Truman E. Coggins

Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

BACKGROUND Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. METHODS A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The 4 study groups included: (i) fetal alcohol syndrome (FAS)/partial FAS (PFAS); (ii) static encephalopathy/alcohol exposed (SE/AE); (iii) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (iv) healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments that were used to compare the sizes of brain regions between the 4 groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately. RESULTS Progressing across the 4 study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups [the 2 groups with the most severe central nervous system (CNS) dysfunction] had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had 1 or more brain regions, 2 or more SDs below the mean size observed in the Control group was 78, 58, and 43%, respectively. Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction. CONCLUSIONS Magnetic resonance imaging provided further validation that ND/AE, SE/AE, and FAS/PFAS as defined by the FASD 4-Digit Code are 3 clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.

The acquisition of communicative intentions in infants eight to fifteen months of age.

The acquisition of a set of nonverbal intentionally communicative behaviors is described for six preverbal infants followed longitudinally between eight and 15 months of age. The infants were observed at monthly intervals as they interacted with their mothers in a free play situation. There was a statistically significant trend for the set of communicative intentions to emerge in the following sequence: Protesting, Request for Action, Request for Object, Comment on Action, Comment on Object, and Answering. Gesture alone and gesture + vocalization were the primary modes of expressing communicative intentions at eight months. By 15 months, the majority of communicative intentions were still conveyed by the gesture + vocalization mode; however, the gesture-alone mode had become relatively infrequent and seemed to be replaced by the. use of single-word utterances as a means of conveying communicative intentions at that time. The data corroborate the findings of other studies regarding the early onset of intentional communication prior to speech and additionally suggest a pattern of emergence of communicative intentions for the six infants studied.

The Communicative Intention Inventory: A system for observing and coding children's early intentional communication

The Communicative Intention Inventory, an observational system for describing childrens early gestural, vocal, and verbal communicative behaviors, is presented in this paper. The Inventory is comprised of eight intentional categories which are included because of their content and construct validity, their likelihood of occurrence in a clinical setting, and their high observerscorer reliability. The rank order of frequency of occurrence of the eight intentional categories is compared across 16 subjects resulting in a reliability coefficient of .66. The value of using the Inventory as a criterion-referenced measure of communicative intentions is explored.

Analysing narrative productions in older school-age children and adolescents with fetal alcohol syndrome: An experimental tool for clinical applications

The most devastating teratogenic effect of alcohol on the unborn child is fetal alcohol syndrome (FAS). FAS is a permanent birth defect that results in lifelong disruptions in cognitive, linguistic and social development. One of the most debilitating effects of prenatal alcohol exposure involves the development and use of social communication. Deficits in social communication jeopardize academic success and appear to play a major role in the maladaptive and dysfunctional behaviours present in older school-age children and adolescents with FAS. The ability to manage longer units of social discourse is a defining feature of adolescent language. Narratives are extended texts that occur frequently in the language of the classroom and in a variety of meaningful social contexts. The demands of narratives provide clinicians with a window of opportunity from which to examine the social-communicative processes of youngsters with FAS. In this paper we introduce an experimental protocol that has been designed to sam...

Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. A comprehensive neuropsychological/behavioral, MR imaging (MRI), MR spectroscopy (MRS) and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine whether global and/or focal abnormalities could be identified and to distinguish diagnostic subclassifications across the spectrum. The four study groups included (1) FAS/partial FAS; (2) static encephalopathy/alcohol exposed (SE/AE); (3) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (4) healthy peers with no prenatal alcohol exposure. Results are presented in four separate reports: MRS (reported here) and neuropsychological/behavioral, MRI and fMRI outcomes (reported separately). MRS was used to compare neurometabolite concentrations [choline (Cho), n-acetyl-aspartate (NAA) and creatine (Cre)] in a white matter region and a hippocampal region between the four study groups. Choline concentration in the frontal/parietal white matter region, lateral to the midsection of the corpus callosum, was significantly lower in FAS/PFAS relative to all other study groups. Choline decreased significantly with decreasing frontal white matter volume and corpus callosum length. These outcomes suggest low choline concentrations may reflect white matter deficits among FAS/PFAS. Choline also decreased significantly with increasing severity of the 4-Digit FAS facial phenotype, increasing impairment in psychological performance and increasing alcohol exposure. NAA and Cre concentrations did not vary significantly. This study provides further evidence of the vulnerability of the cholinergic system in FASD.

