GoFAR: An Intervention for Affective and Metacognitive Control in FASD

胎儿酒精谱系障碍（FASD）是由产前酒精的致畸作用引起的 暴露在中枢神经系统，并导致神经发育障碍， 影响个人和家庭。不幸的是，许多患有FASD的儿童也会经历非最佳的 养育环境、学业失败和干预服务不足以及这些因素之间的相互作用 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的严重性， 群体及其对公共卫生、精神和行为健康、教育系统和 其他社会服务，令人惊讶的是，很少有基于证据的干预措施，旨在解决 他们的特殊需求。这一应用程序，重点是一个核心领域的赤字确定在FASD，即 情感和认知控制障碍，通常是行为和适应障碍的核心。 在婴儿期已经发现了唤醒障碍，随后在努力控制方面出现了问题。 经常报道。到了学龄，这些问题往往表现为注意力问题， 执行功能和行为障碍。有效的干预需要 制定针对这一群体的具体需求的方案;在这里，我们建议 一个两阶段的过程来创建这样一个程序，名为GoFAR。虽然几乎所有的干预， FASD将有资格作为“新颖”鉴于缺乏关注这一领域，目前的建议可能是 特别是创新，因为它将汇集电脑游戏技术和情感技术， 和认知控制。该方法部分是基于以前的工作，表明 元认知技术（FAR）有助于改善FASD的行为和教育结果。 在R21阶段，我们将确定计划要素，并为 在R33阶段进行干预试验。一个重要的因素将是GoFAR 电脑游戏，一个“严肃的游戏”，将支持理解和发展的FAR 元认知控制技术，并加强其在临床转诊的5岁FASD儿童中的使用 至10年在R21阶段结束时完成并进行试点，这款游戏将被纳入一个 10周，手动干预方案，其要素将在样本中进行可行性测试， 30名受酒精影响的儿童及其照顾者。结果指标将包括标准化的 适合于临床环境的评估和生理反应变化的测量。预 并且后测试将允许对程序元素的有用性的初步理解， 包括GoFAR游戏，以及所选结果措施的适用性，并允许 计划更全面地评价这种方法在治疗 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.