Claire Coles - Academia.edu (original) (raw)

Papers by Claire Coles

Clinical Neurophysiology, Nov 1, 2017

Objective-Disruption in the neural activation of the prefrontal cortex (PFC) in modulating arousa... more Objective-Disruption in the neural activation of the prefrontal cortex (PFC) in modulating arousal was explored in children with heavy prenatal alcohol exposure (PAE), who have known neurobehavioral impairment. Methods-During a task that elicits frustration, functional near-infrared spectroscopy (fNIRS) was used to measure PFC activation, specifically levels of oxygenated (HBO) and deoxygenated (HBR) hemoglobin, in children with PAE (n=18) relative to typically developing Controls (n=12) and a Clinical Contrast group with other neurodevelopmental or behavioral problems (n=14). Results-Children with PAE had less activation during conditions with positive emotional arousal, as indicated by lower levels of HBO in the medial areas of the PFC and higher levels of HBR in all areas of the PFC sampled relative to both other groups. Children in the Control group demonstrated greater differentiation of PFC activity than did children with PAE. Children in the Clinical Contrast group demonstrated the greatest differences in PFC activity between valences of task conditions. Conclusions: Specific patterns of PFC activation differentiated children with PAE from typically developing children and children with other clinical problems. Significance-FNIRS assessments of PFC activity provide new insights regarding the mechanisms of commonly seen neurobehavioral dysfunction in children with PAE.

Alcoholism: Clinical and Experimental Research

Journal of Studies on Alcohol, 1987

Advances in experimental medicine and biology, 1998

Advances in Alcohol & Substance Abuse, 1987

Infants exposed to alcohol prenatally, even when they do not suffer from fetal alcohol syndrome (... more Infants exposed to alcohol prenatally, even when they do not suffer from fetal alcohol syndrome (FAS), may be at high risk for many of the negative outcomes typically found among children of alcoholics including hyperactivity and other behavioral and learning problems. A series of studies are described designed to investigate the incidence and persistence of central nervous system (CNS) related behavioral alterations in three groups of infants born to low SES black women: (1) those who never drank in pregnancy; (2) those who drank at an average of 12 ounces of absolute alcohol (AA) per week throughout pregnancy; and (3) those who drank an equivalent amount but stopped by the second trimester of pregnancy. Only healthy, full-term infants were examined for the physical dysmorphic features associated with FAS and for behavioral alterations that could be assessed using the Brazelton Neonatal Behavioral Assessment Scale. One hundred and three neonates were examined at three days; those who had been exposed to alcohol were found to be less optimal in neurobehavioral responses. Infants whose mothers continued to drink were significantly lower on their orientation toward auditory and visual stimuli, motor performance, and autonomic regulation than the nonexposed infants. Although a second study found that some of these effects were related to neonatal withdrawal syndrome, a follow-up to 30 days of age in a subsample of the original group found that there were persistent behavioral alterations. Infants in the stopped-drinking group showed more recovery over the first month than did those in the continued-drinking group in reflexive behavior and autonomic control. A reassessment at six months of 60 of the infants who had been tested at three days indicated that differences in orientation, motor performance, reflexive behavior and autonomic control were predictive of mental and motor performance on the Bayley Scales of Infant Development. This series of studies supports the contention that the negative effects on infant behavior of prenatal alcohol exposure are both immediate and persistent.

SPIE Proceedings, 2013

ABSTRACT Electrical stimulation of the human cortex in conjunction with physical rehabilitation h... more ABSTRACT Electrical stimulation of the human cortex in conjunction with physical rehabilitation has been a valuable approach in facilitating the plasticity of the injured brain. One such method is transcranial direct current stimulation (tDCS) which is a non-invasive method to elicit neural stimulation by delivering current through electrodes placed on the scalp. In order to better understand the effects tDCS has on cortical plasticity, neuroimaging techniques have been used pre and post tDCS stimulation. Recently, neuroimaging methods have discovered changes in resting state cortical hemodynamics after the application of tDCS on human subjects. However, analysis of the cortical hemodynamic activity for a physical task during and post tDCS stimulation has not been studied to our knowledge. A viable and sensitive neuroimaging method to map changes in cortical hemodynamics during activation is functional near-infrared spectroscopy (fNIRS). In this study, the cortical activity during an event-related, left wrist curl task was mapped with fNIRS before, during, and after tDCS stimulation on eight healthy adults. Along with the fNIRS optodes, two electrodes were placed over the sensorimotor hand areas of both brain hemispheres to apply tDCS. Changes were found in both resting state cortical connectivity and cortical activation patterns that occurred during and after tDCS. Additionally, changes to surface electromyography (sEMG) measurements of the wrist flexor and extensor of both arms during the wrist curl movement, acquired concurrently with fNIRS, were analyzed and related to the transient cortical plastic changes induced by tDCS.

