Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure

Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient

The Clinical Utility and Specificity of Parent Report of Executive Function among Children with Prenatal Alcohol Exposure

Prenatal alcohol exposure and attention-deficit/hyperactivity disorder (ADHD) result in behavioral issues related to poor executive function (EF). This overlap may hinder clinical identification of alcohol-exposed children. This study examined the relation between parent and neuropsychological measures of EF and whether parent ratings aid in differential diagnosis. Neuropsychological measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), were administered to four groups of children (8–16 years): alcohol-exposed with ADHD (AE+, n = 80), alcohol-exposed without ADHD (AE−, n = 36), non-exposed with ADHD (ADHD, n = 93), and controls (CON, n = 167). Primary caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). For parent ratings, multivariate analyses of variance revealed main effects of Exposure and ADHD and an interaction between these factors, with significant differences between all groups on nearly all BRIEF scales. For neuropsychological measures, results indicated main effects of Exposure and ADHD, but no interaction. Discriminant function analysis indicated the BRIEF accurately classifies groups. These findings confirm compounded behavioral, but not neuropsychological, effects in the AE+ group over the other clinical groups. Parent-report was not correlated with neuropsychological performance in the clinical groups and may provide unique information about neurobehavior. Parent-report measures are clinically useful in predicting alcohol exposure regardless of ADHD. Results contribute to a neurobehavioral profile of prenatal alcohol exposure

Neuropsychological deficits associated with heavy prenatal alcohol exposure are not exacerbated by ADHD.

Neuropsychological functioning of individuals with attention-deficit/hyperactivity disorder (ADHD) or heavy prenatal alcohol exposure has been well documented independently. This study examined the interaction between both factors on cognitive performance in children

Information content and reward processing in the human striatum during performance of a declarative memory task

Negative feedback can signal poor performance, but it also provides information that can help learners reach the goal of task mastery. The primary aim of this study was to test the hypothesis that the amount of information provided by negative feedback during a paired-associate learning task influences feedback-related processing in the caudate nucleus. To do this, we manipulated the number of response options: With two options, positive and negative feedback provide equal amounts of information, whereas with four options, positive feedback provides more information than does negative feedback. We found that positive and negative feedback activated the caudate similarly when there were two response options. With four options, the caudate’s response to negative feedback was reduced. A secondary goal was to investigate the link between brain-based measures of feedback-related processing and behavioral indices of learning. Analysis of the posttest measures showed that trials with positive feedback were associated with higher posttest confidence ratings. Additionally, when positive feedback was delivered, caudate activity was greater for trials with high than with low posttest confidence. This experiment demonstrated the context sensitivity of feedback processing and provided evidence that feedback processing in the striatum can contribute to the strengthening of the representations available within declarative memory

Development of a Management Algorithm for Post-operative Pain (MAPP) after total knee and total hip replacement: study rationale and design.

BACKGROUND: Evidence from clinical practice and the extant literature suggests that post-operative pain assessment and treatment is often suboptimal. Poor pain management is likely to persist until pain management practices become consistent with guidelines developed from the best available scientific evidence. This work will address the priority in healthcare of improving the quality of pain management by standardising evidence-based care processes through the incorporation of an algorithm derived from best evidence into clinical practice. In this paper, the methodology for the creation and implementation of such an algorithm that will focus, in the first instance, on patients who have undergone total hip or knee replacement is described. METHODS: In partnership with clinicians, and based on best available evidence, the aim of the Management Algorithm for Post-operative Pain (MAPP) project is to develop, implement, and evaluate an algorithm designed to support pain management decision-making for patients after orthopaedic surgery. The algorithm will provide guidance for the prescription and administration of multimodal analgesics in the post-operative period, and the treatment of breakthrough pain. The MAPP project is a multisite study with one coordinating hospital and two supporting (rollout) hospitals. The design of this project is a pre-implementation-post-implementation evaluation and will be conducted over three phases. The Promoting Action on Research Implementation in Health Services (PARiHS) framework will be used to guide implementation. Outcome measurements will be taken 10 weeks post-implementation of the MAPP. The primary outcomes are: proportion of patients prescribed multimodal analgesics in accordance with the MAPP; and proportion of patients with moderate to severe pain intensity at rest. These data will be compared to the pre-implementation analgesic prescribing practices and pain outcome measures. A secondary outcome, the efficacy of the MAPP, will be measured by comparing pain intensity scores of patients where the MAPP guidelines were or were not followed. DISCUSSION: The outcomes of this study have relevance for nursing and medical professionals as well as informing health service evaluation. In establishing a framework for the sustainable implementation and evaluation of a standardised approach to post-operative pain management, the findings have implications for clinicians and patients within multiple surgical contexts

Auditory vs. general information processing deficits in infants of mothers who smoked during their pregnancy

Research on the effects of maternal smoking during pregnancy have suggested that offspring have a general cognitive deficit and a differential deficit in the area of auditory processing. Infant cardiac responses to auditory and visual stimuli were used to examine whether or not infants of smokers displayed poorer orienting responses for both tasks, reflecting a general information processing deficit, and a significantly greater deficit in response to the auditory stimuli than visual stimuli, reflecting a differential deficit in auditory processing. Performances on the Bayley Scales of Infant Development, 2nd ed., were also examined to determine if infants of female smokers have a differential deficit in language development relative to their cognitive development. After controlling for social and demographic variables, alcohol consumption, and caffeine intake, maternal smoking was related to poorer language facet scores but higher social facet scores on the BSID-II. Maternal smoking was also associated with poorer orienting responses on auditory habituation trials after controlling for confounding variables. Among economically disadvantaged women, infants of women who smoked demonstrated poorer orienting responses during visual habituation trials than did infants of nonsmokers. The results were discussed in terms of the relative contributions of a general information processing deficit and a specific auditory deficit

RECRUITMENT AND ENROLLMENT OF PREGNANT WOMEN WITH SUBSTANCE ABUSE AND THE NEWBORN **

The HEALthy Brain and Child Development study (HBCD) is an ongoing prospective longitudinal study of approximately 7500 pregnant mothers and their newborn babies across 25 sites in the United States. The study digs deep into the assessments of the brain, evaluating the cognitive and emotional development of children from birth through the first 10 years of childhood. Twenty-five percent of the sample includes children who have a history of prenatal exposure to substances of abuse (alcohol, cigarettes, opiates, and marijuana). For a longitudinal study, research participant recruitment and retention are incredibly challenging, despite the enormous commitment of the researchers. This study aimed to deepen the knowledge on recruitment and retention of pregnant women in birth cohort studies and expand the insight into a more effective research engagement. The study evaluated the relationship between participant recruitment and the amount of effort needed to recruit the participants after they showed some primary interest at one enrollment site. The amount of the researchers’ engagement efforts were recorded on a weekly basis through unsolicited cold emails, phone calls, and texts The amount of patient recruitments were also recorded. The time interval between the first outreach from the researcher to a potential participant and the day when the participant completed the consent form was also recorded. Current data analysis suggests that researchers average 2.87 contacts (via emails, texts or calls) before a participant signs up. Also, it takes 10.25 days on average for a potential participant to enroll in the study. This one-and-a-half-week delay in enrollment aligns well with the weekly engagement efforts by the researchers, providing a reliable and consistent prediction for the overall pattern of study enrollment. Up to 75% of the participants were enrolled within 2 weeks, and a threshold of 29.125 days indicates that further contacts are no longer necessary