Dr. Wozniak is a longtime FASD researcher. He discusses the value of the CIFASD initiative in building collaborations and his latest research on brain stimulation as an intervention for children and adolescents, MRI as a diagnostic tool, and the role of white matter in FASD.
Dr. Jeffrey Wozniak has been a leading researcher on FASD for over 20 years and has been a professor at the University of Minnesota since 1996. He has for many years been deeply involved in CIFASD (the Collaborative Initiative on FASD), which is a project of NIAAA (National Institute on Alcohol Abuse and Alcoholism) that is designed to bring researchers from different specialties who work on FASD together to work in collaboration.
FASD United recently spoke with Dr. Wozniak about his research and how his important work is supported by CIFASD. Working in the Department of Psychiatry & Behavioral Sciences with a background in pediatric neuropsychology, Dr. Wozniak describes his research as at its core being about “understanding the implications of FASD and testing new treatments and interventions.” His work focuses on understanding the implications of prenatal alcohol exposure (PAE) for cognitive development, which involves areas such as learning, memory, and executive function. His research utilizes tools that look at the structure of the brain and measure the performance of the brain, all in service of developing new interventions and treatments for those living with FASD.
“I love working on interventions and treatments, and I continue to gain new ideas from working with individuals living with FASD,” Dr. Wozniak told me. He describes research in FASD as complex, very involved, quite expensive, and with very long timeframes. Despite this, the work has been well worth it. Dr. Wozniak told me, “We have been successful in our research so far and we plan to continue our progress.”
Dr. Wozniak describes his introduction to FASD as coming from seeing patients with FASD at the university’s clinic, stating, “I found FASD a very interesting condition to work with in the clinic because the needs of people affected by PAE are so specific and unique to that individual, and with children there is even more variety depending on the developmental stage they are going through. It’s a high-needs clinical population because of the complexity.”
As Dr. Wozniak puts it, “The FASD field has kept me all these years because it’s a small community of folks who work on FASD clinically or in research and I have gotten to know many of these individuals from around the world. It’s been such a rewarding community to be a part of because we know each other and collaborate with each other, and we’re focused on similar goals.”
Dr. Wozniak described CIFASD as tremendously valuable for collaboration, which has greatly enhanced his research. “In science, researchers often stay in their realm and have limited interactions outside of that,” Dr. Wozniak remarked. “To have a single entity in CIFASD with the ability to bring people together from different backgrounds, under the leadership of NIH, is very powerful. CIFASD contributes to a lot of collaborations that would not otherwise happen.”
A substantial number of publications have come out of CIFASD work. Dr. Wozniak characterizes that productivity as “driven by the synergy you get when you bring people together.” In addition, “The leadership from NIAAA in CIFASD yields extra impact to the work.” NIAAA is committed to disseminating the research, in partnership with FASD United. Dr. Wozniak adds that, “CIFASD allows the researchers to be connected to the larger FASD field and FASD community.”
“I have gained a great perspective from CIFASD in understanding the research that’s taking place at all levels of FASD, from the scientific and minute cellular level to the national public policy level and everywhere in between,” Dr. Wozniak stated, adding that CIFASD makes it possible for him to put his own work in the context of this big picture and to see how he can maximize the benefits of his research. “I see how my research can go beyond the limits of a niche by showing how it can fit into the bigger picture. CIFASD actively causes us to stretch our research, and that’s a major benefit.”
By bringing people together, CIFASD enables efficiencies in Dr. Wozniak’s work, allowing him to share some of the same infrastructure with colleagues. For example, tools for diagnostic evaluations are shared, providing for consistency. As an example, researchers can share the genetic findings from an animal model with each other and then connect these to findings from human samples.
“Science, in the traditional model, can be a lonely endeavor,” Dr. Wozniak points out. “CIFASD is a regular ongoing community and a set of relationships that form as a result, that leads researchers to feel attached. I feel attached to this community because I know these people. Before CIFASD, other FASD researchers were abstract names in a professional journal. Getting to know them personally makes me feel that my contributions are having an impact and influencing the people that are designing the next sets of studies.”
On a personal and professional level, Dr. Wozniak expressed his deep gratitude in getting to know Dr. Kenneth Jones, who first coined the term fetal alcohol syndrome in 1973 and continues to work in the FASD field. Dr Wozniak told me that working with and getting to know Dr. Jones, through CIFASD, has been a highlight of his career, not only because of Dr Jones’ history of studying FASD, but also because of the person that he is.
“I get a boost of professional motivation from getting to know someone like Dr. Jones, who is as deeply invested in the FASD work as he is. That has influenced and motivated me and given me more compassion for people living with FASD,” Dr. Wozniak adding that, “These relationships are everything in a field that can sometimes be a bit dry and about data and numbers on a computer. It is so important to feel the human element of the science. This is critical to keeping me motivated through the long processes of scientific research.”
