A serious consequence of maternal consumption of alcohol during pregnancy is the fetal alcohol syndrome (FAS): characterized by growth deficiency (both pre- and post-natal), craniofacial dysmorphology and central nervous system (CNS) dysfunction. However, in the absence of the characteristic facial features, and without confirmed history of alcohol exposure, clinical diagnosis remains a significant challenge. Recently, the term fetal alcohol spectrum disorders (FASD) has been adopted to encompass all diagnoses relating to a history of prenatal alcohol exposure. The purpose of this study was to test the following three general hypotheses: Children with FASD 1) demonstrate specific deficits in oculomotor control that can be measured using saccadic eye movement tasks, 2) display specific deficiencies in multiple domains of executive function that can be determined using standardized neuropsychological tasks, and 3) reveal deficits in oculomotor control that correlate with deficiencies in executive function as measured using standardized neuropsychological tasks. A preliminary study revealed significant deficits in saccadic eye movement tasks and provided the foundation for a large, multi-centered study assessing oculomotor control and neuropsychological function in children with FASD. A mobile laboratory was created, which facilitated recruitment of 92 control subjects and 89 subjects with FASD. We found significant evidence for oculomotor deficits across multiple outcome measures following the saccadic eye movement experiments, especially for oculomotor tasks that probe aspects of executive function. Additionally, children with FASD exhibited performance deficits in neuropsychological tasks that assess planning, attention, spatial working memory and strategy; cognitive skills also included within the domain of executive function. Finally, significant correlations between these two objective measures were found for children with FASD, which were not evident in the control sample. These findings are consistent with significant frontal lobe dysfunction. This is an exciting area of research that may hold promise in developing effective screening tools that can assist in the diagnosis of individuals with a history of prenatal alcohol exposure. / Thesis (Ph.D, Neuroscience Studies) -- Queen's University, 2008-08-28 15:41:20.595

Alcohol consumption during pregnancy is detrimental to the developing nervous system of the unborn offspring. The hippocampus, one of the two brain regions where neurogenesis persists into adulthood, is particularly sensitive to the teratogenic effects of alcohol. The present study examined the effects of alcohol exposure throughout all three trimester equivalents on the stages of adult neurogenesis. Prenatal and early postnatal alcohol exposure (PPAE) altered cell proliferation in adult but not adolescent animals and increased early neuronal differentiation without affecting cell survival in both age groups. The levels of brain-derived neurotrophic factor (BDNF) were not affected by PPAE in the dentate gyrus but were significantly decreased in the Cornu ammonis region of the hippocampus. These results might explain the functional deficits seen in this hippocampal sub-region. This study identified that voluntary wheel running increased cell proliferation, differentiation and survival as well as BDNF expression in both PPAE and control animals. / Graduate

The chronic and severe executive functioning (EF) and self regulation deficits experienced by children with fetal alcohol spectrum disorders (FASD) are well documented and EF and self regulation have been identified as core targets for intervention. The goals of this dissertation were to: (i) examine the effects of a self regulation treatment for children with FASD on a range of EF measures (ii) examine neural markers of treatment outcome and determine if functional magnetic resonance imaging (fMRI) can differentiate treatment responders from nonresponders; (iii) determine if treatment effects generalize to child compliance and qualitatively examine the treatment process. Twenty-five children with FASD participated. Using a wait-list control design children were assigned to an immediate treatment (TXT; n = 12) or delayed treatment control (DTC; n = 13) condition. All children received an evaluation of EF and fMRI at baseline and 12-week follow-up. Parents also completed questionnaires assessing EF and behavior as well as a feedback questionnaire upon completion of treatment. A subset of parents tracked compliance over the course of their child’s therapy. For the TXT group only, parent questionnaires were readministered at 6 month follow-up. At 12-week follow-up, children in the TXT group displayed significant improvements in inhibitory control and social cognition. Additionally, parents reported improved behavioral and emotional regulation. This improvement, along with a further improvement in parent-rated inhibitory control, was maintained at the 6-month follow-up. Neuroplastic changes were also observed as the TXT group showed increased BOLD response in the right prefrontal cortex (PFC) and left caudate on a task of inhibitory control. When treatment responders were compared to nonresponders a pattern of increased BOLD response was found bilaterally in the PFC and left caudate. Compliance tracking revealed that self regulation therapy generalized to improved child compliance at home. Qualitative analysis indicated that perceived clinician competence, caregiver insight about child’s problems and caregiver perceptions of child’s insight about their problems, were the most commonly endorsed themes by caregivers. Results from this research signify that children with FASD are responsive to psychotherapy and following a brief intervention, showed improvements in self regulatory abilities that generalize to other EF areas and parent-reported behaviors.

Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 92-105).