Journal of Maternal-Fetal and Neonatal Medicine, 2003

Although the prevalence of fetal alcohol syndrome (FAS) varies within the population, few data ar... more Although the prevalence of fetal alcohol syndrome (FAS) varies within the population, few data are available concerning variation in the prevalence of prenatal drinking. Postpartum women delivering singleton infants at two Atlanta hospitals in 1993 or 1994 were interviewed. Those delivering infants who were small for gestational age (SGA) (n = 638) were over-sampled relative to those delivering infants with birth weights that were appropriate for gestational age (AGA) (n = 247). The prevalence of prenatal drinking was estimated as a weighted average of reports from mothers of SGA and AGA infants. Estimates of the prevalence of FAS come from the Metropolitan Atlanta Congenital Defects Program (MACDP) of the Centers for Disease Control and Prevention. The prevalence of first-trimester drinking was half that reported for the three previous months (private hospital: 72% vs. 35%; public hospital: 52% vs. 28%). Most women (85%) reported abstaining throughout the second trimester. Fewer than 10% of women delivering at the public hospital (7.5%), but one-quarter of those delivering at the private hospital, reported third-trimester drinking. Binge, moderate and heavy drinking in pregnancy were more common among women delivering at the public hospital. Eight infants born at the public hospital during this period, but none of those born at the private hospital, were identified as possibly having FAS; four of the eight were identified as probably having FAS. These results have implications for health education programs. For example, obstetricians in private practice may wish to reaffirm their advice to abstain from drinking in the third trimester. They also suggest that prenatal abstinence programs be targeted at populations identified as most likely to engage in risky drinking.

International Journal of the Addictions, 1993

Empirical research on the behavioral consequences to the offspring of use of recreational and add... more Empirical research on the behavioral consequences to the offspring of use of recreational and addictive drugs and alcohol by pregnant women is reviewed. The current epidemic of cocaine use has raised the specter of a host of "cocaine babies" whose prenatally induced impairments will interfere with social and academic functioning and constitute an immense social burden. In fact, examination of effects of drug exposure on infant behavior and subsequent development suggests a much more subtle and complicated process which must take into account not only the child's prenatal exposure but the various other environmental factors which contribute to eventual outcome. These other factors include caregiving competence and social environment.

School Psychology Quarterly, 1992

Reviewed 39 empirical studies in which direct observational methods were used to assess children ... more Reviewed 39 empirical studies in which direct observational methods were used to assess children in whom attention deficit hyperactivity disorder (ADHD) had been diagnosed. Classroom studies distinguished ADHD children from comparison groups better than laboratory studies. Behaviors that most consistently distinguished ADHD children from comparison groups included measures of attention, activity, and vocalization. Suggests ways to improve the efficiency and reliability of observational research. Recommendations made regarding the importance of classroom observations in the evaluation of ADHD children. Attention deficit hyperactivity disorder (ADHD), a multifaceted condition involving chronic inattention, impulsivity, and heightened motor activity (Barkley, 1988b; Campbell, 1985), is the most frequently diagnosed childhood psychiatric disorder (Barkley, 1988a). These children frequently are referred because of a history of academic and classroom behavior difficulties that are believed to result from problems with attention. Social skills deficits often accompany a diagnosis of ADHD and may include disruptive and aggressive behaviors that alienate peers, parents, and teachers (

