6th International Conference on
FASD 2015
Topic 3: Cognitive, Behavioral,
and Education Intervention
Julie A. Kable, PhD
Emory University School of
Medicine
Atlanta, GA
Interventions and
“the Burden of Care”
Children with FASD
may have problems in the
following areas through out their lives:
Physical/
Developmental/
Health/Motor
Cognitive
•
•
•
•
•
•
Eye exams
Cardiology
Neurology
Physical
therapy
Feeding issues
Developmental
pediatric care
•
•
•
Developmental/
cognitive
assessments
Individual
speech and
occupational
therapy
Child cognitive
habilitation
Behavioral/
Social
Academic/
Vocational
• Parent education and
training/therapy
• Child therapy
• Psychiatry care
• Social skills training
• Social supports and
assistance with
linking to community
resources
• Psychoeducational
assessments
• Special education or
modified educational
programs
• Tutoring services
• Parent training to
“partner with the
schools”
Parent Education Programs
Author
Skill
Sample
Treatment Result
Kable &
Coles,
2012
FAS
Caregiver
Advocacy
and
Behavioral
regulation
Children with
FASD
Comparison
of parent
training via
workshop
or on-line
program
Both methods of
information deliver were
well received and
improved knowledge but
better behavioral change
was obtained via
workshops
Fisher
FAS
training for
parents and
teachers
Case studies of
families who
attended
trainings at
Double
ARC/NODAS
Ohio
Curriculum
Delivered in
Group
Sessions
with
ManualsTRIUMPH
Parents reported
training effective and
maintained knowledge
over 6-months
Behavioral Change
Author
Skill
Sample
Treatment
Result
Kable, Coles, &
Taddeo, 2007 & Coles,
Kable, & Taddeo, 2009
Behavior and math
functioning using
metacognitive training
techniques
61 US Children
between, 3-10 years
Socio-cognitive
habilitation
Improved behavior and
math knowledge
Carmichael-Olsen et al
(in Bertrand et al.,
2009)
Parental stress and
child behavioral
functioning
52 US Children
between 5-11 years
Positive behavioral
support/parent
training
Parents reported
greater met needs,
improved parental
efficacy, and reported
reduced problem
behaviors for child
Kerns et al,, 2010
Attentional control
10 Canadian children
between 6-15 years
Computerized
Attentional Control
Training- CPAT
Improved sustained
attention and selective
attention
Wells et al, 2012
Self-regulation
78 US Children
between 6-11 years
Alert Program
Improved Executive
function skills and
emotional problemsolving skills
Nash et al, 2014
Self-regulation
25 Canadian Children
between 8-12 years
Alert Program
Improvements in
inhibitory control,
emotional regulation
and social cognition
Social Communication and Social Skills
Timler, 2005 Social
skills/comm
unication
Case study
of 1
2 1-hour
individual
sessions & 4
2-hour
group
sessions
Increased
strategies on how
to behave in social
situations and
increased number
of mental state
verbs
O’Connor et
al., 2006
Social skills
100 US
children 612
Bruin
Buddies
social skills
training
program
Improved social
skills and reduced
behavior problems
via parental report
O’Connor et
al., 2012
Social skills
85 US
children 612
Bruin
Buddies
social skills
training
program
Improved social
skills and selfconcept
Building Academic Skills
Author
Skill
Sample
Treatment
Result
Johnson &
Lapadat, 2000
Reading and spelling
achievement
One adolescent child
with FAS
One-on-one tutoring,
Improved
standardized test
scores for reading
and spelling
Porter-Larson,
2000
Reading
3rd grade male who
probably had FAS
Reading tutoring
program
Improved
standardized reading
scores
Adnams in Riley et
al., 2007
Language and literacy
65 South African
Children, 9-10 years
Language and literacy
intervention
