The FAS DPN core site at the University of Washington maintains a comprehensive, confidential database on all patients evaluated at the FAS DPN with patient consent and University of Washington and WA State Human Subjects Review Board approval. The data allows the FAS DPN to:

• Track regional demand for services and diagnostic outcomes over time.
  
• Develop new state-of-the-art screening and diagnostic tools.
  
• Support intervention research that could directly benefit patients and their families.
  

Investigators:
Susan J. Astley, Ph.D., Professor of Epidemiology/Pediatrics, P.I.
Heather Carmichael Olson, Ph.D., Child-Clinical Psychologist
Truman Coggins, Ph.D., Associate Professor, Speech Language Pathologist
Tracy Jirikowic, Ph.D., O.T.R./L., Assistant Professor of Rehabilitation Medicine
Allison Brooks, Ph.D., Licensed Psychologist
Elizabeth Aylward, Ph.D., Professor of Radiology, Neuroimaging Psychologist
Kimberly Kerns, Ph.D., Neuropsychologist
Todd Richards, Ph.D., Professor of Radiology, MRI/S Physicist
Kenneth Maravilla, M.D., Professor of Radiology, Radiologist

Fetal alcohol syndrome (FAS) is a permanent birth defect syndrome caused by maternal drinking during pregnancy. FAS is characterized by growth deficiency, a unique facial phenotype and central nervous system (CNS) damage/dysfunction. The cognitive/behavioral problems in this condition stem from prenatal organic brain damage. Not all individuals with prenatal alcohol exposure suffer brain damage and not all who do suffer brain damage have FAS. The degree of brain damage among individuals with prenatal alcohol exposure may vary from microcellular and neurochemical aberrations to gross structural anomalies. Similarly, cognitive/behavioral dysfunction varies considerably. Teratogenic physical findings in individuals with FAS lend credence to the clinical judgment that their cognitive and behavioral dysfunction is due, in part, to organic brain damage. But without the physical features of FAS or at least a severe expression of brain damage, the injury often goes undiagnosed and unserved.

Magnetic resonance (MR) technology offers non-invasive methods for in vivo assessment of neuroabnormalities. A comprehensive neuropsychological/psychiatric, MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified across the spectrum. The four study groups included: 1) FAS/Partial FAS; 2) Static Encephalopathy/Alcohol Exposed (SE/AE); 3) Neurobehavioral Disorder/Alcohol Exposed (ND/AE) diagnosed with the FASD 4-Digit Code; and 4) healthy peers with no prenatal alcohol exposure. Results will be presented in a series of four reports: Part 1: FASD neuropsychological/psychiatric outcomes; Part II: MRI; Part III: MRS, and Part IV: fMRI.

Four manuscripts have been published.
Part I: Neuropsychological and behavioral outcomes
Part II: MRI Outcomes
Part III: MRS Outcomes
Part IV: fMRI Outcomes

Behavioral Consultation and Social Communication

The FAS DPN was funded by the CDC to evaluate the effectiveness of intervention targeted to children with the full spectrum of disorders associated with prenatal alcohol exposure, and their families. Study period: 2001-2010

Investigators:
Susan J. Astley, Ph.D., Professor of Epidemiology/Pediatrics
Heather Carmichael Olson, Ph.D., Child-Clinical Pscyhologist. P.I.
Lesley Olswang, Ph.D., Professor of Speech and Hearing Sciences, P.I.
Liselotte Svensson, Ph.D. Speech and Hearing Sciences
Truman Coggins, Ph.D., Associate Professor of Speech and Hearing Sciences.
Tracy Jirikowic, Ph.D., O.T.R./L., Assistant Professor of Rehabilitation Medicine
Allison Brooks, Ph.D., Licensed Psychologist
Julie Gelo, Family Advocate/Resource Advisor
Beth Gendler, M.S.W., Social Worker

School-aged children with FASD are an essential group to target when building empirically-based intervention models. The age range of 5 to 11 years is a period when a large group of children with FASD can be identified, and there are pressing clinical needs. In these school years, alcohol-affected children's deficits in areas such as executive functioning and behavioral regulation, memory, and social communication are clearly emerging and beginning to negatively impact their adaptive function and life success. These are the years when behavior problems - and especially difficulties with peers and disruptive behavior- are widely reported among children with FASD by their parents and teachers. These caregivers struggle to understand the children's challenging, maladaptive, or atypical behavior, and apply treatment techniques that do not always yield expected success. In these years, when home and school are a child's main life settings and developmental outcomes can be meaningfully improved, parents and teachers need access to effective interventions. These can either be multimodal interventions providing caregiver support, education, assistance with advocacy, and access to a menu of services such as behavioral consultation- or high-yield, single-modality treatments that target critical domains of deficit shown by children with FASD.

Two recently completed studies responded to this important clinical need for school-aged children with FASD: (Study 1) A randomized control trial assessing the efficacy of an individualized, supportive, behavioral consultation intervention for parents and school staff of children with FASD (brochure)(2009 publication); and (2) A school-based social communication observational study of children with FASD that targeted critical deficits in social communication and peer relations (2010 publication).

Motor Sensory

Investigators:
Tracy Jirikowic, PhD, Assistant Professor of Rehabilitation Medicine
Sarah Westcott McCoy PhD, Associate Professor of Rehabilitation Medicine
Susan Astley PhD, Professor of Epidemiology/Pediatrics

Two published studies (Jirikowic et al 2008, Franklin et al 2008) using FAS DPN data revealed over 80% of children evaluated in the FAS DPN present with sensory-processing deficits. These deficits co-occur with problem behaviors at a very high rate. An ADAI-sponsored study (P.I.: Jirikowic, 2009-2010) is currently underway to examine the relationship between behavioral measures of sensory processing with psychophysiologic (automonic and neuroendocrine) responses to sensation among children with FASD. A NIAAA-sponsored study (Co-PIs: Westcott & Jirikowic, 2009-2014) is also currently underway to develop and test a novel sensorimotor intervention for children withFASD. Children with FASD demonstrate balance and postural control deficits in which poor central processing and integration of sensory input are suspect. The proposed sensorimotor training intervention employs a virtual reality system to improve the weighting and re-weighting of sensory (visual, vestibular and somatosensory) information during balance.