Functional magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders

A comprehensive neuropsychological/psychiatric, MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The four study groups included: 1. FAS/Partial FAS; 2. Static Encephalopathy/Alcohol Exposed (SE/AE); 3. Neurobehavioral Disorder/Alcohol Exposed (ND/AE); and 4. healthy peers with no prenatal alcohol exposure. fMRI outcomes are reported here. The neuropsychological/psychiatric, MRI, and MRS outcomes are reported separately. fMRI was used to assess activation in seven brain regions during performance of N-back working memory tasks. Children across the full spectrum of FASD exhibited significant working memory deficits and altered activation patterns in brain regions that are known to be involved in working memory. These results demonstrate the potential research and diagnostic value of this non-invasive MR tool in the field of FASD.

Outcome Measures for School-Age Children with Social Communication Problems.

&NA; This article addresses outcome measures for social communication problems exhibited by school‐age children. General guidelines for selecting outcome measures are provided. Specific outcome measures are discussed relative to (1) a model for viewing abilities that are necessary for social communication and (2) a framework for sampling these abilities across four different contexts. A case example provides an application of outcome measures to monitoring change.

Examining Early Intentional Communication in Down's Syndrome and Nonretarded Children

This study examined the communicative intentions encoded by a group of normally developing preschool children and a group of Downs syndrome children matched for cognitive level and general linguistic abilities. the results revealed no significant differences between groups with respect to their use of a variety of intentional communicative behaviours. These findings suggest that young retarded children at a two-word stage of linguistic development may be as flexible and diverse in their use of language during social interactions as are nonretarded children.

The Influence of Language/Cognitive Profile on Discourse Intervention Outcome

Children with communication needs are often allocated intervention services as a result of the relationship between their cognitive ability and language performance. Children with higher cognitive skills relative to language skills are considered promising candidates for language services. In contrast, children who are delayed in both cognitive and language abilities are considered poor candidates for intervention and are often excluded from services, or given a lower priority for services. This study examines the effects of intervention on one aspect of pragmatic development (discourse skills) following intervention for two groups of young children with delayed language development: one group with measured cognitive performance above language performance, and the other group with similar delays in both language and cognitive performance. Repeated measures analyses of variance indicated significant differences between groups for two of 15 measures derived from language samples. Both favored the children with equivalent delays in language and cognition. These findings do not support the notion that children with equivalent delays in cognition and language development are poor candidates for language intervention. Service delivery and policy implications are discussed.

A Diagnostically Promising Technique for Tallying Nominal Reference Errors in the Narratives of School-Aged Children with Foetal Alcohol Spectrum Disorders (FASD).

BACKGROUND Foetal Alcohol Spectrum Disorders (FASD) include the range of disabilities that occur in children exposed to alcohol during pregnancy, with Foetal Alcohol Syndrome (FAS) on the severe end of the spectrum. Clinical research has documented a range of cognitive, social, and communication deficits in FASD and it indicates the need for diagnostic tools that can identify children with diminished communicative capacities resulting from prenatal alcohol exposure. Previous research indicates that analysis of nominal reference errors within narrative discourse may provide such a tool. AIMS To demonstrate the potential diagnostic utility of a new tool for tallying nominal reference errors in the oral narratives of school-aged children with FASD by presenting quantitative measurement data that address interrater agreement and predictive accuracy. METHODS & PROCEDURES Retrospective analysis was conducted on spontaneously produced oral narratives from 32 school-aged children (8;5-11;7) with a range of socio-economic and ethnic profiles. Sixteen of the children had been previously diagnosis with an FASD, including five with full or partial FAS (pFAS). The remaining 16 children were considered typically developing (TD). A range of methods for calculating the rate of nominal reference errors (rNRE) were used to predict which narratives were produced by children from each group. Accuracy (sensitivity and specificity) for two predictions (FASD versus TD, and FAS/pFAS versus all others) was quantified using receiver-operating characteristic curve analyses. Pairwise statistical comparisons were made between methods to determine which had the most diagnostic potential. OUTCOMES & RESULTS The proposed system for calculating the rNRE was highly accurate at predicting which narratives were produced by children with FASD (versus TD, 88% overall accuracy), and which were produced by children with FAS/pFAS (versus all others, 97% overall accuracy), and outperformed all other methods tested. Agreement on coding decisions between independent judges was high (kappa = 0.90). CONCLUSIONS The strong predictive accuracy demonstrated in this study provides empirical evidence that the system proposed in this feasibility study has sufficient sensitivity and diagnostic utility to warrant further development for use with children suspected of prenatal alcohol exposure. It also points to the potential for the tool to be used with other clinical populations that, even in the absence of a confirmed alcohol exposure, share many of the communication challenges of this complex clinical population.