Current Projects

Principal Investigators: Claire Coles, Ph.D. (Emory University, Atlanta, Georgia), Therese Grant Ph.D. (University of Washington, Seattle, Washington)

Co-Investigator: Sandra Radin, Ph.D. (University of Washington, Seattle, Washington)

Dysmorphologist: Margaret Adam, M.D.

Research Coordinators, Seattle site: Kathryn Kelly, B.A. and Tim Smith-Stewart, B.F.A.

Funded by NIH/NIAAA

07/01/17 through 06/30/22

Recent epidemiological studies suggest that Fetal Alcohol Spectrum Disorder (FASD) may have a prevalence of up to 5% in the population, however, it is rarely diagnosed in adulthood and there are no recognized treatment protocols because, despite decades of research on the effects of prenatal alcohol exposure, scientific study of adults with FASD is almost unknown. The current NIH/NIAAA-funded research addresses this deficit with the following Specific Aims: 1) Establish a registry of 500 individuals, older than 30 years of age, with known alcohol exposure/FASD diagnosis or who are matched controls who will respond to a health survey, and who will be available for future studies; 2) Evaluate in depth current physical health, mental health, and functional status among affected individuals (FAS or FASD) and controls (120 from Seattle and 120 from Atlanta); with the goal of refining diagnostic criteria for FASD in this age group and determining the persistence and severity of disability associated with PAE. and 3) Assess immune status in collaboration with Dr. Weinberg (University of British Columbia) and identify outcomes associated with health indicators.

Principal Investigators: Claire Coles, Ph.D. (Emory University, Atlanta, Georgia), Therese Grant Ph.D. (University of Washington, Seattle, Washington)

Co-Investigator: Susan Stoner, Ph.D. (University of Washington, Seattle, Washington)

Research Coordinators, Seattle site: Tim Smith-Stewart, B.F.A., Kristina Rowlett, B.A.

Funded by NIH/NIAAA

07/01/20 through 06/30/22

There are two important, and related, reasons to include attention to COVID-19 and the medical and social implications of the pandemic in the ongoing study of adults affected by prenatal alcohol exposure (PAE). First, is evidence that the adults in the cohorts being followed are particularly vulnerable to the impact of the pandemic. Secondly, given this vulnerability, the pandemic represents a historic threat to the validity of study outcomes that must be addressed. Coronavirus disease-2019 (COVID-19) represents a significant risk for the cohorts of individuals being followed by the Fetal Alcohol Spectrum Disorders in Adults: Health and Neurobehavior study that is the parent grant for this application. These risks are both direct, in terms of health outcomes, and indirect, in terms of environmental stressors resulting from the pandemic. There is, as yet, no information about the impact for individuals with disabilities in general or fetal alcohol spectrum disorders (FASD), in particular, despite the likelihood that such impaired individuals will have greater difficulty in understanding and implementing social distancing and other safety measures that are necessary to reduce their risk of infection. This supplement will add more information to the study of a sample that is unique and that is exploring the long term consequences of PAE in a population that has never been assessed previous. Secondly, given that the sample is particularly vulnerable to effects of the COVID-19 virus due to both demonstrable social factors and to hypothesized physical conditions, the study will be the first of its kind to examine the impact in this high risk group of individuals. There are no previous studies of this kind.

Principal Investigator: Sandra Radin, Ph.D. (University of Washington, Seattle, Washington)

Consultant: Therese Grant, Ph.D. (University of Washington, Seattle, Washington)

Funded by NIH/NIAAA

2018 through 2023

Exposure to alcohol in utero can have devastating effects on the developing fetus, including alterations in brain structure and functioning. Collectively the effects of prenatal alcohol exposure (PAE) are referred to as fetal alcohol spectrum disorders (FASD). Very little data exist on long-term consequences of PAE as the majority of clinical research has focused on children and adolescents, despite animal model data suggesting long-term consequences and altered trajectories of behavioral development. The goal of this study is to address this significant shortfall in our knowledge by evaluating the protracted effects of prenatal alcohol exposure on the brain.

Previous large studies from Seattle, Washington developed well-characterized research samples of individuals with a classification of having an FASD. Over 150 of these individuals had structural MRI scans conducted while in their teens and twenties, and are now between 30 and 60 years of age. In this current study we are recruiting a subset of these past subjects, as well as matched controls, (total N=90) to undergo another MRI session in which structural, DTI, and connectivity assessments will be conducted. Comparisons between these and the earlier scans will provide insight into the changes in overall brain structure, white matter integrity, and function with age in subjects with alcohol exposure histories.

We postulate that brain maturation following PAE follows an altered trajectory relative to normal developing controls. This work will begin to examine a major gap in our knowledge about the impact of PAE by addressing for the first time the longitudinal changes in brain during the adult period, and identify gaps in knowledge regarding FASD in adulthood.

Principal Investigators:  Sandra Jacobsen, Ph.D. (Wayne State University, Detroit, Michigan), Joseph Jacobsen , Ph.D. (Wayne State University, Detroit, Michigan)

Consortium

Principal Investigator, Seattle site: Heather Carmichael Olson, Ph.D. (University of Washington, Seattle, Washington)

Consultant: Therese Grant, Ph.D. (University of Washington, Seattle, Washington)

Research Coordinator, Seattle site: Sandra Radin, Ph.D.