Dr. Wozniak lit up as he described his memories of working, as part of CIFASD, with Dr. Kenneth Jones. Dr. Jones would come to Dr. Wozniak’s clinic in Minnesota and evaluate patients who were enrolled in CIFASD studies. He would often come for a weekend and see about 30-35 patients over 2 or 3 days, for the purpose of standardizing the evaluation of FASD across clinics. “Those weekends remain highlights of my career,” Dr Wozniak told me. “It was so exciting to see these families be evaluated by the person who founded this field. It was a highlight watching his interactions, seeing his joy in working with children and his compassion for people, his generosity through the dedication of his time.”
Dr. Wozniak was excited to describe some of his ongoing FASD research that is supported by CIFASD. He is currently studying brain white matter in the context of FASD. Dr. Wozniak describes white matter as the wiring of the brain. “Within the brain, there are many nerve cells that carry information across the brain, from one side to another, bundled together and wrapped in an insulation called myelin. The purpose of this insulation is to speed up the signals along the wiring. The information is being passed very quickly and when there are deficiencies in the white matter, the brain can’t carry the information as effectively. As an analogy, it’s like when a website loads very slowly because something is down.
Dr. Wozniak’s CIFASD-supported research has found that PAE can interfere with the development of this white matter insulation, causing information processing to slow down. MRI has shown that people with FASD have impacts to their white matter that interrupt information processing. Dr. Wozniak concludes that, “this probably contributes to problems we see in individuals with FASD related to learning, memory, and attention. These are all skills that require high speed information processing.”
Dr. Wozniak talked to me about his ongoing research into practical interventions for FASD. “There are very few interventions for FASD, and relatively few interventions for neurodevelopmental disorders in general,” Dr Wozniak told me. “My research has tried to capitalize on development as a source of leverage. Development is a natural process that happens regardless of outside circumstances like education or nutrition. Children grow and develop, and this gives us a natural built-in source of energy as far as growth.”
Dr. Wozniak is looking at ways to leverage this energy to improve the lives of people with FASD. An important part is knowing which developmental window to target. “We are developing an intervention using cognitive stimulation as an intervention for older kids, school age children and adolescents, that we can tailor for the particular development that occurs during this stage.” As Dr. Wozniak described it, cognitive training and brain stimulation work together. “Cognitive training by itself has some benefits but they’re limited. Brain stimulation by itself doesn’t do much of anything. When combined, these act together and produce synergistic effects.”
The idea underlying this intervention is that “cells that fire together wire together.” In the brain, if a connection is repeatedly being used, it will become stronger and the connection will last. The way this intervention works is that children and adolescent patients in the clinic will practice important cognitive skills, such as memory or planning skills. “While they are working on these skills, we stimulate the outermost layers of the brain with a simple device, through the scalp, the very outer layers of the brain’s cortex where very important cells reside. When we stimulate the parts of the brain that are being used in these skills, the brain takes that as a signal to strengthen these connections.”
As Dr Wozniak describes it, “The repetition of skills and the extra stimulation to the brain give a boost to building stronger connections. The brain tells itself, “This is important.” The brains of school-age kids and adolescents are quite adaptable at this age. “We’re hoping to capitalize on the development that is happening at this age and to push it in a particular direction to improve outcomes.”
In addition, Dr. Wozniak is studying MRI (magnetic resonance imaging) as a diagnostic tool for FASD. Currently, MRI is not used to diagnose FASD. Dr. Wozniak explained that, “We currently diagnose FASD on the basis of some knowledge of alcohol exposure, along with physical measurements of the head and face, and measuring a person’s cognitive performance. Measuring head circumference with a tape measure is a pretty good, though crude, way of seeing if the brain is small in size.” Yet, as Dr. Wozniak pointed out, this method has some flaws. “We are measuring the skull instead of the brain directly. Kids move around, people have differences in hair and head shape, so MRI can offer a more precise method.”
Dr. Wozniak described how he and his team can take an MRI of an individual with FASD, put it through an MRI-based brain growth chart, and get a more accurate assessment of their relative brain size. “We can also measure particular centers in the brain, such as the memory center, and get a growth chart measurement of that. This allows us to pick up some kids that would not have been picked up with measuring physical head circumference.” This approach is yielding results. “Studies are showing that MRI picks up a significant number of individuals who would not be identified on the physical measurement alone. This can allow us to identify more individuals to target with interventions aimed at developing their brains.”
Towards the end of our conversation, Dr. Wozniak expressed his heartfelt appreciation for the opportunity to be part of CIFASD. “It contributes greatly to my understanding of the big picture of FASD. CIFASD has gone through a number of iterations and cycles and continues to thrive because it has been very productive in yielding research and new collaborations and building momentum for the FASD field. For those of us that are part of it, CIFASD gives us a community to attach to. Through my work with CIFASD, I feel an added motivation in my research that comes from being part of a community.”