Fetal alcohol spectrum disorder among pre-adopted and foster children

Prevalence of fetal alcohol spectrum disorder in foster care: A scoping review

The prevalence of fetal alcohol spectrum disorder (FASD) has been reported to be disproportionately high among children in foster care compared with the general population. However, updated prevalence estimates of infants and children with FASD in foster care or the prevalence of placement of children with FASD in foster care make this unclear. This study examines two questions. Firstly, what is the prevalence of FASD among infants and children in foster care? Secondly, what is the likelihood of placement in foster care for infants and children with FASD? This review was designed using PRISMA-SCR and JBI scoping review guidelines. Three databases were searched for the period June 2012 to June 2023: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar for all countries. Overall prevalence estimates were calculated using a complementary log-log link model along with 95% confidence intervals. Firstly, the estimated prevalence of FASD among infants and children in foster care was 18.8%. Secondly, among children diagnosed with FASD 30.5% are placed into foster care, reflecting greatly increased risk of placement of infants and children with FASD in foster care. We conclude that routine screening for FASD is needed to improve the identification of infants and children with FASD. Increased attention is also needed on developing strategies for FASD prevention. Recognition that nearly one of every three children with FASD will enter foster care demonstrates the need for increased funding, enhanced training and greater availability of services for families and children impacted by FASD.

Professional Quality of Life of Foster and Kinship Carers in Australia, United Kingdom, and the United States: A Scoping Review

Professional quality of life (ProQOL) refers to workers' subjective feelings associated with work involved in helping others who have experienced trauma. It consists of positive and negative aspects, that is, subscales of compassion satisfaction, and burnout and secondary traumatic stress. Foster and kinship caring inherently involves risks associated with exposure to the trauma responses of children in their care. This exposure can lead to poor ProQOL, carer attrition, and placement instability. While limited studies specifically explore ProQOL of carers, many studies have examined factors and interventions related to ProQOL. However, there is a lack of synthesis of these studies. To fill such a research gap, we undertook a scoping review of 70 empirical studies from Australia, the United Kingdom, and the United States, published from 2012 to 2022 reporting on ProQOL, and its related factors and concepts. We applied a multilevel ecosocial construct to examine complex interrelationships between private and governance settings to better understand factors related to ProQOL of carers and interventions aimed to improve it in these dynamic systems. In our review, some studies showed positive outcomes for carers, such as reduced stress or burnout associated with training. However, there was insufficient attention to factors associated with ProQOL at relational and sociopolitical levels. It is crucial to improve carers' ProQOL or well-being to ensure their retention and placement stability. Long-term systemic improvements require interventions across different levels of the system.

The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review

ISSUES

Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.

KEY FINDINGS

Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.

IMPLICATIONS

Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.

CONCLUSIONS

Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.

Parental scaffolding in play: A comparison of fetal alcohol spectrum disorders and autism spectrum disorder

BACKGROUND

Parental support of child play varies based on child needs; however, how parental play level differs from child play level remains an understudied area of research, especially in relation to specific developmental disabilities.

AIMS

To preliminarily explore differences in child and parent play levels in age- and IQ-matched children with fetal alcohol spectrum disorders (FASD) and autism spectrum disorder (ASD).

METHODS

and Procedures: Parent-child dyads were recorded during free-play sessions. Parent/child play levels were coded for highest level achieved during each minute of play. Mean play level and dPlay (difference in parent versus child play level) were calculated across play sessions for each dyad.

OUTCOMES AND RESULTS

On average, parents of children with FASD demonstrated higher levels of play than other parents. Children with FASD demonstrated higher levels of play than their own parents. In contrast, the play level of parents of children with ASD did not differ from their child's. There were no between-group differences in dPlay.

CONCLUSIONS AND IMPLICATIONS

This preliminary exploratory study suggests that parents of children with developmental disabilities may differentially 'match' their child's play level. Further research on developmental play levels during parent-child play is warranted.

Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD)

Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.

Exploring the relationship between adoption and psychological trauma for children who are adopted from care: A longitudinal case study perspective

Children who have been adopted from care are very likely to have experienced early adversity that may result in psychological trauma. A current debate in the field is whether adoption provides a pathway to healing for traumatised children, helping them to recover from past psychological harm, or creates trauma for children through the very nature of being an adopted child.

OBJECTIVE

This study aimed to use longitudinal data pertaining to children who had been adopted from care to examine the relationship between being adopted from care and psychological trauma.

PARTICIPANTS AND SETTING

Seventeen adopted children had been interviewed in their adoptive homes during the third wave of the Care Pathways and Outcomes study (McSherry et al., 2013), when they were aged between nine and 14 years old. Ten of these children were selected for specific consideration in this article. Checklists for early adversities and psychological trauma were used to support the creation of case studies that highlighted the extent of psychological trauma in the children's lives.

RESULTS

The adopted children either experienced possible pre-care psychological trauma, with the impact of this reducing over time, in utero developmental harm due to their mother's alcohol misuse during pregnancy, inherited an intellectual disability, with the resultant difficulties superseding any concern regarding possible pre-care psychological trauma, or possible psychological trauma when moving from an established foster placement to adoption. Recommendations for policy and practice are provided.

The contribution of the Neurobehavioral Screening Tool to identifying fetal alcohol spectrum disorders in children at high risk of prenatal alcohol exposure and neurobehavioral deficits

BACKGROUND

Fetal alcohol spectrum disorders (FASD) describe various conditions resulting from prenatal alcohol exposure. The diagnosis of FASD can be challenging and complex. The Neurobehavioral Screening Tool (NST), derived from Achenbach's Child Behavior Checklist, has been suggested as a tool for identifying FASD.

