Jacqueline Pei

• Ph. D., R.Psych
• Professor at University of Alberta

Background Dysbiosis of the gut microbiota has been demonstrated in neurodevelopmental disorders but the underlying mechanisms that may explain these associations are poorly understood. Gut secretory immunoglobulin A (SIgA) binds pathogenic microbes, preventing mucosal penetration. Gut microbes also influence SIgA production and its binding charact...

Three key areas of dysfunction reported as having a significant impact on how adolescents with Prenatal AlcoholExposure (PAE) navigate their teen years and work towards independence are: mental health, social skills, andadaptive functioning. However, little is known about how adolescents with PAE perceive their own functioningrelative to others, an...

Fetal alcohol spectrum disorder (FASD) is a complex neurodevelopmental disability characterized by a range of brain- and body-based difficulties which, when left unsupported, can lead to experiences of significant adversity across the lifespan. Caregivers of individuals with FASD play a critical role in advocating and supporting healthy outcomes fo...

The Covid-19 pandemic presented numerous challenges and changes for all frontline providers, but the impacts on care staff in community service agencies is less understood. The current study involving secondary data analysis explored how frontline care staff with a fetal alcohol spectrum disorder (FASD) program describe their work during the public...

Background Individuals with fetal alcohol spectrum disorder (FASD) experience complex needs that often necessitate support from multiple systems. There is growing evidence that people with FASD may benefit from integrated service delivery (ISD), but little is known about ISD elements and processes for this population. Method Using a multi‐method a...

Math development in children relies on several underlying cognitive functions, including executive functions (EF), working memory (WM), and visual-motor abilities, such as visual-motor integration (VMI). Understanding how these cognitive factors contribute to children’s math performance is critical to supporting math learning and long-term math suc...

Adolescents with Fetal Alcohol Spectrum Disorder (FASD) often have challenges with executive functioning (EF), which impacts their ability to self-regulate. In this study, 23 adolescents with FASD completed a self-regulation intervention. The intervention was a manualized Teen Adaptation of the Alert Program®. A nonrandomized waitlist control desig...

Background Screening for fetal alcohol spectrum disorder (FASD) has been identified as a promising approach to improve recognition, understanding and effective response to the unique needs of those with FASD in criminal legal settings. However, to date, there has been limited synthesis of relevant screening tools, indicators, or implementation cons...

Objective Breastfeeding is associated with reduced postpartum depression, stronger parent-child relationships, and fewer behavioral disorders in early childhood. We tested the mediating roles of postpartum depression and parent-child relationship in the association between breastfeeding practices and child behavior. Study design We used standardiz...

There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregna...

Background Prenatal alcohol exposure (PAE) can result in reduced brain volume and an increased risk of mental health challenges. Limbic brain structures such as the hippocampus, thalamus, and amygdala often exhibit smaller volumes in youth with PAE, and similar volume reductions are observed in unexposed youth with symptoms of depression, bipolar d...

Individuals with fetal alcohol spectrum disorder (FASD) can experience multiple layers of adversity that increase vulnerability to justice involvement. Given the systemic overrepresentation of Indigenous Peoples in the justice system, community-based interventions are important for supporting Indigenous individuals with FASD who are justice-involve...

Overrepresented and often misunderstood, adverse outcomes such as justice system involvement have been a dominant storyline in the FASD literature; this is neither an inevitable outcome, nor one that will impact all individuals with FASD. Increased understanding of the mechanisms that influence development, behavior, and action should inform our re...

This practice article advances an ethical imperative for guiding collaborative approaches to evaluation with low incidence and underserved communities. We describe our evaluation processes for building transformative partnerships during a DeafBlind Support Services pilot program evaluation in Western Canada using collaborative approaches to evaluat...

Children with Fetal Alcohol Spectrum Disorder (FASD) are able to experience growth and success when they receive responsive support and individualized interventions that are FASD-informed. In this chapter, we review targeted interventions in the areas of self-regulation and behaviour, executive functions, academics, and activities of daily living a...

Background Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for...

