Fetal Alcohol Spectrum Disorders: A Population Based Study of Premature Mortality Rates in the Mothers

Fetal alcohol spectrum disorders (FASD) are associated with an increase in risk for mortality for people with an FASD and their siblings. In this study we examine mortality rates of birth mothers of children with FASD, using a retrospective case control methodology. We utilized the North Dakota FASD Registry to locate birth certificates for children with FASD which we used to identify birth mothers. We then searched for mothers' death certificates. We then compared the mortality rates of the birth mothers with an age matched control group comprised of all North Dakota women who were born and died in the same year as the birth mother. The birth mothers of children with FASD had a mortality rate of 15/304 = 4.93%; (95% CI 2.44-7.43%). The mortality rate for control mothers born in same years as the FASD mothers was 126/114,714 = 0.11% (95% CI 0.09-0.13%). Mothers of children with an FASD had a 44.82 fold increase in mortality risk and 87% of the deaths occurred in women under the age of 50. Three causes of death (cancer, injuries, and alcohol related disease) accounted for 67% of the deaths in the mothers of children with FASD. A diagnosis of FASD is an important risk marker for premature death in the mothers of children diagnosed with an FASD. These women should be encouraged to enter substance abuse treatment.     

Fetal Alcohol Spectrum Disorders: understanding the effects of prenatal alcohol exposure and supporting students

BACKGROUND: Fetal Alcohol Spectrum Disorders (FASD) affect a significant number of children in this country. This article addresses diagnostic issues related to fetal alcohol syndrome (FAS) and other alcohol-related disabilities, discusses associated features and behaviors of FASD, and introduces interventions to support children with FASD in school settings. METHODS: A comprehensive review of FAS and FASD literature as it relates to school functioning was conducted. RESULTS: Prenatal alcohol exposure can result in a broad range of negative developmental consequences, including deficits in cognitive and academic functioning, psychological disorders, behavioral problems, and difficulties with independent living. Children with prenatal alcohol exposure are at risk for a spectrum of difficulties at school. CONCLUSIONS: This topic is of considerable relevance to all professionals in a school setting, including teachers, administrators, school psychologists, special education providers, special service providers, and school nurses who interact with children who may be prenatally exposed to alcohol. Successful interventions will need to balance the use of environmental modifications, immediate and meaningful positive and negative consequences for behaviors, and opportunities to teach children skills to monitor and modify their behavior.     

Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders: Identification of Systems-Level Barriers

Fetal alcohol spectrum disorders (FASD) impact 2–5 % of the US population and are associated with life-long cognitive and behavioral impairments. Individuals with FASD have high rates of secondary conditions, including mental health problems, school disruptions, and trouble with the law. This study focuses on systems-level barriers that contribute to secondary conditions and interfere with prevention and treatment. Using a phenomenological methodology, semi-structured interviews and focus groups were conducted with parents of children with FASD and service providers. Data were analyzed using a framework approach. Participants emphasized the pervasive lack of knowledge of FASD throughout multiple systems. This lack of knowledge contributes to multi-system barriers including delayed diagnosis, unavailability of services, and difficulty qualifying for, implementing, and maintaining services. FASD is a major public health problem. Broad system changes using a public health approach are needed to increase awareness and understanding of FASD, improve access to diagnostic and therapeutic services, and create responsive institutional policies to prevent secondary conditions. These changes are essential to improve outcomes for individuals with FASD and their families and facilitate dissemination of empirically supported interventions.     

Fetal alcohol syndrome disorders: experience on the field. The Lazio study preliminary report

In Italy, little is known about the problems related to alcohol drinking during pregnancy. In this paper, the Italian literature about this subject is briefly reviewed. This first Italian experience of a field study, aimed to the assessment of the prevalence of fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASD) in an area in the Rome province (Lazio region) is reported. This in-field study was performed in the school years 2003-2004 and 2004-2005 in cooperation with American researchers, most from University of New Mexico (Albuquerque), and Italian researchers from University "la Sapienza" of Rome. First grade children (n(o) = 1,086) of primary school were contacted to enter in the in-school study for the detection of FAS and FASD and were examined by the experts team of clinicians, pediatrics, psychologists. Preliminary consideration and the implications of this study for FASD prevention are discussed.     

