Fetal Alcohol Spectrum Disorder and Neurodevelopmental Disorders: An International Practice Survey of Forensic Mental Health Clinicians

Owing to their central nervous system impairments, children with Fetal Alcohol Spectrum Disorder (FASD) commonly exhibit externalizing behaviours such as hyperactivity, impulsivity, and (or) delinquency. The purpose of this study was to estimate the prevalence of neurodevelopmental disorders with prominent externalizing behaviours, namely Attention-Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), as well as Autism Spectrum Disorders (ASD) among children with FASD. A comprehensive systematic literature search was performed, followed by disorder-specific random-effects meta-analyses. Of the disorders investigated, ADHD was found to be the most common co-morbid disorder among children with FASD (52.9%), followed by ODD (12.9%), CD (7.0%), and ASD (2.6%). When compared with the general population of the USA, these rates are notably higher: 15 times higher for ADHD, 2 times higher for ASD, 3 times higher for CD, and 5 times higher for ODD. The results call attention to the need for identifying a distinct neurodevelopmental profile to aid in the accurate identification of children with FASD and the discrimination of FASD from certain idiopathic neurodevelopmental disorders.

Download Full-text

59 Fetal Alcohol Spectrum Disorder in Canada’s Children: Pediatric Advocacy for Optimal Physical and Mental Health

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.058 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e24-e25

Author(s):

Jocelynn Cook ◽

Ana Hanlon-Dearman ◽

Kathy Unsworth

Keyword(s):

Public Health ◽

Mental Health ◽

At Risk ◽

Children And Adolescents ◽

Fetal Alcohol Spectrum Disorder ◽

Spectrum Disorder ◽

Physical And Mental Health ◽

Fetal Alcohol ◽

Canadian Population ◽

Fetal Alcohol Spectrum

Abstract Introduction/Background Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe the range of physical and neurobehavioural effects that may result from prenatal exposure to alcohol. With school prevalence figures of approximately 4%, this may represent as many as 224,000 children across Canada. The pediatrician is key to identifying children who may be at risk based on exposure and in providing regular health and developmental surveillance to families caring for these children. To date, information about the range of specific co-morbidities in the paediatric population has not been clearly established for the Canadian population. The Canadian National FASD Dataform has been collecting diagnostic and assessment data from specialty FASD clinics across Canada for the last 6 years. Objectives The purpose of this abstract is to describe the physical and mental health conditions seen in children and adolescents with FASD in Canada. Design/Methods The Canadian National Dataform collects information from 29 Canadian FASD diagnostic clinics. Dataform started in 2011 as a project funded by the Public Health Agency of Canada to provide national clinical information on FASD in Canada. The database is hosted on the RedCap platform. De-identified clinical data collected includes information on FASD diagnoses, other prenatal exposures, brain domains of impairment and physical/mental health co-morbidities. Descriptive and quantitative analyses were used to compare individuals with and without FASD in the sample. Results Of the 1,684 records in the database, 58% had FASD, 11% were designated as At Risk for FASD and 31% did not receive an FASD-related diagnosis. Nine percent (N=152) were between the ages of 0-5 years, 46% (N=780) were 6-12 years and 24% (N=402) were 13-17 years of age. Of all individuals with FASD, 53% were also exposed prenatally to other substances including nicotine (43%), cannabis (29%) and cocaine/crack (18%), which did not significantly differ from the exposures of those who do not have FASD in the sample. Eighty-eight percent of the sample had confirmed prenatal alcohol exposure (PAE). Data show that children and adolescents across all age groups who meet criteria for FASD had significantly more impairment across each of the 10 brain domains measured when compared to those who have PAE but do not meet criteria for an-FASD diagnosis (Figure 1). The children and adolescents with FASD had significantly higher physical and mental health co-morbidities across all age cohorts (Tables 1 and 2). It is important to note that, in most cases, the rates of co-morbidities are higher than in the general Canadian population. Conclusion Children with FASD/PAE are at risk for physical and mental health co-morbidity and on-going risk for developing new and significant health challenges. They should be followed by a community pediatrician. Appropriate anticipatory guidance should be provided to families at check-ups, including referrals for early intervention. A community team to support families caring for complex children optimizes developmental outcomes, reducing the burden of care. Understanding complexities of PAE changes how we consider public health policy/service delivery.

