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Evans S, Lucas BR, Monds LA, Montebello M. Identifying and responding to fetal alcohol spectrum disorder in child and family health: Lessons from an exploratory mixed methods study. Drug Alcohol Rev 2024; 43:1505-1514. [PMID: 39138002 DOI: 10.1111/dar.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills. METHODS Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD. RESULTS The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers 'patching together' care planning in a 'referral black hole'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge. DISCUSSION AND CONCLUSIONS Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.
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Affiliation(s)
- Susan Evans
- Australian College of Applied Professions, Sydney, Australia
| | - Barbara R Lucas
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Lauren Ann Monds
- Specialty of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia
| | - Mark Montebello
- Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, Australia
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Tanfield Y, Burrows K, Middllemiss M. Assessing and supporting children and young people with probable or diagnosed fetal alcohol spectrum disorder: The experience of clinicians working within child and adolescent mental health services. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39138612 DOI: 10.1111/acer.15376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are a group of conditions that occur due to prenatal alcohol exposure (PAE), which impacts physical, behavioral, and cognitive ability. The literature demonstrates that healthcare professionals lack knowledge and understanding of FASD, resulting in children and young people (CYP) often getting misdiagnosed with neurodevelopmental disorders or the diagnosis of FASD missed, increasing their risk of experiencing secondary mental health difficulties. Child and Adolescent Mental Health Services (CAMHS) are the commissioned service to diagnose neurodevelopmental conditions and support CYP with mental health difficulties, therefore, it is likely that CYP with probable or diagnosed FASD will present in CAMHS. There is currently no research exploring the awareness and understanding of FASD within these services. METHODS Constructivist grounded theory was utilized to explore the barriers and facilitators clinicians experience when assessing and supporting CYP with probable or diagnosed FASD within CAMHS. A sample of 12 CAMHS clinicians from an NHS Mental Health Trust situated in the Northeast of England were interviewed. Interviews were transcribed and analyzed and grounded theory techniques were utilized to generate an end model. RESULTS The end model was developed on a box analogy with four categories. 'Unable to Open the Box' captures barriers CAMHS clinicians experience when exploring FASD, 'Things that Help Open the Box' captures facilitators CAMHS clinicians experience when exploring FASD, 'Asking Others About the Box' captures systemic influences CAMHS clinicians may experience when exploring FASD, and 'Making the Box Easier to Open in Future' captures how we can support CAMHS clinicians moving forward to explore FASD. CONCLUSIONS This model provides new insights into the barriers and facilitators CAMHS clinicians experience when assessing and supporting CYP with probable or diagnosed FASD, highlighting key clinical implications. Recommendations for future research are outlined to expand the knowledge base for this area.
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Affiliation(s)
- Yasmin Tanfield
- Medical Psychology Service, South Tees NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
- School of Social Sciences, Humanities and Law, Teesside University, Teesside, UK
| | - Kathy Burrows
- School of Social Sciences, Humanities and Law, Teesside University, Teesside, UK
| | - Megan Middllemiss
- Singe Point of Access Service, Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, Darlington, UK
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Clark CA, Nakhid D, Baldwin-Oneill G, LaPointe S, MacIsaac-Jones M, Raja S, McMorris CA. Prevalence of co-occurring diagnoses in people exposed to alcohol prenatally: Findings from a meta-analysis. J Affect Disord 2024; 358:163-174. [PMID: 38718944 DOI: 10.1016/j.jad.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Individuals with prenatal alcohol exposure (PAE) commonly experience co-occurring diagnoses, which are often overlooked and misdiagnosed and have detrimental impacts on accessing appropriate services. The prevalence of these co-occurring diagnoses varies widely in the existing literature and has not been examined in PAE without an FASD diagnosis. METHOD A search was conducted in five databases and the reference sections of three review papers, finding a total of 2180 studies. 57 studies were included in the final analysis with a cumulative sample size of 29,644. Bayesian modeling was used to determine aggregate prevalence rates of co-occurring disorders and analyze potential moderators. RESULTS 82 % of people with PAE had a co-occurring diagnosis. All disorders had a higher prevalence in individuals with PAE than the general population with attention deficit hyperactivity disorder, learning disorder, and intellectual disability (ID) being the most prevalent. Age, diagnostic status, and sex moderated the prevalence of multiple disorders. LIMITATIONS While prevalence of disorders is crucial information, it does not provide a direct representation of daily functioning and available supports. Results should be interpreted in collaboration with more individualized research to provide the most comprehensive representation of the experience of individuals with PAE. CONCLUSIONS Co-occurring diagnoses are extremely prevalent in people with PAE, with older individuals, females, and those diagnosed with FASD being most at risk for having a co-occurring disorder. These findings provide a more rigorous examination of the challenges faced by individuals with PAE than has existed in the literature, providing clinicians with information to ensure early identification and effective treatment of concerns to prevent lifelong challenges.
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Affiliation(s)
- C A Clark
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Canada; Alberta Children's Hospital Research Institute (ACHRI), Canada.
| | - D Nakhid
- Alberta Children's Hospital Research Institute (ACHRI), Canada; Hotchkiss Brain Institute, University of Calgary, Canada
| | | | - S LaPointe
- Department of Psychology, University of Calgary, Canada
| | | | - S Raja
- Department of Psychology, University of Calgary, Canada
| | - C A McMorris
- Werklund School of Education, School and Applied Child Psychology, University of Calgary, Canada; Alberta Children's Hospital Research Institute (ACHRI), Canada; Department of Psychology, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada
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Hartley G, Sirois F, Purrington J, Rabey Y. Adverse Childhood Experiences and Autism: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2297-2315. [PMID: 38041427 DOI: 10.1177/15248380231213314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.