Longitudinal Study of Disadvantaged Prekindergarten Children as Young Adults: Achievers and Non‐Achievers

Seventeen years after they participated in the Syracuse Prekindergarten Program, the school and life experiences of former three‐ and four‐year‐old disadvantaged children were studied to discern the relationship of these learning experiences to later events in the lives of the children and their parents.

From an initial total of 73 designated study children, 20 students (and their parents) were interviewed. Ten students were identified with above average or excellent school achievement and 10 with below average school achievement. No significant IQ differences had been found at the prekindergarten level.

Emerging themes from in‐depth, extensive interviews furnished valuable insights on teenage pregnancy, school dropouts, and the strengths of poor families. Qualitative analyses indicated that the Prekindergarten Program gave these students and their families the kind of education and support services they needed at a critical period in their lives. Despite their differing achievements later on, the children were described as benefiting from the information they gained, from the enhancement of their social‐emotional growth, and from the subsequent development of positive self‐concepts. The parents’ reports were seen as evidence that they were able to utilize the information and to develop feelings of self‐worth.     

Body Size and Intelligence in 6-year-olds: Are Offspring of Teenage Mothers at Risk?

Objectives Children born to teenage mothers are at risk for more physical and cognitive problems than those born to adult mothers. Our objective was to examine differences in size and intelligence between two cohorts of offspring born to adolescent (n = 357) and adult mothers (n = 668) who attended the same prenatal clinic. Methods Two prospective study cohorts assessed children from gestation through age 6 years. The adult cohort was studied in the mid-1980’s and the teen cohort was evaluated in the mid-1990’s. Both samples were of low socio-economic status. The same study design and measures allowed us to adjust for the covariates of size and IQ. Results Offspring of adolescent mothers had a significantly smaller mean head circumference (5 mm) (HC) and higher body mass index (BMI) than offspring of adult mothers. Offspring of adolescent mothers scored significantly lower than the offspring of adult mothers on the Stanford-Binet (SBIS) composite score (4 points), and the quantitative (6.2 points), verbal reasoning (4.8 points), and short-term memory (3.9 points) area scores. Additional predictors of child IQ were maternal IQ, home environment, race, and number of siblings. When child HC was entered into our final regression model for the SBIS, maternal age and HC significantly predicted the composite score, the verbal reasoning, and short-term memory area scores. A 1 cm decrease in HC predicted a 1 point decrease in the SBIS composite score. Conclusions Compared to offspring of adult women, children of adolescent mothers have lower mean scores on cognitive measures, smaller head circumference, and higher BMI. These differences were significant after adjusting for differences between the two groups. Adolescent mothers and their children would benefit from interventions such as parenting support, education about nutritional needs, and advice on enriching the environments of their children.     

Assessing Estonian mothers’ involvement in their children’s education and trust in teachers

Questionnaires assessing mothers’ involvement in children’s education and their trust in teachers were developed for the usage in Estonian kindergartens and elementary schools. The scales were adapted based on the questionnaires by Fantuzzo and colleagues (parental involvement) and Adams and Christenson (trust). Mothers of 454 kindergarten children, 197 first‐ and second‐grade children, and 94 fourth‐ to sixth‐grade children participated in the study. Four subscales of involvement were differentiated: school‐based involvement, home–school conferencing, home‐based academic and home‐based general involvement. Trust was a unitary construct. The psychometric properties of the scales were good. Differences according to kindergarten and school levels were concordant with earlier studies – mothers of younger children generally reported higher involvement and trust than mothers of older children.     

The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders

The purpose of this study was to explore rehabilitation professionals’ knowledge regarding signs and symptoms, prevention, and intervention of fetal alcohol spectrum disorders (FASD). Participants were 111 rehabilitation practitioners (e.g., occupational therapy, physical therapy, and speech-language pathology practitioners) recruited through email using a quantitative online survey design with purposive, snowball sampling. Results showed the majority of participants’ demonstrated accurate knowledge of the signs and symptoms of FASD. Since professionals who received formal education on FASD reported significantly higher feelings of preparedness to identify children with FASD and manage/coordinate intervention plans, this study suggests rehabilitation professionals may be better prepared to treat individuals with FASD if they participate in formal training.     