Neurotoxicology and Teratology, 1991

hol is a potent teratogen associated with dysmorphology, growth retardation, and neurological dam... more hol is a potent teratogen associated with dysmorphology, growth retardation, and neurological damage in children with the full fetal alcohol syndrome (FAS); alcohol is also associated with growth retardation and behavioral alterations in neonates prenatally exposed to various dosages. Questions remain about the long-term consequences of prenatal alcohol exposure. This study reports on the follow-up of a subsample of 68 children, the majority of whom were low income and black (mean age: 5 years, 10 months) who were first evaluated as neonates. Physical and cognitive outcomes of 25 children of women who drank throughout pregnancy [absolute alcohol (AA)/week: mean = 11.80 oz), even after receiving an educational intervention to stop drinking, were compared with outcomes of children in two contrast groups: a) women (n=22) who stopped drinking (AA/week: mean= 11.46 oz) in the second trimester after an educational intervention but resumed postpartum; and b) women who did not drink during pregnancy and who drank little postnatally (n=21). Children were compared for alcohol-related birth defects (ARBDs), growth (height, weight, and head circumference), and cognitive, academic, and adaptive measures. Neonatal and current physical measures were correlated to determine predictability of neonatal status. When the effects of age and gender were controlled, children in the continued-to-drink group showed significantly more ARBDs and had smaller head circumferences than those in the other two groups. When current drinking reported by caretakers was controlled, the children who were exposed throughout pregnancy also showed significant and consistent deficits in several areas of intellectual functioning including sequential processing (shortterm memory and encoding) and overall mental processing. Alcohol-exposed children displayed significant deficits in preacademic skills when compared with children of nondrinkers, with both alcohol groups deficient in premath and reading skills. There were no differences in adaptive behavior at follow-up. These data suggest that alcohol exposure throughout pregnancy is correlated with persistent physical differences as well as identifiable deficits in sequential memory processes and specific academic skills. However, even when alcohol use is limited to the first part of pregnancy, significant deficits in academic skills and growth parameters are measurable. Fetal alcohol syndrome (FAS) Prenatal alcohol exposure Physical development Cognitive development Alcohol-related birth defects (ARBD) Pregnancy ALCOHOL is a teratogen that affects morphology and growth. It also affects behavior as a result of its actions on the developing central nervous system (15). The consequences for the human neonate have been studied extensively (4, 15, 36), as have outcomes in a number of children with the full fetal alcohol syndrome (FAS) (20,40). Nevertheless, many questions about the developmental consequences of alcohol exposure remain to be fully investigated. One issue is the extent to which the characteristic effects of alcohol exposure persist beyond infancy. Spohr, Willems-Bing and Steinhausen (34) have suggested that the physical stigmata associated with FAS become less apparent with maturity; other investigators have refuted this (37). Streissguth (37) has reported that, in FAS children, growth retardation is persistent, although weight tends to normalize, but in children who are mildly exposed, growth effects are not evident beyond infancy. Similar catch-up growth was reported by Ernhart and Kawano (10) in the Cleveland prospective study. However, Day et al. (8) report persistent, although not clinically significant, growth deficits in mildly exposed 3-year-old children from lowsocioeconomic-status (SES) groups. Finally, because of the potential interaction of development and postnatal rearing environment, the extent to which the cog-1This research was supported, in part, by a grant award from the March of Dimes Birth Defects Foundation, Social and Behavioral Sciences Division, Grant #12-189 and a grant from the Georgia Department of Human Resources.

The Journal of Pediatrics, 1984

Although neonatal withdrawal syndrome is often noted in infants of narcotics addicts, ethanol wit... more Although neonatal withdrawal syndrome is often noted in infants of narcotics addicts, ethanol withdrawal has been reported only among neonates Wit h fetal alcohol syndrome. To examine the possibility that ethanol withdrawal occurs more widely and to identify its characteristics, the behavior of eight neonates born to women who drank a mean of 21 ounces of absolut e alcohol per week during gestation was compared with that of two contrast groups: 15 infants whose mothers drank an equivalent amount but stopped in the r trimester, and 29 infants whose mothers never drank. None of the 52 infants had fetal alcohol syndrome, and all were in good health, Neurohehavioral evaluation 3 days postnatally compared the groups for the occurrence of characteri'stic signs of withdrawa! from central nervous system depressants. Whereas there was no difference in the frequency of withdrawal symptoms among infants of mothers who never drank (mean 1.4) or of mothers who stopped drinking (mean 1.8), infants of mothers who continued to drink (mean 4.7) had significantly more tremors, hypertonia, restlessness, excessive mouthing movements, unconsolable crying, and reflex abnormalities. By interfering with state control and interactive behaviors, withdrawal could affect mother-infant bonding as well as the conditions that foster cognitive and social development.

Infant Behavior and Development, 1987

ABSTRACT

Developmental Psychobiology, 2008

Cocaine-exposed infants have been found to have altered arousal responses but little is known abo... more Cocaine-exposed infants have been found to have altered arousal responses but little is known about such responses in later childhood. Physiological responses to stressors were used to assess the arousal modulation of school-aged, cocaine-exposed children (n ¼ 73) and two contrast groups, socioeconomicallymatched controls (n ¼ 58) and children with behavioral disturbance (n ¼ 35). The behaviorally disturbed group had the highest heart rate across conditions but demonstrated a pattern of hyporesponsiveness to the stressors. They had the smallest decrement in skin conductance response at baseline and the least recovery of skin conductance response following exposure to stressors. Cocaine-exposed children demonstrated greater acceleratory responses to the stressors as indexed by their skin conductance level and were intermediate between the socioeconomicallymatched controls and children with behavioral disturbance in recovery of skin conductance response following stressors. Altered arousal responses associated with prenatal cocaine exposure persisted into middle childhood but were different from those found in behaviorally disturbed children.