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Ritfeld GJ, Wang M, Shapiro Z, Kable JA, Coles CD. Parenting by individuals with fetal alcohol spectrum disorders and neurobehavioral outcomes in their offspring. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:400-408. [PMID: 38149361 PMCID: PMC10922647 DOI: 10.1111/acer.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The neurobehavioral health impairments associated with prenatal alcohol exposure are now known to persist through adulthood. However, little is known about how these impairments affect individuals' parenting abilities and the neurobehavioral health of their offspring. This study compares parents with fetal alcohol spectrum disorder (FASD) with socioeconomically matched, nonexposed parents on measures of parenting and family support and assesses the neurobehavioral health of the children in both groups. METHODS Forty-nine parent-child dyads were recruited from a longitudinal cohort of low socioeconomic status. Measures included the Parenting Styles and Dimensions Questionnaire, Family Support Scale, an in-depth psychosocial history, the Pediatric Symptom Checklist (PSC; parent and child reports), the Achenbach Child Behavior Checklist (CBCL), a screening psychiatric evaluation of the child, the NIH Toolbox Cognition Battery for Children, The Vineland Adaptive Behavior Scales-Third Edition caregiver rating form, and the Traumatic Events Screening Inventory (parent and child reports). RESULTS Cognitive functioning was impaired for both offspring of parents with FASD (x ¯ = 81.1, SD = 13.0) and control parents (x ¯ = 79.9, SD = 16.1), but despite similar impairments, children of parents with FASD were less likely to have an Individualized Education Plan than controls. Adaptive functioning was adequate for both groups (x ¯ = 92.1, SD = 15.4 in exposed vs.x ¯ = 94.3, SD = 12.3 in controls) and CBCL and PSC scores in both groups were within normal limits. Parents in both groups showed a predominantly authoritative parenting style. Despite a similar frequency of adverse childhood experiences in both groups, parents with FASD were less likely to recognize their child's adverse experiences. CONCLUSION Parents with FASD display notable strengths including a predominantly authoritative parenting style. However, parents with FASD underrecognize child trauma and underutilize developmental services compared to socioeconomically matched controls, despite similar neurocognitive impairments. Impairments in adaptive functioning in parents with FASD may translate into difficulties with child-parent communication and limit both insight into neurobehavioral problems and advocacy skills. There is a need to identify and support parents with FASD to optimize their parenting abilities in the context of their individual strengths and difficulties.
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Affiliation(s)
- Gaby J Ritfeld
- Barrow Neurological Institute at Phoenix Children's, Phoenix, Arizona, USA
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Department of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Psychiatry, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Michael Wang
- Department of Psychiatry, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Zvi Shapiro
- Department of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julie A Kable
- Department of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Chandler-Mather N, Betts J, Donovan C, Shelton D, Dawe S. Understanding the impacts of childhood adversity on sleep problems in children with fetal alcohol spectrum disorder: A comparison of cumulative and dimensional approaches. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1702-1712. [PMID: 37442612 DOI: 10.1111/acer.15152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The developmental impacts of prenatal alcohol exposure (PAE) and postnatal exposure to adversity are typically considered in isolation. However, both contribute independently to sleep problems. Children with fetal alcohol spectrum disorder (FASD) have PAE and significant sleep disturbances. What is not clear is the relative contribution to these disturbances of exposure to early life adversity. This study examined how exposure to such adversity impacts frequent insomnia symptoms and nightmares in children with FASD and "At Risk" designations. METHODS We compared two approaches to modeling adversity in children who had undergone a diagnostic assessment for FASD: a cumulative risk approach that sums adversities to create a total score and an approach that treats exposure to threat and deprivation as independent dimensions. Data on caregiver-reported exposure to adversity and sleep problems for 63 children (aged 3 years 4 months to 7 years 8 months) were extracted from clinical archives. Cumulative risk, threat exposure, and deprivation exposure scores were computed and were tested as predictors of insomnia symptoms and nightmares. All analyses controlled for age and gender. RESULTS There were high rates of caregiver-reported sleep problems with 60.3% (n = 38) of children having nightmares and 44.4% (n = 28) having a frequent insomnia symptom. The cumulative risk analysis showed that for every additional exposure to adversity, the odds of having a caregiver-reported insomnia symptom increased by 38%. The dimensional analysis showed no relationship between deprivation and sleep problems. However, every additional exposure to threat increased the odds of nightmares by 93%. CONCLUSIONS Exposure to postnatal adversity contributes to sleep disturbances in children with FASD, with unique roles for cumulative risk and the threat dimension of adversity. The implications of these findings for the etiology and treatment of sleep disturbances in children with FASD are discussed.
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Affiliation(s)
- Ned Chandler-Mather
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joseph Betts
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Doug Shelton
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
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Cox LV. The Eastern Door Center: re-balancing the wheel-a Two-Eyed Seeing approach to FASD and other disorders related to transgenerational adversity. FRONTIERS IN SOCIOLOGY 2023; 8:910153. [PMID: 37214599 PMCID: PMC10196138 DOI: 10.3389/fsoc.2023.910153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
In 2015, the Canadian Truth and Reconciliation Commission (TRC) called for immediate action to address the lack of access to health services for Fetal Alcohol Spectrum Disorder (FASD) in Indigenous communities. They called for the provision of culturally safe, community-based, FASD diagnostic, intervention and prevention services. FASD is a neurodevelopmental condition that can affect all aspects of functioning. The term refers to a spectrum of conditions occurring as a result of prenatal alcohol exposure (PAE) and associated risk factors. PAE can affect both physical and mental health leading to problems with learning, memory, attention, language, social behavior, executive functioning, sleep, and affect regulation. According to Elders in Mi'kmaq First Nations (FN) communities, FASD is a condition that is rooted in transgenerational trauma and the loss of relationship to their land, their language and the traditional community culture. The Elsipogtog Eastern Door (ED) Center opened in 2006 to provide culturally informed diagnosis, intervention and prevention for FASD and related conditions. The ED was the first FASD diagnostic team in Atlantic Canada and it served as a demonstration model for the New Brunswick FASD Center of Excellence as well as for Indigenous communities regionally and nationally. In this article, we outline the history and evolution of the Eastern Door Center and its programs and describe some of the successes of this model as well as some of its limitations in practice.
