Gail Andrew - Academia.edu (original) (raw)

Papers by Gail Andrew

Summary of interview guide. (DOCX 13 kb)

BMC Health Services Research, 2019

Background: Transition to adult care represents a vulnerable period for young people with special... more Background: Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. Methods: Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. Results: A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. Conclusions: The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2014

Child Neuropsychology, 2013

The NEPSY-II (Korkman, Kirk, & Kemp, 2007) is a comprehensive instrument designed to assess neuro... more The NEPSY-II (Korkman, Kirk, & Kemp, 2007) is a comprehensive instrument designed to assess neuropsychological development in preschool and school-aged children from 3 years to 16 years, 11 months. It has a strong theoretical foundation that emphasizes the interrelatedness of brain operations. The full assessment evaluates six domains, including Executive Function and Attention, Language, Memory and Learning, Sensorimotor, Visual-Spatial Processing, and Social Perception. The Social Perception domain has been added to the original NEPSY. It includes Affect Recognition and Theory of Mind, which would be beneficial particularly for evaluating children with possible AU. Performance is reported in standard (scaled) scores, process scores, and percentiles. Behavioral observations are presented as cumulative percentages or base rates.

The Canadian journal of clinical pharmacology, 2015

Background Children with fetal alcohol spectrum disorder s (FASD) experience a range of cognitive... more Background Children with fetal alcohol spectrum disorder s (FASD) experience a range of cognitive, emotional, and behavioral challenges. Early assessment, diagnosis, and intervention are critical protective factors against adverse outcomes in FASD. However, FASD evaluations can be challenging in preschoolers and limited guidance is available to inform practice. Objectives We sought to describe the clinical presentation of preschool aged children assessed for FASD . Challenges encountered during the assessment process were also evaluated in order to inform the dev elopment of future diagnostic guidelines for clinicians undertaking FASD assessments in very young children. Methods Retrospective file information was coded for 72 children aged one to five assessed through the Glenrose Rehabilitation Hospital FASD Progr am using a structured coding manual. The sample included children who received an FASD diagnosis, children whose diagnosis was deferred, and children who did not receive a...

Child Abuse & Neglect, 2021

BACKGROUND Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure ... more 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 assessed at a Canadian FASD diagnostic clinic, 66% of whom were diagnosed with FASD. METHODS Data were collected retrospectively via record review, and adversity was measured using the Adverse Childhood Experiences Questionnaire (ACE-Q). RESULTS Participants experienced high levels of adversity (mean ACE score of 3.4), which increased with age, mental health comorbidityes, and number of living placements. Common ACEs included: not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (p < .001, ø = -0.18). There was no difference in total ACE scores between participants diagnosed with FASD versus those not diagnosed, but participants with FASD were less likely to live with both biological parents (p < .001, ø = .19) or to have been exposed to household mental health problems (p = .007, ø = -0.15). CONCLUSIONS Children and adolescents with PAE experience high rates of early adversity. Practice and policy initiatives are needed to improve early detection of ACEs among children with PAE and PAE among children with ACEs. Targeted supports are needed to strengthen the early caregiving environment and mitigate the risks of adversity to support healthy outcomes for individuals with PAE and FASD.

BMJ Open, 2019

IntroductionTransition to adult care is a challenging and complex process for youth with special ... more IntroductionTransition to adult care is a challenging and complex process for youth with special healthcare needs. We aim to compare effectiveness of a patient navigator service in reducing emergency room (ER) use among adolescents with chronic health conditions transitioning to adult care.Methods and analysisPragmatic randomised controlled trial parallel group design comparing ER visit rates between patients with access to a personalised navigator intervention compared with usual care. Unit of randomisation is the patient. Treatment assignment will not be blinded. Embedded qualitative study to understand navigator’s role and cost analysis attributable to the intervention will be performed. Patients aged 16–21 years, followed within a chronic disease clinic, expected to be transferred to adult care within 12 months and residing in Alberta during study period will be recruited from three tertiary care paediatric hospitals. Sample size will be 300 in each arm. Navigator intervention o...

