Positive behavior support (PBS) with children with fetal alcohol spectrum disorders: Characterizing caregivers' use of PBS using follow-up clinical trial data.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are associated with neurodevelopmental challenges leading to difficulties with everyday life tasks. The Families Moving Forward (FMF) Program teaches caregivers to use positive behavior support (PBS), integrated with other techniques. However, it is unknown how caregivers retain and use these PBS strategies after the intervention. METHODS: About 4.5 months after completing the FMF Program, twenty-three caregivers of children with FASD aged 4-12 were interviewed about problem behaviors targeted during the FMF Program and their continued use of PBS strategies. Interviews were recorded and coded thematically by a five-coder team. Higher-level pattern codes were developed to facilitate themes across descriptive codes. RESULTS: Caregivers commonly targeted task incompletion and rule breaking, and problem behaviors were often complex or combined. Caregivers identified environmental and interpersonal triggers for problem behavior. They used many accommodations to prevent problem behaviors, most often related to task or environment simplification. Caregivers also used consequence-based strategies. CONCLUSIONS: This study is the first to characterize caregivers' use of PBS strategies for children with FASD using mixed methods. Problem behaviors such as rule breaking were more difficult to target. Caregivers found most success when using a combination of multiple different accommodations per problem behavior. WHAT THIS PAPER ADDS: This is the first study to use mixed methods to characterize how caregivers of children with fetal alcohol spectrum disorders (FASD) use positive behavior support (PBS) strategies to target problem behavior after completion of the empirically validated Families Moving Forward (FMF) Program. Among other techniques involved in the FMF Program, PBS strategies are taught to caregivers and are used to target two distinct, caregiver-identified problem behaviors. This data provides essential information about behaviors responsive to PBS supports, for children with FASD, to inform clinical intervention and research. Notably, multiple problem behaviors often occurred together, emphasizing complexity of behavior challenges in this population and the resulting need for individualized supports. This study is the first to describe commonly observed triggers (antecedents) and commonly used supports (accommodations) from the perspective of caregivers of children with FASD. Importantly, results indicate that use of a wide variety of accommodations, or antecedent-based strategies, are effective in supporting behavior in children with FASD. However, success was most common when caregivers used multiple accommodations for any given concerning behavior. Findings represent 'real-world' strategies caregivers use to support adaptive behavior in their children several months after completion of the FMF Program, suggesting these strategies are applicable to clinical practice.

Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence.

OBJECTIVE: To examine the association of moderate levels of prenatal alcohol exposure with learning and behavior in early adolescence. METHOD: A population-based cohort of 464 children were followed longitudinally from birth to age 14 years. Alcohol exposure was assessed via in-depth maternal self-report in the fifth month of pregnancy. At age 14, learning and behavior were assessed with multiple measures, tapping parent, teenager, and psychologist viewpoints, drawn from adolescent laboratory examination and parent phone interview. The underlying pattern of association between prenatal alcohol and adolescent outcome was detected using partial least-squares statistical techniques; confounding factors were dealt with by regression methods. RESULTS: Analyses revealed a statistically significant, subtle relationship between greater prenatal alcohol use and increased behavior/learning difficulties during adolescence, even after accounting for other developmental influences. "Binge" maternal drinking and exposure early in pregnancy were associated with a profile of adolescent antisocial behavior, school problems, and self-perceived learning difficulties. CONCLUSIONS: Fetal alcohol exposure (even at "social drinking" levels) is associated with developmental difficulties in adolescence that are consistent with problems seen earlier in life. Clinicians should understand the potential role prenatal alcohol exposure plays in behavioral and cognitive problems.

Pregnant adolescents in chemical dependency treatment. Description and outcomes.

This study examines the treatment, maternal and infant outcomes of pregnant adolescents (16-19 years) enrolled in an adult perinatal chemical dependency treatment program. Twenty-one adolescent subjects were compared to 323 adult women (mean age, 27.4 years) after enrollment into a randomized treatment trial consisting of intensive outpatient or short-term residential conditions. The results show a similar treatment retention rate. Adolescents differed from adult women on marital status, drugs of choice (alcohol, marijuana vs. opiates and cocaine) and method of administration, with no injection drug users in the adolescent cohort. Tobacco use was high (> 85%) in both groups. Obstetric, maternal, and infant outcomes to 1 year were comparable. Older adolescents who are chemically dependent and pregnant have treatment needs similar to adult women and can benefit from programs designed to treat older women. Recruitment difficulties for adolescents in need of treatment is discussed.

PIP: This study describes a sample of 21 pregnant women aged 16-19 years in treatment for substance abuse through the MOMS Project in Seattle, Washington, during 1991-94 who were followed for at least 90 days after the beginning of treatment with regard to a number of variables. The treatment, maternal, and infant outcomes of these pregnant adolescents enrolled in an adult perinatal chemical dependency treatment program are compared with like outcomes for 323 randomized adults of mean age 27.4 years in the program. The randomized treatment trial involved either intensive outpatient or short-term residential conditions. 27% of adolescents and 32% of adults remained in treatment for longer than 90 days, a statistically nonsignificant difference. The adolescents did, however, differ from adult women on marital status, preferred drugs, and the method of drug administration, with no IV drug users among the adolescents. A larger proportion of the adolescents drank alcohol compared to the adults. More than 85% of the women in both groups smoked cigarettes. Obstetric, maternal, and infant outcomes to 1 year were comparable. These findings demonstrate that older adolescents who are chemically dependent and pregnant have treatment needs similar to adult women and can benefit from programs designed to treat older women.

