Socio-cognitive Habilitation Using the Math Interactive Learning Experience Program for Alcohol-Affected Children

Marcus Institute, an Affiliate of Kennedy Krieger Institute at Emory University, Atlanta, Georgia 30329, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 09/2007; 31(8):1425-34. DOI: 10.1111/j.1530-0277.2007.00431.x
Source: PubMed


Fetal alcohol syndrome (FAS) has been recognized as a disabling condition with a significant impact on the neurobehavioral functioning of affected individuals, including cognition, behavior, and academic functioning, but little research has been performed on targeted interventions for these children.
A socio-cognitive habilitative program focused on improving behavior and math functioning in children 3 to 10 years of age (n=61) was developed and evaluated. The intervention provided parental instruction on FAS, advocacy, and behavioral regulation via workshops and interactive math tutoring with children. All families received parental instruction and were then randomly assigned to either the math instruction or standard psychoeducational care groups.
Satisfaction with workshops was very high, with over 90% agreeing that trainers were knowledgeable and materials easy to understand and helpful. Significant gains in knowledge were found for information provided in the instructional groups. At posttesting, caregivers reported fewer problem behaviors on the Achenbach Child Behavior Checklist, Internalizing Problem Behavior, Externalizing Problem Behavior, and Total Problem Behavior summary scales. After 5 months, both groups of children demonstrated gains in math knowledge but significantly higher gains were found in the group receiving direct math instruction. The math treatment group was also more likely to demonstrate a gain of over 1 standard deviation on any of the 4 math outcome measures used.
These findings suggest that parents of children with fetal alcohol spectrum disorders (FAS(D)) benefit from instruction in understanding their child's alcohol-related neurological damage and strategies to provide positive behavioral supports and that targeted psychoeducational programs may be able to remediate some of the math deficits associated with prenatal alcohol exposure.

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Available from: Claire Coles, Jul 17, 2014
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    • "Medication is often used when self-regulation is ineffective but has shown limited success in children with FASD (Doig et al., 2008); however, recent intervention research suggests that EF skills can be improved in individuals with FASD through direct instruction (Wells et al., 2012). In a previous study with children with FASD, a cognitive learning strategy resulted in improvements in behavior as well as in math learning skills immediately following a 6-week intervention (Kable et al., 2007) and after a 6-month delay (Coles et al., 2009). The metacognitive strategy used in this intervention was referred to as FAR, which is an acronym standing for (i) Focus and plan, (ii) Act, and (iii) Reflect. "
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    ABSTRACT: Background Fetal alcohol spectrum disorders (FASD) are often characterized by disruptive behavior problems and there are few effective interventions available. GoFAR is a novel, 3-part intervention designed to improve self-regulation and adaptive living skills of children with FASD by improving metacognitive control of emotions and arousal.Methods The intervention has 3 components: (i) GoFAR: a “serious game” designed to teach a metacognitive control strategy in a computer game environment; (ii) parent training on child behavioral regulation; and (iii) Behavior Analog Therapy (BAT) sessions, a practical application of the metacognitive learning methodology by parent and child in the context of learning adaptive skills. The learning strategy (FAR) teaches the child to Focus and make a plan, Act out the plan, and Reflect back on the plan. Thirty families were randomized to 3 groups: (i) GoFAR (n = 10); (ii) FACELAND (n = 10); or (iii) CONTROL (n = 10). The 2 intervention groups, GoFAR and FACELAND, used computer games to instruct children. Both groups also received 5 sessions of parent training followed by 5 sessions of joint parent/child therapy (BAT). Assessment of disruptive behavior, including frequency of temper tantrums, frustration tolerance, impulsivity, destructiveness, aggression, and maintaining attention were carried out before enrollment at Mid-Treatment, when game play and parent training were completed, and finally, after completing the BAT sessions.ResultsParental report of disruptive behavior overall was significantly reduced in the GoFAR group after the first components, game play and parent training, and after the BAT sessions in the FACELAND group with no changes in the CONTROL group over time.Conclusions The GoFAR® game was well received by children and effective in teaching the required skills. Mastering the FAR metacognitive strategy was associated with a reduction in disruptive behaviors in children with FASD suggesting that effective interventions can improve outcomes for this high-risk group.
    Full-text · Article · Oct 2015 · Alcoholism Clinical and Experimental Research
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    • "Thus, when a child whose mother is suspected of heavy alcohol use during pregnancy presents with ADHD-like symptoms, assessment of magnitude comparison can aid in a differential diagnosis that may lead to a different pharmacological treatment, since methylphenidate and other psychostimulants often prescribed for ADHD have not proven to be as effective with children with FASD (see Kodituwakku and Kodituwakku 2011). The Math Learning Experience (MILE) intervention developed by Kable and Coles (Kable et al. 2007) is particularly well suited for remediating the specific fetal alcohol-related deficits in magnitude comparison. "
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    ABSTRACT: Identification of children with fetal alcohol spectrum disorders (FASD) is difficult because information regarding prenatal exposure is often lacking, a large proportion of affected children do not exhibit facial anomalies, and no distinctive behavioral phenotype has been identified. Castellanos and Tannock have advocated going beyond descriptive symptom-based approaches to diagnosis to identify biomarkers derived from cognitive neuroscience. Classical eyeblink conditioning and magnitude comparison are particularly promising biobehavioral markers of FASD-eyeblink conditioning because a deficit in this elemental form of learning characterizes a very large proportion of alcohol-exposed children; magnitude comparison because it is a domain of higher order cognitive function that is among the most sensitive to fetal alcohol exposure. Because the neural circuitry mediating both these biobehavioral markers is well understood, they have considerable potential for advancing understanding of the pathophysiology of FASD, which can contribute to development of treatments targeted to the specific deficits that characterize this disorder.
    Full-text · Article · Jun 2011 · Neuropsychology Review
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    • "research on FASD interventions such as adaptive strategies, behavior, friendship, and mathematics skills focus on children aged 3 to 9 years (Kable et al., 2007; Frankel et al., 2006; Olson, Oti, Gelo, & Beck, 2009; O'Connor et al., 2006), further underscoring the importance of identification of FASD risk in EI. "
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    ABSTRACT: Prenatal alcohol exposure can result in fetal alcohol spectrum disorders (FASD), which can include physicaland neurobehavioral disorders, including cognitive, social, language, and motor impairments that can persistthroughout life. In order for children with FASD to receive the full benefit of services, recognition of theirdisability needs to be made earlier and more accurately than is common today. Early identification of an FASD helpsto focus targeted treatments, reduce unnecessary medical steps and redundancy in medical care, and increase thelikelihood of efficacious interventions. This article describes an innovative, brief screening tool designed to testthe feasibility of screening for FASD risk in early intervention (EI) settings. Feasibility was demonstrated by ascreening rate of 1161 (61%) of the 1896 available children. The primary resources needed for implementingFASD screening in EI programs are a brief FASD Screening Tool, an FASD trainer, and training time. Replicationefforts would benefit from cost-free cross-training between EI sites and designated pediatricians/diagnosticians whoare interested in improving their skills around FASD, and development of linkages with alcohol use disorderoutpatient/assessment programs for possible referrals for birth mothers. The authors assert that it is practical andfeasible to screen children for FASD in EI settings.
    Preview · Article · Mar 2011 · Infants and young children
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