Paediatrics and Child Health, 2008

L'évolution neurocomportementale des enfants atteints de troubles de l'alcoolisation foetale : Un... more L'évolution neurocomportementale des enfants atteints de troubles de l'alcoolisation foetale : Une perspective canadienne L'ensemble des troubles de l'alcoolisation foetale (ETAF) est l'une des causes évitables d'invalidité les plus courantes, et c'est l'un des problèmes de santé publique les plus urgents au Canada. L'ETAF désigne l'ensemble des invalidités physiques, mentales, comportementales et d'apprentissage dont une personne peut être atteinte à cause de la consommation d'alcool de sa mère pendant la grossesse. L'exposition prénatale à l'alcool provoque de nombreuses invalidités primaires et secondaires chez les enfants atteints, ce qui peut s'associer à une évolution négative à long terme. Le présent article analyse les recherches passées sur l'évolution neurodéveloppementale des enfants atteints de l'ETAF, notamment du point de vue comportemental, intellectuel et adaptatif. Les auteurs s'intéressent également au rôle des facteurs de risque et des facteurs protecteurs sur cette évolution et aux répercussions de l'ETAF sur la famille. Enfin, ils abordent les orientations futures et leurs effets sur les recherches en matière d'issues chez les enfants atteints de l'ETAF, surtout dans le contexte canadien.

PloS one, 2016

Head circumference is used together with other measures as a proxy for central nervous system dam... more Head circumference is used together with other measures as a proxy for central nervous system damage in the diagnosis of fetal alcohol spectrum disorders, yet the relationship between head circumference and brain volume has not been investigated in this population. The objective of this study is to characterize the relationship between head circumference, brain volume and cognitive performance in a large sample of children with prenatal alcohol exposure (n = 144) and healthy controls (n = 145), aged 5-19 years. All participants underwent magnetic resonance imaging to yield brain volumes and head circumference, normalized to control for age and sex. Mean head circumference, brain volume, and cognitive scores were significantly reduced in the prenatal alcohol exposure group relative to controls, albeit with considerable overlap between groups. Males with prenatal alcohol exposure had reductions in all three measures, whereas females with prenatal alcohol exposure had reduced brain vol...

Motivation and Emotion, 2000

In recent years, anger has been conceptualized as an interpersonal script. To investigate the dif... more In recent years, anger has been conceptualized as an interpersonal script. To investigate the different varieties of this script, 109 stories of angry experiences told by clients to their therapists were drawn from audiotapes of psychotherapy sessions. Phrases representing 5 features of a script (i.e., antecedents, beliefs and evaluations, self's expression of anger, behavioral reactions of others, and the consequences)

In presenting this thesis in partial fulfillment of the requirements for a Postgraduate degree fr... more In presenting this thesis in partial fulfillment of the requirements for a Postgraduate degree from the University of Saskatchewan, I agree that the Libraries of the University may make it freely available for inspection. I further agree that permission for copying of this thesis in any manner, in whole or in part, for scholarly purposes may be granted by the professor or professors who supervised my thesis work or, in their absence, by the Head of the Department or the Dean of the College in which my thesis work was done. It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and to the University of Saskatchewan in any scholarly use which may be made of any material in my thesis.

Child Neuropsychology, 2013

Journal of population therapeutics and clinical pharmacology = Journal de la thérapeutique des populations et de la pharamcologie clinique, 2015

BackgroundFetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of ... more BackgroundFetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of effects that can occur in an individual who was prenatally exposed to alcohol and includes an array of complex neurodevelopmental and physical findings. ObjectivesTo give primary healthcare providers (PHCP) evidence-based recommendations for supporting and managing the symptoms of FASD after patients have received a diagnosis. MethodsPrimary health recommendations for the management of children and adolescents with FASD were developed based on expert clinical judgment and supported by evidence-based research, where appropriate. The format was adapted from other health supervision practice guidelines as developed by the American Academy of Pediatrics. Clinical practice "Points" for the PHCP are highlighted. A reference table of anticipatory recommendations by age is presented. ResultsIn most cases, the initial screening and referral for diagnosis will be made by the PHCP, and...

BMC Public Health

Background Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological a... more Background Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. Methods The screenings tools evaluated were chosen from Children’s Healthcare Canada’s National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. ...