Fetal Alcohol Syndrome (FAS) is the most severe of a spectrum of birth defects caused by a mother drinking alcohol whilst pregnant. Its manifestation in the Central Nervous System causes intellectual and behavioural abnormalities, which pose considerable challenges in the classroom. This case study explores the classroom environment and educational outcomes of learners with FAS in a rural South African school. The study was conducted at Elizabethfontein Primary School (EFPS), a farm school near Clanwilliam in the Western Cape. The sample comprises of all 170 learners in Grade 1 to Grade 4. A prevalence rate of FAS of 124 per 1000 (12.4%) was found. EFPS is a Quintile 1 school that relies heavily on fundraising (especially in the form of Riel Dancing) and sponsorship to afford extra staff (such as Koshuis Tannies and teaching assistants), maintenance and transportation of learners. The lack of Grade R school preparation and the environment learners grow up in results in discipline problems, many learners repeating, being progressed before they are ready and a high dropout rate. Child abuse and neglect is common today, prompting the EFPS boarding house to act as "safe haven" during the week for two thirds of its learners. The school provides security, routine and constant meals (as part of the School Nutrition Program and supplemented by the school garden). Data on educational outcomes was collected through participant observation (classroom behaviour), collection of information from existing sauces (Home Language Marks and Mathematics Marks) and collection of new data (Reading Score). A physician diagnosed those children with FAS using a three-stage process. Having FAS is associated with lower home language marks ( 2.8 to 8.55 percentage points) and behavioural scores (1.73 to 4.21 percentage points). The mitigating effect of the school on FAS learners might have reduced the impact of FAS. Children with FAS struggle academically and in following rules and principles as they have lower intellectual capabilities and cannot generalise from one situation to the next. Memory deficits, especially verbally and visuospatially, present challenges in following instructions and copying from the board. Children with FAS are also hyperactive, distractible and inattentive, which causes classroom disruptions and pose a negative externality to other learners. They find it difficult to follow social cues, but want to be helpful and well liked, making children with FAS vulnerable to manipulation. Strategies for intervention have been explored by specialised schools and studies, but must be translated into viable options for the mainstream under-resourced classroom. In order to develop appropriate strategies for classroom intervention a comprehensive understanding of FAS in this context must first be established. Many learners are isolated by a lack of tarred roads and cell phone reception within the large catchment area of EFPS. As descendants of local tribes and slaves the history of this farming area still influences them today. The legacy of the Dop system can still be seen, as alcohol forms a cornerstone of social interactions, especially in binge drinking over weekends, which exposes children to the cycle of alcohol addiction from a young age. Racial segregation and the impact of Apartheid have influenced the educational trajectory of coloured children. The value of this study lies in the in-depth insight into the context learners find themselves in, and the specific challenges associated with FAS learners. Future studies can build on the methodology and explore ways to improve the lives of children with FAS. Research must be interdisciplinary and in collaboration with the community. In response to this research EFPS has declared 2016 as "The Year of Alcohol Awareness" . Intervention strategies must be aimed towards these isolated, under resourced communities.

No description available.

The National Institutes of Health defines Fetal Alcohol Syndrome (FAS) as a debilitating collection of birth defects that include craniofacial dysmorphisms, neurological and motor insufficiencies, growth retardation, and behavioral and social discrepancies. Characteristic craniofacial abnormalities, which include smooth philtrum, thin vermillion border, short palpebral fissures, and microcephaly, are used as a diagnostic tool for FAS. There is agreement across the literature that the characteristic craniofacial dysmorphisms are induced as a result of prenatal alcohol exposure in very specific doses, and during very particular time periods during embryonic development. However, ambiguity still exists about the critical time and dose relationship of prenatal alcohol exposure in the production of FAS. In regards to the critical timing, researchers have concluded that prenatal alcohol exposure during the second half of the first trimester, defined as days 43-94 postconception, was found to cause an increased incidence of smooth philtrum, thin vermillion border, microcephaly and reduced birth weight. Conversely, other studies found that prenatal alcohol exposure on day 7 of gestation in mice, which corresponds to week 3 of human gestation, induced craniofacial abnormalities comparable to those seen in humans with FAS. In regards to the critical dose, there is a linear relationship between the dose of prenatal alcohol exposure and the incidence of FAS-related craniofacial abnormalities, with no safe threshold. It was also found that a binge pattern of drinking was more significantly associated with the craniofacial abnormalities seen in FAS than a continuous or less condensed pattern of drinking, even if the binge pattern involved a smaller absolute dose of alcohol. These results regarding both dose and pattern on prenatal alcohol exposure, suggest that binge-drinking patterns are most significantly associated with craniofacial abnormalities if consumed before pregnancy or during late pregnancy, whereas absolute high doses of alcohol in a non-binge pattern were most significantly associated with craniofacial abnormalities in the first trimester. Further research is required for clarification of the critical time and dose relationships involved in the production of the characteristic craniofacial dysmorphisms seen in FAS. A definite conclusion will aid in the public education and prevention programs for FAS if solid information can be provided about the harms of alcohol consumption during pregnancy in regards to timing and dose.