The concept of neurodiversity is a relatively new phenomenon that represents the wide variety of differences among humanity. Although neurodiversity has been discussed in relation to other disabilities, increased attention is needed to better understand and consider how FASD can be part of neurodiversity. This issue paper describes the concept of n...

This field report summarizes and advances key learnings for leveraging community–university partnerships addressing housing service gaps for high-risk, marginalized populations with complex needs. We describe our navigation of existing and forged intersections to develop a strength-based and individualized approach to humanizing housing service del...

Background Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions. Aims In this study, we sought to characterize patterns...

Objectives Supporting women and girls who are pregnant and experiencing substance use challenges is a high priority for researchers, clinicians, and policymakers. Complementary therapies (CTs) can be effective forms of treatment in some contexts and populations; however, research on the use of CTs in substance use recovery with pregnant women and g...

Background and objective: Individuals with Fetal Alcohol Spectrum Disorder (FASD) may experience a range of behavioral, cognitive, and physiological difficulties that can result from prenatal alcohol exposure. Intervention approaches for individuals with FASD are required to respond to evolving strengths and needs throughout their lifespan. Materi...

Background and Objective: The manner in which language is used reflects how people in a society view one another. Historically, individuals with disabilities have experienced discrimination through the use of stereotypic or demeaning language. Individuals with Fetal Alcohol Spectrum Disorder (FASD) may be particularly susceptible to these negative...

Background and objective Individuals with Fetal Alcohol Spectrum Disorder (FASD) may experience a range of behavioral, cognitive, and physiological difficulties that can result from prenatal alcohol exposure. Intervention approaches for individuals with FASD are required to respond to evolving strengths and needs throughout their lifespan. Materia...

This special issue was created to reflect the evolving approaches to conducting and conceptualizing research in the FASD field.

Background and Objective The manner in which language is used reflects how people in a society view one another. Historically, individuals with disabilities have experienced discrimination through the use of stereotypic or demeaning language. Individuals with Fetal Alcohol Spectrum Disorder (FASD) may be particularly susceptible to these negative i...

Background and Objectives Mathematics achievement as a particular area of difficulty for individuals with fetal alcohol spectrum disorder (FASD) has been a robust finding in the literature. However, existing longitudinal data are outdated and do not consider mathematics performance across time during critical periods of transition such as adolescen...

IntroductionFood sensitization is a first and strong indicator of immune deviation in the progression to other allergic conditions. Sensitization to food or other allergens and related inflammation during critical windows of infant development may adversely affect neurodevelopmental milestones. However, additional research is needed to test this as...

Background Fetal alcohol spectrum disorder (FASD) is characterized by a complex profile of cognitive and behavioural impairments. Although understanding impairment guides diagnosis, little attention has been devoted to considering areas of intact functioning and strengths. Method This review focused on identifying areas of typical performance and/...

BACKGROUND Understanding memory development has fascinated scientists for over 100 years, with important insights in genetics and molecular mechanisms being provided from animal model testing in the last 3 decades. Nonetheless, unlike for animals, testing memory can be challenging in children, especially when they have neurodevelopmental disorders...

Background Neurodevelopmental disorders (NDD) cause individuals to have difficulty in learning facts, procedures, or social skills. NDD has been linked to several genes, and several animal models have been used to identify potential therapeutic candidates based on specific learning paradigms for long-term and associative memory. In individuals with...

There is a need for strength-based research that considers the complex realities of teen families. The purpose of the current study is to provide a springboard for this research by describing the characteristics of teen parents and their children involved in a supportive housing program. We used a community-based participatory research approach wit...

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument , a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample cons...

Interpretation and response to behaviour is predicated on understanding. However, our present understanding of aggressive behaviour, especially for complex and vulnerable populations is limited. The purpose of this review is to enhance our understanding of aggressive behaviour by providing a comprehensive outline of the conditions and underlying me...

There has been a recent theoretical shift toward the inclusion of protective factors within risk assessment. However, there is a lack of empirical evidence surrounding this practice in unique forensic populations. Using a long-term retrospective design, we examined the predictive and incremental validity of the protective factor resistance to antis...

Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and a...

The goal of this study was to examine executive functioning, math performance, and visuospatial processing skills of children with perinatal stroke, which have not been well explored in this population. Participants included 18 children with perinatal stroke (aged 6-16 years old) and their primary caregiver. Each child completed standardized tests...

Individuals with fetal alcohol spectrum disorder (FASD) experience a range of neurodevelopmental challenges, often compounded by social and environmental adversity. One of the most concerning outcomes that can be associated with FASD is involvement in the justice system, where individuals with FASD are vastly over-represented. Individuals with FASD...

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain‐ and body‐based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. I...

Mindset theory is an achievement motivation theory that centers on the concept of the malleability of abilities. According to mindset theory, students tend to have either a growth mindset or a fixed mindset about their intelligence; students with a growth mindset tend to believe that intelligence is malleable, whereas students with fixed mindsets t...

The purpose of this study was to describe the profile of individual, relational, and contextual resilience resources reported by youth with FASD and their caregivers and examine how these resources related to early childhood adversity, potential protective factors, and concurrent emotional and behavioral functioning. Nineteen youth with FASD (aged...

Given the unique challenges and strengths of teen parents, specialized supports are needed to help teen families reach their full potential. This study explored, from the perspectives of teen parents involved in a supportive housing program, what helps teen parents raise their children in healthy ways. Aligned with a community-based participatory r...

There is limited understanding of the effect of perinatal stroke on child and adolescent learning and memory abilities. This study sought to evaluate the clinical utility of the Child and Adolescent Memory Profile (ChAMP) in quantifying memory performance in youth with perinatal stroke. Children and adolescents aged 6–16 years old with a history of...

Children with prenatal alcohol exposure (PAE) experience a range of adverse outcomes that impact multiple domains of functioning, including cognitive, physical, mental health, behavioral, social-emotional, communication, and learning. To inform tailored clinical intervention, the current study examined the relation between caregiver-reported cognit...

Purpose of Review There are a lack of system-wide integrative services for individuals with complex needs and a corresponding demand for advancing cross-disciplinary practices in community settings. This demand is especially acute for individuals with fetal alcohol spectrum disorder (FASD) and a gap we have sought to address. Recent Findings We pr...

Introduction Fetal alcohol spectrum disorder (FASD), which is caused by prenatal alcohol exposure (PAE), affects an estimated 4% of North Americans, and is the most common preventable cause of intellectual disability. Mental health problems, including anxiety and depression, are experienced by nearly all individuals with FASD. However, there is ver...

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the pr...

Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure (PAE) face elevated rates of postnatal environmental adversity across the lifespan. Objective We explored early adversity among children and adolescents with PAE. Participants and setting Our sample included 333 children and adolescents with PAE asses...

Dysbiosis of gut microbiota has been retrospectively linked to autism spectrum disorders but the temporal association between gut microbiota and early neurodevelopment in healthy infants is largely unknown. We undertook this study to determine associations between gut microbiota at two critical periods during infancy and neurodevelopment in a gener...

Individuals with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder caused by prenatal exposure to alcohol, are overrepresented in criminal justice settings and have complex, forensically relevant clinical needs. This study surveyed 81 forensic clinicians recruited via international professional association listserv postings and...

Fetal Alcohol Spectrum Disorder (FASD) is a multifaceted disability, associated not only with complex brain- and body-based challenges, but also with high rates of environmental adversity, diverse sociocultural contexts, and lifelong difficulties with daily living. It is important to consider the complexities of FASD, and the ways in which FASD req...

Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currentl...

Women with cognitive disabilities experience male partner violence at a higher rate than non-disabled women. They also tend to remain in abusive relationships for longer, due in part to their social isolation and a lack of appropriately adapted services. Many survivors suffer post-traumatic stress and or stress-related health conditions long after...

Language is a powerful tool that can influence how society views individuals with disabilities. Stereotypic or negatively valanced language can contribute to negative self-views among individuals with disabilities. Individuals with Fetal Alcohol Spectrum Disorder (FASD) and their families may be particularly susceptible to these negative impacts gi...