Download Full-text

Fetal alcohol spectrum disorder: neurodevelopmentally and behaviorally indistinguishable from other neurodevelopmental disorders

BMC Psychiatry ◽

10.1186/s12888-019-2289-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Shannon Lange ◽

Kevin Shield ◽

Jürgen Rehm ◽

Evdokia Anagnostou ◽

Svetlana Popova

Keyword(s):

Neurodevelopmental Disorders ◽

Predictive Value ◽

Fetal Alcohol Spectrum Disorder ◽

Child Behavior Checklist ◽

Attention Problems ◽

Spectrum Disorder ◽

World Health ◽

Typically Developing ◽

Fetal Alcohol ◽

Fetal Alcohol Spectrum

Abstract Background The lack of universally accepted diagnostic criteria and the high rate of psychiatric comorbidity make it difficult to diagnose Fetal Alcohol Spectrum Disorder (FASD). In an effort to improve the diagnosis of FASD, the current study aimed to identify a neurodevelopmental profile that is both sensitive and specific to FASD. Methods A secondary analysis was conducted on data obtained from the Canadian component of the World Health Organization International Study on the Prevalence of FASD. Data on neurodevelopmental status and behavior were derived from a battery of standardized tests and the Child Behavior Checklist for 21 children with FASD, 28 children with other neurodevelopmental disorders, and 37 typically developing control children, aged 7 to 11 years. Two latent profile analyses were performed to derive discriminative profiles: i) children with FASD compared with typically developing control children, and ii) children with FASD compared with typically developing control children and children with other neurodevelopmental disorders. The classification function of the resulting profiles was evaluated using the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Confidence intervals (CIs) were approximated using 10,000 bootstrapped samples. Results The neurodevelopmental profile of FASD tested consisted of impairments in perceptual reasoning, verbal comprehension, visual-motor speed and motor coordination, processing speed (nonverbal information), attention and executive function, visuospatial processing, and language, in combination with rule-breaking behavior and attention problems. When children with FASD were compared with typically developing control children, a 2-class model fit the data best and resulted in a sensitivity of 95.2% (95% CI: 84.2–100.0%), specificity of 89.2% (95% CI: 78.4–97.5%), PPV of 83.3% (95% CI: 66.7–96.2%), and NPV of 97.1% (95% CI: 90.3–100.0%). When children with FASD were compared with typically developing control children and children with other neurodevelopmental disorders, the neurodevelopmental profile correctly identified only 56.9% (95% CI: 45.1–69.2%) of typically developing children and children with other neurodevelopmental disorders as not having FASD, and thus the profile was found not to be specific to children with FASD. Conclusion The findings question the uniqueness of children with FASD with respect to their neurodevelopmental impairments and behavioral manifestations.

Download Full-text

Perceptions of Fetal Alcohol Spectrum Disorder (FASD) at a Mental Health Outpatient Treatment Provider in Minnesota

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010016 ◽

2018 ◽

Vol 16 (1) ◽

pp. 16 ◽

Cited By ~ 5

Author(s):

Jerrod Brown ◽

Diane Harr

Keyword(s):

Mental Health ◽

Health Care Providers ◽

Outpatient Treatment ◽

Fetal Alcohol Spectrum Disorder ◽

Spectrum Disorder ◽

Care Providers ◽

Fetal Alcohol ◽

Basic Symptoms ◽

Impact On Treatment ◽

Fetal Alcohol Spectrum

Resulting from prenatal exposure to alcohol, Fetal Alcohol Spectrum Disorder (FASD) is characterized by deficits in adaptive and cognitive functioning. This disorder is typically accompanied by co-occurring disorders and conditions (e.g., mood, anxiety, psychosis, and substance use disorders). This complicated presentation of diverse symptoms makes the process of screening, assessing, and diagnosing FASD very difficult, limiting the likelihood that clients receive the treatment and services that they need. Although mental health care providers have an opportunity to intervene on behalf of clients with FASD, professionals may not be very familiar or comfortable with this complicated and life-altering disorder. The present study explores the familiarity of 79 mental health outpatient treatment professionals’ personal knowledge and training about FASD. Findings suggest that the majority of respondents had received at least some FASD training, understood the basic symptoms of FASD, and were realistic about FASD’s impact on treatment.

Download Full-text