1. Colleen M. Adnams CIFASD Winter meeting DC 2 February 2011
South Africa Update
Colleen M. Adnams MD, FCPaed
University of Cape Town
CIFASD Winter Meeting
Rockville, MD
2 February 2011
Colleen M. Adnams
CIFASD Winter meeting DC
2 February 2011

2. CIFASD clinical project collaborators:
Sarah Mattson, PhD, San Diego State University, PI
Elizabeth Sowell, PhD, UCLA, PI
Phil May, PhD, The University of New Mexico, PI
Tatiana Foroud, PhD, Indiana University, PI

3. UCT Site CIFASD Studies updated in progress reports of PI’s
Site specific progress
Snapshots of site data
Challenges and opportunities of research in a South Africa population
Future plans

4. Neurobehavioural Study
DemRecGroup
Age13-15 yr
(PMS2C)
Age 8-10 yr
(PMS8C)
Total
FASD 54 48
102
Control 36 23 59
IQ contrast 17 40
Unknown 6
119 88
207

5. Brain Mapping Study Phase 1
8-10 yr olds
13-15 yr olds
Grand total
Females
Males
Total 13 16 29 31 42 71
100
FASD 6 8 14 20 33 47
Control 7 12 9 21 34
Low IQ 2 5 15
Unknown 1 3 4

6. Face and Brain Mapping Phase II
Females
Males
Total
FASD 1 2
Control
Low IQ 3

7. Neurobehaviour Study Follow-up
FASD 6
Control 3
IQ contrast 1
Unknown
Total 10

8. 3-D Imaging study
FASD 2
Control 1
Total 3

9. FASD research in the context of a developing country: Global Research in Intellectual Disability
Atlas : Global Resources for Persons with Intellectual Disabilities, WHO, 2007

10. Confounding influences of cognitive research in low SES settings
Evidence for an association of poverty and disability, especially intellectual disability, in all countries
Scarce information on how poverty and disability affect each other in developing countries
How does this relationship manifest in terms of prevalence and manifestation of developmental disabilities, such as FASD, and poverty in South Africa?
In 12 African countries, surveys of grade 6 (end of primary school) children showed that on average 57% had not achieved minimum reading levels
(Grantham-McGregor et al, 2007)

11. Measurements of intelligence
Intelligence Scales Measure
FASD n=49
Mean score (SD)
CONTROL n=59
P value
LEITER (age 10yr)
67.6 (10.3)
79.8 (11.3)
.000 **
WISC-IV FULL SCALE (age 4.6 yr)
54.1 (2.13)
69.3 (12.1)
WISC-IV VERBAL
54.7 (11.23)
67.1 (13.3)
WISC-IV PERCEPTUAL REASONING
64.7 (12.84)
78.4 (12.11) **

12. Influence of general intelligence on other cognitive functions: Executive Function (age 14.6 yr)
Test of Executive Function
FASD n = 49
Scale score
Mean (SD)
CONTROL
Mean (SD)
p value
DKEFS Category
25.18
30.31
.001
DKEFS Letter Fluency
13.43
21.08
.000
DKEFS switching
10.08
11.51
.007

13. Effect of IQ on EF F Significance Test of Executive Function
DKEFS Category
Covariant
WISC
LEITER
.039
1.45
.843
.232
DKEFS Letter Fluency
.486
5.10
.487
.026
DKEFS switching
.419
1.230
.519
.270

14. Language deficits in FASD: Production, Comprehension, Naming
Known expressive and receptive deficits described in younger children
Evidence of changes in language ability with age
Sample: years old
SES, Maternal Education similar
IQ: FASD < Control group
Claire Corbett, M.A.
CONTROL
FASD N 25
Age
15.3
15.6
Grade 9 7

15. Language: Production, Comprehension, Naming
COMPREHENSION and NAMING impairments  accounted for by IQ deficits
[TROG-2; CELF-R (receptive); Boston Naming Test]
EXPRESSIVE language  impaired beyond what Perceptual Reasoning IQ accounted for [CELF-R expressive language]
1) Expressive language more complex
2) Flooring effect- could not see differences between CELF-R expressive and receptive prior to regression analysis.
NARRATIVE DISCOURSE  No difference between FASD and Controls
Poor performance by controls
Cookie Jar Theft Picture  ineffective test measure

16. Behavioural and mental health problems: Achenbach Scale Teacher Reports (TRF)
Aim: Examine the behavioural profile of children with FASD and typically developing controls over time in a South African educational setting. N=68 (Wellington lll cohort); (FASD (FAS/PFAS) = 47; CON = 21 Mean age CIFASD 1, T1 = 10.0 yr (SD=0.65); Mean age CIFASD ll, T2 = 14.9 yr (SD= 0.71) Administered ASEBA Teacher Report Form by current teacher.

17. DSM-Oriented Behavioural and mental health problems: Achenbach Scale Teacher Reports (TRF) Time 1, 10yr
T score
**p<0.01
*p<0.05

18. DSM-Oriented Behavioural and mental health problems: Achenbach Scale Teacher Reports (TRF) Time 2, 14.9yr
T score
**=p<0.01
*p<0.05

19. Change in DSM-oriented problems from T1 (10. 0yr) – T2 (14
Change in DSM-oriented problems from T1 (10.0yr) – T2 (14.9 yr) in FASD and CON
T Score

20. Mental health and behaviour
Covariant analysis (IQ, age, sex):
Effect of group on affect, conduct, ADHD, attention and hyper-imp. problems at T1 (p<0.05)
Effect of IQ covariate on affect and attention at T2
No significant changes in FASD of CON group over time
? Some behavioural adaptation in FASD over time
RSA 2011 Abstract submitted:
CM Adnams, T Pomario, PA May, EP Riley, SN Mattson and the CIFASD. Profile and time course of behaviour in South African children with FASD in a school setting.

22. Plans Further data collection including follow up
Further analysis, including integrating multi-source variables
Later analysis of longitudinal data