Since fetal alcohol syndrome was first reported, studies have demonstrated a range of perinatal/developmental abnormalities that fall under the umbrella term fetal alcohol spectrum disorders. Of these, low birth weight in exposed children is among the most commonly observed and widely accepted. However, in the past, assertion of an association between prenatal alcohol exposure and preterm birth was controversial. Methodological difficulties may have contributed to failure to consistently detect such a relationship. However, new evidence suggests that pregnancy drinking may be a major contributor to extreme, but not mild prematurity. Extreme prematurity is a major cause of severe perinatal morbidity and mortality. If recent findings are confirmed, it suggests that extreme prematurity might be reduced by eliminating prenatal alcohol exposure.

Background: Rates of preterm delivery, a major proximate cause of perinatal morbidity and mortality, have been increasing. Prenatal alcohol exposure has been implicated in preterm delivery, although results have been inconsistent due to inadequate control for confounding factors, insufficient power, unreliable and inaccurate assessment of both exposure and gestational age, and lack of stratification of prematurity into severity levels. The purpose of this study was to examine the relation between maternal alcohol, cocaine and cigarette use during pregnancy, and extreme and mild preterm birth. Methods: Three thousand one hundred thirty consecutive gravidas were followed prospectively for antenatal substance use and had ultrasound confirmed pregnancy dating. Results: Alcohol and cocaine, but not cigarette use, were associated with increased risk of extreme preterm delivery after control for potential confounders. For every unit increase in alcohol exposure, risk of extreme preterm delivery increased significantly [odds ratio (OR) 34.8]. Furthermore, in women aged 30+, alcohol exposure was associated with mild prematurity. Abstention from alcohol while continuing to use cocaine and tobacco was related to a decrease in extreme prematurity of 41%. Conclusions: The risk of extreme preterm delivery associated with alcohol use is substantial and similar in magnitude to other well-recognized risks. Increased accuracy in identifying exposure and the use of ultrasound to confirm gestational age dating likely contributed to the findings of the current study. These findings suggest that eliminating pregnancy alcohol use might substantially reduce the risk of preterm delivery.

Background: Fetal alcohol spectrum disorders (FASD), which are caused by prenatal alcohol exposure (PAE), affects people around the world. Certain communities in South Africa have among the highest reported incidences of fetal alcohol syndrome (FAS) in the world. Although PAE-related brain alterations have been widely documented, the mechanisms whereby alcohol affects the brain are not clearly understood. MRI relaxation parameters T1, T2, T2* and proton density (PD), are basic tissue properties that reflect the underlying biology. The present study aims to advance our understanding of how PAE alters the microstructural properties of tissue by examining PAE-related changes in these tissue parameters in adolescents with FASD. Methods: The final sample used in this study consisted of 53 children from a previously studied longitudinal cohort (Jacobson et al., 2008) and 12 additionally recruited subjects. Of the 65 participants, 18 were diagnosed with FAS or partial FAS (PFAS) and made up the FAS/PFAS group, 18 were diagnosed as heavily exposed non-syndromal (HE) and 29 were age matched controls. Subjects were scanned at the Cape Universities Body Imaging Centre (CUBIC) located at Groote Schuur Hospital on a 3T Siemens Skyra MRI. Structural images were obtained using the MEMPRAGE sequence. From these images T1, T2, T2* and PD parameter maps were constructed and segmented into 43 regions of interest (ROI) using Freesurfer, FSL and AFNI. Linear regression analyses were used to analyse group differences as well as correlations between parameter values and the amount of alcohol the mother consumed during pregnancy. Results: Significant T1 differences were found in the caudate, cerebellar cortex, hippocampus, accumbens, putamen, choroid plexus, ventral diencephalon (DC), right vessel and ventricles. Significant T2 differences were found in the caudate, brain stem, corpus callosum (CC), amygdala, cerebral cortex, choroid plexus, vessels and ventricles. Significant T2* differences were found in the cerebellar cortex, optic chiasm and ventricles. Significant PD differences were found in the hippocampus and left lateral ventricle. The exploratory nature of this study resulted in none of the results surviving FDR correction for multiple comparisons. Conclusions: Overall, our findings point to regional PAE-related increases in water content and cellular and molecular changes in underlying tissue of the anatomical structure. Exceptions were the right cerebral cortex, brain stem, hippocampus, amygdala and ventral diencephalon where our findings point to less free water and increased cell density, and cerebellar cortex where simultaneous reductions in T1 and T2* suggest the possibility of increased iron content. In highly myelinated white matter structures, such as the CC and optic chiasm, our results point to PAErelated demyelination, and possibly increased iron. These findings extend previous knowledge of effects of PAE and demonstrate that tissues are affected at a microstructural level.

Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Fetal Alcohol Spectrum Disorder (FASD) is a preventable cause of intellectual delay. Highly prevalent in South Africa, it has become a public health concern. Effective screening measures to identify women at risk of producing a FASD child is therefore important. This study postulated that a distinctive maternal profile may exist for mothers with FASD infants compared to a comparison group. Consequently, the study investigated the occurrence of maternal depression and its potential association with maternal risk factors and infant development respectively; differences in the profiles of mothers; as well as developmental differences in FASD and No FASD groups of children. An ex-post facto design was implemented, where the sample comprised of dyads that completed initial (infants 9-18 months) and follow-up (children 18-45 months) assessments. Severity of maternal depression (measured on the Beck Depression Inventory); maternal current mood states (measured on the Profile of Mood States) and infant developmental differences (measured with the Griffiths Mental Developmental Scales) were assessed. The results showed no distinct patterns in maternal depression in the FASD versus the No FASD groups; maternal depression was not significantly correlated with infant development; infants with FASD showed impaired overall development, with especially poor social adjustment; and all infants (FASD and No FASD) performed lower than the expected developmental norms. Maternal alcohol use was the only significant covariate associated with infant development. Identifying the predictors of high risk behaviour during pregnancy is complex, where prenatal alcohol exposure cannot be viewed in isolation from contextual factors, as limited resources, historical factors, cultural/community knowledge, a lack of stimulation and malnutrition prevail in many areas of South Africa. Profiling maternal predisposition to prenatal alcohol use is essential in reducing the incidence of FASD in South Africa and implementing social skills intervention programs could aid the long-term adjustment of FASD infants.

The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

This study utilized the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) and the Personality Inventory for Children, Second Edition (PIC-2) as measures of cognitive and personality functioning for children with Fetal Alcohol Spectrum Disorder with comorbid Attention-Deficit/Hyperactivity Disorder (FASD/ADHD) and children with ADHD. This study revealed the WISC-IV and PIC-2 each provided unique information to the neuropsychological examination of children with FASD/ADHD and ADHD. Furthermore, the FASD/ADHD group and the ADHD group were found to have significant differences in terms of cognitive and personality functioning. The results also indicated the groups could be differentiated using the WISC-IV and the PIC-2 independently with a high degree of accuracy. The current study further elucidated the unique cognitive and personality profiles of children with FASD/ADHD and ADHD and identified key areas of difference between the two groups. Moreover, the current study documented the utility of the Classification and Regression Tree procedure as a useful diagnostic tool in the differential diagnosis of FASD versus ADHD using commonly used cognitive and personality measures. / Department of Educational Psychology

