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Scholarly Works (20 results)

  • Thesis
  • Peer Reviewed
UC San Diego Electronic Theses and Dissertations (2016)

Despite widespread public health campaigns and increased knowledge of the harmful effects of drinking during pregnancy, greater than 1% of children are estimated to have prenatal alcohol exposure. Reading-related difficulties are of particular concern in the school-age population. The current study aimed to characterize reading performance in children with heavy prenatal alcohol exposure.

Children (6–12y) with histories of heavy prenatal alcohol exposure (n=32) and without (n=40) were administered a two-hour neuropsychological battery, which included multiple measures of reading domains (decoding, fluency, comprehension) and phonological processing (phonological awareness, phonological memory, rapid naming). Caregivers completed assessments of home literacy environment and behavior. Correlation, MANOVA, and regression techniques were conducted to evaluate differences between groups and identify contributing factors for reading performance. Discriminant function and latent class analyses were run to determine whether performance on these measures could aid in differential diagnosis and establish whether distinct subtypes of reading impairment exist.

There were no significant differences on demographic characteristics between groups. Alcohol-exposed children performed significantly worse than their peers on all measures, with the exception of rapid naming. In particular, alcohol-exposed children had relative weaknesses in phonological awareness, decoding, and comprehension. They also had significantly higher rates of reading difficulties in all domains. Aspects of phonological processing accounted for significant variance in reading variables across groups. Exposure history accounted for additional variance in decoding and comprehension. No interaction effects were significant. After other factors were added to the models, vocabulary, behavioral concerns, and attitude towards reading were additional significant contributors. Also, exposure history continued to account for significant variance. Outcome variables distinguished between alcohol-exposed children and controls. Distinct subgroups emerged based on severity of impairment. There were no significant differences between performances on academic domains (reading, spelling, math) for either group.

Alcohol-exposed children had significant difficulties in all aspects of reading, comparable with their performance in math and spelling. They demonstrated specific weaknesses that suggest potential targets for intervention. Cognitive mechanisms that contribute to reading in both typical and neurodevelopmental disorder populations were also found in this population. Therefore, effective interventions in other populations may be utilized to improve outcomes for alcohol-exposed children.

    Cover page: Characterizing Reading Ability in Children with Prenatal Alcohol Exposure
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2020)

    Language and communication are two areas of functioning that are largely understudied among youth with fetal alcohol spectrum disorders (FASD). The current study aimed to elucidate the profile of language (i.e., receptive, expressive) and communication (i.e., functional, social) abilities in adolescents with FASD and investigate the relationship of language to communication.

    Subjects aged 12-17 years with (alcohol-exposed [AE] = 31) and without (control [CON] = 29) prenatal alcohol exposure were included. Receptive and expressive language were measured by the Clinical Evaluation of Language Fundamentals – Fifth Edition (CELF-5). Parents completed the Children’s Communication Checklist – Second Edition (CCC-2) as a subjective measure of general language. Functional communication was measured by the Student Functional Assessment of Verbal Reasoning and Executive Strategies (S-FAVRES) and parents completed the Social Skills Improvement System (SSIS) to measure social communication. Multivariate analysis of variance determined the overall profile of language and communication and whether it differed between groups. Next, multiple regression analyses examined the relationship of cognitive domains (inhibition, working memory, attention) to receptive and expressive language. Finally, multigroup path analysis determined if the proposed mediated effects of language (receptive, expressive) on communication (functional, social) via cognitive domains (inhibition, working memory, attention) differed between groups.

    The AE group performed significantly lower than the CON group on receptive language and parent-report of general language while groups did not significantly differ on expressive language. Groups did not significantly differ in functional communication while social communication was rated as significantly lower in the AE group. All cognitive domains were significantly related to receptive language while attention and inhibition related to expressive language across groups. Expressive language significantly related to both functional and social communication while receptive language significantly related to functional communication only. Overall, no indirect relations via cognitive domains were significant.