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Jolma LM, Koivu-Jolma M, Sarajuuri A, Torkki P, Autti-Rämö I, Sätilä H. Children with FASD-Evolving Patterns of Developmental Problems and Intervention Costs in Ages 0 through 16 in Finland. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050788. [PMID: 37238336 DOI: 10.3390/children10050788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
This is a retrospective chart review of 55 persons (mean age 11 years, range 2-28 years) diagnosed with fetal alcohol spectrum disorder (FASD) in one Finnish central hospital. The aim was to determine typical problems and interventions and estimate their costs during different periods of childhood between ages 0 and 16. During the first year, 29/38 (76.3%) were treated in the neonatal intensive care unit, 29/43 (67.4%) received physiotherapy, 15/43 (34.9%) were diagnosed with congenital malformation, 8/43 (18.6%) had heart defects. Between 1 and 6 years, 39/45 (86.7%) received occupational therapy, 25/45 (55.6%) speech therapy, and 12/45 (26.7%) were diagnosed with strabismus. Between 7 and 12 years, 25/37 (67.6%) were diagnosed with ADHD and special education was recommended for 30/37 (81.1%). Learning disorders and the need for psychiatric care increased with age. Between 13 and 16 years, 12/15 (80%) were treated in the psychiatric unit, and by this age, 8/15 (53.3%) were diagnosed with intellectual disability. Before 16 years, 44/55 (80%) were placed out of home, which caused 78.5% of the estimated cumulative mean extra costs of EUR 1,077,000 in 2022 currency. Except for psychiatric costs, health care costs were highest during early years. Charting typical patterns of problems may help in identifying children with FASD and planning follow-ups, content of assessments, and interventions.
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Affiliation(s)
- Laura Mirjami Jolma
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014 Helsinki, Finland
- Division of Child Neurology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Mikko Koivu-Jolma
- Faculty of Science, University of Helsinki, Gustaf Hällströminkatu 2, P.O. Box 64, 00014 Helsinki, Finland
| | - Anne Sarajuuri
- Division of Child Neurology, Helsinki University Central Hospital, University of Helsinki, Stenbäckinkatu 11, P.O. Box 22, 00014 Helsinki, Finland
| | - Paulus Torkki
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014 Helsinki, Finland
| | - Ilona Autti-Rämö
- Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, 00014 Helsinki, Finland
| | - Heli Sätilä
- Division of Child Neurology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
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Carrick A, Hamilton CJ. Heated Behaviour in the Classroom for Children with FASD: The Relationship between Characteristics Associated with ADHD, ODD and ASD, Hot Executive Function and Classroom Based Reward Systems. CHILDREN 2023; 10:children10040685. [PMID: 37189934 DOI: 10.3390/children10040685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
Possession of characteristics related to Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, and Autism Spectrum Disorder in children prenatally exposed to alcohol contributes to challenges within the diagnostic pathway for Foetal Alcohol Spectrum Disorder (FASD). The presentation of these characteristics, though problematic for the children affected, may not result in referral for diagnosis; focusing on diagnostic thresholds masks the dimensional nature of these characteristics. Children with traits which are undiagnosed may not receive effective support and are often identified as exhibiting challenging behaviour. In the UK, children with undiagnosed Special Educational Needs (SEN) are more likely to experience school exclusion. Common across each condition are challenges to executive function associated with emotional regulation (hot-executive function). This study explored the relationship between characteristics of Attention Deficit Hyperactive Disorder, Oppositional Defiance Disorder, Autistic-Like Traits, and hot executive functions on the helpfulness of reward-based interventions for children with suspected or diagnosed FASD. Data were collected online using caregiver referral questionnaire screeners for each measure (Child Autism Quotient Questionnaire, Vanderbilt ADHD Parental Rating Scale and The Childhood Executive Functioning Inventory) for children aged 6–12 years with suspected or diagnosed FASD (n = 121). Between-group comparisons showed no significant difference in the reporting of Attention Deficit Hyperactive Disorder characteristics, Oppositional Defiance Disorder characteristics, Autistic-Like Traits, and executive function, regardless of diagnostic state. Multiple regression analyses indicated that these personality characteristics and executive functions were associated with the perception of the reward system helpfulness. However, this pattern was qualified by both the type of hot executive function challenged (significant for Regulation not Inhibition) and whether the child had an FASD diagnosis. Thus, a dimensional approach may strengthen our understanding of the child’s classroom experience and help overcome barriers to effective intervention and support.
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Affiliation(s)
- Andrea Carrick
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Colin J. Hamilton
- Department of Psychology, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
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Senturias Y, Ali MM, West K. Psychotropic Medication Utilization Among Children Diagnosed With Fetal Alcohol Spectrum Disorder. Pediatrics 2022; 150:189569. [PMID: 36164844 DOI: 10.1542/peds.2022-056797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To date, there has been no large, population-based study estimating the prevalence of psychotropic medication use and cooccurring medical conditions among children with fetal alcohol syndrome disorder (FASD). In addition, it is not known how psychotropic medication use varies by mental health status of the children with FASD and their health insurance coverage. This study attempts to fill this gap by analyzing a large health insurance claims database covering Medicaid and private insurance. METHODS The study used the 2017 IBM Watson Health MarketScan Multistate Medicaid and Commercial Claims databases. The sample for the analysis includes children between the ages of 0 and 17 with either an FASD diagnosis or a mental health diagnosis (N = 848 721 Medicaid; N = 511 061 private insurance). RESULTS More than half of the children with an FASD diagnosis were prescribed psychotropic medications (63% Medicaid; 57% private). Utilization rates of psychotropic medication among children with cooccurring FASD and a mental health condition (79% Medicaid; 71% private) were higher compared to children with a mental health diagnosis but no FASD (57% Medicaid; 57% private). Stimulants were the most commonly prescribed. Encephalopathy, attention deficit hyperactivity disorder, and epilepsy were the 3 most common cooccurring diagnosis among children with FASD using psychotropic medication under Medicaid compared to encephalopathy, attention deficit hyperactivity disorder, and anxiety with private insurance. CONCLUSIONS These results exemplify the complexity of the neurobehavioral profile of children with FASD and the challenge of treatment. Future studies may determine how supportive services for these children will affect psychotropic medication use.
