Abstract
Children with fetal alcohol spectrum disorder (FASD) exhibit behavioral dysregulation, executive dysfunction, and atypical function in associated brain regions. Previous research shows early intervention mitigates these outcomes but corresponding brain changes were not studied. Given the Alert® Program for Self-Regulation improves behavioral regulation and executive function in children with FASD, we asked if this therapy also improves their neural functioning in associated regions. Twenty-one children with FASD aged 8–12 years were randomized to the Alert®-treatment (TXT; n = 10) or waitlist-control (WL; n = 11) conditions. They were assessed with a Go-NoGo functional magnetic resonance imaging (fMRI) paradigm before and after training or the wait-out period. Groups initially performed equivalently and showed no fMRI differences. At post-test, TXT outperformed WL on NoGo trials while fMRI in uncorrected results with a small-volume correction showed less activation in prefrontal, temporal, and cingulate regions. Groups also demonstrated different patterns of change over time reflecting reduced signal at post-test in selective prefrontal and parietal regions in TXT and increased in WL. In light of previous evidence indicating TXT at post-test perform similar to non-exposed children on the Go-NoGo fMRI paradigm, our findings suggest Alert® does improve functional integrity in the neural circuitry for behavioral regulation in children with FASD.
Highlights
Fetal Alcohol Spectrum Disorder (FASD) is the most preventable cause of intellectual disability worldwide [1] affecting as many as 4% of newborns in North America [2] with much higher prevalence in countries such as Italy, South Africa, and Ireland [3,4,5], as well as among aboriginal youth in Australia, U.S, and Canada [6,7,8]
Four children were eliminated from the neuroimaging analyses: two were from the TXT group who refused to enter the scanner due to anxiety, one was from WL group who received a dental implant between sessions, and another was from WL group who had an excessive motion artifact
The final sample consisted of TXT (5 males, 1 left handed) and WL (6 males, 2 left handed), who did not differ in demographics from the four cases eliminated
Summary
Fetal Alcohol Spectrum Disorder (FASD) is the most preventable cause of intellectual disability worldwide [1] affecting as many as 4% of newborns in North America [2] with much higher prevalence in countries such as Italy, South Africa, and Ireland [3,4,5], as well as among aboriginal youth in Australia, U.S, and Canada [6,7,8]. Brain Sci. 2018, 8, 7 impairments [9]; pFAS is similar but with fewer or less severe physical features [10]. Children with FASD display reduced IQ [12,13,14], poor academic achievement [15,16,17] especially in math [18], and significant disabilities in language, memory, visuospatial, attention, and executive functioning areas [19,20,21,22,23,24,25,26,27]. Within the executive function domain, their impairments reflect poor planning and decision-making and difficulties in working memory and inhibitory control [27,28,29,30,31,32,33]. Research with various magnetic resonance imaging (MRI) techniques has shown they exhibit atypical brain development [34], as evidenced by their smaller than normal global and regional brain volumes [35,36]; reduced size of caudate, hippocampus, and corpus callosum [21,37,38]; and abnormalities in cortical thickness and surface area [39,40,41,42], gyrification [43,44]
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