PERINATAL AND FAMILY SERVICES

Fetal Alcohol Syndrome

This webpage identifies the major literature in the field of perinatal and family services: fetal alcohol syndrome. The time frame is from January 2000 through December 2014.

Douzgou, S., Breen, C., Crow, Y. J., Chandler, K., Metcalfe, K., Jones, E., Kerr, B., & Clayton-Smith, J. (2012). Diagnosing fetal alcohol syndrome: New insights from newer genetic technologies. Archives of Disease in Childhood, 97(9), pp. 812-817. DOI: 10.1136/archdischild-2012-302125.

This article looks at important things to consider when diagnosing a child with FASD including the role the clinical geneticist plays in the assessment, and the need to obtain an accurate history of prenatal exposure to alcohol. Conclusions Genetic assessment was of particular value in excluding other diagnoses and providing information to carers. According to this study FASD was difficult to ascertain in children under a year old when data on growth and development were limited. Structural malformations were not common in the group overall and some previously reported diagnostic signs were not found to be reliable markers of FASD. Chromosome disorders showed phenotypic overlap with FASD and are an important differential diagnosis.

Feldman, K. A. R. (2012). Children and adolescents with fetal alcohol syndrome (FAS): Better social and emotional integration after early diagnosis. Klin Pediatrics, 224(2), pp. 66–71.

This article looked at the FAS diagnosis of 125 patients at the Muenster University Hospital. The researchers found high rates of social and developmental problems. The diagnosis of FASD was identified as a protective factor, with significantly better outcomes for patients being diagnosed in early childhood. A diagnosis established later in life was particularly helpful for the families and caregivers. Improvements in early detection are needed as research shows that receiving the correct diagnosis, despite the persistent impairments, is of major benefit for both patients and their families.

Gummel, K., Ygge, J., Benassi, M., & Bolzani, R. (2012). Motion perception in children with fetal alcohol syndrome. Acta Pediatrica, 101(8), pp. e327-e332.

In this article, the authors looked at the motion perception in children diagnosed with FASD living in orphanages. The results of the study showed a significant difference in the motion perception of the children with FASD and the control group. Children with FAS had lower coherent motion perception ability in all the signal-to-noise ratio conditions. The authors conclude that impaired motion perception in FAS children could be indicative of a dorsal stream developmental dysfunction resulting from alcohol brain damage.

Joseph, J., Warton, C., Jacobson, S. W., Jacobson, J. L., Molteno, C. D., Eicher, A., Marais, P., Phillips, O. R… Meintjes, E. M. (2014). Shape analysis of hippocampus and caudate nucleus in children with fetal alcohol spectrum disorders. Human Brain Mapping, 35(2), pp. 659-672.

The authors of this article used surface deformation-based analysis to assess local shape variations in the hippocampi and caudate nuclei of children with fetal alcohol spectrum disorders. High-resolution structural magnetic resonance imaging images were acquired for children with FASD and no FASD. Although the exposed and control subjects did not differ significantly in their volumes, the shape analysis showed the hippocampus to be more deformed at the head and tail regions in the alcohol-exposed children. Between-group differences in caudate nucleus morphology were dispersed across the tail and head regions. Correlation analysis showed associations between the degree of compression and the level of alcohol exposure. These findings demonstrate that shape analysis using three-dimensional surface measures is sensitive to fetal alcohol exposure and provides additional information than volumetric measures alone.

Koren, G., Zelner, I., Nash, K., & Koren, G. (2014). Fetal alcohol spectrum disorder: Identifying the neurobehavioral phenotype and effective interventions. Current Opinion in Psychiatry, 27(2), pp. 98-104.

This article looks at the pathogenesis of brain damage caused by FASD. According to the authors, identifying the neurodevelopmental phenotype of fetal alcohol spectrum disorder (FASD) is a major challenge. Recently, a behavioral phenotype of FASD has been described and validated using items from the Child Behavior Checklist. This tool has high sensitivity and specificity in separating children with FASD from those with ADHD and from healthy controls. In parallel, a number of intervention studies show promise in improving the abilities of children and adolescents with the syndrome to cope with daily tasks and improve their quality of life. The neurobehavioral screening test can facilitate screening for FASD and is an official screening tool in the FASD toolkit of the Public Health Agency of Canada. Promising new interventions may attenuate the long-term outcome of these children.

Molteno, C. D., Jacobson, J. L., Carter, R. C., Dodge, N. C., & Jacobson, S. W. (2014). Infant emotional withdrawal: A precursor of affective and cognitive disturbance in fetal alcohol spectrum disorders. Alcoholism: Clinical and Experimental Research, 38(2), pp. 479-488.