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Affiliation(s)
- Yasmin Senturias
- Atrium Health, Developmental and Behavioral Pediatrics of the Carolinas Charlotte, Charlotte, North Carolina
| | - Mir M Ali
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning & Evaluation, Washington, District of Columbia
| | - Kristina West
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning & Evaluation, Washington, District of Columbia
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Carpita B, Migli L, Chiarantini I, Battaglini S, Montalbano C, Carmassi C, Cremone IM, Dell’Osso L. Autism Spectrum Disorder and Fetal Alcohol Spectrum Disorder: A Literature Review. Brain Sci 2022; 12:brainsci12060792. [PMID: 35741677 PMCID: PMC9221419 DOI: 10.3390/brainsci12060792] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/07/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Fetal alcohol spectrum disorders (FASD) are a group of conditions associated with the effects of prenatal alcohol exposure and characterized by somatic and neuropsychological alterations. On the other hand, autism spectrum disorder (ASD) is characterized by a multifaceted neurobehavioral syndrome. Since alcohol can affect every stage of brain development, some authors hypothesized that in utero alcohol exposure might be linked to an increased risk of ASD in subjects with genetic vulnerability. The present review aimed to summarize the available literature on the possible association between FASD and ASD, also focusing on the reported clinical overlaps and on the possible shared pathogenic mechanisms. Studies in this field have stressed similarities and differences between the two conditions, leading to controversial results. The available literature also highlighted that both the disorders are often misdiagnosed or underdiagnosed, stressing the need to broaden the perspective, paying specific attention to milder presentations and sub-syndromic traits.
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12
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Ritfeld GJ, Kable JA, Holton JE, Coles CD. Psychopharmacological Treatments in Children with Fetal Alcohol Spectrum Disorders: A Review. Child Psychiatry Hum Dev 2022; 53:268-277. [PMID: 33502703 DOI: 10.1007/s10578-021-01124-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Psychiatric symptoms in children with Fetal Alcohol Spectrum Disorders (FASD) present with high prevalence and morbidity, often across symptom domains, e.g. ADHD-like symptoms, emotional dysregulation and sleep problems. Polypharmacy is often used, but no empirically-based guidelines exist regarding optimal treatment for these children. Moreover, stimulant use in these children is controversial as their responsiveness may be different due to altered neural circuitry associated with prenatal alcohol exposure. The objective of this review is to give an overview of existing data on pharmacological treatments of neurobehavioral symptoms in FASD. Our literature review yielded limited and conflicting clinical data on the effectiveness of pharmacological treatments for psychiatric symptoms in children with FASD, with some symptom domains lacking data altogether. We emphasize the need for clinical trials to guide pharmacological treatments in this complex population.
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Affiliation(s)
- Gaby J Ritfeld
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 200, Atlanta, GA, USA.
| | - Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 200, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer E Holton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 200, Atlanta, GA, USA
| | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, Suite 200, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Brown J, Spiller V, Carter M, Osmonson K, Porth D, Bishop-Deaton D, Jozan A. Fetal alcohol spectrum disorders (FASD) and youth firesetting: A call on criminal justice, emergency responder, and fire prevention specialists to become informed. BEHAVIORAL SCIENCES & THE LAW 2022; 40:186-217. [PMID: 34961964 DOI: 10.1002/bsl.2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/08/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
Central nervous system damage resulting from prenatal exposure to alcohol, often referred to as fetal alcohol spectrum disorders (FASD), commonly manifests as lacking cognitive functioning, problem solving, impulsivity, memory, executive functioning, and social skill deficits. For individuals with FASD, these brain-based deficits translate into impulsive behaviors and poorly thought-out decision-making, coupled with an inability to anticipate and recognize the sometimes very severe consequences of their behaviors. Not unexpectedly, individuals with FASD frequently find themselves disproportionately involved in the criminal justice system and mental health services. For some individuals with FASD, these behaviors can also include firesetting. First responders, like other health and legal professionals, are often unable to recognize the behavioral indicators of FASD, primarily due to a lack of training. As a result, firesetting behaviors are often attributed to deliberate, willful acts of delinquency, a desire to damage property, thrill seeking, or as attempts for personal gain, rather than being viewed as maladaptive attempts to solve problems by individuals who lack the tools to do this in more appropriate ways. These same skill deficits also present when individuals with FASD are interviewed about their involvement in such behaviors, sometimes resulting in confabulation, suggestibility, and false confessions. Further education and training in FASD are vital for first responders if they are to better support individuals with FASD and minimize their chances of becoming involved in firesetting behaviors. Furthermore, this training and education will help ensure that first responders can intervene in more appropriately when crisis situations do occur. This article will outline key behavioral symptoms of FASD as well as provide first responders with suggestions as to how to best support individuals when FASD is suspected. The brief quote that follows highlights some of the key challenges facing individuals with FASD and how poor decision-making and impulsiveness can result in severe consequences for the individual and those around them.