AIMS

To assess the external validity of the NST and to identify additional characteristics of FASD in a cohort of Israeli children and young adults referred to a neurology and child developmental clinic at a tertiary pediatric medical center in Israel.

STUDY DESIGN

An observational study based on medical records.

SUBJECTS

151 children and young adults, of whom 40 were diagnosed with FASD according to updated clinical guidelines.

OUTCOME MEASURES

NST results, as well as demographic and neurobehavioral variables, were compared between those who were and were not diagnosed with FASD.

RESULTS

The NST demonstrated 72 % to 73 % sensitivity, and 34 % to 36 % specificity, in identifying FASD. Items 4 and 5 ('Lies or cheats', 'Lacks guilt after misbehaving') were the most predictive items in the NST. Other variables that were characteristic of the FASD group included: emotional regulation difficulties (p value <0.01), being born and adopted in Israel (vs. other countries) (p value <0.01) and younger age at the first visit to the clinic (p value <0.01).

CONCLUSIONS

Our findings regarding the screening capabilities of the NST were less promising than those of most previous studies. Further research is needed to establish a valid neurobehavioral tool with the possible focus on antisocial behaviors and emotional regulation problems.

Dynamic and Systemic Perspective in Autism Spectrum Disorders: A Change of Gaze in Research Opens to A New Landscape of Needs and Solutions

The first step for a harmonious bio-psycho-social framework in approaching autism spectrum disorders (ASD) is overcoming the conflict between the biological and the psychosocial perspective. Biological research can provide clues for a correct approach to clinical practice, assuming that it would lead to the conceptualization of a pathogenetic paradigm able to account for epidemiologic and clinical findings. The upward trajectory in ASD prevalence and the systemic involvement of other organs besides the brain suggest that the epigenetic paradigm is the most plausible one. The embryo-fetal period is the crucial window of opportunity for keeping neurodevelopment on the right tracks, suggesting that women's health in pregnancy should be a priority. Maladaptive molecular pathways beginning in utero, in particular, a vicious circle between the immune response, oxidative stress/mitochondrial dysfunction, and dysbiosis-impact neurodevelopment and brain functioning across the lifespan and are the basis for progressive multisystemic disorders that account for the substantial health loss and the increased mortality in ASD. Therefore, the biological complexity of ASD and its implications for health requires the enhancement of clinical skills on these topics, to achieve an effective multi-disciplinary healthcare model. Well-balanced training courses could be a promising starting point to make a change.

Epigenetic Impacts of Early Life Stress in Fetal Alcohol Spectrum Disorders Shape the Neurodevelopmental Continuum

Neurodevelopment in humans is a long, elaborate, and highly coordinated process involving three trimesters of prenatal development followed by decades of postnatal development and maturation. Throughout this period, the brain is highly sensitive and responsive to the external environment, which may provide a range of inputs leading to positive or negative outcomes. Fetal alcohol spectrum disorders (FASD) result from prenatal alcohol exposure (PAE). Although the molecular mechanisms of FASD are not fully characterized, they involve alterations to the regulation of gene expression via epigenetic marks. As in the prenatal stages, the postnatal period of neurodevelopment is also sensitive to environmental inputs. Often this sensitivity is reflected in children facing adverse conditions, such as maternal separation. This exposure to early life stress (ELS) is implicated in the manifestation of various behavioral abnormalities. Most FASD research has focused exclusively on the effect of prenatal ethanol exposure in isolation. Here, we review the research into the effect of prenatal ethanol exposure and ELS, with a focus on the continuum of epigenomic and transcriptomic alterations. Interestingly, a select few experiments have assessed the cumulative effect of prenatal alcohol and postnatal maternal separation stress. Regulatory regions of different sets of genes are affected by both treatments independently, and a unique set of genes are affected by the combination of treatments. Notably, epigenetic and gene expression changes converge at the clustered protocadherin locus and oxidative stress pathway. Functional studies using epigenetic editing may elucidate individual contributions of regulatory regions for hub genes and further profiling efforts may lead to the development of non-invasive methods to identify children at risk. Taken together, the results favor the potential to improve neurodevelopmental outcomes by epigenetic management of children born with FASD using favorable postnatal conditions with or without therapeutic interventions.

Prevalence of Fetal Alcohol Spectrum Disorders (FASD) among Children Adopted from Eastern European Countries: Russia and Ukraine

Fetal alcohol spectrum disorder (FASD) is a leading cause of neurodevelopmental disorders. Children adopted internationally from countries where alcohol consumption during pregnancy is very high are at greater risk for FASD. Lack of expertise in diagnosing FASD and mixed neurodevelopmental and behavioral signs due to abandonment complicate a timely diagnosis. The aim of this study was to determine the prevalence of FASD in adopted children. Children between the ages of 8 and 24 adopted from Russia and Ukraine were evaluated for clinical and historical features of FASD. Of the 162 children evaluated, 81 (50%) met FASD diagnostic criteria. Thirty-three (20.4%) children had fetal alcohol syndrome (FAS), 28 (17.2%) had partial FAS, 2 (1.2%) had alcohol-related birth defects (ARBD) and 18 (11.1%) had alcohol-related neurodevelopmental disorder (ARND). Of the 81 children in which fetal alcohol exposure could not be confirmed, many had manifestations that would have established a diagnosis of FASD if a history of maternal alcohol consumption was confirmed. In a population of children with a high risk of prenatal alcohol exposure (adoptees from Eastern European countries), at least 50% showed manifestations associated with FASD. The reported prevalence in this study is in line with the results obtained in a previous study as well as in orphanages of origin.