Heavy prenatal alcohol exposure (AE) is a major public health concern estimated to affect 2-5% of U.S. school children, resulting in a considerable social and economic burden. Fetal Alcohol Spectrum Disorders (FASD) is a non-diagnostic term that reflects the range of significant clinical repercussions from AE, including neuropsychological and behavioral deficits that have life-long consequences. Early identification of affected children and access to effective treatment can lead to better outcomes;however, both have been limited in this population. Effective interventions must target clinically relevant cognitive functions to help improve academic performance. Reading-related dysfunction is of particular interest in the school-age population, as reading abilities are a pillar of elementary education and provide a foundation for learning in all domains. Reading achievement also plays a significant role in school requirements, statewide education policy, access to services, and is associated with better life outcomes. Furthermore, impairments in learning are a key component in the proposed diagnostic scheme for "Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure" in DSM 5. While expressive and receptive language difficulties have been repeatedly documented in the FASD population, reading-related dysfunction and the underlying mechanisms of these deficits have yet to be thoroughly examined. This study aims to determine the scope of reading-related dysfunction in children with FASD and elucidate targets for effective intervention by defining the underlying cognitive processes that contribute to poor reading abilities. Children with FASD are at a higher risk for reading-related dysfunction compared to typically developing controls, partially due to high rates of co-occurring attention-deficit/ hyperactivity disorder (ADHD) and the presence of specific brain abnormalities, both of which have been shown to be associated with higher incidence of reading disorders. An ADHD clinical contrast group will be used to determine if there are differential patterns of impairment that can increase diagnostic specificity. Standardized neuropsychological measures of reading achievement and underlying cognitive processes will be administered to children with FASD, ADHD, and typically developing controls. The relationship between specific cognitive processes and reading achievement will be evaluated for each group. Targeted reading interventions have been developed as a result of increased knowledge of the cognitive predictors of reading achievement in certain populations;however, there have been mixed reports of remediation efficacy. The most effective interventions target specific deficits in a population, which have not yet been determined for children with FASD. This proposal aims to understand the precise mechanisms related to reading achievement affected by AE to elucidate potential targets for intervention. With this knowledge, current interventions will be critically reviewed, and targeted recommendations will be made specifically for children with FASD with the ultimate goal of improved outcomes in both reading and overall scholastic performance for affected children.
The detrimental effects of heavy prenatal alcohol exposure, which continue to occur despite known risks, represent a major public health concern resulting in incredible burdens on families, schools, and society, both in the U.S. and internationally. Children with fetal alcohol spectrum disorders are at high risk for reading-related impairment, which is critical for academic performance and ultimately vocational success. Understanding the nature of reading-related difficulties is a focus of national education reform, and this proposal will help determine how to best target interventions for specific underlying cognitive skills, leading to focused treatment recommendations to improve the scholastic performance of affected children.
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