GoFAR: An Intervention for Affective and Metacognitive Control in FASD

胎儿酒精谱障碍(FASD)是由产前酒精的致畸作用引起的 暴露在中枢神经系统上，并导致终生神经发育障碍 对个人和家庭的影响。不幸的是，许多患有FASD的儿童也经历了非最佳状态 养育环境、学校失败和干预服务不足及其相互作用 这些因素可能非常有害。尽管在这一高风险中观察到的问题很严重 群体及其对公共健康、心理和行为健康、教育系统和 其他社会服务，令人惊讶的是，几乎没有基于证据的干预措施旨在解决 他们的特殊需求。此应用程序侧重于FASD中确定的一个核心缺陷领域；即 情感和认知控制的障碍，通常是行为和适应性障碍的核心。 唤醒障碍已经在婴儿期和随后的努力控制问题中被发现 经常被报道。到了学龄期，这样的问题通常表现为注意力问题，智力缺陷 行为和行为中的执行功能和障碍。有效的干预需要 针对这一群体中确定的特定需求制定计划；在此我们建议 创建这样一个名为Gofar的计划的两个阶段的过程。尽管几乎所有的干预 鉴于对这一领域缺乏关注，FASD将被定义为“新的”，目前的提议可能是 特别具有创新性，因为它将把电脑游戏技术和情感游戏的技巧结合在一起 和认知控制。这种方法在一定程度上是基于以前的工作，这些工作表明 元认知技术(FAR)有助于改善FASD患者的行为和教育效果。 在R21阶段，我们将确定计划元素并制定协议和手册 干预试验将在R33阶段进行。一个重要的因素将是戈法尔 电脑游戏，一个将支持对FAR的理解和发展的“严肃的游戏” 元认知控制技术及其在临床转诊的5岁FASD儿童中的应用 到10年。在R21阶段结束前完成并试行，这款游戏将被纳入一个 10周，手动干预方案，其要素将在以下样本中进行可行性测试 30名酗酒儿童和他们的照顾者。结果衡量标准将包括标准化的 适用于临床环境的评估和生理反应变化的测量。预 并且开机自检将允许初步了解程序元素的有用性， 包括戈法尔游戏，以及所选和允许的结果衡量标准的适宜性 计划更全面地评估这一方法学在治疗本病中的疗效 与FASD相关的神经发育障碍。

Fetal Alcohol Spectrum Disorders (FASD) result 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 GoFAR. 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.