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Descriptors:
Teacher Effectiveness; Supervision; Fetal Alcohol Syndrome; Pregnancy; Psychiatry; Internet; Questionnaires; Medical Education; Drinking; Risk; Prevention; Intervention; Medical Students; Student Attitudes

Abstract:
Background/Objective: Alcohol is a teratogen. Fetal alcohol spectrum disorders (FASDs) affect about 1% of live births, causing severe impairment. Individuals affected by FASDs are overrepresented in psychiatric settings. This study reports on the education and experience of psychiatry trainees in approaching FASDs. Method: Data were collected from psychiatry trainees throughout the country by use of a web-based questionnaire. Results: A representative sample (N=308) of psychiatry trainees responded; 19% rate their education on FASDs as "good" or "excellent," and 89% report that they would like more education on FASDs: 6%, 15%, and 30%, endorsed the statement "It is safe to drink some alcohol" during the 1st, 2nd, and 3rd trimesters, respectively. Only 31% correctly report that individuals with an FASD are at equal risk for adverse outcomes as individuals with full-blown fetal alcohol syndrome. Conclusions: Results reveal that training on FASDs is inadequate. Psychiatry trainees poorly understand the importance of abstinence throughout pregnancy. Trainees who report receiving supervision specifically addressing FASDs also report making the diagnosis much more frequently, suggesting that supervision in clinical settings is effective teaching. Results reveal that FASDs are underrecognized, resulting in missed opportunities for prevention and intervention. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Pregnancy; Risk; Smoking; Teaching Methods; Foreign Countries; Control Groups; International Schools; Prenatal Influences; Mothers; Behavior Problems; Correlation; Elementary School Students; Questionnaires; Measures (Individuals); Scores; Prevention; Health Promotion

Abstract:
This retrospective cross-sectional paper examines the relationship between maternal smoking during pregnancy and children's behavioural problems at 9 years of age independent of a wide range of possible confounders. The final sample comprised 7,505 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information on maternal smoking during pregnancy was obtained retrospectively at 9 years of age via parental recall and children's behavioural problems were assessed using the Strengths and Difficulties Questionnaire across separate parent and teacher-report instruments. A quasi-experimental approach using propensity score matching was used to create treatment (smoking) and control (non-smoking) groups which did not differ significantly in their propensity to smoke in terms of 16 observed characteristics. After matching on the propensity score, children whose mothers smoked during pregnancy were 3.5 % (p less than 0.001) and 3.4 % (p less than 0.001) more likely to score in the problematic range on the SDQ total difficulties index according to parent and teacher-report respectively. Maternal smoking during pregnancy was more strongly associated with externalising than internalising behavioural problems. Analysis of the dose-response relationship showed that the differential between matched treatment and control groups increased with level of maternal smoking. Given that smoking is a modifiable risk factor, the promotion of successful cessation in pregnancy may prevent potentially adverse long-term consequences. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Psychological Characteristics; Socioeconomic Status; Mothers; American Indians; Developmental Disabilities; Alcohol Abuse; Drinking; Pregnancy; At Risk Persons; Psychology; Prenatal Influences; Public Health; Interviews; Fetal Alcohol Syndrome; Comparative Analysis; Stress Variables

Abstract:
The relationship of selected demographic, socioeconomic status (SES), and psychological characteristics was examined in interviews with 176 Northern Plains American Indian mothers whose children were referred to diagnostic clinics for evaluation of developmental disabilities, including fetal alcohol spectrum disorders (FASD). Thirty-nine mothers had children diagnosed with an FASD (Group 1), 107 had children who were not diagnosed with an FASD or other major disability (Group 2), and 30 additional mothers with normally performing children, matched by age, sex, and reservation with those diagnosed with an FASD, were recruited as a comparison group (Group 3). Analysis revealed statistically significant differences (p [less than or equal] 0.001) in alcohol consumption among all three groups, and a statistically significant difference in the mean Total Distress score among the three groups of mothers, F(2, 176) = 9.60, p less than 0.001, with Group 3 having a lower mean score than Groups 1 and 2. Sequential regression analysis revealed that the quantity of alcohol consumed prior to knowledge of pregnancy, when combined with SES and Total Distress, was more highly associated with having a child diagnosed with an FASD (R[superscript 2] = 0.206) than was quantity of alcohol consumed alone. (Contains 5 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Educational Needs; Needs Assessment; Prevention; Fetal Alcohol Syndrome; Alcohol Abuse; Pregnancy; Prenatal Influences; Alcohol Education; Females; Curriculum Development; Knowledge Level; Administrator Role; Postsecondary Education