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Affiliation(s)
- Jerrod Brown
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Vanessa Spiller
- JumpStart Psychology, Brisbane, Queensland, Australia
- Benchmark Psychology, Brisbane, Queensland, Australia
| | - Megan Carter
- University of Washington, Seattle, Washington, USA
- Department of Social and Health Services, Special Commitment Center, Steilacoom, Washington, USA
| | - Kathi Osmonson
- Minnesota State Fire Marshal Division, Walden University, Minneapolis, Minnesota, USA
| | - Don Porth
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
| | - Deanna Bishop-Deaton
- School of Forensic Psychology, College of Social and Behavioral Sciences, Walden University, Minneapolis, Minnesota, USA
| | - Amy Jozan
- American Institute for the Advancement of Forensic Studies, St. Paul, Minnesota, USA
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14
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Sappok T, Tergeist M, Kruse B, Wagner J. [Fetal Alcohol Spectrum Disorders in Adults - Results from a Diagnostic Outpatient Clinic]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:204-211. [PMID: 35008120 DOI: 10.1055/a-1669-8963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY Fetal alcohol spectrum disorders (FASD) are quite common and, due to the risk of psychiatric comorbidities, highly relevant until adulthood. Diagnostic clarification in adulthood is a prerequisite for targeted treatment and needs-based support. METHODS In a German metropolitan region, 80 people with suspicion of FASD were assessed from May 2015 to July 2020. The results of this interdisciplinary diagnostic assessment were systematically evaluated and the clinical characteristics of the persons with or without FASD were analysed. RESULTS Approximately 70% of the population accessing relevant health care was diagnosed with an entity from the FAS spectrum. People with FASD were more likely to have learning disabilities (50 vs. 33%) or intellectual disabilities (40 vs. 10%), while there were no group differences for age and gender. Psychiatric comorbidities, particularly depression (39%) and addiction disorders (31%), were common in both groups. CONCLUSION As part of a multi-professional standardized diagnosis, FASD clarification is also possible and necessary in adulthood. The diagnostic criteria for FASD should be further evaluated and specified for adults.
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Affiliation(s)
- Tanja Sappok
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin-Elisabeth Herzberge, Berlin, Deutschland
| | - Marlene Tergeist
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin-Elisabeth Herzberge, Berlin, Deutschland
| | - Björn Kruse
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin-Elisabeth Herzberge, Berlin, Deutschland
| | - Jessica Wagner
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin-Elisabeth Herzberge, Berlin, Deutschland
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Schölin L, Mukherjee RAS, Aiton N, Blackburn C, Brown S, Flemming KM, Gard PR, Howlett H, Plant M, Price AD, Shields J, Smith LA, Suttie M, Zammitt DC, Cook PA. Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK. Arch Dis Child 2021; 106:636-640. [PMID: 33441316 DOI: 10.1136/archdischild-2020-320435] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 11/03/2022]
Abstract
Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)-the most common neurodevelopmental condition-are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.
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Affiliation(s)
- Lisa Schölin
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Raja A S Mukherjee
- Fetal Alcohol Syndrome Specialist Behaviour Clinic, Surrey and Borders Partnership NHS Foundation Trust, Surrey, UK
| | - Neil Aiton
- One Stop Clinic, Royal Sussex County Hospital, Brighton, Brighton and Hove, UK
| | - Carolyn Blackburn
- Centre for the Study of Practice and Culture in Education, Birmingham City University, Birmingham, West Midlands, UK
| | - Sarah Brown
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Kate M Flemming
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Paul R Gard
- School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, East Sussex, UK
| | - Helen Howlett
- Faculty of Health and Life Science, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Moira Plant
- Faculty of Health and Applied Sciences, University of the West of England Bristol, Bristol, UK
| | - Alan D Price
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Jennifer Shields
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Lesley A Smith
- Institute of Clinical and Applied Health Research, University of Hull, Hull, Kingston upon Hull, UK
| | - Michael Suttie
- Nuffield Department of Women's and Reproductive Health, Oxford University, Oxford, Oxfordshire, UK
| | - David C Zammitt
- Fetal Alcohol Advisory and Support Team, NHS Ayrshire and Arran, Ayr, South Ayrshire, UK
| | - Penny A Cook
- School of Health Sciences, University of Salford, Salford, UK
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Flannigan K, Kapasi A, Pei J, Murdoch I, Andrew G, Rasmussen C. Characterizing adverse childhood experiences among children and adolescents with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. CHILD ABUSE & NEGLECT 2021; 112:104888. [PMID: 33388606 DOI: 10.1016/j.chiabu.2020.104888] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with Fetal Alcohol Spectrum Disorder (FASD) and prenatal alcohol exposure (PAE) face elevated rates of postnatal environmental adversity across the lifespan. OBJECTIVE We explored early adversity among children and adolescents with PAE. PARTICIPANTS AND SETTING Our sample included 333 children and adolescents with PAE assessed at a Canadian FASD diagnostic clinic, 66% of whom were diagnosed with FASD. METHODS Data were collected retrospectively via record review, and adversity was measured using the Adverse Childhood Experiences Questionnaire (ACE-Q). RESULTS Participants experienced high levels of adversity (mean ACE score of 3.4), which increased with age, mental health comorbidity, and number of living placements. Common ACEs included: not being raised by both biological parents (97.3%), caregiver disruption (88.5%), and exposure to household substance use (69.7%). Females had significantly higher rates of sexual abuse than males (p < .001, ø = -0.18). There was no difference in total ACE scores between participants diagnosed with FASD versus those not diagnosed, but participants with FASD were less likely to live with both biological parents (p < .001, ø = .19) or to have been exposed to household mental health problems (p = .007, ø = -0.15). CONCLUSIONS Children and adolescents with PAE experience high rates of early adversity. Practice and policy initiatives are needed to improve early detection of ACEs among children with PAE, and of PAE among children with ACEs. Targeted supports are needed to strengthen the early caregiving environment and mitigate the risks of adversity to support healthy outcomes for individuals with PAE and FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada.