Previous research on Fetal Alcohol Spectrum Disorder (FASD) has identified common physical and behavioural characteristics associated with children who were prenatally exposed to alcohol. The research suggests that many individuals with FASD have experienced involvement with the law, and engaged in inappropriate sexual behaviour. However, there would appear to be a scarcity of research that identifies the life histories of individuals with FASD who have engaged in inappropriate sexual behaviour. Identifying risk and protective factors towards positive outcomes for people with FASD has both individual and societal importance. In order to better understand individuals with FASD, this research paper explores the common characteristics of FASD which may lead to inappropriate sexual behaviour, such as deficits in social skills, self-regulation, and executive functioning. Another important characteristic that is explored in the research paper is how FASD can present as an invisible disability, and the risk associated with treatment of individuals who may not be identified as having organic brain damage, specifically in the criminal justice system. As the research on FASD is limited, this paper also explores the characteristics associated with the general population of people who have engaged in inappropriate sexual behaviour, and people with disabilities who have displayed challenging sexual behaviour. The comparison of populations of people engaging in inappropriate sexual behaviour highlights the importance of the responsivity of interventions. Despite the diagnostic label of “paraphilia” attributed to those who have been convicted of sexual crimes, each individual is a complex being. Responsivity indicates each individual must be holistically understood in order to design services that encourage individual change.

As awareness and diagnoses of FASD grow in Canada, there is increased need to support these individuals across their lifespan. One study suggested the prevalence of FASD may be as high as 10 per 1000 births (May & Gossage, 2001). The impact to society is growing as well, since this population requires support across their lifespan due to cognitive and sometimes physical impairments. It was estimated that the annual cost to Canadians was $53 billion (in 2007 dollar value) to support individuals aged 0-53 years (Stade et al., 2009). There is mounting evidence identifying the cognitive and physical impairments that these individuals have, particularly in children. Studies have also described the adaptive functioning of children with FASD, and their ability to cope in daily life. There is little information on youth and adults regarding their daily lives, and the factors that contribute to success in daily life. The purpose of this study was to identify predictive factors that contribute to success in occupational performance in youth and adults with FASD. Using the Canadian Model of Occupational Performance and Engagement (CMOP-E), the study explored variables reflecting the person, environment, and activity that promoted engagement and participation. The study also investigated the value of using self-report or performance-based assessment with the FASD youth and adult population. Due to memory, cognitive, and executive functioning deficits, the individual with FASD may not be able to accurately self-report. Results from the study suggest an individual’s living situation, involvement with foster care, and family involvement play a role in successful occupational performance. Formal assessments of cognitive, academic and memory abilities did not appear to play a role in the individual’s school completion and daily life. Interestingly, the characteristics of this FASD sample depicted a group of youth and adults, who, in general, lived with family, had completed some schooling at the grade 10-12 level, had limited employment, were not involved with the judicial system, and were just as likely to be Caucasian as Aboriginal. The concept of occupational performance proved complex, and future study on the factors contributing to occupational performance would benefit from additional variables related to environment and activity than were available in the current data set.

The teratogenic effects of prenatal alcohol exposure can significantly influence the development of a child, which may result in a range of structural, cognitive and behavioural abnormalities. The severity of these effects can vary and fall under the fetal alcohol spectrum disorder (FASD). South Africa hosts the highest prevalence rate (12%) of this disorder in the world. All conditions included in the FASD spectrum are completely preventable through maternal abstinence of alcohol during pregnancy. At present, very limited information is available regarding how much pregnant women in South Africa know about adverse effects caused by prenatal alcohol exposure. This study aimed to determine pregnant women’s awareness of alcohol’s potential teratogenic effects on pregnancy and their knowledge of the features and characteristics associated with fetal alcohol syndrome (FAS), the most severe of the FASD conditions. Additionally, the study compared the awareness and knowledge of pregnant women attending private antenatal centres, to those attending an antenatal clinic at Charlotte Maxeke Johannesburg Academic Hospital, a state hospital in the Johannesburg area. Participants (n=211) completed a self-administered questionnaire at their private antenatal class or state clinic. A total of 211 questionnaires were analysed; 107 questionnaires from the state antenatal clinic and 104 from the private antenatal centres. The awareness levels regarding alcohol use in pregnancy were found to be very similar amongst the private (52%) and state (55%) participants. However, results indicated that significantly more private participants (19%), compared to state participants (3%) could be classified as having knowledge of the condition FAS. Overall, this study found that pregnant women from various backgrounds have limited knowledge of the harms caused by alcohol use during pregnancy. Misconceptions about the acceptable levels of maternal alcohol consumption and the effects thereof were also evident. The results of this research highlights that prevention strategies and awareness campaigns regarding alcohol use during pregnancy should incorporate information on the severity and permanent nature of FAS, as well as highlighting the fact that all types of alcoholic beverages can result in this condition. Also, these campaigns should focus on informing women that no level of alcohol is acceptable during pregnancy, as any amount may have potentially teratogenic effects on the developing fetus.