A Multisite Neurobehavioral Assessment of Fetal Alcohol Spectrum Disorders

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DESCRIPTION (provided by applicant): This application is part of the competitive renewal for the "Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD)" (Notice RFA-AA-03-004) to continue and expand the current multidisciplinary CIFASD. This RFA calls for, in part, research aimed at "improved diagnosis" and "enhanced understanding of the domains of neurobehavioral impairment" of fetal alcohol spectrum disorders (FASD). Although 30 years of research have identified myriad deficits in individuals with FASD, most neuropsychological studies are plagued by the question of global dysfunction vs. a pattern of relative sparing and impaired function. Delineation of a neuropsychological profile has been the subject of much recent debate. Limited research, including the current CIFASD consortium, has examined if prenatal alcohol exposure results in general dysfunction or a more specific neurobehavioral profile of strengths and weaknesses. The primary aim of this project is to determine whether a neurobehavioral phenotype exists in children with fetal alcohol syndrome, whether the same phenotype exists in children with FASD who lack facial dysmorphology, and whether the phenotype can be used for differential diagnosis. Secondary aims, involving collaboration with other CIFASD projects and cores, are to determine the relationship between brain dysmorphology, facial dysmorphology, and neurobehavioral function. These aims are in keeping with the overall aims of the CIFASD, including enhanced understanding of the neurobehavioral phenotype and establishment of standardized diagnostic criteria and methods of assessment of FASD. A standard neurobehavioral protocol will be administered to four groups of children at six sites and will address the functional domains of executive function, working memory, verbal function, and psychological symptomatology. In addition to children with FASD and nonexposed controls, children with low IQ scores or ADHD will be included as contrast samples. Using this heterogeneous sample and multivariate statistical methods, neurobehavioral profile specific to FASD will be sought. In addition, participants will be assessed using methodology prescribed by the Dysmorphology Core and the facial and brain imaging projects of the CIFASD. Data from three broad domains (neurobehavior, dysmorphology, and brain morphology and function) will be analyzed both separately and together to address the main aim of the CIFASD: improving the diagnostic criteria for FASD. This project is directly relevant to public health concerns surrounding the effects of heavy prenatal alcohol exposure, improving diagnosis of alcohol-affected individuals, and defining the profile of neurobehavioral effects that are specific to FASD. Improved identification and delineation of these features will ultimately lead to improved treatment.