The effect of maternal employment during preschool years on school readiness

Many children referred because of “learning disability” have mothers in full‐time employment. This study was undertaken to examine the effect of maternal employment on school readiness.

One hundred and seven children were studied. Forty‐six were the offspring of women who had not gone out to work since the birth of the child (group A). The mothers of the other 61 had worked for 1 year or more during the lifetime of the child (group B). The mother of each child completed a detailed questionnaire. Each child was subjected to standardized tests of reasoning, numerical ability, Gestalt, verbal comprehension, eye‐hand co‐ordination, visual and auditory perception and IQ. Groups A and B were compared with regard to marital status of parents, their educational attainments, family size, ordinal position of the index child and years of nursery school experience.

Educational attainments of both fathers and mothers were significantly higher in group A and children had spent significantly longer at nursery school. Group B (working mothers) had a predictably higher incidence of single parents. Comparison of results showed no significant difference between groups A and B for 6 of the 8 tests administered. Group B results did not differ significantly when divided into categories according to years of maternal employment. The study suggests that there is no direct relationship between maternal employment and maturity at school entry.     

Diagnostic nomenclature for foetal alcohol spectrum disorders: the continuing challenge of causality

Prenatal alcohol exposure is a risk factor for neurologically based cognitive and adaptive disability. Diagnostic nomenclature for prenatally exposed children with cognitive and adaptive disability who lack features for foetal alcohol syndrome (FAS) or partial FAS includes the terms alcohol‐related neurodevelopmental disorder (ARND) and foetal alcohol spectrum disorder(s) (FASD). Although these terms are now widely used, this paper argues that both are problematic. ARND is flawed by unjustifiably turning a risk factor into a causal factor and shrouding the result in terminological ambiguity, while FASD is not appropriate as a clinical label, and its use as a proxy for ARND deflects critical attention from the causal inferencing that is integral to diagnosing children with an alcohol‐related teratogenic condition. Existing nomenclature is at odds with logical and evidence‐based diagnosing and also has implications for interpretation of epidemiological data. Diagnostic nomenclature that is not tightly linked to causal inference is preferable at the present stage of this field's development.     

Unpacking the lunchbox: biopedagogies,mothering and social class

This study investigates how mothers respond to school surveillance of their children's packed lunches. In a context where increasing attention is focused on healthy eating, we adopt a biopedagogical approach to illustrate different positions and strategies which mothers occupy in relation to feeding their children in the school setting. We use photo‐elicitation interviews and focus groups to trace both the discursive and practical significance of these biopedagogies. We find that the subjective experiences of feeding children at school are infused with classed notions of mothering in public. Our analysis highlights two broad positions. Firstly, there were those with strong distinctions between home‐food and school‐food, which was associated more clearly with middle class families. Secondly, there were those with more fluid boundaries between home‐food and school‐food. This was more commonly encapsulated by working class mothers who were seen to place more emphasis on their children as autonomous decision‐makers. Overall the findings document localised and classed practices of resisting the school's normalising gaze.     

The effects of breastfeeding on cognitive and neurological development of children at 9 years