    The results of this study provide important information regarding the relations between basic language abilities and higher-level communication skills of adolescents with FASD. Interventions targeting working memory, inhibition, and attention may improve language abilities, which in turn may improve communication skills. Ultimately, improving communication skills of youth with FASD may translate to better overall functioning in multiple settings.

      Cover page: Language and Communication Abilities in Adolescents with Fetal Alcohol Spectrum Disorders
      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2009)
      Based on caregiver report, children with prenatal alcohol exposure have difficulty with social functioning, but little is known about their social cognition. The current study assessed the social information processing patterns of school-age children with heavy prenatal alcohol exposure using a paradigm based on Crick and Dodge’s reformulated six-stage model. Fifty-two children (aged 7–11) with and without heavy prenatal alcohol exposure were tested using a structured interview measure of social information processing involving 18 videotaped vignettes of children in group entry and provocation situations. Alcohol-exposed children displayed maladaptive processing patterns on the goal, response generation, and response evaluation steps in group entry situations, and encoding, attribution, response evaluation, and enactment steps during provocation situations. Children with heavy prenatal alcohol exposure also had difficulty on the Test of Problem Solving, and performance correlated with social information processing measures. Such difficulties may lead to problems in social functioning and warrant early intervention.
        Cover page: Social Information Processing Skills in Children with Histories of Heavy Prenatal Alcohol Exposure
        • Article
        • Peer Reviewed
        UC Irvine Previously Published Works (2020)
        The positive relationship between socioeconomic status (SES) and cognitive performance is mediated, in part, by differences in brain structure in typically developing youth. Associations between brain regions that relate to SES overlap with brain regions known to be sensitive to prenatal alcohol exposure (PAE). Animal models demonstrate that PAE attenuates neural and cognitive benefits of early life enrichment. However, whether or not environmental factors related to SES are associated with brain development in youth affected by PAE remains unknown in humans.

        Methods

        T1-weighted magnetic resonance imaging (MRI) scans were obtained in participants with PAE and compared to age- and sex- matched Controls (n = 197, 48% with PAE, 44% girls, 6.5-17.7 years old). General linear modeling was utilized to examine associations between SES and subcortical brain volumes for youth with PAE compared to Controls.

        Results

        Group by SES interactions were observed within the hippocampus (HPC), nucleus accumbens (NAc) and ventral diencephalon (vDC) (corrected p values <0.05), where positive associations (e.g., higher SES related to larger subcortical volumes) were observed within Controls, but not youth with PAE. Post hoc analyses examined associations between SES and brain volumes within each group independently, and revealed widespread positive associations among Controls (Amyg, HPC, NAc, Pallidum, Putamen, vDC), but not youth with PAE. Across both groups, larger subcortical volumes were related to higher cognitive performance.

        Conclusion

        Typically developing youth exhibit increased subcortical volumes with increased SES, and surprisingly, this relationship is absent in adolescents with PAE. Findings suggest that subcortical brain volumes are neurocognitively relevant in both groups. The present results expand our understanding of the impact of PAE on the developing human brain within varying environmental contexts, and may inform novel environmental interventions that aim to improve, in part, on-going disruptions in brain development among youth with PAE. Our study highlights novel complexities in the pursuit to understand SES-brain associations, as we provide evidence that SES matters for brain outcomes among typically developing youth, and possibly not as much on an already altered brain as a result of PAE.
          Cover page: The Relationship Between Socioeconomic Status and Brain Volume in Children and Adolescents With Prenatal Alcohol ExposureCreative Commons 'BY' version 4.0 license
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2016)

          Background

          Prenatal alcohol exposure results in a broad range of cognitive and behavioral impairments. Because of the long-lasting problems that are associated with fetal alcohol spectrum disorders (FASDs), the development of effective treatment programs is critical. Preclinical animal studies have shown that choline, which is an essential nutrient, can attenuate the severity of alcohol-related cognitive impairments.

          Objective

          We aimed to translate preclinical findings to a clinical population to investigate whether choline supplementation can ameliorate the severity of memory, executive function, and attention deficits in children with FASDs.