Adolescents with Fetal Alcohol Spectrum Disorder (FASD) experience a range of cognitive, behavioral, and physical difficulties, including difficulties with self-regulation. We investigated self-regulation strategy use in adolescents with FASD who completed a self-regulation intervention program. The intervention was an adapted version of the Alert...

Rationale: There are limited tools to identify which children are at greatest risk for developing Sleep Disordered Breathing (SDB)-associated behavioral morbidity. Objectives: To examine associations between age of onset and duration of parent-reported symptoms of SDB and behavioral problems at age five years. Methods: Data collection and anal...

Perinatal stroke is the most common form of stroke in childhood and is followed by a variety of outcomes, with many children experiencing specific functional and neuropsychological deficits. The association of these outcomes with the psychosocial impact caregivers face is not well documented. The goal of our pilot study was to examine caregivers’ p...

Rationale: Sleep study interpretation in children needs to be based on age-specific normal values. While several studies have reported normal cardiorespiratory parameters during sleep in children and adolescents, few have included younger children. Objectives: To describe cardiopulmonary indices specifically oxygen saturation, heart rate, as wel...

Community-based participatory research (CBPR) and developmental evaluation (DE) have emerged over recent decades as separate approaches for addressing complex social issues. Current literature offers little with respect to the use of CBPR and DE in combination, although the two approaches are complementary. Through the current paper, we outline how...

Individuals with Fetal Alcohol Spectrum Disorder (FASD) have a heightened sensitivity to stress because of the brain-based impacts of prenatal alcohol exposure (PAE). There are also disproportionately high rates of chronic and complex adversity among people with FASD, which differentiates them from other disability groups. In order to address these...

Individuals with prenatal alcohol exposure (PAE) exhibit neurological deficits associated with brain injury including smaller brain volumes. Additional risk factors such as lower socioeconomic status (SES) may also have an impact on brain development for this population. This study examined how brain volumes are related to SES in both neurotypicall...

Objectives A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal...

Objectives Prenatal maternal metabolic problems such as pre-pregnancy adiposity, excess gestational weight gain, and gestational diabetes mellitus (GDM) are associated with an increased risk of psychopathology in offspring. We examined whether these exposures were linked to symptoms of emotional and behavioral problems in offspring at 2 years of ag...

Background Pre-school children spend an average of two-hours daily using screens. We examined associations between screen-time on pre-school behavior using data from the Canadian Healthy Infant Longitudinal Development (CHILD) study. Methods CHILD participant parents completed the Child Behavior Checklist (CBCL) at five-years of age. Parents repor...

List of CHILD study investigators contributors. (DOCX)

Univariate t-test analysis results for associations between screen-time, physical activity, and sleep and behavioral morbidity at five years (n = 2322). Note: SD = standard deviation; SES: socioeconomic status; SDB = sleep disordered breathing aAnalyzed by One-way ANOVA *p≤0.05 based on Tukey post hoc test. (DOCX)

Univariate t-test analysis of associations between categorical explanatory variables and externalizing behavior problems (primary outcome) at five years (n = 2447). Note: SD = standard deviation; SES: socioeconomic status; SDB = sleep disordered breathing a Analyzed by One-way ANOVA *p≤0.05 based on Tukey post hoc test. (DOCX)

Description of supplemental methods. (DOCX)

Univariate t-test analysis of associations between categorical explanatory variables and total behavior problems (primary outcome) at five years (n = 2447). Note: SD = standard deviation; SES: socioeconomic status; SDB = sleep disordered breathing a Analyzed by One-way ANOVA *p≤0.05 based on Tukey post hoc test. (DOCX)

Multivariate results for total behavior problems. (DOCX)

Univariate logistic regression results for associations between screen-time, physical activity, and sleep and behavioral morbidity. Caption: CI = confidence interval; SDB = sleep disordered breathing. (DOCX)

Univariate linear regression analysis of associations between continuous explanatory variables and externalizing behavior problems at five-years of age (n = 2,447). Caption: PSI-SF = Parenting Stress Index-Self Report, higher score presents increased levels of parenting stress; P-CDI = Parent-Child Dysfunction Index, higher scores reflect increased...