Frontiers in Human Neuroscience

Individuals with prenatal alcohol exposure (PAE) exhibit neurological deficits associated with br... more 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 neurotypically developing children and adolescents, and those with PAE. 3D T1-weighted MPRAGE images were acquired from 69 participants with PAE (13.0 ± 3.2 years, range 7.1–18.8 years, 49% female) and 70 neurotypical controls (12.4 ± 2.9 years, range 7.0–18.5 years, 60% female) from four scanning sites in Canada. SES scores calculated using Hollingshead’s Four-Factor Index of Social Status from current caregiver placement were not significantly different between groups, though more children with PAE had lower SES scores compared to controls. Psychometric data comprised 14 cognitive measures, including executive functioning, attention and working memory, memory, math/numerical ability, and word reading. All cognitive scores were significantly worse in children with PAE compared to controls, though SES was not correlated with cognitive scores in either group after correction for multiple comparisons. All 13 brain volumes were smaller in children with PAE compared to children in the control group. Higher SES was associated with larger hippocampus and amygdala volumes in controls, but there were no such associations in children with PAE. Direct evaluation of the interaction between SES and diagnostic group did not show a significant differential impact of SES on these structures. These findings support previous links between SES and brain volumes in neurotypically developing children, but the lack of such a relationship with SES in children with PAE may be due to the markedly smaller brain volumes resulting from the initial brain injury and postpartum brain development, regardless of later SES.

Frontiers in Pediatrics

Transitional care interventions have the potential to optimize continuity of care, improve health... more Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systemati...

Journal of Occupational Therapy, Schools, & Early Intervention

Research in Developmental Disabilities

Applied neuropsychology. Child, Jan 12, 2018

Early intervention for individuals with FASD is paramount, thus exploring factors that affect the... more 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 prenatal alcohol exposure. This study is a retrospective file review of 154 children (44% female; mean age 8.4 years, range 1.0 to 16.9) deferred at their first FASD assessment, and 51 (43% female; mean 9.9 years, range 2.7 to 17.2) who returned for a second assessment. Data was collected from three Canadian FASD clinics to explore reasons for deferral, the clinical profile of deferred children, why some returning children were diagnosed while others were not, and changes between assessments. Results suggest that deferred children initially lacked evidence of abnormalities sufficient for a diagnosis, presented with areas of relative neurobehavio...

Summary of interview guide. (DOCX 13 kb)

BMC Health Services Research, 2019

Background: Transition to adult care represents a vulnerable period for young people with special... more Background: Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. Methods: Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. Results: A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. Conclusions: The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2014

Child Neuropsychology, 2013

The NEPSY-II (Korkman, Kirk, & Kemp, 2007) is a comprehensive instrument designed to assess neuro... more The NEPSY-II (Korkman, Kirk, & Kemp, 2007) is a comprehensive instrument designed to assess neuropsychological development in preschool and school-aged children from 3 years to 16 years, 11 months. It has a strong theoretical foundation that emphasizes the interrelatedness of brain operations. The full assessment evaluates six domains, including Executive Function and Attention, Language, Memory and Learning, Sensorimotor, Visual-Spatial Processing, and Social Perception. The Social Perception domain has been added to the original NEPSY. It includes Affect Recognition and Theory of Mind, which would be beneficial particularly for evaluating children with possible AU. Performance is reported in standard (scaled) scores, process scores, and percentiles. Behavioral observations are presented as cumulative percentages or base rates.

The Canadian journal of clinical pharmacology, 2015

Background Children with fetal alcohol spectrum disorder s (FASD) experience a range of cognitive... more Background Children with fetal alcohol spectrum disorder s (FASD) experience a range of cognitive, emotional, and behavioral challenges. Early assessment, diagnosis, and intervention are critical protective factors against adverse outcomes in FASD. However, FASD evaluations can be challenging in preschoolers and limited guidance is available to inform practice. Objectives We sought to describe the clinical presentation of preschool aged children assessed for FASD . Challenges encountered during the assessment process were also evaluated in order to inform the dev elopment of future diagnostic guidelines for clinicians undertaking FASD assessments in very young children. Methods Retrospective file information was coded for 72 children aged one to five assessed through the Glenrose Rehabilitation Hospital FASD Progr am using a structured coding manual. The sample included children who received an FASD diagnosis, children whose diagnosis was deferred, and children who did not receive a...

