Abstract
Children with fetal alcohol spectrum disorder show executive function (EF) deficits, particularly in self-regulation skills, and abnormalities in brain regions critical for these skills. None of the validated EF interventions for these children has been evaluated with regards to impacts on brain structure. Twenty-nine children with FASD were assigned to either an immediate-treatment (TX) or delayed-treatment control (DTC) group (DTC). Nineteen typically developing children served as healthy controls (CT). All received a structural MRI scan and baseline neuropsychological testing, following which the TX group underwent 12 weekly 1.5-h sessions of the Alert Program for Self-Regulation®. After treatment or a period of ~14 weeks, all received a repeat scan and post-intervention testing. Whole-brain and region-of-interest analyses using voxel-based morphometry evaluated group differences and changes over time in gray matter (GM). Exploratory analyses revealed significant group changes: (1) At baseline, combined TX and DTC groups demonstrated global GM reductions compared with the CT group. (2) Region-of-interest analysis using a frontal mask, comparing post-intervention to pre-intervention results, showed significantly increased GM in the left middle frontal gyrus (BA10), right frontal pole (BA11), and right anterior cingulate (BA32) in the TX group. Similar results were not found in the DTC or CT groups. (3) At post-intervention, both TX and CT groups showed larger GM volumes than the DTC group in the left superior frontal gyrus (BA9), which was smaller in the FASD group at baseline. These results suggested that Alert led to improvements in post-intervention testing of self-regulation skills and typical brain development in treated children.
Highlights
Fetal Alcohol Spectrum Disorder (FASD) is the umbrella term used to describe the often challenging developmental abnormalities that arise from prenatal alcohol exposure (PAE) and affects as many as 4% of children in North America (May et al, 2014)
(3) At post-intervention, both TX and CT groups showed larger gray matter (GM) volumes than the delayed-treatment control (DTC) group in the left superior frontal gyrus (BA9), which was smaller in the FASD group at baseline
Note that the two FASD subgroups differed with regard to why their scans were not included in analysis, with a greater number of drop-outs and refusals in the TX group, and excessive motion in the DTC group
Summary
Fetal Alcohol Spectrum Disorder (FASD) is the umbrella term used to describe the often challenging developmental abnormalities that arise from prenatal alcohol exposure (PAE) and affects as many as 4% of children in North America (May et al, 2014). The three primary forms of FASD are Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS), and AlcoholRelated Neurodevelopmental Disorder (ARND). FAS, which is characterized by the symptom triad of a distinctive dysmorphic face (i.e., small palpebral fissures, elongated philtrum, thin vermillion), growth abnormalities, and cognitive and behavioral impairments (Stoler and Holmes, 1999), is generally considered the most severe disorder along the fetal alcohol spectrum; pFAS with fewer or less severe physical features is considered a milder variant (Stratton et al, 1996). FASD places an extraordinary burden on parents or caregivers (Leenaars et al, 2012), as well as teachers, and it results in a high cost to society (Lupton et al, 2004; Stade et al, 2007)
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