Developmental delay of infants and young children with and without fetal alcohol spectrum disorder in the Northern Cape Province, South Africa

Abstract

Objective: To describe the extent and nature of developmental delay at different stages in childhood in a community in South Africa, with a known high rate of Fetal Alcohol Spectrum Disorder (FASD). Method: A cohort of infants, clinically examined for FASD at two time periods, 7-12 months (N= 392; 45 FASD) and 17-21 months of age (N= 83, 35 FASD) were assessed using the Griffiths Mental Developmental Scales (GMDS). Results: Infants and children with FASD perform worse than their Non-FASD counterparts over all scales and total developmental quotients. Mean quotients for both groups decline between assessments across subscales with a particularly marked decline in the hearing and language scale at Time 2 (scores dropping from 110.6 to 83.1 in the Non-FASD group and 106.3 to 72.7 in the FASD group; P=0.004). By early childhood the developmental gap between the groups widens with low maternal education, maternal depression, high parity and previous loss of sibling/s influencing development during early childhood. Conclusion: The FASD group show more evidence of developmental delay over both time points compared to their Non-FASD counterparts. Demographic and socio-economic factors further impact early childhood. These findings are important in setting up primary level psycho-educational and national prevention programmes especially in periurban communities with a focus on early childhood development and FASD.

Five year neurodevelopment outcomes of perinatally HIV‐infected children on early limited or deferred continuous antiretroviral therapy

“…The GMDS may be insufficiently sensitive to discriminate between the groups at five years, thus creating an impression of “catch up” in the infected groups. Alternatively, the effects of poverty and deprivation on early childhood development may outweigh those of the different ART strategies on neurodevelopment .…”

“…The GMDS may be insufficiently sensitive to discriminate between the groups at five years, thus creating an impression of "catch up" in the infected groups. Alternatively, the effects of poverty and deprivation on early childhood development may outweigh those of the different ART strategies on neurodevelopment [22,23]. p-values for pairwise comparisons between groups for general Griffiths quotients The decline in all GMDS scores except for the personalsocial subscale most likely reflects the application of British norms [11,12] to South African children from impoverished environments, and emphasizes the importance of having uninfected controls from the same communities.…”

Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders

“…Slightly more advantaged social and developmental circumstances have likely mitigated some of the teratogenic damage exerted by alcohol prenatally. 96 So even though this model underestimates the negative effects of prenatal alcohol exposure, it promotes a more complete understanding of maternal traits which protect or remediate exposed children. Therefore the promise of early intervention via intellectual and behavioral stimulation for FASD children is demonstrated here in a disadvantaged population.…”

Alcohol exposure during pregnancy altered childhood developmental trajectories in a rural South African community

“…This prospective study compared the developmental trajectories from year one to year five for prenatally alcohol‐exposed children without syndromic features to those of children with FAS/pFAS and to unexposed controls, in a poorly‐resourced rural community in South Africa. The differences between the groups at year five, when the children were 5–6 years, were considerably larger than those reported in the same cohort when children were younger at 7–12 months and 17–21 months of age . As expected, infants diagnosed with FAS/pFAS performed worse at both year one and year five over most developmental domains when compared to other groups and struggled most with the higher‐order cognitive tasks associated with manipulation and regulation.…”

“…As expected, infants diagnosed with FAS/pFAS performed worse at both year one and year five over most developmental domains when compared to other groups and struggled most with the higher-order cognitive tasks associated with manipulation and regulation. This difficulty with higher cognitive functions, which becomes even more apparent with age, has been well described with FAS (7,8,11,13,19).…”