Improved
phonological
awareness and early
literacy. No
difference in general
achievement
Kable, Coles, &
Taddeo,
2007/Coles,
Kable, & Taddeo,
2009
Behavior and math
functioning
61 US Children
between , 3-10 years
Socio-cognitive
habilitation
Improved behavior
and math knowledge
Kable, J. A.,
Taddeo, E.,
Strickland, D., &,
Coles, C. D. (2015)
Math functioning
68 US Children
between , 3-10 years
Socio-cognitive
habilitation
MILE/FAR
Improved math skills
Virtual Reality: Personal Safety
Padgett,
Strickland, &
Coles, 2006
Child fire safety
All children able
5 US Children 4-7 Virtual reality
game to teach fire to perform skills
safety skills
in analog setting
Coles, Strickland,
Padgett, &
Belmoff, 2007
Child fire and
street safety
32 US Children
4-10 years of age
Virtual reality
game to teach fire
and street safety
skills
Greater
knowledge gains
for fire and street
safety
immediately but
only fire after 1
week post-test
Key Features Needed to Improve
Learning
• Appropriate environment
• Simplified learning environment
• Reduce chances of failure or making
wrong choices
• Monitor arousal and teach in “calm
alert states”
GAPS: Interventions and
“the Burden of Care”
Children with FASD
may have problems in the
following areas through out their lives:
Physical/
Developmental/
Health/Motor
Cognitive
Behavioral/
Social
Academic/
Vocational
Missing research on interventions for infants/toddlers, teens and adults
Soon to hear…
Project Step Up-16-18 year-olds
Partners for Success-16-25 year-olds
GoFAR-5-10 year-olds
MILE in the School System-Rasmussen
Sensorimotor Training to Affect Balance,
Engagement and Learning in Children with
FASD (McCoy, Jirikowic)
• Fostering Self-Regulation in Infants and
Toddlers with FASDs (Paley)
•
•
•
•
•
Novel Pharmacological Interventions
•Animal model research
•Antioxidants during pregnancy to
ameliorate the effects of prenatal alcohol
•Cognitive enhancers (ABT-239)administered prior to training improved
performance in prenatally exposed rats
(presynaptic H3 (histamine) receptor
antagonists)
•Choline supplementation
•Considerable research suggests that
choline ameliorates the impact of
prenatal alcohol and improves
functioning if delivered postnatally
Human Choline Supplementation
Studies
•Prenatal Supplementation
Ongoing study in the Ukraine with
pregnant women
PI: Christina Chambers
•Postnatal Supplementation
Protocol for delivering the supplement to children
postnatally is being delivered and piloted
PI: Jeffrey Wozniak
Correlations between cardiac OR outcomes and choline and its metabolites
Visual Habituation/Dishabituation Paradigm
Habituation
Average HR1 ∆
Dishabituation
Average HR1 ∆
Habituation
Latency
Dishabituation
Latency
∆Choline2
.19*
ns
ns
ns
∆Betaine2
.18T
ns
ns
ns
∆DMG2
.23*
.19T
-.20*
-.18T
Relationships between Alcohol Consumption Level and
Changes in Choline Related Nutrients by Group Status
No MVM
n=19
AA/Day
MVM
n=11
AA/Drinking
Day
AA/Day
MVM+ Choline
n=15
AA/Drinking
Day
AA/Day
AA/Drinking
Day
∆Choline2
-.60**
-.60**
.14
.13
-.16
-.29
∆Betaine2
-.56**
-.56**
.33
.23
.22
.20
∆DMG2
-.34
-.34
.61*
.62*
-.34
-.19
2Indicates
the change in nutrient from enrollment into the
study until the subsequent prenatal follow-up
***p < .001,** p < .01 *p < .05, T p < .15
What about the
future of
interventions?
• Improving access to care
• Timeline from bench to bedside
• Continue to develop targeted behavioral
interventions
• Develop targeted pharmaceutical interventions
• Develop innovative methods for assessing
treatment effects
• Develop mechanisms for multi-site clinical
trials
• Develop standardized methodology and
protocols for evaluating treatments