Prenatal cocaine and neuromotor outcome at four months: effect of duration of exposure.

The effect of prenatal cocaine exposure on the motor development of full-term infants was examined in a prospective study, controlling for maternal characteristics and exposure to other substances. Intrauterine cocaine exposure was determined at birth by maternal self-report and was verified by hair analysis. At 4 months, 120 cocaine-exposed (COC) and 186 non-cocaine-exposed (NON-COC) infants were assessed by blinded examiners using a standard evaluation of neuromotor function, the Movement Assessment of Infants (MAI). Relative to NON-COC infants, COC infants had significantly higher full-scale MAI total risk scores after adjusting for covariates (p = .05). Infants exposed through the third trimester of pregnancy (n = 48) had higher MAI scores for both total risk (p = .02) and Volitional Movement (p = .01), and when compared with infants exposed only within the first two trimesters (n = 72), they had significantly more deficits in Volitional Movement (p = .03). Although MAI scores for the majority of exposed infants were within the normal range, infants exposed through the third trimester were at significantly increased risk for motor dysfunction (relative risk = 1.6; 95% confidence interval = 1.1, 2.8). Intrauterine cocaine exposure had an adverse effect on infant motor development after the neonatal period; this association was related to the timing and duration of gestational exposure. Further study is needed to evaluate the long-term clinical implications of neuromotor abnormalities in prenatally exposed infants.

Heat-Resistant Psychrotrophic Bacteria Isolated from Pasteurized Milk 1.

Psychrotrophic bacteria were isolated from 227 pasteurized milk samples which had a shelf life in excess of 20 days at 7.2 C. Of 700 cultures isolated, 135 were resistant to heating at 72 C for 16 sec and were able to re-establish growth at 7.2 C. Thirty-five cultures, representing 15 different types were subjected to detailed examination to determine their actions on refrigerated milk, growth temperatures, thermal resistance at various temperatures, and their identities. The spore-forming genus Bacillus occured most frequently. The non-sporing types were assigned to the genera Arthrobacter , Microbacterium , Streptococcus , and Corynebacterium .

Neuropsychological deficits in adolescents with fetal alcohol syndrome: clinical findings.

Understanding the nature of cognitive deficits among adolescent patients with fetal alcohol syndrome (FAS) can direct future research on assessment and intervention. In an exploratory study, nine nonretarded teenagers with FAS were administered tests of IQ and adaptive behavior, and neuropsychological tests presumed sensitive to alcohol effects. Their performance was compared with psychometric norms and to data from a sample of 174 adolescents with minimal or no prenatal alcohol exposure. These nonretarded FAS patients commonly showed behavior problems, decreased social competence, and poor school performance. Neuropsychological testing revealed significant deficits, although no one neuropsychological profile characterized all patients and not all tests revealed problems. Relatively intact performance was observed in procedural memory, some measures of reaction time, and some reading measures. Deficits were seen on attentional and memory tasks tapping visual-spatial skills, short-term auditory attention and memory, declarative learning, and cognitive flexibility and planning. Difficulties in processing speed and accuracy were also seen. Comparison with a subgroup of 52 nonalcohol-exposed or minimally alcohol-exposed adolescents with a similar range of IQ scores demonstrated that deficits among these FAS patients were not fully explained by a general lowering of IQ.

Drinking during pregnancy decreases word attack and arithmetic scores on standardized tests: adolescent data from a population-based prospective study.

Women (1529) were interviewed in midpregnancy, and a cohort of their children has been examined at various ages. The two standardized tests presented herein are part of a large battery of tests administered when the children were 14 years old. "Word Attack" (n = 462) measures phonological processing on a task involving the reading of pseudowords in nontimed performance. "Arithmetic" (n = 191) measures auditorily processed mental computations in timed performance. Scores on both tests were associated with prenatal alcohol exposure in a dose-dependent fashion. These effects were robust when considered in relation to a wide variety of potentially confounding variables, such as prenatal exposure to tobacco and other drugs, sociodemographic characteristics, and traumatic postnatal events. A variety of alcohol scores were related to these two performance measures, but those involving a massing of drinks on a given occasion had the strongest association. The higher the average number of drinks/occasion, the poorer the offspring performance on tasks thought to underlie numerical problem solving and reading proficiency. Earlier reports of prenatal, alcohol-related neurobehavioral deficits in childhood have now been extended into adolescence.

Maternal drinking during pregnancy: attention and short-term memory in 14-year-old offspring--a longitudinal prospective study.

A large and compelling experimental literature has documented the adverse impact of prenatal alcohol exposure on the developing brain of the offspring. This is the first report of adolescent attention/memory performance and its relationship with prenatal alcohol exposure in a population-based, longitudinal, prospective study (n = 462) involving substantial covariate control and "blind" examiners. Prenatal alcohol exposure was significantly related to attention/memory deficits in a dose-dependent fashion. A latent variable reflecting 13 measures of maternal drinking was correlated 0.26 with a latent variable representing 52 scores from 6 tests measuring various components of attention and short-term memory performance. The number of drinks/occasion was the strongest alcohol predictor. Fluctuating attentional states, problems with response inhibition, and spatial learning showed the strongest association with prenatal alcohol exposure. A latent variable reflecting the pattern of attention/memory deficits observed at 14 years correlated 0.67 with a composite pattern of deficits previously detected on neurobehavioral tests administered during the first 7 years of life. The 14-year attention/memory deficits observed in the present study appear to be the adolescent sequelae of deficits observed earlier in development. As is usual in such studies, not all exposed offspring showed deficits.