Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder Research Team, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
PLoS One. 2020 Jun 24;15(6):e0234895. doi: 10.1371/journal.pone.0234895. eCollection 2020.
Executive functioning and self-regulation influence a range of outcomes across the life course including physical and mental health, educational success, and employment. Children prenatally exposed to alcohol or early life trauma (ELT) are at higher risk of impairment of these skills and may require intervention to address self-regulation deficits. Researchers partnered with the local Aboriginal health organization and schools to develop and pilot a manualized version of the Alert Program® in the Fitzroy Valley, north Western Australia, a region with documented high rates of fetal alcohol spectrum disorder and ELT. This self-controlled cluster randomized trial evaluated the effect of an 8-week Alert Program® intervention on children's executive functioning and self-regulation skills. Following parent or caregiver consent (referred to hereafter as parent), 271 students were enrolled in the study. This reflects a 75% participation rate and indicates the strong community support that exists for the study. Teachers from 26 primary school classrooms across eight Fitzroy Valley schools received training to deliver eight, one-hour Alert Program® lessons over eight-weeks to students. Student outcomes were measured by parent and teacher ratings of children's behavioral, emotional, and cognitive regulation. The mean number of lessons attended by children was 4.2. Although no significant improvements to children's executive functioning skills or behavior were detected via the teacher-rated measures as hypothesized, statistically significant improvements were noted on parent-rated measures of executive functioning and behavior. The effectiveness of future self-regulation programs may be enhanced through multimodal delivery through home, school and community based settings to maximize children's exposure to the intervention. Despite mixed findings of effect, this study was an important first step in adapting and evaluating the Alert Program® for use in remote Australian Aboriginal community schools, where access to self-regulation interventions is limited.
执行功能和自我调节会影响人的一生的各种结果，包括身心健康、教育成功和就业。在子宫内接触酒精或早期生活创伤 (ELT) 的儿童更有可能出现这些技能受损的情况，可能需要干预来解决自我调节缺陷问题。研究人员与当地的土著健康组织和学校合作，在澳大利亚西北部的菲茨罗伊谷开发并试点了一种经过标准化的 Alert Program®，该地区有记录显示胎儿酒精谱系障碍和 ELT 的发病率很高。这项自我对照的聚类随机试验评估了为期 8 周的 Alert Program®干预对儿童执行功能和自我调节技能的影响。在家长或照顾者同意（此后简称家长）后，共有 271 名学生参加了这项研究。这反映了 75%的参与率，表明该研究得到了社区的大力支持。来自 8 所菲茨罗伊谷学校的 26 个小学教室的教师接受了培训，以便在 8 周内为学生提供 8 个小时的 Alert Program®课程。学生的学习成果通过家长和教师对儿童行为、情绪和认知调节的评分来衡量。儿童实际参加课程的平均次数为 4.2 次。尽管没有像假设的那样通过教师评分的测量方法发现儿童执行功能技能或行为有显著改善，但在家长评分的执行功能和行为测量中观察到了统计学上的显著改善。通过家庭、学校和社区等多种方式提供的未来自我调节项目的有效性可能会得到提高，从而最大限度地让儿童接触到干预措施。尽管效果存在差异，但这项研究是在澳大利亚偏远地区的土著社区学校中适应和评估 Alert Program®的重要的第一步，这些学校的自我调节干预措施有限。
