, 2004; Mattson, Riley, Gramling, Delis, & Jones, 1998; Russell, Czarnecki, Cowan, McPherson, & Mudar, 1991). The differences in the findings relating to the spontaneous and elicited play measures illustrate the difficulty in determining which alcohol-exposed infants are adversely affected. Given that the effect of prenatal alcohol on spontaneous play was not significant after adjustment for the HOME and SES, the data suggest that infant play observed casually by a clinician will not be relevant for assessing

fetal alcohol-related impairment, whereas a direct assessment CDK inhibitor of the infant’s capacity to imitate symbolic play behavior modeled by the examiner might well be highly informative. Identification of neurobehavioral biomarkers is particularly important in infancy when the facial dysmorphology is difficult to distinguish to facilitate determination of affected infants most in need of early intervention. A limitation of human fetal alcohol exposure studies is they that are by necessity correlational, and all possible confounding variables can not be controlled. However, replication of previous findings relating prenatal alcohol exposure to symbolic play in infants in two PD0325901 manufacturer independent, cross-culturally distinct populations suggest that

this is a robust finding. The alcohol information in this study relies on self-report from the mothers. The self-reports based on timeline follow-back interviews enabled us to examine

continuous measures of alcohol exposure, which were prospectively obtained during pregnancy by trained interviewers, an approach that we have previously Resveratrol shown to be more valid than retrospective self-report in predicting neurobehavioral outcomes (Jacobson et al., 2002). The validity of the self-report was further confirmed by findings showing significant correlations between maternal self-report of drinking during pregnancy and fatty acid ethyl esters of alcohol in meconium specimens obtained from a subsample of newborns from this cohort (Bearer et al., 2003). Diagnoses of FAS at 5 years also showed a dose-dependent relation between the maternal reports obtained during pregnancy and the subsequent severity of the diagnosis (Jacobson et al., 2008), thereby further strengthening the validity of the maternal self-report measure. In this cohort of infants from an urban socioeconomically disadvantaged community in Cape Town characterized by heavy prenatal alcohol use, it is of particular interest that competence in symbolic play was associated independently with both alcohol exposure in utero and quality of parenting. These data suggest that even infants whose symbolic play development is adversely affected by prenatal exposure may benefit from input from a responsive caregiver who uses play materials to provide appropriate stimulation.