Children exposed prenatally to alcohol are at risk for learning deficits and behavioral problems in school even when they do not exhibit full Fetal Alcohol Syndrome. Although decrements in Full Scale IQ are modest, deficits have been noted particularly in arithmetic, spatial reasoning, and nonverbal short-term memory. Poorer sustained attention has been documented by objective test procedures, but other aspects of attention have not been evaluated systematically. We have recently completed a study of 480 black inner city infants, who were assessed on both the Bayley Scales and a new battery of domain- specific tests with better predictive validity for school-age performance. Prenatal alcohol exposure was associated with poorer Bayley Scale performance and slower, less efficient processing of information in three domains: visual recognition memory, cross-modal transfer, and processing of dynamic visual information. The proposed study will re-evaluate these children at 7 years to determine (a) the degree to which the processing efficiency deficit seen during infancy continues to be evident at school age; (b) effects of this exposure on four distinct dimensions of attention using standard tests adapted for young children; (c) whether children born to women over 30 years old are more vulnerable to this exposure; (d) the degree to which the alcohol-related deficits in IQ test performance seen in the white middle class Seattle sample also hold for our cohort of black inner city children exposed at similar levels; and (e) the degree to which alcohol-related cognitive deficits at 7 years are attributable to processing efficiency and/or attentional impairment. If processing efficiency is implicated, we will test the hypothesis that slower processing in infancy may provide a marker for early identification of affected children in need of remedial intervention. Assessment of fetal alcohol exposure will be based on a series of 2-week, day-by-day drinking histories obtained contemporaneously during pregnancy, which proved highly sensitive in the infant study. A broad range of control variables will be assessed, including prenatal exposure to illicit drugs, quality of parental stimulation, and current maternal drinking and drug use. Alcohol effects will be inferred only after statistical adjustment for confounders. Dose dependence and exposure thresholds will be evaluated, as well as the degree to which observed statistically significant effects are also clinically meaningful.
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