A swirling tornado of energy—that’s how ShawnMarie Prevost describes her 6-year-old daughter, Kailei.

“She sings, she hums, she moves,” ShawnMarie Prevost says. “She’s jacked. She’s just always, always going.”

Kailei’s constant motion rises above the typically high energy level of a first-grader. She is affected by fetal alcohol spectrum disorder (FASD), a cluster of symptoms caused by prenatal alcohol exposure and characterized by developmental concerns such as hyperactivity, difficulty focusing, and cognitive problems, and sometimes a set of physical attributes as well. 

Kailei also was born addicted to opioids (her birth mother was in a methadone program) and spent almost two months in the neonatal intensive care unit withdrawing before ShawnMarie and Shane Prevost, her eventual adoptive parents, brought her home. Then Kailei spent another 10 months withdrawing from the methadone at home.

Exposures like these so early in a child’s life can have lasting and significant effects on the developing brain, and Kailei is no exception. Besides FASD, she also has been diagnosed with attention deficit hyperactivity disorder, sensory processing disorder, and Tourette’s syndrome.

The Prevost family, which includes three other children (including Kailei’s biological brother, 8-year-old Kasten, who also has FASD), bought a trampoline for their home to help the kids release some of their physical energy, and they’re experts in moving quickly from one activity to the next. 

The kids’ most significant challenges, ShawnMarie Prevost says, involve managing their emotions.

“Kailei really cannot self-regulate,” she says. “When she gets upset, if she gets past a five on a scale of one to 10, you have to ride the wave. It could go on for an hour and a half, or it could go on for 10 minutes. You don’t know. It’s not for the fainthearted.”

So when the Prevosts heard about a study at the University of Minnesota that aims to help kids with FASD, they were eager to sign on.

U researchers believe that giving choline, a nutrient essential for brain development, during a specific timeframe could improve these kids’ memory and executive functions such as planning and organizing. Kailei was enrolled, but Kasten did not fit the age criteria.

“What we’re hoping is that, by affecting these attention and memory systems early on, it allows these children then to do everything from that point forward just a little bit better,” says Jeffrey Wozniak, Ph.D., a University of Minnesota Medical School psychiatry professor and coprincipal investigator on the study. “So even if that’s 1% better, over time, with 24 hours a day, 7 days a week, that could be a huge change. All of development is additive, meaning that early interventions can be quite powerful in the long run.”

Why timing matters

It’s hard to overstate the value of a strong start to a child’s brain development. That’s because about 80% of brain growth happens before a child turns 3 years old.

“There’s a trajectory, and each stage begets the next stage,” says Michael Georgieff, M.D., executive vice chair for the Medical School’s Department of Pediatrics and holder of the Martin Lenz Harrison Land Grant Chair in Pediatrics. “So where can you make the biggest influence? Early on.”

Georgieff, Wozniak, and their colleagues from across the University are coming together through a new institute (see sidebar) to find out more about how the young brain develops during its two most sensitive periods—the first 1,000 days of life and adolescence.

Their choline study capitalizes on the first of those periods. The team worked with two groups of children affected by FASD: 2- to 3-year-olds and 4- to 5-year-olds. Half of the children in each group received the choline supplement (in the form of a fruity, slightly fizzy 4-ounce beverage) daily for 9 months. Half got a placebo.

ShawnMarie Prevost observed that Kailei, then 4, seemed calmer when she was in the study. “She seemed like she was more engaged. It seemed like she didn’t have that intense hyperactivity when she was on the choline.”

And overall, the U team observed small but significant changes, most notably in the 2- to 3-year-olds, says study collaborator and associate professor of pediatrics Christopher Boys, Ph.D. The choline recipients showed higher nonverbal intelligence, better working memory, fewer behavioral symptoms, and better attention than their peers who did not get it.

“For me, clinically, this impact is important from a functional standpoint,” says Boys, also an M Health Fairview pediatric neuropsychologist who works with children affected by FASD and other neurodevelopmental disorders. “The working memory aspect and those precursors to executive function—that’s where we often will see weaknesses [in kids who have FASD]. Anything we can do to try to change that trajectory is really important.”

A widening gap

The team is encouraged by the findings of a four-year follow-up study on the choline recipients as well. Investigators measured qualities like memory, intelligence, and problem-solving skills, and now they’re seeing more separation between the choline group and the placebo group.

“That’s exactly what we would expect to see with developmental change,” Wozniak says. “If we make the change back at age 2 or 3, by the time they’re 6, 7, 8, 9, you would expect that there’s going to be more of an improvement. That’s the idea with a developmental intervention. It should result in a widening of the gap.”

Wozniak isn’t sure exactly how much benefit the choline intervention might bring to these kids, but he believes what he’s seen so far is significant enough to keep moving forward.

“It’s a noticeable difference in their learning,” he says, “to the point that they would be much closer to a typically developing child than the untreated FASD trajectory.”

And that has a societal benefit that goes far beyond childhood.

“Someone who has fetal alcohol spectrum disorder otherwise is going to have lifelong difficulties with attention and memory and all the things that build off of attention and memory systems, like problem-solving,” Wozniak says. “We would expect that [the benefits of affecting their] brain development early would be with them for their lifetime.”