          Design

          In the current study, which was a randomized, double-blind, placebo-controlled clinical trial, we explored the effectiveness of a choline intervention for children with FASDs who were aged 5-10 y. Fifty-five children with confirmed histories of heavy prenatal alcohol exposure were randomly assigned to either the choline (n = 29) or placebo (n = 26) treatment arms. Participants in the choline group received 625 mg choline/d for 6 wk, whereas subjects in the placebo group received an equivalent dose of an inactive placebo treatment. Primary outcomes, including the performance on neuropsychological measures of memory, executive function, and attention and hyperactivity, were assessed at baseline and postintervention.

          Results

          Compared with the placebo group, participants in the choline group did not differentially improve in cognitive performance in any domain. Treatment compliance and mean dietary choline intake were not predictive of treatment outcomes.

          Conclusions

          Findings of the current study do not support that choline, administered at a dose of 625 mg/d for 6 wk, is an effective intervention for school-aged (5-10 y old) children with FASDs. This research provides important information about choline's therapeutic window. Combined with other studies of choline and nutritional interventions in this population, this study emphasizes a further need for the continued study of the role of nutritional status and supplementation in children with FASDs and the contributions of nutrition to neurocognition. This trial was registered at clinicaltrials.gov as NCT01911299.
            • Article
            • Peer Reviewed
            UC San Diego Previously Published Works (1996)
            Abnormalities of the cerebellar vermis have been well documented in animal models of fetal alcohol syndrome. At this point, it is not known if the same brain region is affected in humans prenatally exposed to alcohol. In this study, the area of the cerebellar vermis was measured from brain magnetic resonance images of 9 children and young adults with prenatal alcohol exposure and 24 control subjects in the same age range. Six of the exposed children met standard criteria for fetal alcohol syndrome. The remaining three subjects had significant histories of prenatal exposure to alcohol, but did not have enough of the classic facial features for the diagnosis. For each subject with a suitable midsagittal section, three vermal areas were circumscribed: anterior vermis (vermal lobules I-V), posterior vermis (vermal lobules VI and VII), and the remaining vermal area (including lobules VIII-X). Statistical analyses revealed that the anterior region of the vermis was significantly smaller in subjects with prenatal alcohol exposure, whereas the posterior region and the remaining vermal area did not differ between groups. Previous findings from an animal model of neonatal alcohol exposure have documented Purkinje cell loss in vermal lobules I-V and IX-X, with notable sparing in lobules VI-VII. Thus, the results of both studies indicate similar patterns of abnormal brain development in the anterior vermal region, with apparent sparing in the posterior vermal region. Our findings, for the first time, suggest that regionally specific Purkinje cell death may also occur in humans prenatally exposed to alcohol.
              Cover page: Abnormal Development of the Cerebellar Vermis in Children Prenatally Exposed to Alcohol: Size Reduction in Lobules I–V
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2017)
              Individuals prenatally exposed to alcohol often have impaired spatial working memory (SWM). This study examines functional connections of frontal and parietal regions that support SWM in children with and without prenatal alcohol exposure. Children ages 10 to 16 with histories of heavy prenatal alcohol exposure (AE group; n = 18) and controls (CON group; n = 19) underwent functional magnetic resonance imaging (fMRI) while performing a SWM task. Whole brain task-related functional connectivity of bilateral dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex (PPC) seed regions were estimated for each participant using a psychophysiological interaction approach. Children in the AE group were less accurate than children in the CON group when performing the SWM task (p = 0.008). Positive coupling between bilateral DLPFC seeds and regions within the fronto-parietal network was observed in the CON group, whereas the AE group showed negative connectivity. In contrast to the CON group, the AE group showed positive connectivity between PPC seeds and frontal lobe regions. Across seeds, decreased negative coupling with regions outside the fronto-parietal network (e.g., left middle occipital gyrus) were observed in the AE group relative to the CON group. Functional data clusters were considered significant at p < 0.05. Overall findings suggest that localized alterations in neural activity, aberrant fronto-parietal network synchrony, and poor coordination of neural responses with regions outside of this network may help explain SWM deficits in individuals with a history of heavy prenatal alcohol exposure.
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2012)

                Background

                Fetal alcohol spectrum disorders result from heavy prenatal alcohol exposure and are characterized, in some cases, by central nervous system anomalies and cognitive impairment. Regional patterns of neuroanatomical abnormalities suggest that alcohol exerts selective damage on the developing fetal brain. This study assessed brain-behavior relationships in a sample of youth with histories of heavy prenatal alcohol exposure. The aim was to characterize how structural brain alterations observed in our previous studies relate to cognitive deficits commonly reported in individuals with histories of heavy prenatal alcohol exposure.