Abstract:
As many as 4.5 live births per 1000 are affected by fetal alcohol spectrum disorders (FASDs), preventable birth defects with life-long consequences. Prevention of FASDs is gaining in importance, and recruitment of diverse disciplines in delivering prevention to women of childbearing age is essential. This needs assessment explored to what extent FASD education has been embraced by academic programs and incorporated into curricula. Results (based on 45 programs) suggest that directors are open to FASD education for trainees but with few resources to support it within their own programs. Misunderstandings about their own disciplines' roles vis-a-vis FASD prevention may limit their commitment to incorporating FASD requirements into their programs. Entities interested in facilitating FASD prevention need to be prepared to educate directors about their disciplines' roles in FASD prevention and to make resources available that are neither cost- nor time-intensive. Online resources and clearinghouses of guest lecturers prepared to deliver a variety of contents and methods appear particularly likely to bear fruit. (Contains 7 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Pregnancy; Well Being; Depression (Psychology); Mothers; Fathers; Nurses; Prediction; Children; Mental Health; Physical Health; Prenatal Influences; Measures (Individuals); Behavior Problems; Risk; Health Services; Symptoms (Individual Disorders); Preadolescents; Foreign Countries; Therapy; Help Seeking

Abstract:
In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child's first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents' well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers' postnatal distress predicted subsequent internalizing problems. Furthermore, mother's depressed mood in the first trimester best predicted the child's externalizing problems at age 12. Nurses's ratings of mother's antenatal and perinatal need for support, perinatal distress, and family's need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring's externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Smoking; Autism; Pregnancy; Risk; Foreign Countries; Pervasive Developmental Disorders; Mothers; Prenatal Influences; Case Studies; Educational Attainment; Family Income; Employment Level

Abstract:
Prenatal exposure to tobacco smoke is suggested as a potential risk factor for autism spectrum disorders (ASD). Previous epidemiological studies of this topic have yielded mixed findings. We performed a case-control study of 3,958 ASD cases and 38,983 controls nested in a large register-based cohort in Sweden. ASD case status was measured using a multisource case ascertainment system. In adjusted results, we found that maternal smoking during pregnancy is not associated with increased risk of ASD regardless of presence or absence of comorbid intellectual disability. Apparent associations were attributable to confounding by sociodemographic characteristics of parents such as education, income, and occupation. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Evidence; Risk; Smoking; Intervention; Behavior Modification; Depression (Psychology); Low Income Groups; Socioeconomic Status; Counseling; Counseling Effectiveness; Drug Therapy; Health Promotion; Prevention; Health Behavior; Behavior Change; Health Education; Public Health; Community Health Services; Health Personnel; Program Implementation; Program Effectiveness; Outcomes of Treatment; Correlation

Abstract:
Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in an LHA intervention with 147 Ohio Appalachian female daily smokers. Participants were randomly selected from clinics and randomized to the intervention condition of a randomized controlled trial. Overall, 75.5% of participants received all seven planned LHA visits, 29.3% used patches for greater than 7 weeks and approximately half received high average ratings on participant responsiveness. Depressive symptoms and low nicotine dependence were associated with lower patch adherence while high poverty-to-income ratio was associated with high responsiveness. Compared with those with fewer visits, participants who received all visits were more likely to be abstinent (22.5 versus 2.8%, P = 0.026) or have attempted quitting (85.0 versus 47.4%, P = 0.009) at 3 months. High participant responsiveness was associated with 12-month abstinence. LHA interventions should focus on improving adherence to nicotine patches and managing depression because it is an independent risk factor for low adherence. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Social Integration; Civil Rights; Physical Disabilities; Developmental Disabilities; Mental Retardation; Parent Rights; Parents with Disabilities; Childrens Rights; United States History; Veterans; Barriers; Mental Disorders; Social Discrimination; Attitudes toward Disabilities; Child Rearing; Adoption; Access to Education; Educational Legislation; Access to Health Care; Child Welfare; American Indians; Cultural Relevance; Foster Care; Evaluation Methods; Courts; Pregnancy; Assistive Technology; Social Services; Poverty; Transportation; Housing; Early Intervention; Advocacy; Prevention; Court Litigation; State Legislation; Federal Legislation

