Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Abstract

Background Heavy prenatal alcohol exposure (AE) results in a broad array of neurobehavioral deficits. Recent research has focused on identification of a neurobehavioral profile or profiles that will improve identification of children affected by AE. The current study aimed to build on our preliminary neurobehavioral profile in order to improve classification accuracy and test the specificity of the resulting profile in an alternate clinical group. Methods A standardized neuropsychological test battery was administered to three groups of children: subjects with AE (n = 209), typically developing controls (CON, n = 185), and subjects with attention-deficit/hyperactivity disorder (ADHD, n = 74). We assessed a large sample from six sites in the U.S. and South Africa, using standardized methodology. Data were analyzed using three latent profile analyses (LPA) including: (1) subjects with FAS and controls, (2) subjects with AE without FAS and controls, (3) subjects with AE (with or without FAS) and subjects with ADHD. Results Classification accuracy was moderate but significant across the three analyses. In analysis 1, overall classification accuracy was 76.1% (77.2% FAS, 75.7% CON). In the second analysis, overall classification accuracy was 71.5% (70.1% AE/Non-FAS, 72.4% CON). In the third analysis, overall classification accuracy was 73.9% (59.8% AE, 75.7% ADHD). Subjects that were misclassified were examined for systematic differences from those that were correctly classified. Conclusion The results of this study indicate that the neuropsychological effects of AE are clinically meaningful and can be used to accurately distinguish alcohol-affected children from both typically developing children and children with ADHD. Further, in combination with other recent studies, these data suggest that approximately 70% of children with heavy prenatal alcohol exposure are neurobehaviorally affected while the remaining 30% are spared these often-devastating consequences, at least those in the domains under study. Refining the neurobehavioral profile will allow improved identification and treatment development for children affected by prenatal alcohol exposure.

Ethanol Alters the Balance of Sox2, Oct4, and Nanog Expression in Distinct Subpopulations During Differentiation of Embryonic Stem Cells

“…With a rate of 9-50 cases per 1,000 live births, FASD is a leading cause among birth defects and developmental disorders [10]. The most severe manifestation of the disorder, fetal alcohol syndrome (FAS), is characterized by a specific craniofacial dysmorphology, central nervous system defects, intellectual disability, growth retardation, and multiple-organ abnormalities [11,12]. High blood alcohol concentrations as in binge drinking has been associated with the development of FAS [9], and the heaviest binge alcohol consumption was reported in the first trimester (12.14 drinks per day, and 84 binge episodes in the 99th percentile group) [8].…”

Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths

“…Moderators . Relative strengths A well-documented range of adverse effects is associated with prenatal alcohol exposure (PAE), including impaired neurobehavioral functioning, facial dysmorphology, and growth deficiency (Astley and Clarren 1999;Mattson et al 2011;Mattson et al 2013). Fetal alcohol spectrum disorder (FASD) comprises the range of alcohol-related conditions resulting from PAE.…”

“…Some areas appear to be more often affected, including executive functioning, attention, adaptive functioning, and mathematics Rasmussen and Bisanz 2010). Significant variability is typically observed across cognitive indicators in studies of children with FASD, and between-group comparisons with other clinical populations show a great deal of overlap in functioning (Mattson et al 2013;Ware et al 2014). …”

“…In light of the complex host of factors that influence the teratogenic effects of PAE in utero (e.g., dose, timing, maternal factors, and genetic suceptibility; May et al 2013;Ramsay 2010;Smith et al 2014), as well as the range of environmental exposures that may further shape a child's cognitive development, it is unlikely that a single neurobehavioral Bphenotype^of FASD exists. However, refining the profile of neuropsychological problems that are typically observed in children with PAE may greatly inform the reliability of clinical assessment and confidence of clinicians tasked with rendering diagnoses on the spectrum (Kodituwakku 2009;Koren et al 2014;Mattson et al 2013;Nash et al 2013).…”

Fetal Alcohol Spectrum Disorder (FASD): A call on mental health treatment professionals to become informed

“…For this reason, it is never safe to drink alcohol when trying to get pregnant or during pregnancy. FASD can include a wide range of cognitive (e.g., intelligence, executive functions, shortand long-term memory, and attention), social (e.g., communication skills and gullibility), physical (e.g., reduced height and weight, and smaller head size), and adaptive impairments (e.g., decision making and problem-solving abilities) [10][11][12][13][14]. Of critical concern is the disruption of immune system development that leads to increased risk of disease and infection throughout the exposed individual's life [15], with deleterious effects of FASD presenting not only in the individual, but also on the family and in the community.…”