                Methods

                Twenty-one youth (mean age 13 years) with histories of heavy prenatal alcohol exposure and 7 nonexposed healthy comparison subjects underwent structural magnetic resonance imaging and neurobehavioral testing. Regional brain volumes within the alcohol-exposed group were correlated with neuropsychological measures of cognitive control and verbal learning/recall, as these aspects of cognition have previously been shown to be vulnerable to alcohol teratogenesis.

                Results

                Between-group effect sizes revealed moderate to large cognitive performance and brain volume decrements in alcohol-exposed subjects, compared with typically developing peers. Within the alcohol-exposed group, volume of the caudate nuclei was the most consistent predictor of neuropsychological performance, after controlling for potentially confounding variables including total brain volume, IQ, and age.

                Conclusions

                These data are consistent with previous research associating gestational alcohol exposure with structural and functional changes of the caudate nucleus. Our findings extend this previous work by demonstrating that volume reductions of the caudate have behavioral relevance for this population, in relation to cognitive control and verbal learning and recall abilities.
                  Cover page: Caudate Volume Predicts Neurocognitive Performance in Youth with Heavy Prenatal Alcohol Exposure
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (1995)
                  For 20 years, it has been known that fetal alcohol syndrome (FAS) is associated with abnormal brain development. Early autopsy studies point to the corpus callosum as one area affected by heavy alcohol exposure. Little is known, however, about the integrity of the brain in alcohol-exposed children who survive the perinatal period. This study was designed to assess the corpus callosum in living children exposed to high doses of alcohol prenatally. Thirteen children with histories of significant prenatal alcohol exposure and 12 normal control children were evaluated using magnetic resonance imaging. Using the midsagittal section, images were measured for the area of the corpus callosum using a computer-assisted measurement technique. In addition to the overall area, five equiangular regions were determined for each corpus callosum. Of the 13 alcohol-exposed children assessed, two had agenesis of the corpus callosum. The remaining alcohol-exposed children had significantly smaller overall callosal areas, as well as smaller regional areas of four of the five callosal regions, when compared with the normal control children. Importantly, when corrected for brain size, three of the five callosal regions were still smaller in the alcohol-exposed children, although overall area of the corpus callosum was no longer significantly different. These results suggest that prenatal exposure to high levels of alcohol is associated with abnormalities of the corpus callosum. They verify callosal agenesis in children with FAS, which previously had only been noted in autopsy reports.(ABSTRACT TRUNCATED AT 250 WORDS)
                    Cover page: Abnormalities of the Corpus Callosum in Children Prenatally Exposed to Alcohol
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (1996)
                    Magnetic resonance imaging was conducted on six children and adolescents with fetal alcohol syndrome and seven matched normal controls. Detailed volumetric analyses demonstrated significant reductions in the cerebral vault, basal ganglia, and diencephalon in the children with fetal alcohol syndrome, compared with control children. In addition, the volume of the cerebellar vault was smaller than controls in 4 of the 6 children with fetal alcohol syndrome, although the group difference did not reach significance. When the basal ganglia were divided into the caudate and lenticular nuclei, both of these regions were significantly reduced in the children with fetal alcohol syndrome. Finally, when the overall reduction in brain size was controlled, the proportional volume of the basal ganglia and, more specifically, the caudate nucleus was reduced in the children with fetal alcohol syndrome. These results may relate to behavioral findings in both humans and animals exposed to alcohol prenatally.
                      Cover page: A Decrease in the Size of the Basal Ganglia in Children with Fetal Alcohol Syndrome
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