As many as 13% of infants born in the United States are exposed t

As many as 13% of infants born in the United States are exposed to varying levels of alcohol during pregnancy, with higher rates found among disadvantaged populations (Center for Disease Control and Prevention, 2002). Descriptive studies spanning three decades have identified a broad range of neurocognitive and behavioral deficits in children with fetal alcohol spectrum disorder (FASD). FASD ranges from the most severe, fetal alcohol syndrome (FAS), which is characterized by a distinctive craniofacial dysmorphology, small head circumference, and pre- and/or postnatal growth retardation, to children with alcohol-related

neurodevelopmental disorder (ARND), who exhibit significant cognitive impairment but lack the distinctive facial anomalies (Hoyme et al., 2005). Children with FASD exhibit deficits in diverse domains, BGB324 mouse including verbal intelligence quotient (IQ; Jacobson, Jacobson, Sokol, Chiodo, & Corobana, 2004), arithmetic

(Goldschmidt, Richardson, Stoffer, Geva, & Day, 1996; Howell, Lynch, Platzman, Smith, & Coles, 2006; Jacobson et al., 2004; Streissguth et al., 1994), and executive function (Coles, Platzman, Raskind-Hood, Falek, & Smith, 1997; Kodituwakku, Handmaker, Cutler, Weathersby, & Handmaker, 1995). Although objective criteria have been developed to diagnose the facial anomalies and growth Luminespib retardation associated with FAS in preschool and school-age children, the facial dysmorphology is difficult to identify in infants and the cognitive and behavioral deficits are nonspecific. Neurobehavioral deficits

of prenatal alcohol exposure have been linked to the Bayley Scales of Infant Development in several studies (Golden, Sokol, Kunhert, & Bottoms, 1982; J. L. Jacobson et al., 1993; Streissguth, Barr, Martin, & Herman, 1980). In the Detroit Longitudinal Alcohol Exposure Study, an attempt was made to identify specific neurobehavioral markers of fetal alcohol exposure by administering a series of DOCK10 narrow-band infant tests, and elicited symbolic play emerged as one of the most sensitive and specific endpoints (S. W. Jacobson, Jacobson, Sokol, Martier, & Ager,1993). This study used the Belsky, Garduque, and Hrncir (1984) 14-level standardized measure of infant play development to assess spontaneous play, the level the infant exhibits during free play, and elicited play, the highest level the infant exhibits when attempting to imitate the examiner. By analogy to language development, the highest level of spontaneous play indicates the child’s performance level. Based on the assumption that the infant can not imitate a behavior that s/he does not understand and can not assimilate, the highest level of play elicited by the examiner can be considered to indicate the child’s competence. Few studies have examined the influence of both socioenvironmental and prenatal and perinatal risk factors on the development of symbolic play in infancy.

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