Child Abuse & Neglect, 2021

BACKGROUND Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure ... more 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 assessed at a Canadian FASD diagnostic clinic, 66% of whom were diagnosed with FASD. METHODS Data were collected retrospectively via record review, and adversity was measured using the Adverse Childhood Experiences Questionnaire (ACE-Q). RESULTS Participants experienced high levels of adversity (mean ACE score of 3.4), which increased with age, mental health comorbidityes, and number of living placements. Common ACEs included: not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (p < .001, ø = -0.18). There was no difference in total ACE scores between participants diagnosed with FASD versus those not diagnosed, but participants with FASD were less likely to live with both biological parents (p < .001, ø = .19) or to have been exposed to household mental health problems (p = .007, ø = -0.15). CONCLUSIONS Children and adolescents with PAE experience high rates of early adversity. Practice and policy initiatives are needed to improve early detection of ACEs among children with PAE and PAE among children with ACEs. Targeted supports are needed to strengthen the early caregiving environment and mitigate the risks of adversity to support healthy outcomes for individuals with PAE and FASD.

BMJ Open, 2019

IntroductionTransition to adult care is a challenging and complex process for youth with special ... more IntroductionTransition to adult care is a challenging and complex process for youth with special healthcare needs. We aim to compare effectiveness of a patient navigator service in reducing emergency room (ER) use among adolescents with chronic health conditions transitioning to adult care.Methods and analysisPragmatic randomised controlled trial parallel group design comparing ER visit rates between patients with access to a personalised navigator intervention compared with usual care. Unit of randomisation is the patient. Treatment assignment will not be blinded. Embedded qualitative study to understand navigator’s role and cost analysis attributable to the intervention will be performed. Patients aged 16–21 years, followed within a chronic disease clinic, expected to be transferred to adult care within 12 months and residing in Alberta during study period will be recruited from three tertiary care paediatric hospitals. Sample size will be 300 in each arm. Navigator intervention o...

Paediatrics and Child Health, 2008

L'évolution neurocomportementale des enfants atteints de troubles de l'alcoolisation foetale : Un... more L'évolution neurocomportementale des enfants atteints de troubles de l'alcoolisation foetale : Une perspective canadienne L'ensemble des troubles de l'alcoolisation foetale (ETAF) est l'une des causes évitables d'invalidité les plus courantes, et c'est l'un des problèmes de santé publique les plus urgents au Canada. L'ETAF désigne l'ensemble des invalidités physiques, mentales, comportementales et d'apprentissage dont une personne peut être atteinte à cause de la consommation d'alcool de sa mère pendant la grossesse. L'exposition prénatale à l'alcool provoque de nombreuses invalidités primaires et secondaires chez les enfants atteints, ce qui peut s'associer à une évolution négative à long terme. Le présent article analyse les recherches passées sur l'évolution neurodéveloppementale des enfants atteints de l'ETAF, notamment du point de vue comportemental, intellectuel et adaptatif. Les auteurs s'intéressent également au rôle des facteurs de risque et des facteurs protecteurs sur cette évolution et aux répercussions de l'ETAF sur la famille. Enfin, ils abordent les orientations futures et leurs effets sur les recherches en matière d'issues chez les enfants atteints de l'ETAF, surtout dans le contexte canadien.

PloS one, 2016

Head circumference is used together with other measures as a proxy for central nervous system dam... more Head circumference is used together with other measures as a proxy for central nervous system damage in the diagnosis of fetal alcohol spectrum disorders, yet the relationship between head circumference and brain volume has not been investigated in this population. The objective of this study is to characterize the relationship between head circumference, brain volume and cognitive performance in a large sample of children with prenatal alcohol exposure (n = 144) and healthy controls (n = 145), aged 5-19 years. All participants underwent magnetic resonance imaging to yield brain volumes and head circumference, normalized to control for age and sex. Mean head circumference, brain volume, and cognitive scores were significantly reduced in the prenatal alcohol exposure group relative to controls, albeit with considerable overlap between groups. Males with prenatal alcohol exposure had reductions in all three measures, whereas females with prenatal alcohol exposure had reduced brain vol...

Motivation and Emotion, 2000

In recent years, anger has been conceptualized as an interpersonal script. To investigate the dif... more In recent years, anger has been conceptualized as an interpersonal script. To investigate the different varieties of this script, 109 stories of angry experiences told by clients to their therapists were drawn from audiotapes of psychotherapy sessions. Phrases representing 5 features of a script (i.e., antecedents, beliefs and evaluations, self's expression of anger, behavioral reactions of others, and the consequences)

In presenting this thesis in partial fulfillment of the requirements for a Postgraduate degree fr... more In presenting this thesis in partial fulfillment of the requirements for a Postgraduate degree from the University of Saskatchewan, I agree that the Libraries of the University may make it freely available for inspection. I further agree that permission for copying of this thesis in any manner, in whole or in part, for scholarly purposes may be granted by the professor or professors who supervised my thesis work or, in their absence, by the Head of the Department or the Dean of the College in which my thesis work was done. It is understood that any copying or publication or use of this thesis or parts thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and to the University of Saskatchewan in any scholarly use which may be made of any material in my thesis.