Univariate linear regression analysis of associations between continuous explanatory variables and internalizing behavior problems at five-years of age (n = 2,447). Caption: PSI-SF = Parenting Stress Index-Self Report, higher score presents increased levels of parenting stress; P-CDI = Parent-Child Dysfunction Index, higher scores reflect increased...

Univariate linear regression analysis of associations between continuous explanatory variables and total behavior problems at five-years of age (n = 2,447). Caption: PSI-SF = Parenting Stress Index-Self Report, higher score presents increased levels of parenting stress; P-CDI = Parent-Child Dysfunction Index, higher scores reflect increased perceiv...

Univariate t-test analysis of associations between categorical explanatory variables and internalizing behavior problems (primary outcome) at five years (n = 2447). Note: SD = standard deviation; SES: socioeconomic status; SDB = sleep disordered breathing a Analyzed by One-way ANOVA *p≤0.05 based on Tukey post hoc test. (DOCX)

Multiple regression analysis examining associations between screen-time and the CBCL total behavior problem T-score at five-years of age (n = 2,427). Caption: SDB = Sleep Disordered Breathing, based on 6 items; PCD-I = Parent-Child Dysfunction Index, higher scores represents; PSI-SF = Parenting Stress Index-Self Report, higher score presents increa...

Metacognitive training is an emerging cognitive intervention for children with fetal alcohol spectrum disorder (FASD) that teaches children to think about their thinking and use strategies to improve learning and regulation. We investigated how children with FASD acquired metacognitive strategies during a computerized intervention delivered in a sc...

Background This study provides initial evidence of the contributions and suitability of relational, trauma‐informed, and community‐based approaches for programs aimed at the prevention of future alcohol‐and drug‐exposed births. Specifically, this study extends understanding of the experiences of mentors providing evidence‐based 3‐year home visitati...

Background Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a...

Issue: The occurrence of inappropriate sexual behaviours (ISB) is an adverse life outcome that may be experienced by individuals with FASD. The purpose of this paper is to highlight an overview of the current existing research conducted in this area and offer implications for individuals, families, caregivers, and policy makers.

Objective: Childhood sleep-disordered breathing (SDB) symptoms may comprise multiple phenotypes depending on craniofacial anatomy, tonsil and adenoid growth, body habitus, and rhinitis symptoms. The primary objective of this study is to identify and characterize the different SDB phenotypes to two years of age. Methods: Data from 770 infants in...

Introduction Health disorders early in life have tremendous impact on children’s developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally represent...

Background: Both short sleep duration and sleep-disordered breathing (SDB) are associated with poor neurocognitive development. However, the co-contributions of short sleep duration and SDB on neurodevelopment in pre-school children are relatively unknown. Methods: We assessed both sleep duration and SDB by quarterly questionnaire from three mon...

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) among youth in the criminal justice system is currently unknown, although early indications place it at higher incidence than in the nonoffending population (Burd et al. 2003). Limited screening and diagnostic resources are noted as being among current barriers to determining an accurate prev...

Early intervention for individuals with FASD is paramount, thus exploring factors that affect the diagnostic process is critical. This process can be complicated by challenges gathering background information, accurately evaluating higher-level cognitive skills across ages, and teasing apart the impact of life adversities from the effects of prenat...

Children and adolescents with fetal alcohol spectrum disorder (FASD) experience significant impairments in cognitive functioning, though substantial within-group heterogeneity is often observed. The purpose of this study was to characterize the cognitive profile of children and adolescents with FASD with a special focus on examining moderators of f...

Despite our knowledge that individuals with Fetal Alcohol Spectrum Disorder (FASD) are over-represented and vulnerable in the justice system, there is a critical paucity of research related to supporting offenders with FASD. The Alexis FASD Justice Program (AFJP) is an innovative and multidisciplinary justice program in rural Alberta that uses info...