A Case for Early Screening: Prenatal Alcohol Risk Exposure Predicts Risk for Early Childhood Communication Delays.

OBJECTIVE: Studies have confirmed the detrimental effects of prenatal alcohol exposure on language development in children. Little is known about the ability of prenatal alcohol risk (PAR) screening measures to predict language or other neurodevelopmental delays in young children, however. The intent of this study is to identify whether PAR predicts communication development in children at 12, 24, and 36 months of age. METHOD: Data from 772 women and their children who participated in the All Our Families pregnancy cohort were analyzed. Respondents completed the T-ACE, a validated screening tool for detecting PAR. Communication development in children was measured through the Ages and Stages Questionnaire, Third Edition. Logistic regression was used to generate odds ratios and 95% confidence intervals. RESULTS: A positive screen for PAR places a child at risk for communication delay (≤1 SD below mean) by approximately 1.5-fold at 12, 24, and 36 months of age, even after adjustment for demographic variables. Follow-up analysis revealed a significant difference in the prevalence of risk for communication delays between 12 and 24 months and between 24 and 36 months in both low- and high-risk drinking groups, with 24-month-old children showing the greatest risk for delay. CONCLUSION: The results of this study suggest that screening for PAR in expectant mothers may identify a group of young children at increased risk for communication delays. This research carries clinical implications and provides support for PAR screening in informing early childhood developmental screening efforts.

Construct and factorial validity of Neurobehavioral Disorder associated with Prenatal Alcohol Exposure (ND-PAE).

BACKGROUND: ND-PAE, as a condition needing further study, requires validation. Few studies have assessed the validity of ND-PAE with none using a prospective sample. METHODS: Fifty-eight children underwent multidisciplinary FASD assessments and were evaluated for ND-PAE using a prospective, clinical approach. Construct and factorial validity of ND-PAE were assessed, and associations between domains and symptoms described. Post hoc analysis assessed external validity of factors. RESULTS: ND-PAE demonstrated weak construct validity with variable convergence and divergence within and between symptoms. Factor analysis revealed one strong factor consisting of abilities associated with adaptive behavior and general cognitive ability. Relative contribution of symptoms and domains were variable. CONCLUSION: This study provides an evidence-based approach to assessing ND-PAE symptoms and is a starting point to elucidating its neurobehavioral pattern.

Articulation Speaks to Executive Function: An Investigation in 4- to 6-Year-Olds.

Executive function (EF) and language learning play a prominent role in early childhood development. Empirical research continues to point to a concurrent relation between these two faculties. What has been given little attention, however, is the association between EF and speech articulation abilities in children. This study investigated this relation in children aged 4-6 years. Significant correlations indicated that children with better EF [via parental report of the Behavior Rating Inventory of Executive Function (BRIEF) inventory] exhibited stronger speech sound production abilities in the articulation of the "s" and "sh" sounds. Furthermore, regression analyses revealed that the Global Executive Composite (GEC) of EF as measured by the BRIEF, served as a predictor for speech sound proficiency and that speech sound proficiency served as a predictor for the GEC. Together, these results demonstrate the imbricated nature of EF and speech sound production while bearing theoretical and practical implications. From a theoretical standpoint, the close link between EF and speech articulation may indicate a common ontogenetic pathway. From a practical perspective, the results suggest that children with speech difficulties could be at higher risk for EF deficits.

Comparing diagnostic classification of neurobehavioral disorder associated with prenatal alcohol exposure with the Canadian fetal alcohol spectrum disorder guidelines: a cohort study.

BACKGROUND: Diagnostic criteria have recently been introduced in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), for neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). The purpose of this study is to assess the classification of this condition using the Canadian fetal alcohol spectrum disorder (FASD) multidisciplinary diagnostic guidelines as the standard of comparison. First, classification of ND-PAE was compared with Canadian FASD diagnoses of fetal alcohol syndrome (FAS), partial FAS and alcohol-related neurodevelopmental disorder. Second, classification of ND-PAE was compared with FAS and pFAS only, a criterion for which includes facial features highly predictive of prenatal alcohol exposure and effects. METHODS: Eighty-two patients underwent multidisciplinary clinical evaluations using the Canadian FASD diagnostic guidelines between 2011 and 2015. Two clinicians independently reviewed patient files for evidence of diagnostic criteria for ND-PAE when applying an impairment cut-off level of 2 or more standard deviations below the mean, or clinically significant impairment in the absence of standardized norm-referenced measures. RESULTS: Good interrater reliability was established between clinicians (κ = 0.79). Classifications of ND-PAE and Canadian FASD diagnoses, including alcohol-related neurodevelopmental disorder, were moderately correlated (Cramer V [82] = 0.44, p < 0.01). However, ND-PAE possessed low sensitivity in FASD identification. Further, there was no correlation between ND-PAE and FAS/pFAS classifications (Cramer V [82] = 0.05, p > 0.05). INTERPRETATION: Although there is considerable overlap between both sets of criteria, ND-PAE was less likely to identify patients with FASD. Although the neurobehavioral domains assessed by ND-PAE are supported in research, its diagnostic structure restricts the identification of FASD at the impairment threshold of 2 or more standard deviations. A disconnect remains with regard to impairment thresholds between FASD, which relies on neurodevelopmental data, and ND-PAE, which relies on clinical judgment.

Is that graspable? Let your right hand be the judge.

A right-hand preference for visually-guided grasping has been shown on numerous accounts. Grasping an object requires the integration of both visual and motor components of visuomotor processing. It has been suggested that the left hemisphere plays an integral role in visuomotor functions. The present study serves to investigate whether the visual processing of graspable objects, without any actual reaching or grasping movements, yields a right-hand (left-hemisphere) advantage. Further, we aim to address whether such an advantage is automatically evoked by motor affordances. Two groups of right-handed participants were asked to categorize objects presented on a computer monitor by responding on a keypad. The first group was asked to categorize visual stimuli as graspable (e.g. apple) or non-graspable (e.g. car). A second group categorized the same stimuli but as nature-made (e.g. apple) or man-made (e.g. car). Reaction times were measured in response to the visually presented stimuli. Results showed a right-hand advantage for graspable objects only when participants were asked to respond to the graspable/non-graspable categorization. When participants were asked to categorize objects as nature-made or man-made, a right-hand advantage for graspable objects did not emerge. The results suggest that motor affordances may not always be automatic and might require conscious representations that are appropriate for object interaction.