed children. The groups were compared on measures of communication, daily living skills, and socialization. The groups were matched on sex, age, IQ, and outpatient or inpatient status. Results: Analyses revealed that the prenatally alcohol-exposed children did not differ significantly from the nonexposed children in any of the domains of adaptive functioning. However, with age, exposed children showed a more rapid decline in socialization standard scores compared with the nonexposed clinical sample. Conclusions: Young children who were exposed to alcohol prenatally show deficits in all domains of adaptive functioning. Although these deficits do not seem to differ from those exhibited by young children with psychiatric problems but no prenatal exposure, deficits in socialization behavior of prenatally exposed children may become more significant with age.

Cette etude a examine la continuite des variations negatives du temperament de la naissance a la petite enfance. Nous etudions aussi l'association de l'exposition prenatale a l'alcool avec un affect negatif chez les bebes et avec des traits de depression chez les jeunes enfants. 41 enfants de six ans participerent a l'etude, et ont ete suivis longitudinalement des l'âge d'un an. L'affect negatif des bebes fut observe et evalue selon le comportement a l'âge d'un an, et les symptomes depressifs des enfants ont ete mesures a l'âge de six ans en utilisant un questionnaire personnel. Les resultats ont revele une continuite entre l'affect negatif chez le bebe et les symptomes de depression dans l'enfance. De plus, l'exposition prenatale a l'alcool s'est averee etre un facteur de risque important dans le developpement de traits depressifs a la fois a travers son association directe avec l'enfant et avec son effet indirect sur l'affect negatif chez le bebe. Les enfants ayant de plus haut niveaux d'exposition a l'alcool, qui avaient de plus hauts niveaux d'affect negatif a un an, avaient plus de symptomes depressifs a six ans. Cet effet fut observe avant tout chez les filles. Les resultats suggerent un mecanisme suivant lequel les enfants exposes a l'alcool in utero peuvent etre predisposes a faire preuve de plus hauts niveaux d'emotionalite negative dans la toute petite enfance, les mettant a plus risque de depression durant leur enfance. La continuite de l'affect negatif et des symptomes negatifs chez les jeunes exposes prenatalement a l'alcool suggere que les interventions pourraient commencer durant la toute petite enfance et pourraient specifiquement cibler les comportements negatifs de l'enfant.

This overview outlines the magnitude of the impact of parental substance abuse on children's development. The aim of this special issue is described: to encourage research productivity by promoting integration between two traditionally separate literatures with quite different theoretical perspectives: (1) the effects of prenatal substance exposure; and (2) the impact on children of postnatal rearing by parents addicted to substances. Because study of the developmental impact of parental alcohol use has a long research tradition, lessons learned can guide the field. Thus, this overview focuses on the role of maternal drinking in the emergence of childhood psychopathology, a topic of interest to infant mental health. As an example, this article features multiple findings from O'Connor's programmatic research, which is built upon current models of development and integrated theoretical perspectives, and includes both lower and higher risk samples. These data show that women in a middle-class sample who drank more heavily during pregnancy had infants with higher levels of negative affect and insecure attachments. At ages 5–6, a greater percentage of these alcohol-exposed children showed significant levels of depression than expected for their age. Prenatal alcohol exposure and maternal depression both contributed significantly to prediction of preschoolers' depression, and findings could not be explained by mother's current drinking. Congruent results from a higher risk sample show how cumulative risk can exacerbate problems, and extend earlier data by documenting the mother–child interplay that can maintain or reduce the deleterious effects of prenatal alcohol exposure over time. Results are discussed in light of current theory about the early emergence of internalizing disorders, with implications for research and intervention. This overview ends by introducing the articles in this special issue, and how each contributes to advancing its aim. ©2001 Michigan Association for Infant Mental Health.

Background: This study examined the association between prenatal alcohol exposure and self-report of depressive symptoms in 5- to 6-year-old children. Higher levels of prenatal alcohol exposure were hypothesized to be associated with endorsement of a greater number of depressive symptoms in children. It was also hypothesized that maternal depression, although associated with drinking behavior, would contribute independently to outcome. Finally, the mother's behavior toward the child, as well as current drinking practices, were postulated to mediate the relationship between prenatal alcohol exposure and child depressive symptoms. Methods: Participants were 41 mother-child dyads who had been followed longitudinally since the children were 1 year of age. Self-report questionnaires for maternal and child depression were used. Results: Results revealed that prenatal alcohol exposure, maternal depression, and child gender seemed to be highly associated with child depressive symptoms. Girls who had higher levels of prenatal alcohol exposure and whose mothers acknowledged higher levels of depression endorsed the highest number of depressive symptoms. Neither the mother's behavior in interaction with the child nor her current level of alcohol consumption mediated the relationship. Conclusions: The importance of considering prenatal alcohol exposure as a risk variable in the prediction of childhood-onset depression and the possible neurological mechanisms underlying depression in children with alcohol exposure in utero are discussed.

In addition to the adverse effects of alcohol on the fetus, alcohol use can leads to other adverse effects on the health of women including reproductive health conditions that are not addressed in this brief. Though the approaches mentioned here are primarily aimed at reduction of prenatal alcohol-related pregnancies, any reduction in hazardous alcohol consumption among women will add to improvements in the general health of women. Multiple federal and non-fedral health agencies and organizations recommend that pregnant women and those planning a pregnancy should abstain from alcohol use. Although assessment and interventions are valuable tools to recognize and address alcohol use and secondary pregnancy outcomes, they are underutilized in primary care settings. To reduce the burden of alcohol exposed pregnancies and alcohol’s impact on the health of families, it is critical for physicians and health care providers to consistently screen childbearing-aged women for alcohol use with validated screening tools which can be embedded in the patient screening protocol. Tools are now available for pediatricians and child health care providers to enhance early recognition of FASD and reduce secondary conditions that often accompany physical maturation [4]. Brief clinician-delivered behavioral interventions to women and their partners, counseling regarding effective contraceptive options when not planning a pregnancy, and improving access to such services for those who are unable reduce their alcohol intake can help more women reduce their risk for an alcohol exposed pregnancy [11]. Referral to needed social services should complement health services in order to achieve maximum benefits of primary care-based attempts to reduce alcohol-exposed pregnancies. Given the levels of alcohol use among childbearing aged women, primary care-based individual level assessment and intervention continues to remain a critical prevention strategy for reducing alcohol-exposed pregnancies.

Recent attempts to identify a neurocognitive profile of children with prenatal alcohol exposure (PAE) have led to an emerging "generalized deficit" conceptualization marked by diffuse information processing and integration difficulties as opposed to a specific profile. This study examines whether this conceptualization can be extended to higher functioning children with PAE who are without intellectual disability and addresses several limitations of previous research. One hundred twenty-five children aged 6-12 years with social skills deficits, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD), underwent a comprehensive, multi-informant assessment of neurocognitive, emotional, social, behavioral, and adaptive functioning. Multivariate analyses of variance examined differences in functioning between the PAE group and a nonexposed comparison group with and without controlling for child IQ. Results indicated that the PAE group returned significantly poorer scores than the nonexposed group on every construct assessed, including executive functioning, attention, working/visuospatial memory, linguistic abstraction, adaptive behavior, emotional/behavioral functioning, and social cognition. These differences largely maintained after controlling for IQ and were similar regardless of informant, although teachers reported somewhat fewer group differences. Within the PAE group, no differences were found across FASD subtypes. These results provide evidence extending the emerging generalized deficit conceptualization of children with PAE to those higher functioning individuals without global intellectual disability.