The six-year-old boy plays the game Operation, skillfully wielding a pair of tweezers in a school gym that doubles as a research lab. His brain has been damaged by the alcohol his mother drank when he was in the womb, but he's adept at extracting tiny plastic bones.
"When it gets too easy we will have him switch to his left hand," says Chris Bertram, a scientist at the University of the Fraser Valley in Abbotsford, B.C., who is investigating whether children with a fetal alcohol spectrum disorder, or FASD, can rewire their brains by improving their strongest motor skills. Advances in understanding neuroplasticity, or how experience can change the brain, have led to therapies that have helped people who have suffered strokes or traumatic brain injuries learn to speak again or move paralyzed limbs. Now, a growing number of scientists hope the revolution can help children whose brains were damaged by alcohol before they were born.
They are testing different approaches - including computer games and other specialized training - in hopes of helping kids with FASD strengthen connections in their brains and boost their cognitive skills.
Dr. Bertram and his colleagues have assessed all eight kids with FASD who are hard at play at various stations in the gymnasium. All are good at something, perhaps the fine motor skills needed to pluck a rib out of a cartoonish chest or the co-ordination needed for the interactive videogame Dance Dance Revolution.
But they have a wide variety of cognitive and emotional problems that include trouble paying attention, remembering what they have learned, anticipating the consequences of their actions and controlling their impulses. Hyperactivity is common; they can be challenging to manage at home and at school. Dr. Bertram's hypothesis is that the eight-week program will do more than just improve their rope climbing and free-throw shooting.
The idea is that improving one area of brain function, in this case motor skills, will also boost their ability to pay attention and to regulate their impulses. He is still analyzing the data from the 35 kids who have been through the program, but the preliminary results have been encouraging, he says.
"We call it transfer of learning, or transfer of performance," Dr. Bertram says.
Alcohol damages many parts of the developing brain, says Christian Beaulieu, a brain imaging expert at the University of Alberta. It can affect areas and structures critical for memory, learning and abstract thinking. He and his colleagues have shown it also damages white matter, the connections that allow parts of the brain to communicate and work together.
But recent experiments with laboratory animals offer hope. At the University of Victoria, Brian Christie has been able to reverse the brain damage caused by fetal alcohol exposure in rats by getting them to exercise.
No one expects it will be so easy in humans.
"The rat brain doesn't have the same complexities," says Dr. Christie, a member of B.C's Brain Research Centre.
Dr. Bertram says that many of the current therapies or interventions being used with children with FASD focus on their deficits - for example, anger management therapy for a child who is acting out in school or extra time devoted to reading or math for a child struggling in those subjects.
"Traditional intervention programs have these kids doing things their brains are not adept at doing, and their success rates are not great. We flipped things around and said, 'Why don't we build intervention programs based on things they are good at.' "
He and his colleagues build an individual program for each child based on three areas of strength, making it increasingly challenging over the eight weeks. The kids also get to pick a fourth activity they like. The researchers carefully monitor their progress when they come twice a week after school for two hours. He is also monitoring levels of cortisol, a stress hormone, to see if it drops after the eight weeks.
There is growing scientific evidence that children with FASD have a heightened response to stress that can make it difficult for them to cope with situations at home or in the classroom.
At the University of British Columbia, Joanne Weinberg is investigating this phenomenon in laboratory animals and, in particular, how areas of the brain that are important in the stress response system overlap to a large extent with areas of the brain involved in depression, addictions and other mental-health problems, also common among people with FASD.
One day, the work could lead to new drugs that target the stress response system.
Other researchers are studying drugs that improve cognitive function in laboratory animals. In the lab, these drugs help animals remember how to negotiate a maze.
These kinds of drugs will probably become part of future treatments for alcohol-affected children, says Piyadasa Kodituwakku, an expert in FASD at the University of New Mexico.
But he cautions not to expect too much. A reasonable goal, he says, is to reduce or eliminate some of the problems that can come with FASD, including dropping out, drug and alcohol abuse, troubles with the law or mental illness.
Sterling Clarren, a UBC researcher who is CEO of the Canada Northwest FASD Research Network, says an ambitious project, recently funded by the federal government, should yield important new information about the brains of people with FASD.
NeuroDevNet, a new national centre of excellence, will get $19.5-million over five years and will focus on FASD and two other disorders. Researchers will combine brain imaging and genetic studies to explore what goes wrong in brain development, and perhaps, how it can be fixed.
Few people understand the challenges of FASD better than Jan Lutke. She and her husband, who died two years ago, adopted 15 children with the diagnosis. They are now adults - the oldest is 46 - and seven still live with her in Surrey, B.C., because they can't cope on their own.
The range of difficulties is astronomical, she says, and no two people have the same constellation of symptoms. One of her daughters enjoys reading Shakespeare but can't tell time or make change from a dollar. Some people with FASD don't feel pain. Others are hypersensitive to it. But they do have many common problems, including difficulties with abstract thinking and memory.
One daughter had been setting the table for a long time, but one night she couldn't remember what to do with the knives. As adults, they need programs tailored to their handicap, she says, and support so they don't end up on the streets or in jail.
She says she doesn't delude herself that there will be a quick fix or miracle therapy for people with FASD. But she can't help hoping that the work, now in its early stages, will lead to progress.
"I would like to think that if the best minds could put themselves together with a lot of money, and real energy to do it, I believe we can find things that work."