| | - Aamena Kapasi
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, PO Box 11364 Wessex PO, Vancouver BC, V5R 0A4, Canada; University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Isabel Murdoch
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
| | - Gail Andrew
- Glenrose Rehabilitation Hospital, 10230 111 Avenue, Edmonton AB, T5G 0B7, Canada
| | - Carmen Rasmussen
- University of Alberta, Educational Psychology, 6-131 Education North, 116 Street and 85 Avenue, Edmonton AB, T6G 2R3, Canada
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17
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Burns J, Badry DE, Harding KD, Roberts N, Unsworth K, Cook JL. Comparing outcomes of children and youth with fetal alcohol spectrum disorder (FASD) in the child welfare system to those in other living situations in Canada: Results from the Canadian National FASD Database. Child Care Health Dev 2021; 47:77-84. [PMID: 33068027 DOI: 10.1111/cch.12817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
AIMS The current study aimed to explore differences in adverse outcomes between youth and adolescents with fetal alcohol spectrum disorder (FASD) living in child welfare care (i.e., foster care or group home) with those living with their biological parent(s) or with adoptive or other family member(s) in Canada. METHODS Data gathered from the Canadian National FASD Database were used for analysis. A total of 665 youth and adolescents with a clinical diagnosis of FASD under the age of 18 living in child welfare care, with biological, adoptive or other family members, were included in the sample. Key areas examined included living situation, legal problems, experience of sexual or physical abuse, mental health (anxiety, conduct disorder, mood disorder and post-traumatic stress disorder) and suicidal ideation. Descriptive statistics and chi-square comparisons were utilized to explore these differences. RESULTS Results revealed a significantly higher rate of reported sexual and physical abuse among individuals in child welfare care compared with those living with biological parents or with adoptive or other family member(s). Rates of difficulty with the law were also higher among those in child welfare care compared with adoptive/other family members. Conversely, the rate of mood disorders was significantly higher among those living with adoptive/other family members compared with child welfare care. Results highlight similar rates of reported suicidal ideation/attempts across all living situations, as well as mental health concerns. CONCLUSIONS Results offer rare insight into the lives of youth and adolescents under age 18 with diagnosed FASD who reside in child welfare care in contrast to those living with biological parent(s) or with adoptive or other family members. These findings increase our awareness of the complexity of mental health concerns and suicide risk across all living environments. Results have further implications for policy, practice and clinical intervention.
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Affiliation(s)
- Jessica Burns
- The Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Dorothy E Badry
- The Canada FASD Research Network, Vancouver, British Columbia, Canada.,Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Kelly D Harding
- The Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, Laurentian University, Sudbury, Ontario, Canada
| | | | - Kathy Unsworth
- The Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Jocelynn L Cook
- The Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Obstetrics, Gynaecology and Newborn Care, The University of Ottawa, Ottawa, Ontario, Canada.,The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
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Craig SG, Bondi BC, O'Donnell KA, Pepler DJ, Weiss MD. ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years. Curr Psychiatry Rep 2020; 22:79. [PMID: 33161561 DOI: 10.1007/s11920-020-01193-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW The purpose of the current paper was to review and summarize the literature on ADHD and maltreatment over the past 10 years. RECENT FINDINGS The majority of research on ADHD and exposure to maltreatment focuses on the high rates of comorbidity, including international studies from Asia, South America, North America, and Europe. Longitudinal studies showed that early exposure to maltreatment is a risk factor for ADHD symptoms later in development; however, this finding was not consistent. There were some preliminary studies on the neurological and genetic mechanisms underlying the link between ADHD and exposure to maltreatment. Finally, ADHD and exposure to maltreatment were found to have an additive effect on clinically salient outcomes (e.g., aggression, suicide attempts). Results from the review have direct clinical and future implications, including the need to understand the effect of comorbid ADHD and exposure to maltreatment in treatment studies.
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Affiliation(s)
- Stephanie G Craig
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada.
| | - Bianca C Bondi
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
| | | | - Debra J Pepler
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
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19
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Language Development Disorder in Fetal Alcohol Spectrum Disorders (FASD), a Case Study. LANGUAGES 2020. [DOI: 10.3390/languages5040037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prenatal alcohol exposure can cause developmental damage in children. There are different types and ranges of alterations that fall under the name of fetal alcohol spectrum disorders (FASD). Disabilities in learning, cognition, and behavior are observed. Environmental conditions are an influencing factor in this population since they are generally adverse and are either not diagnosed at an early stage or given the appropriate support and approach. We present a case study of a 9-year-old child, in which all the variables affecting his development (FASD diagnosis and socioenvironmental conditions) were observed and analyzed. His early childhood under institutional care, the move to a foster home at the age of 6, and several measures of evaluation from foster care to the present are described. Difficulties in vocabulary, access to vocabulary, morphology, syntax, grammar, oral narrative, pragmatics, speech, and communication were observed, along with cognitive difficulties in memory, perception and executive functioning, social adaptation, learning, and behavior. An early diagnosis and approach enable this population to develop skills in different dimensions to address early adversity despite their neurological and behavioral commitment. Speech-language pathologist services are crucial for the diagnosis and treatment of the language and communication difficulties that characterize this syndrome.
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20
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Koponen AM, Nissinen NM, Gissler M, Autti-Rämö I, Sarkola T, Kahila H. Prenatal substance exposure, adverse childhood experiences and diagnosed mental and behavioral disorders - A longitudinal register-based matched cohort study in Finland. SSM Popul Health 2020; 11:100625. [PMID: 32685656 PMCID: PMC7358713 DOI: 10.1016/j.ssmph.2020.100625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023] Open
Abstract
Both prenatal substance exposure (PSE, alcohol/drugs) and experiences during the first years of life have powerful effects on brain development. However, only a few studies have investigated the combined effect of PSE and adverse childhood experiences (ACEs) on mental and behavioral disorders among exposed adolescents and adults. This longitudinal register-based cohort study 1) compared the nature and extent of diagnosed mental and behavioral disorders among youth with PSE and matched unexposed controls, and 2) investigated the influence of PSE, health in infancy and ACEs (maternal risk factors and out-of-home care, OHC) on diagnoses of mental and behavioral disorders. The data consisted of 615 exposed youth aged 15-24 years and 1787 matched unexposed controls. Data from hospital medical records and nine registers were merged for the analysis. Descriptive analysis methods and Cox regression were used. The results showed that the prevalence of mental and behavioral disorders was twice as high among exposed compared with controls. The highest levels of mental and behavioral disorders and ACEs were found among exposed with at least one OHC episode. The difference in the risk of mental and behavioral disorders between exposed and controls diminished after controlling for the effect of ACEs. Low birth weight, maternal risk factors, and OHC were the strongest predictors of mental and behavioral disorders. The results suggest that PSE alone does not explain poorer mental health among exposed youth. Risk factors accumulate, and low birth weight and ACEs are strongly associated with increased risk of mental and behavioral disorders.