Background The effect of breastfeeding on cognitive development in the child remains controversial. The commonly observed association between breastfeeding and higher intelligence quotient (IQ) scores in children may result from the numerous confounding factors in this complex relationship. The aim of this study was to examine whether breastfeeding is associated with later differences in children's cognitive and neurological development. Methods Secondary analysis from a 9‐year follow‐up study of children of 982 smokers recruited to a randomized controlled trial of anti‐smoking education in pregnancy in a maternity hospital between November 1981 and October 1982; and all ex‐smokers and a random 25% sample of non‐smokers during the same period (total 1853 women). Cognitive and neurological development of children was assessed by psychologists in schools using the British Ability Scales and Quick Neurological Screening Test (QNST). Data on breastfeeding and factors relevant to child development were drawn from interviews with mothers at home. Main outcome measures were IQ and QNST scores. Results A total of 1218 (66%) children were followed up. In total, 61.6% of children were breastfed, median duration being 12 weeks. Before adjustment, breastfeeding was significantly associated with higher total, verbal and visual IQ scores in children, and increasing duration was significantly correlated with IQ scores. Total IQ was 5.49 points higher in breastfed children (P≤ 0.001), but became non‐significant after adjustment. Total IQ scores were most strongly associated with maternal education, maternal age, parity, housing and chronic childhood illness. Breastfeeding was significantly associated with better QNST scores on bivariate analysis but not after adjustment. QNST scores were most strongly associated with maternal education and the child's sex. Conclusions Breastfeeding was not associated with any crude IQ advantage or difference in neurological soft signs in children at 9 years. The greater IQ score associated with breastfeeding is accounted for by confounding, with maternal and socio‐economic characteristics particularly important.     

The prevention of intellectual impairment in children of impoverished families: findings of a randomized trial of educational day care.

We estimated the effects of an experimental educational day care program on the intellectual development of preschoolers from 86 high-risk families in a randomly allocated longitudinal study. At six through 54 months of age, the IQs of experimental program children ranged from 7.9 to 20.1 points higher than those of control children when maternal mental retardation and home environment effects were controlled; at every age, a greater proportion of the experimental program children had normal range IQs (greater than 84). In 13 children with retarded mothers, none of six experimental program children, but six of seven control children, had IQ scores below normal.     

The health of children in sole‐parent families in New Zealand: results of a population‐based cross‐sectional survey

Objective: To investigate whether children in sole‐parent families in New Zealand bear excess risks of poor mental and physical health relative to children in two parent families. Data sources and statistical methods: The data source was the 2006/07 New Zealand Health Survey, a nationally representative household survey that sampled 502 children (5‐14 years) of sole mothers and 1,281 children of partnered mothers. Results: Children of sole mothers were 1.26 (0.94 – 2.69) times as likely as children of partnered mothers to return a low PhS score. Adjusting for maternal health and family socio‐economic disadvantage eliminated this weak association (which in any case was of borderline statistical significance). Children of sole mothers were more than twice as likely as children of partnered mothers to return a low PsS score, adjusting for demographic variables only. Conclusions: There is only a weak negative association (if any) between sole‐parenting and child physical health, but a stronger association with child mental health – consistent with most of the New Zealand and international literature. The association with child mental health is largely (but possibly not completely) ‘explained’ by the poorer mental health of sole‐parents and the poorer socio‐economic circumstances of single‐parent families (on average). Implications: These findings support policies aiming to improve access of sole‐parents and their children to community mental health services, and (more especially) policies aiming to ameliorate the disadvantaged economic circumstances of single parent families.     

Maternal smoking during pregnancy and offspring IQ

BACKGROUND: Maternal smoking in pregnancy lowers birthweight. It is unclear, however, whether smoking during pregnancy lowers offspring IQ, and, if it does, whether it is through the smoking effect on fetal growth. METHOD: Representative samples of low birthweight (<2500 g) and normal birthweight children born in 1983-85 from inner-city and suburban communities in southeast Michigan, USA were assessed at ages 6, 11, and 17, using Wechsler intelligence tests. Smoking during pregnancy was ascertained from mothers at the first assessment; and smoking at any time was ascertained at the first and second assessment. Generalized estimating equation models were used, with children's IQ at all three assessments as outcomes (n = 798). RESULTS: Without adjustment, offspring of mothers who smoked during pregnancy scored 6.8 IQ points lower than offspring of mothers who never smoked, on average. Low birthweight children scored 5.4 IQ points lower than normal birthweight children, on average. The statistical association of maternal smoking with offspring IQ was confounded by maternal characteristics, chiefly, maternal cognitive ability as measured by IQ and education; adjustment for these factors eliminated the association. By contrast, adjustment for maternal IQ and education as well as smoking during pregnancy had a negligible effect on the low birthweight-related IQ deficit. Low birthweight did not mediate the association of smoking and lowered IQ in offspring. CONCLUSION: Maternal smoking during pregnancy is a proxy for a matrix of vulnerabilities for adverse child cognitive development and has no direct causal effect on child's IQ. The relationship of low birthweight and IQ is independent of maternal smoking and maternal cognitive abilities.     