10/1/17 through 9/30/2021

Extensive evidence from experimental and epidemiological studies has linked prenatal alcohol exposure to a broad range of cognitive and behavioral deficits, growth impairment, and physical anomalies. However, to date there has been no systematic attempt to use sophisticated meta-analytic techniques to integrate data across studies, and virtually no information is available regarding the levels of exposure associated with an increased risk of clinically meaningful adverse effects. This study will integrate extensive data collected from five large U.S. prospective longitudinal cohorts, including a cohort from the University of Washington Fetal Alcohol and Drug Unit, to better define the nature of the adverse effects associated with prenatal alcohol exposure and to derive more reliable and robust estimates of effect size and critical dose. Although these five studies were conducted independently, there was substantial convergence in the approaches used to measure exposure and developmental outcomes. Three complementary statistical approaches will be used to evaluate effect size in four domains: cognitive function, externalizing behavior problems, growth, and physical anomalies. In these analyses, we will also consider the degree to which (a) larger effect sizes are associated with greater average daily dose vs. dose/occasion; (b) effect sizes appear to be stable or to increase or attenuate across development; (c) effect sizes differ for different aspects of cognitive and behavioral function; and (d) effect sizes are moderated by maternal age at delivery, history of alcohol use disorders, and/or body mass index. With respect to dose-response relationships, we will (a) examine the shape of the dose-response curves to identify nonlinearities and inflection points that may suggest threshold effects; (b) use benchmark dose analysis to determine critical doses of prenatal alcohol exposure at which there is an increased likelihood of clinically significant adverse effects; and (c) evaluate the sensitivity and specificity of critical doses suggested by these analyses for predicting a range of developmental outcomes. This project is being conducted by a team of leading fetal alcohol researchers in collaboration with an internationally respected expert statistician. Data from the study will be critically important to the further development and refinement of the diagnostic criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., recognizing FASD for the first time as a “condition in need of further study.”

Jacobsen, J.L., Akkaya-Hocagil, T., Ryan, L.M., Dodge, N.C., Richardson, G.A., Carmichael Olson, H., Coles, C.D., Day, N.L, Cook, R.J. & Jacobson, S.W. (2021). Effects of prenatal alcohol exposure on cognitive and behavioral development: Findings from a hierarchical meta-analysis of data from six prospective longitudinal U.S. cohorts. Alcoholism: Clinical & Experimental Research, 45, 2040-2058.

Principal Investigator: Susan Stoner, Ph.D.

Program Evaluator: Cara Ernst, M.S.

Research Coordinator: Stacy Dimmich, B.A.

Funded by the Washington State Health Care Authority, Division of Behavioral Health and Recovery (1997 – present)

07/01/21 through 06/30/23 (current biennium)

Washington State’s Parent-Child Assistance Program (PCAP) serves high-risk mothers who have used alcohol and/or drugs during pregnancy in King, Pierce, Yakima, Spokane, Cowlitz, Skagit, Clallam, Kitsap, Clark, Grays Harbor/Pacific, Thurston/Mason/Lewis, Whatcom, Snohomish, Benton/Franklin and Chelan Counties. Mothers are enrolled in PCAP during pregnancy or up to twelve months postpartum and up to twenty-four months postpartum when space allows, and receive three years of case management/advocacy, home visitation (when possible), coaching, and family support from experienced, highly trained and well-supervised case managers. The program has been operating in King County since July 1991, in Pierce County since July 1996, in Yakima and Spokane County since July 1999, in Cowlitz County since July 2005, in Skagit County July 2006, in Clallam and Kitsap Counties since July 2008, in Clark and Grays Harbor/Pacific Counties since July 2013, in Thurston/Mason/Lewis Counties since January 2016, in Whatcom, Snohomish and Benton/Franklin Counties since 2017, and in Chelan County since 2018. The primary goals of PCAP are to help mothers with substance use disorders achieve and maintain recovery, build healthy family lives, and prevent the births of subsequent alcohol/drug exposed infants. PCAP sites across the state work with the strengths and challenges of the unique communities in which they operate, while maintaining consistency in the theoretical foundations, core components, and operational protocols of the PCAP model.

Principal Investigators: Erin Maher, Ph.D. (University of Oklahoma, Norman, Oklahoma), Susan Stoner, Ph.D. (University of Washington, Seattle, Washington)

Co-Investigator: Therese Grant, Ph.D. (University of Washington, Seattle, Washington)

Funded by the Arnall Community Fund, Annie E. Casey Foundation, Oklahoma Department of Human Services

As a result of a partnership between the University of Oklahoma and the University of Washington and discussions with top leadership in the state, we have obtained funding to bring the well-established, award-winning, and demonstrated effective Parent-Child Assistance Program (PCAP) to Oklahoma. Doing so creates a unique opportunity to conduct a randomized controlled trial to obtain the level of evidence necessary for PCAP to be rated as “supported” or “well supported” in accordance with the Family First Prevention Services Act. We will conduct a randomized control trial of PCAP with 100 women in the experimental group, i.e., PCAP, and 100 women in a control group, i.e., services as usual. Data collection will occur at regular pre-described time periods. Outcomes to be examined include participants’ substance use, substance use disorder treatment treatment outcomes, and a host of other well-being outcomes including subsequent substance-exposed births, use of public assistance, education, use of family planning methods, child custody, and employment.