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Affiliation(s)
- Anne M. Koponen
- Folkhälsan Research Center, And University of Helsinki, Department of Public Health, Helsinki, Finland
| | - Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland and University of Tampere, Department of Health Sciences, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Department of Child Neurology, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, And Helsinki University Hospital, Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW To highlight research, publications, and medical advancements in fetal alcohol spectrum disorder (FASD) over the past 18 months. RECENT FINDINGS Prevalence numbers have been updated, allowing for a more accurate account of the societal impact. Further work on diagnostic techniques and the underlying mechanisms will allow us to better understand the pathophysiology of FASD and could translate into treatments for the condition. Continued research on new treatments and interventions is needed to improve the affected individual's health care and quality of life. Measurable outcomes allow us to tangibly measure improvements for individuals and families affected by FASD. SUMMARY The current review highlights recent publications from January 2018 to August 2019 showing continued medical advancement in improving the care for children and families affected by FASD.
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Affiliation(s)
- Joshua J Baker
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
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22
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Kambeitz C, Klug MG, Greenmyer J, Popova S, Burd L. Association of adverse childhood experiences and neurodevelopmental disorders in people with fetal alcohol spectrum disorders (FASD) and non-FASD controls. BMC Pediatr 2019; 19:498. [PMID: 31842817 PMCID: PMC6912946 DOI: 10.1186/s12887-019-1878-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a highly prevalent lifelong disorder with high rates of comorbid neurodevelopmental disorders. Individuals with FASD are often exposed to abuse, neglect and foster home placements which have uncertain effects on the lifelong course of FASD. In this study we compare the prevalence of adverse childhood events (ACEs) and neurodevelopmental disorders in subjects with fetal alcohol spectrum disorders (FASD) and non-FASD controls. METHODS A cross-sectional chart review of patients referred to a regional developmental center was used to identify people with FASD and non-FASD controls. We recorded the number of ACEs and neurodevelopmental disorders in each patient's chart. The most common diagnoses were attention deficit hyperactivity disorder, comprehension deficits, sleep disorders, and cognitive impairments. T-tests and a regression equation were utilized to determine significant differences between the groups. RESULTS The review identified 203 subjects, 98 with FASD and 105 non-FASD controls. Group mean age was 8.6 years and 64.5% were male. People with FASD were more likely to have any ACEs (mean 5.3) with ACE scores 3.7 points higher than non-FASD controls (mean 1.69) (t = 11.29; p < .001). Increased ACEs were associated with increased rates of neurodevelopmental disorders for people with FASD (R = .179, p = .026) but not for non-FASD controls (R = .130, p = .094). CONCLUSIONS Both FASD and subsequent exposure to ACEs are associated with increased risk for development of comorbid neurodevelopmental disorders. Prevention of ACEs during childhood may decrease risk for development of comorbid neurodevelopmental disorders.
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Affiliation(s)
- Cassondra Kambeitz
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202-9037 USA
| | - Marilyn G. Klug
- Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND USA
| | - Jacob Greenmyer
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202-9037 USA
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto Graduate, Toronto, Ontario Canada
- Faculty Associate Member, Institute of Medical Science, University of Toronto, Toronto, Ontario Canada
| | - Larry Burd
- Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202-9037 USA
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Landgren V, Svensson L, Gyllencreutz E, Aring E, Grönlund MA, Landgren M. Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe. BMJ Open 2019; 9:e032407. [PMID: 31666274 PMCID: PMC6830611 DOI: 10.1136/bmjopen-2019-032407] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest. OBJECTIVE To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children. DESIGN Prospective observational cohort study SETTING: Western Sweden PARTICIPANTS: A population-based cohort of 37 adoptees diagnosed with FASD in childhood. OUTCOME MEASURES Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist. RESULTS Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18-28) and a mean follow-up time of 15.5 years (range 13-17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately -1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5-21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = 'severely ill'. CONCLUSION Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.
