Identification of FASD in South African Children

描述（由申请人提供）：由于难以可靠地评估面部畸形，以及研究者尚未确定一组与产前酒精暴露相关的神经行为缺陷，早期识别FASD儿童一直受到限制。然而，新一代的神经发育措施已经与更具体的神经过程和通路联系起来，有可能改善FASD的诊断。我们最近完成了一项对来自南非开普有色人种（混合种族）社区的母亲所生的159名婴儿的前瞻性研究，该研究证实了先前在该人群中记录的母亲酒精滥用和依赖以及FAS的异常高发生率。算术和执行功能（EF）是年龄较大的FASD儿童中最受影响的领域。在我们的开普敦队列中，我们能够通过两种创新的婴儿评估来检测婴儿在这些领域的缺陷：数数测试，评估数量级表征，这是与下顶叶功能相关的算术的先驱，以及a -非- b测试，EF的早期先驱。来自底特律产前酒精暴露队列的新数据也提供了证据，证明在年龄较大的儿童中存在特定的幅度表征缺陷和较差的冲突监测，EF的一个方面被认为是由前扣带皮层介导的。

DESCRIPTION (provided by applicant): Early identification of children with FASD has been limited by the difficulty of reliably evaluating facial dysmorphology and because investigators have not yet identified a set of neurobehavioral deficits specifically related to prenatal alcohol exposure. However, a new generation of neurodevelopmental measures that have been linked more specifically to neural processes and pathways has the potential to improve FASD diagnosis. We have recently completed a prospective study of 159 infants born to mothers from the Cape Coloured (mixed race) community in South Africa, which has confimed the exceptionally high incidence of maternal alcohol abuse and dependence and FAS previously documented in this population. Arithmetic and executive function (EF) are among the most consistently affected domains in older children with FASD. In our Cape Town cohort, we were able to detect deficits in these domains in infancy using two innovative infant assessments: a numerosity test, which assesses magnitude representation, a precursor of arithmetic that has been linked to inferior parietal function, and the A-not-B test, an early precursor of EF. New data from our Detroit prenatal alcohol exposure cohort also provide evidence of a specific deficit in magnitude representation in older children and poorer conflict monitoring, an aspect of EF believed to be mediated by the anterior cingulate cortex. This component of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) will follow up our Cape Town cohort at 4 and 6 years of age. The specific aims are: (1) to administer new narrowband tests of arithmetic and EF to determine which elements of these domains appear to be core deficits of FASD; (2) to administer event-related potential (ERP) assessments of magnitude representation and recognition of facial emotional expression, two domains that are hypothesized to relate specifically to FASD; (3) to test the hypothesis that two moderator variables---maternal age and the absence of an ADH2*2 allele--can improve the identification of FASD in prenatally exposed children; (4) to assess the predictive validity of infant numerosity and A-not-B in relation to cognition and attention in early childhood; (5) to determine the degree to which measures of craniofacial variation derived from 3-D photography can improve FASD diagnosis; and (6) to administer additional neurobehavioral assessments in common with other CIFASD projects to provide data on the sequelae of FASD that can be pooled and compared across age, site and ethnic group. Improvement of diagnosis in infancy and early childhood and a better understanding of the specific domains of neurobehavioral function affected by fetal alcohol exposure are critically important for the development and implementation of targeted, effective interventions for FASD.