INFANT ASSESSMENT IN FASD:
UKRAINE EXPOSURE SAMPLE
Claire D. Coles, Ph.D
CIFASD Joint Meeting
February 1, 2011
ASSESSMENT OF ALCOHOL EXPOSED
INFANTS FOR RESEARCH
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Exposure Samples
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Maternal Alcohol Use information obtained via self
report
Confounding factors identified and measured
Provides information on the full range of
developmental outcomes in exposed infants
Allows appropriate control groups to aid
interpretation of outcome data.
Established methods for assessment of infants
available.
GOALS OF INFANT ASSESSMENT IN
UKRAINE EXPOSURE SAMPLE
Evaluate alcohol quantity, frequency, timing in
relation to growth, structure and
neurodevelopment.
 Assess infants using global measures of
development (BSID-II) and early infant measures
of processing speed and attentional regulation
skills.
 Evaluate the contribution of baseline nutritional
status, measured during pregnancy.
 Evaluate the impact of micronutrient
supplementation with and without choline.
 Examine the relationship between indicators of
oxidative stress and developmental outcomes.
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Infant
Testing is
not Easy!
Infants are not
socialized yet
to cooperate
with the
tester.
Must be in the
right “state” to
achieve
optimal
performance.
Cannot be
hungry, tired,
sick…..
DEVELOPMENTAL TESTS (DQ) (0 TO 3)

Developmental tests are used to measure infant
development.
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At risk children
Suspect developmental delays
specific questions about a child
placement
tracking effects of treatment
research
DEVELOPMENTAL ASSESSMENT IN
INFANCY: LIMITATIONS

What you can measure, 0 to 3, versus what you want
to know, long term.
Facets of development affected by alcohol may not be
measurable early in development (e.g., Executive
functioning; language)
 The more severe the impact, the more likely to be
observed. “Subtle” information may be missed.
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Development is “in process” so that early measures of
outcome may not be predictive.
Neuronal plasticity (recovery)
 Postnatal environmental effects
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Requires specialized skills both to administer and
interpret.
Various experimental biases
SPECIFIC ASSESSMENTS OF INFANT
FUNCTIONING THAT HAVE BEEN USED TO ASSESS
EFFECTS OF PRENATAL ALCOHOL EXPOSURE
Newborn assessments (e.g., BNBAS)
 Specific motor tests
 Prelinguistic and Early Language Development
 Numerosity (“is it two or three items?”)
 Early “executive functioning” tasks (e.g., “A not
B”)
 Temperament and Behavior (e.g., CBCL)
 Measures of memory and attention (Methods)
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Habituation
Visual preference
Speed of processing
ASSESSMENT OF THE NEWBORN
Neonatal Behavioral Assessment Scale, 3rd Edition
(NBAS)
•Conceptualizes Neonate as
Complexly Organized individual
•Defends self from negative
stimuli
•Control motor and autonomic
responses to attend to
environment
•Elicit stimulation from the
environment
No “Newborn IQ”
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There is no summary score created.
It is a description of the infant
A controlled observation
Observations are grouped into 7
categories with summary scores
1.
2.
3.
4.
5.
6.
7.
Habituation
Orientation
Motor Performance
Range of State
Regulation of State
Autonomic Regulation
Reflexes
BAYLEY SCALES OF INFANT
DEVELOPMENT (2ND EDITION)
Provides a “global” measure of child’s status
relative to other children of the same age on an
ordinal scale of development.
 Individually administered measure of Infant
Development. Tester must be familiar with
infants, testing and be trained to reliability.
 Ages 2 months to 42 months
 Standardized scores (Developmental Quotient)
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Mental Development Index (MDI) (M=100, SD=15)
 Psychomotor Development Index (PDI) (M=100,
SD=15)
 Behavior Rating Scale (BRS) (Percentiles)
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VALIDITY AND RELIABILITY IN TESTING
Two Sites: Rivne and Khmelnytsky
 Testers experienced in evaluation and infancy
but not Bayley Testing
 Have to be trained to do tests and to score
properly.
 Reliability in test Administration/Scoring
maintained through training, observation and
checking scoring.
