A Multisite Neurobehavioral Assessment of Fetal Alcohol Spectrum Disorders

描述（由申请人提供）：本申请是对NIH/NIAAA资助机会的回应，题为“胎儿酒精谱系障碍合作倡议（CIFASD）”（RFA-AA-12-004）。这项拟议的研究与CIFASD资助机会的总体目标有关，即“根据生物学、物理学、神经学或行为评估或其组合，进一步完善生命不同阶段的FASD明确诊断。“这也直接符合RFA中确定的三个具体研究领域：（1）加强对FAS和ARND神经行为表型的理解，（2）FASD的诊断，（3）早期病例识别。尽管自胎儿酒精综合征（FAS）的最初临床描述以来已经过去了近40年，但对产前酒精暴露（AE）影响的全方位理解仍不完整。尽管许多AE儿童经历了与其暴露史相关的显著神经行为和适应困难，但对于大多数病例，这些困难与AE之间的联系可能无法识别。鉴于早期识别与改善预后有关， 提高识别酒精影响的儿童与敏感的，临床上可利用的神经行为概况。最近的研究，包括由CIFASD资助的研究，通过比较AE儿童和注意力缺陷/多动障碍（ADHD）儿童，重点关注酒精影响的特异性。 虽然这项研究已经记录了AE和ADHD之间的重要相似性和差异，但与更异质的对照组进行比较可能会增加该特征的普遍性，并检测神经发育状况与产前酒精暴露影响之间常见的缺陷。最后，以前的工作主要集中在执行功能领域的神经行为概况，然而，初步数据和以前的研究表明，包括记忆功能的措施可能会加强现有的配置文件。当前提案的总体目标是开发和实施临床相关且可行的测量工具，以准确识别受AE影响的儿童。这项拟议的研究将建立在我们现有的数据库基础上，这些数据库来自多个临床研究中心从8-16岁儿童中收集的数据，并将其扩展到两个年龄组（5-7岁和10-16岁），以改善早期识别，并评估额外的神经心理学领域（记忆）。将在新的和现有的研究中心从发生AE的儿童、未暴露的对照组和异质性临床对比受试者中收集数据。这项研究将通过持续不断的努力来开发和完善敏感和特异的神经行为特征，从而提高对胎儿酒精谱系障碍（FASD）的理解。这些数据将与其他CIFASD项目的数据相结合，以开发使用多学科方法准确捕获最大数量的受影响儿童的模型。

DESCRIPTION (provided by applicant): This request for a renewal of funding is in response to the NIH/NIAAA funding opportunity entitled, "Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD)" (RFA-AA-12-004). The proposed study is relevant to the overall goal of the CIFASD funding opportunity of "further refining definitive diagnoses of FASD at different stages of the lifespan based on biological, physical, neurological, or behavioral assessment, or a combination thereof." It is also directly in line with three of the specific research areas identifed in the RFA: (1) Enhanced understanding of the neurobehavioral phenotype of FAS and ARND, (2) Diagnosis of FASD, and (3) Early case identification. Although nearly 40 years have passed since the initial clinical delineation of fetal alcohol syndrome (FAS), understanding of the full spectrum of effects of prenatal alcohol exposure (AE) is incomplete. Even though many children with AE experience significant neurobehavioral and adaptive difficulties that are related to their exposure history, for a majority of the cases, the link between those difficulties and AE may go unrecognized. Given that early identification has been linked to improved prognosis, it is critical to improve identification of alcohol-affected children with a sensitive, clinically utilizable neurobehavioral profile. Recent research, including that funded by CIFASD, has focused on the specificity of alcohol's effects by comparing children with AE and those with attention-deficit/hyperactivity disorder (ADHD). While this research has documented important similarities and differences between AE and ADHD, comparisons with a more heterogeneous contrast group may increase the generalizability of the profile as well as detect deficits that are common between neurodevelopmental conditions and those that are unique to the effects of prenatal alcohol exposure. Finally, previous work on the neurobehavioral profile has focused primarily on the executive function domain, however, preliminary data and previous research suggests that including measures of memory function may strengthen the existing profile. The overarching aim of the current proposal is to develop and implement clinically relevant and feasible measurement tools to accurately identify children who are affected by AE. The proposed study will build on our existing database derived from data collected from children between 8-16 years of age, across multiple clinical sites and expand it to include two age groups (5-7 years and 10-16 years) to improve early identification, as well as assess an additional neuropsychological domain (memory). Data will be collected from children with AE, non-exposed controls and heterogeneous clinical contrast subjects at both new and existing sites. This research will improve understanding of fetal alcohol spectrum disorders (FASD) by continuing ongoing efforts to develop and refine a sensitive and specific neurobehavioral profile. These data will be combined with data from other CIFASD projects to develop models that accurately capture the greatest number of affected children using multidisciplinary methodology.