GoFAR: An Intervention for Affective and Metacognitive Control in FASD

描述（由申请人提供）：胎儿酒精谱系障碍（FASD）是由产前酒精暴露对中枢神经系统的致畸作用引起的，并导致对个人和家庭产生终身影响的神经发育障碍。不幸的是，许多患有FASD的儿童也经历了非最佳的养育环境，学业失败和干预服务不足，这些因素的相互作用可能非常有害。尽管在这一高风险群体中观察到的问题及其对公共卫生、精神和行为健康、教育系统和其他社会服务的影响很严重，但令人惊讶的是，旨在解决其特殊需求的循证干预措施却很少。这种应用程序集中在一个核心领域的缺陷确定FASD，即情感和认知控制障碍，往往是中央的行为和适应性障碍。唤醒障碍在婴儿期就已经被发现，随后的努力控制问题也经常被报道。到了学龄，这些问题往往表现为注意力问题、执行功能缺陷以及行为和行为障碍。有效的干预将需要针对这一群体的具体需求制定计划;在这里，我们提出了一个两阶段的过程来创建这样一个计划，名为Gynecology。尽管几乎任何对FASD的干预都有资格被称为“新颖”，因为缺乏对这一领域的关注，但目前的提案可能特别具有创新性，因为它将把计算机游戏技术与情感和认知控制技术结合在一起。该方法的基础上，部分，以前的工作表明，元认知技术（FAR）是有助于改善行为和教育成果FASD。在R21阶段，我们将确定项目要素，并为R33阶段进行的干预试验制定方案和手册。一个重要的元素将是GoFAR电脑游戏，这是一个“严肃的游戏”，将支持对FAR元认知控制技术的理解和发展，并加强其在5至10岁的FASD临床转诊儿童中的使用。在R21阶段结束时完成并进行试点，该游戏将被纳入一个为期10周的手动干预方案，该方案的内容将在30名受酒精影响的儿童及其照顾者的样本中进行可行性测试。结果测量将包括适用于临床环境的标准化评估和生理反应变化的测量。前和后测试将允许初步了解程序元素的有用性，包括GoFAR游戏，以及所选择的结果测量的适用性，并允许计划更全面地评估该方法在治疗与FASD相关的神经发育障碍中的疗效。 公共卫生相关性：本申请响应RFA-MH-09-161，提出开发一种针对与胎儿酒精谱系障碍（FASD）相关的神经发育障碍的新型干预措施。该计划将通过采用“严肃游戏”和对儿童和家庭的直接干预来解决与行为和心理健康问题发展相关的核心缺陷。目前，还没有这样的循证FASD计划。因此，这一应用的结果将广泛应用于公共卫生和教育的几个领域，在治疗和预防这一服务不足和高风险临床群体的继发性残疾方面。

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.