Alcoholism: Clinical & Experimental Research, 2004

Alcoholism: Clinical and Experimental Research, 1997

Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other indiv... more Behavioral deficits are often noted in children with fetal alcohol syndrome (FAS) and other individuals with prenatal alcohol exposure, including mental retardation, learning problems, social problems, and deficits in attention. Because attention deficit, hyperactivity disorder (ADHD) has been diagnosed so frequently in children with FAS and other alcohol related birth defects, there has been speculation that alcohol is an etiological factor in ADHD. To examine the relationship between behavior characteristics of children with fetal alcohol exposure and those seen in children with a diagnosis of ADHD, 149 low socioeconomic status (SES), African‐American children (mean age = 7.63 years) were given a battery of neuropsychological and behavioral tests. One hundred and twenty‐two were a sub‐sample from a longitudinal study of prenatal alcohol exposure, whereas twenty‐seven were identified in an ADHD Clinic. Children were given two sets of tests: (1) “traditional model” of conventional b...

Alcoholism: Clinical & Experimental Research, 2005

Background: Since chronic alcohol use suppresses the adult immune system, we tested the hypothesi... more Background: Since chronic alcohol use suppresses the adult immune system, we tested the hypothesis that maternal alcohol ingestion increases the risk of infection in term newborns.* Methods: Analysis of a large case-control study of birth weight for gestational age was performed focusing on maternal alcohol ingestion and the development of infection in term newborns Ն36 weeks gestation. After delivery, mothers were asked about alcohol and tobacco use in the 3 months prior to conception, the 1 st , 2 nd , and 3 rd trimester of pregnancy. Results: Eight hundred and seventy-two singleton newborns (872) Ն 36 weeks gestation were identified for analysis. A total of 51 (5.8%) had newborn infections. Gestational age, sex, and small for gestational age (SGA) were similar in the newborns with and without infection (p ϭ NS). Infants whose mothers reported alcohol use, excessive drinking or smoking in pregnancy were more likely to have a newborn diagnosed with an infection than were mothers who reported abstaining from alcohol or cigarettes (p Ͻ 0.05). When controlling for race and smoking, SGA infants whose mothers used any alcohol had a 2.5-fold increase risk of infection, while excessive alcohol use increased the risk 3-4-fold. In a multivariable logistic regression analysis controlling for low maternal income, smoking, and SGA, excessive alcohol use during the 2 nd trimester increased the risk of newborn infection (OR 3.7 [1.1,12.8], p Ͻ 0.05). Conclusions: Excessive maternal alcohol use is associated with an increased risk of newborn infection in this patient sample. Increased awareness and further clinical investigations are warranted to address the detrimental effects of fetal alcohol exposure on the developing immune system.

Developmental Neurorehabilitation, Jan 9, 2018

Objective: This brief report describes the GoFAR intervention designed to improve attention, beha... more Objective: This brief report describes the GoFAR intervention designed to improve attention, behaviour and adaptive functioning in children with FASD, ages 5 to 10 years. Methods: 30 children were randomized to one of 3 conditions: GoFAR; FACELAND and CONTROL; 25 completed the interventions. Over 10 sessions children and caregivers learned a metacognitive strategy (FAR) designed to improve cognitive control of behaviour and adaptive functioning and practiced it during behaviour analog therapy. Attention, behaviour problems and adaptive skills were measured pre and post intervention. Results: From pre to post testing the GoFAR intervention group improved on the Test of Variables of Attention (TOVA). Both intervention groups improved in Daily Living Skills. Conclusion: This pilot study demonstrated that children with FASD and their caregivers benefit from a focused intervention designed to improve effortful control of behaviour. The study suggests the need for a larger clinical trial to evaluate the intervention's effectiveness.

Stat, 2022

Evidence from animal models and epidemiological studies has linked prenatal alcohol exposure (PAE... more Evidence from animal models and epidemiological studies has linked prenatal alcohol exposure (PAE) to a broad range of long‐term cognitive and behavioural deficits. However, there is a paucity of evidence regarding the nature and levels of PAE associated with increased risk of clinically significant cognitive deficits. To derive robust and efficient estimates of the effects of PAE on cognitive function, we have developed a hierarchical meta‐analysis approach to synthesize information regarding the effects of PAE on cognition, integrating data on multiple outcomes from six U.S. longitudinal cohort studies. A key assumption of standard methods of meta‐analysis, effect sizes are independent, is violated when multiple intercorrelated outcomes are synthesized across studies. Our approach involves estimating the dose–response coefficients for each outcome and then pooling these correlated dose–response coefficients to obtain an estimated “global” effect of exposure on cognition. In the fi...