GoFAR: An Intervention for Affective and Metacognitive Control in FASD

Emory University, Atlanta GA

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Abstract

Fetal Alcohol Spectrum Disorders (FASD) result from the teratogenic effects of prenatal alcohol exposure on the central nervous system and lead to neurodevelopmental disorders that have a lifelong impact on individuals and families. Unfortunately, many children with FASD also experience nonoptimal rearing environments, school failure and inadequate intervention services and the interaction of these factors can be very detrimental. Despite the seriousness of the problems observed in this high risk group and their implications for public health, mental and behavioral health, educational systems and other social services, there are surprisingly few evidenced-based interventions designed to address their special needs. This application, focuses on a core area of deficit identified in FASD; that is, on disorders of affective and cognitive control that are often central to behavioral and adaptive disorders. Disorders of arousal have been identified in infancy and subsequent problems in effortful control reported frequently. By school age, such problems often present as attentional problems, deficits in executive functioning and disorders in conduct and behavior. Effective intervention will require development of programs targeted toward the specific needs identified in this group; here we propose a two stage process to create such a program, entitled GoFAR. Although almost any intervention for FASD would qualify as novel given the lack of attention to this area, the current proposal may be particularly innovative as it will bring together computer game technology and techniques for affective and cognitive control. The methodology is based, in part, on previous work that suggests that a metacognitive technique (FAR) is helpful in improving behavioral and educational outcomes in FASD. During the R21 phase, we will identify program elements and develop protocols and manuals for an intervention trial to be carried out during the R33 phase. An important element will be the GoFAR computer game, a serious game that will support the understanding and development of the FAR metacognitive control technique and reinforce its use by clinically-referred children with FASD, ages 5 to 10 years. Completed and piloted by the end of the R21 phase, this game will be incorporated into a 10 week, manualized intervention protocol whose elements will be tested for feasibility in a sample of 30 alcohol-affected children and their caregivers. Outcome measures will include both standardized assessments suitable for a clinical setting and measurement of changes in physiological response. Pre and post testing will allow a preliminary understanding of the usefulness of the program elements, including the GoFAR game, as well as the suitability of the outcomes measures selected and allow planning for a more comprehensive evaluation of the efficacy of this methodology in treating the neurodevelopmental disorders associated with FASD.