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2009 March

Sensory Processing and Stress Reactivity in Children with Fetal Alcohol Spectrum Disorders

Tracy Jirkowic, PhD, OTR/L
Assistant Professor

Rehabilitation Medicine, Div. of Occupational Therapy

Description: Prenatal alcohol exposure may result in a continuum of neurobehavioral impairments known as Fetal Alcohol Spectrum Disorders (FASD). Sensory processing problems are among the neurobehavioral problems associated with FASD. Children with sensory processing disorders (SPD) misinterpret everyday sensation (e.g. touch, sound, movement) which can lead to behavior, adaptive or developmental impairments. High rates of SPD (80-88%) are reported among clinical samples of children with FASD (Franken et al, 2008; Jirkowic et al, 2008) in association with more problem behaviors (r = -.72; P < .05) and poorer adaptive skills (r = .42; p < .05). Although emerging empirical evidence now substantiates clinical and anecdotal reports of SPD symptoms among children with FASD these problems have been studied from only a behavioral perspective. SPD have been studied extensively among other groups of children with neurodevelopmental disabilities (e.g. autism) using psychophysiologic methods. Findings clearly link behavioral symptoms to sensory reactivity and atypical autonomic nervous system responses.

Expanding the investigation of SPD among children with FASD to include psychophysiologic methods provides a more direct and objective means to identify atypical sensory processing patterns and validate caregiver reported behavioral symptoms. Clinically, a richer understanding of SPD among a high-risk population with multiple and complex neurobehavioral problems can help clinicians and parents disentangle challenging behaviors associated with SPD and guide intervention. This study aims to examine the behavioral and physiological correlates of SPD among a clinical sample of children with FASD compared to a matched peer group with typical development. The first goal is to determine the feasibility of a standard laboratory protocol that gauges psychophysiological reactivity to sensation with children with FASD. The second is to lay the groundwork for a future study that examines SPD among a larger FASD sample and more fully investigates the relationships between SPD; child behaviors, and parenting behaviors.

Resulting articles & projects:

  • This study produced pilot data to be used for an NIH R01in preparation that will be submitted in Fall 2016.
  • Hansen, K. & Jirikowic, T. (2013). A comparison of the sensory profile and sensory processing measure- home form for children with fetal alcohol spectrum disorders. Physical and Occupational Therapy in Pediatrics, 33(4):440–452, 2013. View article
  • Jirkowic, T., Molton, I., Pettet, M., & Nash, J. Sensory Processing and Stress Reactivity: A Pilot Study Comparing Children With Fetal Alcohol Spectrum Disorders And Children Without Prenatal Alcohol Exposure. (submitted).
  • Jirikowic, T., Molton, I., Nash, J., & Pettet, M. (2013). Sensory processing and stress reactivity: Comparison of children with fetal alcohol spectrum disorders to children without prenatal alcohol exposure. [Abstract] Alcoholism: Clinical and Experimental Research, 37(6).
  • April, 2014: Comparison of the Sensory Profile and Sensory Processing Measure Home Form for children with fetal alcohol spectrum disorders. Research paper presented American Occupational Therapy Association Annual Conference and Exposition. San Diego, CA (Hansen & Jirikowic).
  • April 2015: Sensory processing and stress reactivity: Comparison of children with fetal alcohol spectrum disorders to children without prenatal alcohol expossure Research paper/platform presented American Occupational Therapy Association Annual and Exposition. Baltimore, MD (Jirikowic & Nash).
  • May 2013 Sensory Processing and FASD: FASD: Best Practices in the Last Frontier Anchorage, AK.
  • May 2014 Sensory Processing and Occupational Therapy Supports to Enhance Daily Function in Children with FASD. Developing Strategies Post Diagnosis for Individuals with FASD Conference, Lakeland Centre for FASD University of Alberta, Edmonton

Prescription Opioid Use among Adolescents: Risk Factors for Chronic Use and Association with Substance Abuse

Laura Richardson, MD, MPH
Associate Professor

Pediatrics

Description: Objective: To understand patterns of prescription use of opioid medications among youth including examining risk factors for chronic use and the impact of chronic use on the development of subsequent abuse of opioids or other substances. Background: opioids are one of the most commonly abused drugs among adolescents. Despite a recent rise in opioid abuse among adolescents and the fact that 37% of 12th graders report that opioids are "fairly easy" or "very easy" to obtain, little is known about how adolescents are accessing these drugs or the factors that predispose to abuse of these drugs. Prescription medications are one potential source of opioids used for abuse. Total prescriptions of opioid medications have increased over the past two decades, paralleling the increase in abuse of these substances. Among adults, chronic opioid use has been associated with increased risk for the development of abuse or addiction and individuals with a history of mental health disorders or substance use are at increased for chronic opioid use. However, little is known about patterns of prescription use or risk factors for opioid abuse among youth who may be at even greater risk for developing addiction given their developing brains. Methods: This project will use a large nationally-representative dataset to enhance understanding regarding prescription opioid use among youth, with a particular focus on chronic use of these medications. This represents an opportunity to analyze previously unavailable data to assess risk factors for prescription opioid use and substance abuse, including potential associations with opioid use and abuse among parents and other family members. This also represents a new direction for the principal investigator and will provide important pilot data for future funding endeavors to explore prescription opioid use and its association with opioid and other substance abuse among youth.