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Affiliation(s)
- Valdemar Landgren
- Psychiatry, Skaraborg Hospital Skövde, Skövde, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Leif Svensson
- Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden
| | - Emelie Gyllencreutz
- Ophthalmology, Skaraborg Hospital Skövde, Skövde, Sweden
- Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Eva Aring
- Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Marita Andersson Grönlund
- Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Magnus Landgren
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
- Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden
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24
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Holiga Š, Hipp JF, Chatham CH, Garces P, Spooren W, D’Ardhuy XL, Bertolino A, Bouquet C, Buitelaar JK, Bours C, Rausch A, Oldehinkel M, Bouvard M, Amestoy A, Caralp M, Gueguen S, Ly-Le Moal M, Houenou J, Beckmann CF, Loth E, Murphy D, Charman T, Tillmann J, Laidi C, Delorme R, Beggiato A, Gaman A, Scheid I, Leboyer M, d’Albis MA, Sevigny J, Czech C, Bolognani F, Honey GD, Dukart J. Patients with autism spectrum disorders display reproducible functional connectivity alterations. Sci Transl Med 2019. [DOI: 10.1126/scitranslmed.aat9223 order by 39635--] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Štefan Holiga
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Joerg F. Hipp
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Christopher H. Chatham
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Pilar Garces
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Will Spooren
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Xavier Liogier D’Ardhuy
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Alessandro Bertolino
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70121 Bari, Italy
| | - Céline Bouquet
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Jan K. Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen Medical center, Nijmegen 6525 EN, Netherlands
| | - Carsten Bours
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen Medical center, Nijmegen 6525 EN, Netherlands
| | - Annika Rausch
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen Medical center, Nijmegen 6525 EN, Netherlands
| | - Marianne Oldehinkel
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen Medical center, Nijmegen 6525 EN, Netherlands
- Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Manuel Bouvard
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Charles Perrens Bordeaux, 33076 Bordeaux, France
| | - Anouck Amestoy
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Charles Perrens Bordeaux, 33076 Bordeaux, France
| | - Mireille Caralp
- INSERM, National Biobank Infrastructure, 75013 Paris, France
| | - Sonia Gueguen
- INSERM, Clinical Research Department, 75014 Paris, France
| | | | - Josselin Houenou
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
- NeuroSpin, UNIACT Lab, Psychiatry Team, CEA Saclay, 91191 Gif-Sur-Yvette, France
| | - Christian F. Beckmann
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen Medical center, Nijmegen 6525 EN, Netherlands
| | - Eva Loth
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Declan Murphy
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Julian Tillmann
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
- Department of Applied Psychology: Health, Development, Enhancement, and Intervention, University of Vienna, 1010 Vienna, Austria
| | - Charles Laidi
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
| | - Richard Delorme
- APHP, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
- Pasteur Institute, 75019 Paris, France
| | - Anita Beggiato
- APHP, Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France
- Pasteur Institute, 75019 Paris, France
| | - Alexandru Gaman
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
| | - Isabelle Scheid
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
| | - Marion Leboyer
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
| | - Marc-Antoine d’Albis
- Hôpitaux Universitaires Mondor, DHU PePSY, Pôle de psychiatrie, Faculté de Médecine, Université Paris Est, INSERM U955, IMRB, Equipe 15, Psychiatrie Translationnelle, Fondation FondaMental, 94000 Créteil, France
- NeuroSpin, UNIACT Lab, Psychiatry Team, CEA Saclay, 91191 Gif-Sur-Yvette, France
| | - Jeff Sevigny
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Christian Czech
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Federico Bolognani
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
- Therachon AG, Aeschenvorstadt 36, 4051 Basel, Switzerland
| | - Garry D. Honey
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
| | - Juergen Dukart
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, 52428 Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, 40223 Düsseldorf, Germany
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Holiga Š, Hipp JF, Chatham CH, Garces P, Spooren W, D’Ardhuy XL, Bertolino A, Bouquet C, Buitelaar JK, Bours C, Rausch A, Oldehinkel M, Bouvard M, Amestoy A, Caralp M, Gueguen S, Ly-Le Moal M, Houenou J, Beckmann CF, Loth E, Murphy D, Charman T, Tillmann J, Laidi C, Delorme R, Beggiato A, Gaman A, Scheid I, Leboyer M, d’Albis MA, Sevigny J, Czech C, Bolognani F, Honey GD, Dukart J. Patients with autism spectrum disorders display reproducible functional connectivity alterations. Sci Transl Med 2019; 11:11/481/eaat9223. [DOI: 10.1126/scitranslmed.aat9223] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/22/2018] [Accepted: 02/05/2019] [Indexed: 01/16/2023]
Abstract
Despite the high clinical burden, little is known about pathophysiology underlying autism spectrum disorder (ASD). Recent resting-state functional magnetic resonance imaging (rs-fMRI) studies have found atypical synchronization of brain activity in ASD. However, no consensus has been reached on the nature and clinical relevance of these alterations. Here, we addressed these questions in four large ASD cohorts. Using rs-fMRI, we identified functional connectivity alterations associated with ASD. We tested for associations of these imaging phenotypes with clinical and demographic factors such as age, sex, medication status, and clinical symptom severity. Our results showed reproducible patterns of ASD-associated functional hyper- and hypoconnectivity. Hypoconnectivity was primarily restricted to sensory-motor regions, whereas hyperconnectivity hubs were predominately located in prefrontal and parietal cortices. Shifts in cortico-cortical between-network connectivity from outside to within the identified regions were shown to be a key driver of these abnormalities. This reproducible pathophysiological phenotype was partially associated with core ASD symptoms related to communication and daily living skills and was not affected by age, sex, or medication status. Although the large effect sizes in standardized cohorts are encouraging with respect to potential application as a treatment and for patient stratification, the moderate link to clinical symptoms and the large overlap with healthy controls currently limit the usability of identified alterations as diagnostic or efficacy readout.
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Sakano M, Mukherjee R, Turk J. Behaviour and adaptive functioning in children and young people with fetal alcohol spectrum disorders: a UK study. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-10-2018-0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose
The purpose of this paper is to explore the profiles of behaviours and adaptive functioning in the UK children and young people with fetal alcohol spectrum disorders.
Design/methodology/approach
Data of 106 participants registered from 2005 to 2015 were extracted from a clinic database. In total, 99 individuals with confirmed prenatal alcohol exposure (PAE), aged from 5 to 25 years, were analysed using scaled scores of the Vineland Adaptive Behavior Scales-Second Edition (VABS-II), and the Developmental Behaviour Checklist-Primary Carer Version (DBC-P) and Teacher Version (DBC-T). Differences due to age, gender, IQ and family structure (adopted/living with birth parents) were also explored.
Findings
The mean composite adaptive behaviour score on the VABS-II was classified as “low” at 68.2 (SD=8.5), with the socialisation domain being the most impaired. Significantly lower VABS-II composite scores were found in individuals with lower IQ’s, older ages and in males. Disruptive behaviours were the most commonly observed on the DBCs, whereas primary carers scored significantly higher than teachers across all subscales. IQ, age and gender were not associated with the total percentile scores of both DBCs. Adoption made no differences compared to living with birth parents.
Research limitations/implications
Future studies would replicate these findings in a larger sample size including individuals without PAE and those living with birth parents.
Originality/value
This study is the first UK report that examines this issue.
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