Infant Emotional Withdrawal: A Precursor of Affective and Cognitive Disturbance in Fetal Alcohol Spectrum Disorders

Abstract

Objectives To test the hypothesis that emotional withdrawal is an early indicator of affective disorder in infants heavily exposed prenatally to alcohol, which is independent of alcohol-related effects on mother-infant interaction and temperament and discriminated between children later diagnosed with fetal alcohol syndrome (FAS) and partial FAS (PFAS) and predicted cognitive and affective outcomes at 5 and 9 years. Methods The sample consisted of Cape Coloured (mixed ancestry) infants, whose mothers were interviewed during pregnancy regarding their alcohol consumption using a timeline follow-back approach. Infant emotional withdrawal (n = 85) was assessed on the Alarm Distress Baby Scale at 6.5 months. Mother-infant interaction was evaluated from video recordings during free play and infant feeding at 6.5 months (n = 127). Infant temperament was assessed by maternal report on the EAS Temperament Survey at 13 months (n = 119). Socio-demographic and psychological correlates of maternal alcohol use and infant iron deficiency were examined as potential confounders. The children were diagnosed for FAS/PFAS by expert dysmorphologists at 5 years; cognitive and affective function, at 5 and 9 years. Results Prenatal alcohol exposure was associated with increased infant emotional withdrawal and decreased activity, but unrelated to mother-infant interaction or any other temperament measures. Children later diagnosed with FAS and PFAS at 5 years exhibited more emotional withdrawal and less responsivity and activity as infants. Infant withdrawal, responsivity, quality of interaction, and maternal sensitivity also predicted poorer IQ and affective response at 5 and 9 years. When all four infant affective measures were examined simultaneously in a regression analysis, only infant emotional withdrawal persisted as a significant predictor of 9-year IQ. Conclusions This study is the first to document a direct effect of fetal alcohol exposure on emotional withdrawal in infancy. These data link prenatal alcohol to a specific aspect of infant affective function not attributable to mother-infant interaction, infant temperament, or other socioemotional aspects of the infant’s environment and identify infant emotional withdrawal as an early indicator of affective disturbance, particularly in children later diagnosed with FAS and PFAS.

Mütterlicher Alkoholkonsum in der Schwangerschaft und fetales Alkoholsyndrom

“…Hoher Alkoholkonsum scheint zu emotionalem Rückzug von Säuglingen zu füh-ren, der wiederum ein Prädiktor für affektive und kognitive Störungen bei Kindern mit FAS sein kann [24]. Bei den Studien zur Bestimmung eines signifikanten und somit für das Kind schädlichen Alkoholkonsums der Mutter muss immer berück-sichtigt werden, dass die mütterlichen Angaben subjektiv und nicht frei von mögli-chen Störfaktoren sind.…”

Retraimento social em bebês: um estudo exploratório sobre os irmãos mais novos de crianças com transtorno do espectro do autismo

“…Estudo realizado por Molteno (2014), na África do Sul, a partir da avaliação de 85 bebês cujas mães faziam uso abusivo de álcool, evidenciou esta mesma associação. Sabemos, ainda, que a baixa escolaridade materna está relacionada a problemas do desenvolvimento da prole de maneira geral (Assis, 2009).…”

“…A maior parte dos trabalhos desenvolvidos até o presente momento, a partir da ADBB, foi realizada a partir da avaliação de bebês de baixo risco, embora alguns tenham investigado o retraimento em populações de risco -bebês identificados previamente com problemas socioemocionais e/ou distúrbios na relação com seus pais; prematuros; soropositivos; filhos de mães imigrantes ou usuárias de álcool; institucionalizados ou recém adotados após período de institucionalização (Dollberg et al, 2006;Braarud, 2013;Hartley et al, 2010;Burtchen et al, 2013;Molteno, 2014;Baptista, 2013;Dollberg, Keren, 2013). Novamente, a maior parte destas avaliações publicadas foi realizada durante consultas de rotina pediátrica ou de puericultura, tomando por base o comportamento do bebê em relação a um profissional de saúde estranho a ele.…”

“…A maior parte das pesquisas desenvolvidas com populações de baixo risco em situação de consulta de rotina pediátrica/puericultura encontrou taxas entre 6,9% e 14% (Puura et al, 2010;Mäntymaa et al, 2008;Lopes et al, 2008;Guedeney et al, 2008;Guedeney et al, 2012), embora outros estudos tenham encontrado taxas entre 25% e 34,1% para população semelhante (Plevak et al, 2012;Mathey et al, 2005). Entre os bebês sob condição de risco avaliados nesta mesma situação -prematuros ou filhos de mães usuárias de álcool durante a gestação -, as taxas encontradas situam-se entre 3,5% e 27,1% (Braarud et al, 2013;Molteno, 2014).…”

“…c) Características relacionadas à mãe: escolaridade materna (Moura, 2010;Molteno, 2014;Guedeney et al 2012); idade (Gravena, 2013); número de filhos (Moura, 2010);…”