The majority of children with Fetal Alcohol Spectrum Disorder (FASD) have comorbid Attention-Deficit Hyperactivity Disorder (95%; Fryer et al., 2007). The goal of this study was to compare the neuropsychological and adaptive skills profiles of children with Attention-Deficit/Hyperactivity Disorder (ADHD) with or without comorbid FASD in order to improve interventions for both of these populations. This study paid particular attention to neurological, cognitive, and adaptive skills strengths and weaknesses in children with ADHD/FASD and children with ADHD without comorbid FASD. By identifying these strengths and weaknesses recommendations were able to be made to help the functioning of each of children with ADHD/FASD and children with ADHD in their home, community, and school environments based on their neuropsychological and adaptive skills profiles. Neurologically, children with ADHD/FASD and children with ADHD have been shown to have impairment in the basal ganglia, cerebellum, corpus callosum, frontal lobes, hippocampus, hypothalamus, occipital lobes, parietal lobes, temporal lobes, and thalamus. Cognitively, children with ADHD have been shown to have difficulty in areas such as working memory and processing speed with less significant deficiencies in verbal ability and perceptual organization whereas children with ADHD/FASD have shown impairment in all of these cognitive abilities. When compared to typically developing children with approximately the same level of general intelligence, children with ADHD have been shown to obtain lower standard scores in all domains of adaptive functioning and children with FASD have been shown to demonstrate significant adaptive skills deficits throughout the lifespan. This study used specialized statistical procedures including Multivariate Analysis of Variance (MANOVA), Discriminant Analysis (DA), and Classification and Regression Tree (CART) in order to investigate the neuropsychological and adaptive skills in 81 children with ADHD/FASD and 147 children with ADHD. The statistical analyses indicated that children with ADHD/FASD and children with ADHD have similar cognitive and adaptive skills profiles; however, the children with comorbid ADHD/FASD were significantly more impaired in verbal ability, perceptual reasoning, working memory, processing speed, and overall adaptive skills. The current study took a step forward in helping to make diagnostic decisions based on the similarities and differences between children with ADHD with and without comorbid FASD. Given the data from the current study indicating the significant differences in cognitive and adaptive skills in these two samples, it is imperative that psychopharmacological interventions be tailored to these two seemingly similar yet different groups, especially as these two groups may respond differently to stimulant medication, the first line of medicinal treatment for ADHD. Children with ADHD/FASD should also be treated with more intense interventions in the home, community, and school than children with ADHD. / Department of Educational Psychology

