title: Infant emotional withdrawal: a precursor of affective and cognitive disturbance in fetal alcohol spectrum disorders.
abstract: BACKGROUND
  Our aim was to test the hypothesis that emotional withdrawal is an early indicator of affective disorder in infants heavily exposed prenatally to alcohol, which is independent of alcohol-related effects on mother-infant interaction and temperament and discriminated between children later diagnosed with fetal alcohol syndrome (FAS) and partial FAS (PFAS) and predicted cognitive and affective outcomes at 5 and 9 years.
  
  
  METHODS
  The sample consisted of Cape Coloured (mixed ancestry) infants, whose mothers were interviewed during pregnancy regarding their alcohol consumption using a timeline follow-back approach. Infant emotional withdrawal (n = 85) was assessed on the Alarm Distress Baby Scale at 6.5 months. Mother-infant interaction was evaluated from video recordings during free play and infant feeding at 6.5 months (n = 127). Infant temperament was assessed by maternal report on the EAS Temperament Survey at 13 months (n = 119). Sociodemographic and psychological correlates of maternal alcohol use and infant iron deficiency were examined as potential confounders. The children were diagnosed for FAS/PFAS by expert dysmorphologists at 5 years, cognitive and affective function at 5 and 9 years.
  
  
  RESULTS
  Prenatal alcohol exposure was associated with increased infant emotional withdrawal and decreased activity, but unrelated to mother-infant interaction or any other temperament measures. Children later diagnosed with FAS and PFAS at 5 years exhibited more emotional withdrawal and less responsivity and activity as infants. Infant withdrawal, responsivity, quality of interaction, and maternal sensitivity also predicted poorer IQ and affective response at 5 and 9 years. When all 4 infant affective measures were examined simultaneously in a regression analysis, only infant emotional withdrawal persisted as a significant predictor of 9-year IQ.
  
  
  CONCLUSIONS
  This study is the first to document a direct effect of fetal alcohol exposure on emotional withdrawal in infancy. These data link prenatal alcohol to a specific aspect of infant affective function not attributable to mother-infant interaction, infant temperament, or other socioemotional aspects of the infant's environment and identify infant emotional withdrawal as an early indicator of affective disturbance, particularly in children later diagnosed with FAS and PFAS.
authors.affiliation: Department of Psychiatry and Mental Health , Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Molteno
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Jacobson
authors.forename: R Colin
authors.initials: RC
authors.lastname: Carter
authors.forename: Neil C
authors.initials: NC
authors.lastname: Dodge
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Jacobson
mesh_terms: D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000139:chemically induced* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000139:chemically induced* / Q000523:psychology*; D004522:Educational Status; D004644:Emotions / Q000187:drug effects; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000523:psychology*; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000187:drug effects*; D007231:Infant, Newborn; D007360:Intelligence; D000090463:Iron Deficiencies; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D009483:Neuropsychological Tests; D009752:Nutritional Status; D011247:Pregnancy; D012919:Social Behavior; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications; D013694:Temperament / Q000187:drug effects; D055815:Young Adult
keywords: Draw-A-Person Test; Fetal Alcohol Syndrome; IQ; Infant Emotional Withdrawal; Infant Temperament; Iron Deficiency; Mother-Infant Interaction; Prenatal Alcohol Exposure
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