CIFASD Meeting Santa Barbara June 2005

Progress Report: Pilot Multi-method Intervention Study in Children in South Africa who are Alcohol Exposed

Rationale of Intervention Study No systematic study evaluating the effectiveness of intervention methods for children with FASD has yet been published. The study of effectiveness of behavioral and pharmacological interventions is envisioned as a primary goal of this consortium. Access to a large group of well-diagnosed children with FAS / FASD has provided the opportunity to undertake a systematic intervention

Specific Aims To determine the nature and degree to which 3 interventions improve academic skills and behavior in alcohol-exposed children. 1. Cogntive Control Therapy 2. Language and literacy training 3. Family interventions To assess the effects of three mediating variables (self-efficacy, attention, meta-cognitive skills) and three moderating variables (child’s IQ, life stress, maternal education) on therapeutic outcomes.

Research Team Phil May, Wendy Kalberg, PW Kodituwakku, University of New Mexico Colleen Adnams, Bernice Castle, Sean September, School of Child and Adolescent Health, UCT Petra Engelbrecht, Marechen Perold, Department of Educational Psychology and Specialised Education, University of Stellenbosch Pharyn Sorour, Division of Communication Sciences and Disorders, UCT Rubin Adams, Western Cape Department of Education

Interventionalists Ellick Williams, Ed. Psych. Anna Kotze, Sp. and L. Therapist Wilma Rossouw, Ed. Psych

Methodology 104 Grade 2/3 participants at 10 schools from Wellington 3 Epidemiology study (extensive demographic data) 65 FAS/PFAS; 15 ‘deferred’ on initial diagnosis; confirmed exposure to alcohol; 23 non-exposed controls FASD randomised to 3 intervention, 1 control group. Baseline assessment; 18 mths intervention; mid, post intervention assessment. Analysis focus on clinically, statistically significant improvements and scale of change.

Core Intervention battery 1. Reading test: a. Single word: UCT Graded (video/audiotape) b. Reading passages: Paarl Passages (video/audiotape) 2. Spelling Test: UCT Single Word Spelling 3. Mathemathics: a. S-SAIS Number Problems b. Ballard Addition, subtraction 4. Language tests: a. FROG expressive narrative (video/audiotape) b. TROG receptive grammar 5. Cognitive Control Battery Teacher Questionnaires: a. Open questions and checklist b. Self Efficacy Questionnaire c. Achenbach Teacher checklist

Intervention Core Battery cont: Parent Questionnaires: Mental Pain Alcoholism Screening - RAPS-4 Achenbach CBCL Classroom observation: Qualitative observations and checklist Snellen’s Visual Acuity Screening Auditory Screening: Otoacoustic Emissions (OAE) and Tympanogram The different intervention groups were administered further specific tests. All children will also be administered the Neuropsychological Battery.

Accomplishments 2003 – March 2004: planning, development of core and specific test batteries SA + UNM co-researchers March /May 2004 – recruitment and training psychometrist. Translation of tests, questionnaires May, June 2004 - participant recruitment via field worker visits to parents → 99%. June, July 2004 – commencement of baseline testing, interviews, questionnaires. Recruitment of co-ordinator. August 2004 – randomisation of FASD participants to intervention groups; preparation for interventions August 2004 - reports to schools September 2004 - commenced interventions June 2005 completed 28 weeks classroom interventions

Some Baseline Data FASD N=81 Mean age =113m N/exp Controls Test P <0.01 * FASD N=81 Mean age =113m N/exp Controls n=23 Mean age =113m Reading * MA mths (SD) 89.2 (13.8) 104.7 (14.4) Spelling * MA mths (SD) 87.3 (10.7) 100.3 (15.2) Maths Add * MA mths SD) 77.1 (11.6) 95.3 (15.2) Maths Sub * MA mths (SD) 75.2 (12.1) 94.3 (14.9) Maths Gen. * scale score 3.8 (2.7) 6.1 (2.4) Syllable Identification * % 43.9 (34.4) 73.4 (16.9) Syllable segmentation * % 59.8 (28.6) 81.2 (18.7) *

Baseline Data Reading passages comprehension % correct FASD Mean (SD) N/E Control P-value Level 1 37.0 (33.3) 66.12 (30.9) .000 Level 2 19.26 (29.4) 41.74 (34.6) Level 3 4.89 (18.7) 23.47 (27.2)

Correlation with dysmorphology scores, head circumference measures at diagnosis with baseline cognitive data