Abstract:
Despite a dark history marked by the eugenics movement, increasing numbers of people with disabilities are choosing to become parents. Recent research reveals that more than 4 million parents--6 percent of American mothers and fathers--are disabled. This number will unquestionably increase as more people with disabilities exercise a broader range of lifestyle options as a result of social integration, civil rights, and new adaptive technologies. Likewise, there has been a dramatic increase in the number of veterans who are returning from war with service-connected disabilities, some of whom may already be parents and others who will enter parenthood after acquiring their disability. The National Council on Disability (NCD) undertook this groundbreaking study to advance understanding and promote the rights of parents with disabilities and their children. This report provides a comprehensive review of the barriers and facilitators people with diverse disabilities--including intellectual and developmental disabilities, psychiatric disabilities, sensory disabilities, and physical disabilities--experience when they are exercising their fundamental right to create and maintain families. This report also describes the persistent, systemic, and pervasive discrimination against parents with disabilities. It analyzes how U.S. disability law and policy apply to parents with disabilities within the child welfare and family law systems, and the disparate treatment of parents with disabilities and their children. Examination of the impediments prospective parents with disabilities encounter when adopting or accessing assisted reproductive technologies provides further examples of the need for comprehensive protection of these rights. This report sets forth suggested action to ensure the rights of parents with disabilities and their children. Whether such action is taken at the state or federal level--as an amendment or a new law--the need for action could not be more timely or clear. Appended are: (1) Interviews; (2) State-by-State Analysis of Dependency Statutes and Their Inclusion of Disability; (3) Model Legislation (State or Federal); and (4) Proposed ADA Amendment. (Contains 1329 endnotes.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Young Children; Early Intervention; Drinking; Fetal Alcohol Syndrome; Screening Tests; At Risk Persons; Prenatal Influences; Neurological Impairments; Cognitive Development; Social Development; Language Acquisition; Developmental Disabilities; Disability Identification

Abstract:
Prenatal alcohol exposure can result in fetal alcohol spectrum disorders (FASD), which can include physical and neurobehavioral disorders, including cognitive, social, language, and motor impairments that can persist throughout life. In order for children with FASD to receive the full benefit of services, recognition of their disability needs to be made earlier and more accurately than is common today. Early identification of an FASD helps to focus targeted treatments, reduce unnecessary medical steps and redundancy in medical care, and increase the likelihood of efficacious interventions. This article describes an innovative, brief screening tool designed to test the feasibility of screening for FASD risk in early intervention (EI) settings. Feasibility was demonstrated by a screening rate of 1161 (61%) of the 1896 available children. The primary resources needed for implementing FASD screening in EI programs are a brief FASD Screening Tool, an FASD trainer, and training time. Replication efforts would benefit from cost-free cross-training between EI sites and designated pediatricians/diagnosticians who are interested in improving their skills around FASD, and development of linkages with alcohol use disorder outpatient/assessment programs for possible referrals for birth mothers. The authors assert that it is practical and feasible to screen children for FASD in EI settings. (Contains 4 tables and 2 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Fetal Alcohol Syndrome; Young Adults; Memory; Brain; Prenatal Influences; African Americans; Neurological Impairments; Developmental Disabilities; Comparative Analysis; Diagnostic Tests; Recall (Psychology); Brain Hemisphere Functions

Abstract:
The impact of prenatal alcohol exposure on memory and brain development was investigated in 92 African-American, young adults who were first identified in the prenatal period. Three groups (Control, n = 26; Alcohol-related Neurodevelopmental Disorder, n = 36; and Dysmorphic, n = 30) were imaged using structural MRI with brain volume calculated for multiple regions of interest. Memory was measured using the Verbal Selective Reminding Memory Test and its nonverbal counterpart, the Nonverbal Selective Reminding Memory Test, which each yielding measures of learning and recall. For both Verbal and Nonverbal Recall and Slope, linear trends were observed demonstrating a spectrum of deficits associated with prenatal alcohol exposure. Dysmorphic individuals performed significantly poorer than unexposed controls on 5 of 6 memory outcomes. Alcohol-exposed individuals demonstrated significantly lower total brain volume than controls, as well as lower volume in a number of specific regions including hippocampus. Mediation analyses indicated that memory performance associated with effects of prenatal alcohol exposure was mediated from dysmorphic severity through hippocampal volume, particularly right hippocampus. These results indicate that the association between the physical effects of prenatal alcohol exposure and deficits in memory are mediated by volumetric reduction in specific brain regions. (Contains 2 figures and 4 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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