Kathleen A. Platzman

Effects of prenatal alcohol exposure at school age. I. Physical and cognitive development

Alcohol is a potent teratogen associated with dysmorphology, growth retardation, and neurological damage in children with the full fetal alcohol syndrome (FAS); alcohol is also associated with growth retardation and behavioral alterations in neonates prenatally exposed to various dosages. Questions remain about the long-term consequences of prenatal alcohol exposure. This study reports on the follow-up of a subsample of 68 children, the majority of whom were low income and black (mean age: 5 years, 10 months) who were first evaluated as neonates. Physical and cognitive outcomes of 25 children of women who drank throughout pregnancy [absolute alcohol (AA)/week: mean = 11.80 oz), even after receiving an educational intervention to stop drinking, were compared with outcomes of children in two contrast groups: a) women (n = 22) who stopped drinking (AA/week: mean = 11.46 oz) in the second trimester after an educational intervention but resumed postpartum; and b) women who did not drink during pregnancy and who drank little postnatally (n = 21). Children were compared for alcohol-related birth defects (ARBDs), growth (height, weight, and head circumference), and cognitive, academic, and adaptive measures. Neonatal and current physical measures were correlated to determine predictability of neonatal status. When the effects of age and gender were controlled, children in the continued-to-drink group showed significantly more ARBDs and had smaller head circumferences than those in the other two groups. When current drinking reported by caretakers was controlled, the children who were exposed throughout pregnancy also showed significant and consistent deficits in several areas of intellectual functioning including sequential processing (short-term memory and encoding) and overall mental processing. Alcohol-exposed children displayed significant deficits in preacademic skills when compared with children of nondrinkers, with both alcohol groups deficient in premath and reading skills. There were no differences in adaptive behavior at follow-up. These data suggest that alcohol exposure throughout pregnancy is correlated with persistent physical differences as well as identifiable deficits in sequential memory processes and specific academic skills. However, even when alcohol use is limited to the first part of pregnancy, significant deficits in academic skills and growth parameters are measurable.

Effects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status.

Effects on fetal growth and neonatal behavior of cocaine and alcohol use in pregnancy were investigated in infants born to women in a low-income, predominantly black population. Despite the increased use of cocaine by pregnant women and the accompanying public concern, behavioral studies of exposed neonates are limited in number and scope. In most studies, confounding factors (e.g., polydrug abuse, prematurity, infant health status) have not been controlled so the actual effects of cocaine and other drug exposure are not clear. Accordingly, this study investigated effects of prenatal drug exposure although controlling experimentally for other factors known to be associated with poor outcomes in infants: prematurity, other illicit drug use, associated diseases (e.g., sexually transmitted diseases [STDs]), and duration of drug use. In addition, other factors statistically controlled were: experimenter effects, timing of assessment, and effects of duration, amount, and frequency of cocaine, alcohol, marijuana, and nicotine exposure. One hundred and seven full-term infants were assessed at 2, 14, and 28 days using the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) by testers blind to infant status. Growth factors (i.e., birthweight, length, head circumference) were also assessed.

Effects of prenatal alcohol exposure at school age. II. Attention and behavior

Alcohol, a potent teratogen, has been suggested as an etiologic agent in attention deficit disorder with hyperactivity (ADHD), which is often diagnosed in children with fetal alcohol syndrome (FAS) and in children of alcoholics. We studied attentional and behavioral factors associated with diagnosis of this disorder in children selected from a predominantly low-income, black population who were tested as part of a longitudinal follow-up of children with prenatal alcohol exposure. Sixty-eight children with a mean age of 5 years 10 months, born to three groups of mothers, were assessed. These groups consisted of: a) women who reported not drinking during pregnancy (n = 21), b) women who reported drinking throughout pregnancy (n = 25), and c) women who reported drinking an equivalent amount but who stopped drinking after educational intervention during the second trimester (n = 22). Dimensions assessed included factors related to attention on a computerized task, impulsivity, and the presence of psychiatrically significant internalizing and externalizing behaviors. In addition, free play and mother-child interactions were video-taped, and evidence of overactive and noncompliant behaviors were noted. Hyperactivity and impulsive behavior were not evident. Results indicated that children exposed throughout pregnancy showed deficits in the ability to sustain attention and were more often described by teachers, although not by their mothers, as showing attentional and behavioral problems. Problems in both internalizing and externalizing behaviors also were noted by teachers. However, when current drinking was controlled, only externalizing behaviors remained different by group.(ABSTRACT TRUNCATED AT 250 WORDS)

Orientation to social and nonsocial stimuli in neonatal chimpanzees and humans

Abstract The behavioral capabilities of neonatal chimpanzees are not well known. A major goal of this study was to document their ability to orient to social and nonsocial objects and to compare their performance with that of human infants. The Brazelton Neonatal Behavioral Assessment Scale (NBAS) was administered to 13 nursery-reared chimpanzees, every other day during their first month of life, and to 42 humans, twice, on the third and thirtieth day of life. The orientation items included social stimuli (a human face and both human and chimpanzee sounds) and nonsocial stimuli (a red ball and a red rattle). Repeated-measures analysis of variance on the orientation cluster of the NBAS revealed that chimpanzee neonates have the capacity for sustained attention to all stimuli, both social and nonsocial, indistinguishable from that of human neonotes. Significant improvements in orientation performance from Day 2 to Day 30 were found for both species. These striking similarities in early orientation ability are viewed as a challenge to notions of unique human propensities.

Cry analysis detects subclinical effects of prenatal alcohol exposure in newborn infants

The threshold, latency, and peak fundamental frequency (basic pitch) of crying were sensitive to the subclinical effects of prenatal alcohol exposure through the first month of postnatal life. Whereas infants with prenatal alcohol exposure showed a lower cry pitch and higher cry threshold at 2 days of age, higher pitched cries, typical of nervous system insult, were evident at 14 and 28 days. A longer latency was also evident at 14 days.

The practice of programmed writing (PW) in therapy and prevention with families

Abstract Programmed writing (PW) is presented as a method for increasing efficiency and effectiveness in family therapy and prevention. A rationale for its use in structuring treatment is given. PW is a replicable and verifiable method which has been found thus far to be clinically useful as a secondary paratherapeutic and parapreventive type of intervention with individuals, couples, and families. Several applications of PW, ranging from unstructured journal keeping to structured workbooks for specific symptoms, are possible. PW is relatively new and may have meager empirical support. Its impact on therapeutic and preventive outcomes with families has yet to be fully realized beyond the experience of a few clinicians. Implications for research, practice, and service delivery are discussed. Possible links of PW with a developmental theory of interpersonal competence are briefly presented.

Analysis of Infant Crying is Predictive of Neurobehavioral Integrity in Newborns with Prenatal Polydrug Exposure † 88

Analysis of Infant Crying is Predictive of Neurobehavioral Integrity in Newborns with Prenatal Polydrug Exposure † 88