The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

Thesis (MEdPsig)--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: The research in this qualitative study focuses on the role of the Educational Psychologist in facilitating inclusion of a learner with Fetal Alcohol Syndrome (FAS). The international movement towards inclusive education, with emphasis on the inclusion of all learners irrespective of their special needs in mainstream schools, gained momentum in the South African context with the announcement of Education White Paper 6, Special Needs Education: Building an Inclusive Education and Training system. More learners with FAS are accommodated in mainstream schools and research has indicated that most cases of FAS in the world prevailed in the Western Cape. FAS is one of the leading causes of mental retardation and the challenges which the inclusion of learners with FAS pose to those who have to facilitate inclusive education, has urged this study. The study seeks to explore the role of the Educational Psychologist in the process of facilitating inclusion of a learner with FAS. An eco-systemic approach underpins the study. A single learner with FAS within the context of the family and education system was chosen by means of purposive sampling as the focus of a qualitative, case study. The eco-systemic approach makes it possible to explore special needs in terms of intrinsic factors (within the learner) and extrinsic factors (within the system) in order to address the needs of the system. Semistructured interviews were held with respondents from different levels of the eco-system in which the learner functions. A review of personal records and field notes were used to gather information related to the education and learning process. The data were analysed using aspects of content analyses. Four themes emerged: support to the learner, support to the school, support to the parents and support to the school community. The findings indicated that the inclusion of learners with FAS predicts a change and an expansion in the role of the educational psychologist. Early identification, early intervention and a multi-functional team approach seem to improve the long-term prognoses of learners with FAS. The facilitation of inclusive education for learners with FAS poses a challenge to the educational psychologist to render individual support, but also to provide support in a holistic systemic manner, focusing on those who work and live with the individual learners. The learning, behaviour and developmental barriers which learners with FAS may experience were highlighted with the hope to guide those who work with these learners. Several positive and negative factors were indicated and recommendations were made. / AFRIKAANSE OPSOMMING: Hierdie kwalitatiewe studie fokus op die rol van die Opvoedkundige Sielkundige in die fasilitering van inklusiewe onderwys aan 'n leerder met Fetale Alkohol Sindroom (FAS). Die internasionale beweging na inklusiewe onderwys, wat die insluiting van alle leerders, ongeag hulle spesiale behoeftes, by hoofstroomskole onderskryf, het ook in Suid-Afrika neerslag gevind met die uitreiking van die Onderwys Witskrif 6, Special Needs Education: Building an Inclusive Education and Training System. Meer leerders met FAS word by hoofstroomskole ingesluit en navorsing het getoon dat die voorkomssyfer van FAS in die Wes-Kaap die hoogste ter wêreld is. Die feit dat FAS tans een van die vernaamste oorsake van verstandelike gestremdheid is, en die uitdagings wat die insluiting van leerders met FAS aan diegene wat inklusiewe onderwys moet fasiliteer bied, het hierdie navorsingsondersoek genoop. Die doel van hierdie studie is om 'n in diepte ondersoek te doen na die rol van die Opvoedkundige Sielkundige in die fasilitering van inklusiewe onderwys aan 'n leerder met FAS. 'n Ekosistemiese benadering het die teoretiese raamwerk van die studie gevorm. 'n Enkele leerder met FAS is binne die konteks van sy familie en die onderwyssisteem, met behulp van doelgerigte steekproefneming, gekies om die fokus van die kwalitatiewe gevallestudie te vorm. Die ekosistemiese benadering maak dit moontlik om spesiale behoeftes ten opsigte van faktore wat primêr by die leerder (intrinsiek) voorkom, sowel as faktore wat in die sisteem (ekstrinsiek) voorkom, te ondersoek en te verseker dat die behoeftes van die sisteem aangespreek word. Semi-gestruktureerde onderhoude is gevoer met respondente uit die verskillende vlakke van die ekosisteem waarbinne die leerder funksioneer. 'n Oorsig van persoonlike rekords en verslae asook veldnotas is gebruik om inligting oor die leerder, die onderrig en die leerposes te bekom. Inhouds-analise is gebruik om die data te analiseer. Vier temas het uit die data na vore gekom, naamlik: ondersteuning aan die leerder, ondersteuning aan die skool, ondersteuning aan die ouers en ondersteuning aan die skoolgemeenskap. Die bevindinge dui daarop dat die insluiting van 'n leerder met FAS 'n roluitbreiding en 'n veranderende rol vir die Opvoedkundige Sielkunde in die vooruitsig stel. Vroeë identifikasie, vroeë intervensie en 'n multi-funksionele spanbenadering kan die langtermyn prognose van leerders met FAS verbeter. Die rol wat die Opvoedkundige Sielkundige op die verskillende vlakke van die ekosisteem kan speel, ten einde inklusiewe onderwys aan 'n leerder met FAS te fasiliteer, lê opgesluit in die mate waarin geïndividualiseerde, maar tog ook holisties omvattende ondersteuning aan diegene wat met hierdie leerders werk, gelewer kan word. Uit die bevindinge het suksesvolle en minder suksesvolle aspekte duidelik geword. Dit het daartoe bygedra dat die leer-, gedrag- en ontwikkelingshindernisse, sowel as die sterkpunte van die leerder met FAS, duidelik geword het en wenke vir toekomstige gebruik verbesonder kon word. Op grond van die bevindinge en aan die hand van literatuur is aanbevelings gemaak.

Externalizing disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) have a high prevalence rate in both children of alcoholics and in those with prenatal alcohol exposure (PAE). These disorders are also predictors of alcohol dependence (alcdep), heritable, and share an underlying genetic liability with alcdep. Furthermore, a mother who drinks while pregnant is likely to be alcohol dependent (AD), and vice-versa. This study incorporated these factors into one model, including as well as a measure of broad genetic risk for ADHD and alcdep to test for the contributions of these effects simultaneously. An independent sample was used to confirm the results for PAE and broad genetic risk. The hypothesis is that PAE will increase the risk to ADHD but not to CD or ODD.