The aim of this study was to test the hypothesis that emotional withdrawal is an early indicator of affective disorder in infants heavily exposed prenatally to alcohol. The results of the study reflect that prenatal alcohol exposure was associated with increased infant emotional withdrawal and decreased activity, but unrelated to mother–infant interaction. This study is the first to document a direct effect of FA exposure on emotional withdrawal in infancy. The data link prenatal alcohol to infant affective function not attributable to mother–infant interaction, infant temperament, or other socioemotional aspects of the infant’s environment and identify infant emotional withdrawal as an early indicator of affective disturbance, particularly in children later diagnosed with FAS and PFAS.

Paolozza, A., Rasmussen, C., Pei, J., Hanlon-Dearman, A., Nikkel, S. M., Andrew, G., McFarlane, A… Reynolds, J. N. (2014). Deficits in response inhibition correlate with oculomotor control in children with fetal alcohol spectrum disorder and prenatal alcohol exposure. Behavioral Brain Research, 259(1), pp. 97-205.

The objective of this study was to determine if a performance-based relationship exists between psychometric tests and eye movement tasks in children with FASD. Results of the study show that the FASD and the PAE groups performed worse than controls on the subtest measures of attention and inhibition. These data suggests that response inhibition deficits in children with FASD/PAE are associated with difficulty controlling saccadic eye movements which may point to overlapping brain regions damaged by prenatal alcohol exposure. The results of this study demonstrate that eye movement control tasks directly relate to outcome measures obtained with psychometric tests that are used during FASD diagnosis, and may therefore help with early identification of children who would benefit from a multidisciplinary diagnostic assessment.

Popova, S., Lange, S., Burd. L., & Rehm, J. (2012). Health care burden and cost associated with fetal alcohol syndrome: Based on official Canadian data. Plos One, 7(8), pp. 1-7.

The purpose of this study was to determine the use of health care used by individuals diagnosed with FAS and estimate costs associated with those visits for Fiscal Year 2008-2009. The total direct health care cost of acute care, psychiatric care, day surgery, and emergency department services associated with was about $6.7 million. The authors believe that the utilization of health care services by individuals diagnosed with FAS are likely to be underreported and costs likely underestimated. The quantification of the health care costs associated with FAS is crucial for policy developers and decision makers alike, of the impact of prenatal alcohol exposure, with the ultimate goal of initiating preventive interventions to address FASD.

Popova, S., Lange, S., Burd, L., & Rehm, J. (2014). Canadian children and youth in care: The cost of fetal alcohol spectrum disorder. Child and Youth Care Forum, 43(1), pp. 83-96. DOI: 10.1007/s10566-013-9226-x

The purpose of the current study was to estimate the number of children (0–18 years) in care with FASD and to determine the associated cost by age group, gender, and province/territory in Canada in 2011. The estimated number of children in care with FASD ranged from 2,225 to 7,620, with an annual cost of care ranging from $57.9 to $198.3 million Canadian dollars (CND). The highest overall cost ($29.5 to $101.1 million CND) was for 11–15 year-olds. The study findings can be used to demonstrate the substantial economic burden that FASD places on the child welfare system. Attention towards the needs of this population and prevention efforts to reduce FASD incidence in Canada, and other countries are urgently needed.

Stephen, J. M., Kodituwakku, P. W., Kodituwakku, E. L., Romero, L., Peters, A. M., Sharadamma, N. M., Caprihan, A., & Coffman, B. A. (2012). Delays in auditory processing identified in preschool children with FASD. Alcoholism: Clinical and Experimental Research, 36(10), pp. 1720-1727.

The goal of the study was to characterize auditory responses in preschool-aged children with FASD. Results of the study reflect that there is widespread auditory deficits with prenatal ethanol exposure. Auditory delay revealed by MEG in children with FASDs may prove to be a useful neural marker of information processing difficulties in young children with prenatal alcohol exposure. The fact that delayed auditory responses were observed across the FASD spectrum suggests that it may be a sensitive measure of alcohol-induced brain damage. Therefore, this measure in conjunction with other clinical tools may prove useful for early identification of alcohol affected children, particularly those without dysmorphia.

Williams, L., Jackson, C. P. T., Choe, N., Pelland, L., Scott, S. H., & Reynolds, J. N. (2014). Sensory-motor deficits in children and fetal alcohol spectrum disorder assessed using a robotic virtual reality platform. Alcoholism: Clinical and Experimental Research, 38(1), pp. 116-125.

The goal of this study was to use robotic technology to examine sensory-motor impairments in the upper limbs of children with FASD. The current study has shown that robotic technology is a sensitive and powerful tool that provides increased specificity regarding the type of motor problems exhibited by children with FASD. The high frequency of motor deficits in children with FASD suggests that interventions aimed at stimulating and/or improving motor development should routinely be considered for this population.

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