1. Infant Assessment in FASD: Ukraine Exposure Sample
Claire D. Coles, Ph.D
CIFASD Joint Meeting
February 1, 2011

2. Assessment of Alcohol Exposed Infants for Research
Exposure Samples
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.

3. 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.

4. 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…..

5. Developmental Tests (DQ) (0 to 3)
Developmental tests are used to measure infant development.
At risk children
Suspect developmental delays
specific questions about a child
placement
tracking effects of treatment
research

6. 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.
Development is “in process” so that early measures of outcome may not be predictive.
Neuronal plasticity (recovery)
Postnatal environmental effects
Requires specialized skills both to administer and interpret.
Various experimental biases

7. 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)
Habituation
Visual preference
Speed of processing

8. 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

9. No “Newborn IQ” 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
Habituation
Orientation
Motor Performance
Range of State
Regulation of State
Autonomic Regulation
Reflexes

10. 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)
Mental Development Index (MDI) (M=100, SD=15)
Psychomotor Development Index (PDI) (M=100, SD=15)
Behavior Rating Scale (BRS) (Percentiles)

11. 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.

15. Results: 6 Months
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.

16. BSID-II Outcomes at 6 months M(SD)(N=89). Multivariate Analysis
Alcohol Exposure
None
Exposed
Micronutrients
None (n=24)
Supplement (n=19)
(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.

17. Mental Development Index-6 months

18. Psychomotor Development Index-6 months

19. 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.

20. BSID-II Outcomes at 12 months M(SD)(N=55). Multivariate Analysis
Alcohol Exposure
None
Exposed
Micronutrients
None (n=15)
Supplement (n=12)
(n=13)
Supplement (n=15)
Mental (MDI)
101
(14.87)
97.42
(10.13)
92.38 (13.69)
103.0
(9.73)
Motor (PDI)
(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 .

21. Mental Development Index-12 months

22. Motor Development Index-12 months

23. Exploratory Analysis: BSID and Micronutrients
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

24. Comments 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.