Ronald T. Brown

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 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)

Psychiatric and Family Functioning in Children with Leukemia and Their Parents

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

Adolescent Cancer Survivors: Psychosocial and Familial Adaptation

Adolescent cancer survivors were compared with nondiseased control subjects on measures of adaptation, coping, body image, sexual adjustment, psychopathology, and family functioning. Cancer survivors reported no major difficulties in social competence, overall coping, and family communication. Although their school teachers reported no symptoms of psychopathology, the cancer survivors did report body image disturbances and adjustment difficulties. Further, the surviving adolescents were eager to present themselves favorably. Compared with nondiseased control families, families of survivors were characterized as somewhat inflexible. Implications for clinical practice include the careful monitoring of youth who have survived cancer as well as sensitivity to underlying concerns that the survivors and their families may avoid.

Psychosocial and Family Functioning in Children with Sickle Cell Syndrome and Their Mothers

OBJECTIVE The purpose of this study was to compare the psychiatric functioning of 61 sickle cell youth and their families with nondiseased sibling controls. METHOD Functioning assessed by multiple informants included indices of behavioral, cognitive, and family/interpersonal functioning, self-esteem, life events, coping strategies, temperament, adaptive behavior, and parental psychopathology. RESULTS Key findings were that sickle cell patients evidenced more depressive symptoms and associated attributional style, and externalizing behavioral difficulties than did nondiseased siblings. With age, sickle cell youth evidence increasing adaptive behavior deficits and internalizing symptoms. Illness severity was related to symptoms of internalizing behavior and fewer daily living skills. Associations were found between maternal and child coping. CONCLUSIONS It is recommended that psychiatric consultations routinely be conducted with these children, particularly at times of family stress and developmental transitions. Psychiatric interventions should focus on ameliorating emotional difficulties via enhancing adaptive coping strategies.

Chemotherapy for acute lymphocytic leukemia: Cognitive and academic sequelae

Iatrogenic cognitive impairments have been reported for survivors of childhood leukemia after prophylactic central nervous system therapy with craniospinal radiation. To determine whether chemotherapy alone might be a source of central nervous system damage, we assessed in a cross-sectional design the cognitive and academic functioning of 48 children with acute lymphocytic leukemia who were at various stages in their treatment or who had completed treatment. The off-therapy patients who had completed a 3-year course of chemotherapy were more impaired in tasks of higher-order cognitive functioning than were those children whose leukemia had been newly diagnosed and those children whose diagnoses had been 1 year earlier. Off-therapy patients also had concomitant diagnosable learning disabilities in mathematics. We recommend appropriate liaison and special education placements, as well as continued evaluation of cognitive and leaning functioning of children treated for moderate-risk acute lymphocytic leukemia who receive chemotherapy alone.

Neurocognitive Aspects of Pediatric Sickle Cell Disease

Studies pertaining to the neurocognitive functioning and learning of children in whom sickle cell disease is diagnosed are reviewed, and findings suggest diffuse neurocognitive deficits, with much variability across subjects. A hypothesis is presented about the cumulative nature of such deficits in children who have not sustained cerebral vascular accidents. Important methodological shortcomings in the literature are identified and recommendations are made for future neurocognitive research with children in whom sickle cell disease has been diagnosed. Studies pertaining to the psychosocial development of these children are also reviewed, and it is concluded that behavioral problems, low self-esteem, and disturbances of body image are frequently characteristic of these children. Recommendations are made including early special education and psychosocial intervention programs for children with sickle cell disease.

Attributional Styles of Aggressive Boys and Their Mothers

To determine if mothers of aggressive boys have the same propensity as their sons to infer hostile intentions in ambiguous interpersonal situations, 50 mothers of aggressive and nonaggressive boys were each asked to interpret hypothetical situations involving themselves with their child, their partner, and a peer as well as hypothetical situations involving their child in interaction with classmates and teachers. Their sons also were each requested to interpret hypothetical situations involving themselves with their mother, a teacher, and a classmate. The results indicated that mothers of aggressive boys do share the propensity to infer hostility in ambiguous situations and may, in effect, model a hostile attributional bias. Mothers of aggressive boys failed to differentiate ambiguous from hostile situations and were as likely to infer hostile intentions in ambiguous as in hostile situations. The results also suggest a generalized tendency on the part of mothers of aggressive boys to infer negative motives and/or dispositions when accounting for the noxious behavior of their sons. Further, for the aggressive boys, the hostile attributional bias was evident with both peers and teachers. The presence of a hostile attribution was predictive of an aggressive response for the aggressive boys. Even in the face of clearly hostile, provocative behavior, nonaggressive boys were less likely to offer aggressive solutions than aggressive boys.

Gender differences in a clinic-referred sample of attention-deficit-disordered children

This study of attention-deficit-disordered children revealed that females were more frequently retained in school and evidenced greater impairment on spatial memory tasks. Moreover, there was a trend for girls to be older at the time of referral. With age, the girls evidenced more severity across a wider array of measures, including cognitive functioning, poorer academic achievement, and more problems with peers.

Cognitive and psychosocial sequelae for children with acute lymphocytic leukemia and their families

Abstract The literature concerning the cognitive and psychosocial sequelae of children in whom acute lymphocytic leukemia (ALL) has been diagnosed, indicates that ALL children exhibit deficits in cognitive functioning as well as academic achievement in response to the iatrogenic effects of central nervous system (CNS) irradiation. Preliminary studies suggest that similar emanative effects may follow chemotherapy, an alternative to CNS irradiation for those children given a favorable prognosis. Moreover, recent publications suggest that these children experience significant psychosocial problems and that their families are at risk for psychological adjustment disorders. In our suggestions for future research on ALL as well as other cancers, we particularly recommend studies of these children within a number of systems and across many settings.