GoFAR: An Intervention for Affective and Metacognitive Control in FASD

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DESCRIPTION (provided by applicant): Fetal Alcohol Spectrum Disorders (FASD) results from the teratogenic effects of prenatal alcohol exposure on the central nervous system and lead to neurodevelopmental disorders that have a lifelong impact on individuals and families. Unfortunately, many children with FASD also experience nonoptimal rearing environments, school failure and inadequate intervention services and the interaction of these factors can be very detrimental. Despite the seriousness of the problems observed in this high risk group and their implications for public health, mental and behavioral health, educational systems and other social services, there are surprisingly few evidenced-based interventions designed to address their special needs. This application focuses on a core area of deficit identified in FASD; that is, on disorders of affective and cognitive control that are often central to behavioral and adaptive disorders. Disorders of arousal have been identified in infancy and subsequent problems in effortful control reported frequently. By school age, such problems often present as attentional problems, deficits in executive functioning and disorders in conduct and behavior. Effective intervention will require development of programs targeted toward the specific needs identified in this group; here we propose a two stage process to create such a program, entitled Gofer. Although almost any intervention for FASD would qualify as "novel" given the lack of attention to this area, the current proposal may be particularly innovative as it will bring together computer game technology and techniques for affective and cognitive control. The methodology is based, in part, on previous work that suggests that a metacognitive technique (FAR) is helpful in improving behavioral and educational outcomes in FASD. During the R21 phase, we will identify program elements and develop protocols and manuals for an intervention trial to be carried out during the R33 phase. An important element will be the GoFAR computer game, a "serious game" that will support the understanding and development of the FAR metacognitive control technique and reinforce its use by clinically-referred children with FASD, ages 5 to 10 years. Completed and piloted by the end of the R21 phase, this game will be incorporated into a 10 week, manualized intervention protocol whose elements will be tested for feasibility in a sample of 30 alcohol-affected children and their caregivers. Outcome measures will include both standardized assessments suitable for a clinical setting and measurement of changes in physiological response. Pre and post testing will allow a preliminary understanding of the usefulness of the program elements, including the GoFAR game, as well as the suitability of the outcomes measures selected and allow planning for a more comprehensive evaluation of the efficacy of this methodology in treating the neurodevelopmental disorders associated with FASD. PUBLIC HEALTH RELEVANCE: This application, in response to RFA-MH-09-161, proposes the development of a novel intervention targeted at neurodevelopmental disorders associated with fetal alcohol spectrum disorders (FASD). The program will address core deficits associated with development of behavioral and mental health problems through an intervention employing both "serious games" and direct intervention with children and families. At present, there are no such evidenced-based programs for FASD. Thus the results of this application would have wide application for several areas of public health and education in terms of both treatment and prevention of secondary disabilities in this underserved and high risk clinical group.