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Preclinical studies have identified choline as a potential treatment for cognitive deficits in FASD. We previously conducted three randomized controlled trials (RCTs) in children under age 6 and reported on memory benefits following all three trials. Two RCTs compared a fixed 500\u2009mg daily dose to placebo, and the third RCT tested a weight\u2010adjusted choline dose. Here, we report on a longitudinal follow\u2010up 5\u2009years post\u2010study completion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The RCTs included 2.5\u2010 to 5.9\u2010year\u2010old children with FASD who received choline (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953) or placebo (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951). Participants described here (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928 choline;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930 placebo) were 9.1\u2009years old on average at follow\u2010up. Of these, 9% had fetal alcohol syndrome (FAS), 43% partial FAS (PFAS), and 48% alcohol\u2010related neurodevelopmental disorder (ARND). Parents completed a diagnostic interview and behavior checklists while participants completed assessments of general cognitive ability, executive functioning, and memory.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants who received choline in the initial RCT showed a medium effect size performance advantage (9.1% better) for non\u2010verbal IQ and a medium effect size advantage (11.3% better) for working memory over placebo. Age at enrollment did not explain significant variance in outcome but choline dose was significantly associated with non\u2010verbal IQ and working memory (higher dose contributed to better performance at follow\u2010up). High rates of anxiety disorders and impulse\u2010control disorders were observed. While there were no statistically significant differences in mental health diagnoses for choline versus placebo, there were some differences that neared significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Very few RCTs have been conducted in FASD, and interventions targeting cognitive functioning are needed. The data reported here suggest that choline supplementation has long\u2010lasting neurodevelopmental benefits, especially in non\u2010verbal IQ and working memory for individuals with FASD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70394","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:00:34Z","timestamp":1791813634000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010Term Neurodevelopmental Outcome Following Three Randomized Controlled Trials of Choline in Fetal Alcohol Spectrum Disorder (\n                    <scp>FASD<\/scp>\n                    )"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7132-8519","authenticated-orcid":false,"given":"Jeffrey R.","family":"Wozniak","sequence":"first","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9441-6407","authenticated-orcid":false,"given":"Judith K.","family":"Eckerle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-0823","authenticated-orcid":false,"given":"Blake A.","family":"Gimbel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Psychology &amp; Neuropsychology Nationwide Children's Hospital  Columbus Ohio USA"},{"name":"Department of Pediatrics The Ohio State University College of Medicine  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1645-8785","authenticated-orcid":false,"given":"Abigail M.","family":"Ernst","sequence":"additional","affiliation":[{"name":"Great Lakes Neurobehavioral Center  Eagan Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary E.","family":"Anthony","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent A.","family":"Tuominen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"de Water","sequence":"additional","affiliation":[{"name":"Great Lakes Neurobehavioral Center  Eagan Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra L.","family":"Doughty","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9282-161X","authenticated-orcid":false,"given":"Steven H.","family":"Zeisel","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael K.","family":"Georgieff","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Manual for the Child Behavior Checklist\/6\u201318","author":"Achenbach T. 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