Complexity of Father Involvement in Low‐Income Mexican American Families*

We identify multiple predictors of five types of father involvement in 167 low‐ to moderate‐income two‐parent Mexican American families with fifth‐grade children. Analyses show that fathers’ egalitarian gender attitudes and mothers’ education are associated with higher levels of father involvement. Fathers are more involved in monitoring and interacting with children when families place more emphasis on family rituals, they are more involved in supervising children when mothers are employed more hours, and they perform more housework when mothers earn more and the family is under economic stress. Counter to “macho” stereotypes, Mexican‐identified men are more likely than more acculturated men to supervise children and engage them in conventionally feminine activities. Implications for theory and practice are discussed.     

Mothers' perceptions of children's quality of life following early diagnosis and treatment for retinoblastoma (Rb)

We describe the Quality of Life (QoL) and IQ of survivors of retinoblastoma (Rb), both in relation to the normal population and between subgroups of Rb patients differing in relative risk (i.e. unilateral vs. bilateral disease). The sample included 54 children (28 males, age-range 8-16 years) and their mothers. Mothers completed standardized questionnaires to report their own QoL and that of their child. Children completed a brief IQ test. Compared with population norms, mothers reported lower levels of QoL for their child on total QoL and for sub-scales measuring Physical and Psychosocial function. Mothers reported their own QoL to be comparable or higher than norms on all but one of eight sub-scales (energy/vitality). Compared with population norms, children with no visual impairment scored in the normal range for tasks measuring Verbal IQ, but below the mean on tasks measuring Performance IQ. According to their mothers, survivors of Rb have excellent school attendance and take part in most school activities. However, based on standardized questionnaire, they show compromised QoL. We consider that excellent survival rates in Rb are matched with good QoL according to mothers' report.     

Maternal Depressive Symptoms and Weight-Related Parenting Behaviors

This study examined associations between mothers’ depressive symptoms and parenting behaviors related to children’s nutrition and physical activity. Data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children from infancy through kindergarten entry. Contemporaneous and lagged associations between maternal depressive symptoms and mothers’ parenting behaviors were tested, controlling for background characteristics. The mediating effect of use of a physician’s office or clinic as a source for routine care was tested. At each wave, between 18 and 20 % of mothers were considered as having moderate or severe depressive symptoms. These mothers were 1.3 percentage points more likely to put their infants to bed with a bottle, 2.6 percentage points less likely to have rules about the foods their children eat, and their children were 3.0 percentage points less likely to be in bed by 9:00 p.m. than mothers lacking depressive symptoms. These mothers also reported that their families ate dinner together fewer nights per week, and their children watched more television per day, than non-depressed mothers. The use of a physician’s office or clinic partially mediated associations between maternal depressive symptoms and whether infants went to bed with a bottle. Interventions that identify maternal depression early may be useful in promoting healthy parenting behaviors and weight outcomes among young children.     

“I’m Sure She Chose Me!” Accuracy of Children’s Reports of Mothers’ Favoritism in Later Life Families*

Abstract: We used data from 769 mother‐child dyads nested within 300 later life families to explore the accuracy of adult children’s perceptions of mothers’ patterns of favoritism in terms of closeness and confiding. Adult children were generally accurate regarding whether their mothers preferred a specific child, but often had difficulty identifying whom mothers favored. Multivariate analyses indicated that overall accuracy of children’s reports was positively related to similarity of religious participation and negatively related to parental status of the adult child and family size. Because parental favoritism may affect adult children psychologically and have implications for later life care for parents, family practitioners should be aware of mothers’ patterns of favoritism and the sometimes inaccurate perceptions adult children have concerning this favoritism.