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RESULTS: 6 MONTHS
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In December, 2010, 93 6-month-olds (30+
currently being entered) with 4 in “questionable”
category and not used in the analysis.
2 Factor Analysis included: Alcohol (2 levels:
Exposed/Unexposed) and Micronutrients (2
levels: none/supplements, collapsed over choline).
Potential covariates examined: SES, maternal
smoking, maternal nutritional status.
BSID-II OUTCOMES AT 6 MONTHS
M(SD)(N=89). MULTIVARIATE ANALYSIS
Alcohol
Exposure
None
Exposed
Micronutrients
None
(n=24)
Supplement
(n=19)
None
(n=20)
Supplement
(n=24)
Mental (MDI)
94.46
(10.81)
97.89
(5.55)
89.60
(14.04)
96.50
(6.28)
Motor (PDI)
98.83
(9.68)
99.21
(10.78)
88.65
(18.31)
96.71
(10.40)
Alcohol, MDI (F1,83)=2.21,p<.14; NS; PDI (F1,83)=5.48,p<.02
Supplement, MDI (F1,83)=6.04,p<.02; ; PDI (F1,83)=2.0,p<.16,NS
No significant interactions.
MENTAL DEVELOPMENT INDEX-6 MONTHS
PSYCHOMOTOR DEVELOPMENT INDEX-6
MONTHS
EXPLORATORY ANALYSES: FACTORS TO BE
CONTROLLED IN LARGER ANALYSES
SES as a covariate-attenuated effects of alcohol
use on motor performance; did not change
micronutrient effects.
 Cigarette use by mother-had a significant effect
on MDI (p<.05) with trend for PDI (p<.07). When
cigarettes controlled, effects of alcohol on motor
development were attenuated, while effects of
micronutrients were increased on both mental
and motor development.
 Maternal use of prenatal vitamin prestudy was
significantly related to MDI. Folic acid was not.
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BSID-II OUTCOMES AT 12 MONTHS
M(SD)(N=55). MULTIVARIATE ANALYSIS
Alcohol
Exposure
None
Exposed
Micronutrients
None
(n=15)
Supplement
(n=12)
None
(n=13)
Supplement
(n=15)
Mental (MDI)
101
(14.87)
97.42
(10.13)
92.38
(13.69)
103.0
(9.73)
Motor (PDI)
106.73
(8.15)
102.42
(11.12)
96.86
(18.94)
99.93
(11.91)
Alcohol, MDI (F1,51)<.1,NS; PDI (F1,51)=3.10,p<.084,NS
Supplement, MDI (F1,51)=1.04,p=.3,NS; PDI (F1,51)<1,NS
Interaction: Alcohol Use and Supplements:
MDI (F1,51)=4.61,p<.04,; PDI (F1,51)=1.11,p<.29,NS
.
MENTAL DEVELOPMENT INDEX-12
MONTHS
MOTOR DEVELOPMENT INDEX-12 MONTHS
EXPLORATORY ANALYSIS:
BSID AND MICRONUTRIENTS
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Analysis of micronutrients and BSID outcomes
done in the No Intervention group (n=43) . A
second analysis was done with the whole group
with similar results.
No significant relationships between PDI and
individual micronutrients.
 Significant correlations with PDI found when
interactions terms used. That is Alc*Zinc (Zn): r=-.32,
p<.04; Alc*Ca:r=-.299, p<.05; ALC* Copper (Cu): r=.37, p<.02; Alc*Cp activity: r=-.34, p<.04;
Alc*Magnesium (Mg);r=-.32,p<.04; Alc*C-Reactive:
r=-.32, p<.03.
 No significant correlations with MDI
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COMMENTS
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These preliminary data suggest that
Alcohol exposure affects global development,
particularly motor development at 6 months.
 Supplements with vitamin and other micronutrients
may compensate for these effects on BSID-II scores.
 There are a number of other factors that must be
considered in the final analysis including maternal
baseline nutritional status, SES, other drug use.
 When a larger “N” is obtained, it will be possible to
evaluate effects of individual micronutrients in
relation to outcomes (and we have some data to
support this now) and to evaluate effects at different
levels of alcohol exposure.
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