Child Neuropsychology, 2013

Journal of population therapeutics and clinical pharmacology = Journal de la thérapeutique des populations et de la pharamcologie clinique, 2015

BackgroundFetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of ... more BackgroundFetal Alcohol Spectrum Disorder (FASD) is an umbrella term that describes the range of effects that can occur in an individual who was prenatally exposed to alcohol and includes an array of complex neurodevelopmental and physical findings. ObjectivesTo give primary healthcare providers (PHCP) evidence-based recommendations for supporting and managing the symptoms of FASD after patients have received a diagnosis. MethodsPrimary health recommendations for the management of children and adolescents with FASD were developed based on expert clinical judgment and supported by evidence-based research, where appropriate. The format was adapted from other health supervision practice guidelines as developed by the American Academy of Pediatrics. Clinical practice "Points" for the PHCP are highlighted. A reference table of anticipatory recommendations by age is presented. ResultsIn most cases, the initial screening and referral for diagnosis will be made by the PHCP, and...

BMC Public Health

Background Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological a... more Background Fetal Alcohol Spectrum Disorder (FASD) is characterized by physical and neurological abnormalities resulting from prenatal alcohol exposure. Though diagnosis may help improve patient outcomes, the diagnostic process can be costly. Subsequently, screening children suspected of FASD prior to diagnostic testing has been suggested, to avoid administering testing to children who are unlikely to receive a diagnosis. The present study set out to assess the cost-effectiveness of currently recommended FASD screening tools. Methods The screenings tools evaluated were chosen from Children’s Healthcare Canada’s National Screening Toolkit for Children and Youth Identified and Potentially Affected by FASD and include meconium testing of fatty acid ethyl esters (meconium testing) and the neurobehavioral screening tool (NST). An economic model was constructed to assess cost-effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of findings. ...

Frontiers in Human Neuroscience

Individuals with prenatal alcohol exposure (PAE) exhibit neurological deficits associated with br... more 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 neurotypically developing children and adolescents, and those with PAE. 3D T1-weighted MPRAGE images were acquired from 69 participants with PAE (13.0 ± 3.2 years, range 7.1–18.8 years, 49% female) and 70 neurotypical controls (12.4 ± 2.9 years, range 7.0–18.5 years, 60% female) from four scanning sites in Canada. SES scores calculated using Hollingshead’s Four-Factor Index of Social Status from current caregiver placement were not significantly different between groups, though more children with PAE had lower SES scores compared to controls. Psychometric data comprised 14 cognitive measures, including executive functioning, attention and working memory, memory, math/numerical ability, and word reading. All cognitive scores were significantly worse in children with PAE compared to controls, though SES was not correlated with cognitive scores in either group after correction for multiple comparisons. All 13 brain volumes were smaller in children with PAE compared to children in the control group. Higher SES was associated with larger hippocampus and amygdala volumes in controls, but there were no such associations in children with PAE. Direct evaluation of the interaction between SES and diagnostic group did not show a significant differential impact of SES on these structures. These findings support previous links between SES and brain volumes in neurotypically developing children, but the lack of such a relationship with SES in children with PAE may be due to the markedly smaller brain volumes resulting from the initial brain injury and postpartum brain development, regardless of later SES.

Frontiers in Pediatrics

Transitional care interventions have the potential to optimize continuity of care, improve health... more Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systemati...

Journal of Occupational Therapy, Schools, & Early Intervention

Research in Developmental Disabilities

Applied neuropsychology. Child, Jan 12, 2018

Early intervention for individuals with FASD is paramount, thus exploring factors that affect the... more 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 prenatal alcohol exposure. This study is a retrospective file review of 154 children (44% female; mean age 8.4 years, range 1.0 to 16.9) deferred at their first FASD assessment, and 51 (43% female; mean 9.9 years, range 2.7 to 17.2) who returned for a second assessment. Data was collected from three Canadian FASD clinics to explore reasons for deferral, the clinical profile of deferred children, why some returning children were diagnosed while others were not, and changes between assessments. Results suggest that deferred children initially lacked evidence of abnormalities sufficient for a diagnosis, presented with areas of relative neurobehavio...