2009 October

Substance Abuse and Psychiatric Disorders in Intensive Care Unit Survivors

Dimitry S. Davydow, MD
Acting Assistant Professor

Psychiatry & Behavioral Sciences

Description: Over the last decade, an evidence base has accumulated for the beneficial effects of alcohol screening and brief intervention or referral for treatment (SBIRT) for trauma survivors. This evidence led the American College of Surgeons Committee on Trauma to mandate that Level 1 trauma centers must have an alcohol screening and intervention mechanism for injured patients. Recent policy initiatives are attempting to extend alcohol SBIRT to non-injured inpatients.

A large and relatively understudied patient population is non-traumatically injured intensive care unit (ICU) survivors. Approximately 4.4 million Americans require ICU admission annually for the treatment of critical illnesses. Survivors are often faced with a long, complicated recovery, including comorbid psychiatric disorders and diminished quality of life. Few studies have been completed examining the epidemiology of alcohol use disorders in non-injured ICU survivors. Furthermore, little is known about potential risk factors for persistent alcohol use in critical illness survivors. Moreover, alcohol misusing ICU survivors may be open to the "teachable moment," similar to the hypothesized mechanism of SBIRT in trauma survivors.

Our goal is to prospectively evaluate the epidemiology of alcohol use disorders in a cohort of non-traumatically injured ICU survivors. We hypothesize that we will observe a reduction in drinking in the months immediately post-ICU, followed by a recurrence in drinking over the course of the year post-ICU as has been described in traumatically injured cohorts. We will examine potential risk factors for increased alcohol use at 3 and 12 months post-ICU. We will also evaluate the longitudinal course of drug use post-ICU. This research could lead to the development of interventions to limit substance use in critical medical illness survivors, which in turn could inform the evidence base required to extend policy mandates for SBIRT

Resulting articles & projects:

  • Davydow DS, Zatzick D, Hough CL, Katon WJ. A longitudinal investigation of alcohol use over the course of the year following medical-surgical intensive care unit admission. Psychosomatics 2013;54(4):307-16. doi: 10.1016/j.psym.2013.01.003. [ PubMed abstract ]. ]
  • Davydow DS, Zatzick D, Hough CL, Katon WJ. A longitudinal investigation of posttraumatic stress and depressive symptoms over the course of the year following medical–surgical intensive care unit admission. Gen Hosp Psychiatry 2013;35(3):226-32. doi: 10.1016/j.genhosppsych.2012.12.005. [ PubMed abstract ]. ]

Study and Travel Abroad Research Project

Eric R. Pedersen, MA
Pre-doctoral Student

Psychology

Mary E. Larimer, PhD (Mentor)
Professor, Psychiatry & Behavioral Sciences

Description: Study Abroad (SA) programs in the United States promote cultural, experiential, and personal development for a growing number of college students ever year. However, research shows increased and problematic alcohol use during SA experiences and continued elevated drinking upon return home. In addition, SA students may be a self-selecting subgroup of students who drink at greater rates than non-SA students both prior to and after trips. Despite increasing numbers of SA students each year and a growing concern about this high-risk event, there is sparse research available documenting effective preventive programs with these students. Our work suggests perceptions of SA peer drinking are a risk factor for increased alcohol use while abroad, while components related to engaged participation and immersion in the culture (EPIC) while living abroad may protect against problematic use.

Employing a 2 x 2 longitudinal intervention design with an assessment-only control condition, our study seeks to prevent increased and problematic alcohol use by correcting misperceptions of SA student norms and by promoting engagement into the host culture through brief online personalized feedback interventions. This selective prevention intervention will be pilot tested with a sample of 400 SA students from the University of Washington. Three intervention conditions including personalized normative feedback (PNF) only, EPIC feedback only, and combined PNF + EPIC feedback will be empirically examined in comparison to an assessment-only control condition. Mediators of intervention efficacy, including changes in perceived norms and changes in EPIC components, and a moderator (region of study) will be investigated. This project addresses the public health concern of problematic drinking among an at-risk population lacking empirically supported intervention. In addition, this research can inform future work with other groups during transitions to new environments/cultures, e.g. international students, foreign aid workers, and military personnel.

Resulting articles & projects:

  • This grant funded the research for Dr. Pedersen's dissertation.
  • Pedersen, E. R., Skidmore, J. R., & Aresi, G. (in press). Demographic and predeparture factors associated with drinking and alcohol-related consequences for college students completing study abroad experiences. Journal of American College Health.
  • Pedersen, E. R. (2013). Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad. Paper presented at the Oral Communication Session 10 “Tweetment” in the 21st Century of the 75th annual meeting of the College on Problems of Drug Dependence, San Diego, CA.
  • Pedersen, E. R., & Skidmore, J. R. (2013). Demographic and predeparture factors associated with drinking and alcohol-related consequences for college students completing study abroad experiences. Poster presented at the 47th annual meeting of the Association for Behavioral and Cognitive Therapies, Nashville, Tennessee.
  • Pedersen, E. R. (2012). Brief online interventions targeting risk and protective factors for increased and problematic alcohol use among American college students studying abroad. Poster presented at the 35th annual meeting of the Research Society on Alcoholism, San Francisco, CA.
  • Although an initial application for an R01 based on this project was not funded, in October 2013 Dr. Pedersem was awarded as PI, an R34 grant from NIAAA (R34 AA022400) to conduct an online alcohol intervention with young adult veterans in the community. "My experience with recruitment and retention of online participants was a major strength cited by reviewers. This experience also helped me as obtain funding as co-I for another NIAAA R34 with UW alumni Karen Osilla (PI) (R34 AA023123) for an online couples-based alcohol intervention with military spouses."