Fetal Alcohol Spectrum Disorder Assessment Research Articles

Challenges in Accurately Assessing Prenatal Alcohol Exposure in a Study of Fetal Alcohol Spectrum Disorder in a Youth Detention Center.

BackgroundPrenatal alcohol exposure (PAE) can result in permanent disability, including physical, neurodevelopmental, and cognitive impairments, known as fetal alcohol spectrum disorder (FASD). Individuals with FASD are more likely to engage with the law, including being placed in detention, than individuals without FASD. Young people who were sentenced to detention participated in a FASD prevalence study in Western Australia. The diagnosis of FASD requires a multidisciplinary assessment and confirmation of maternal alcohol consumption during pregnancy. Obtaining accurate assessment of PAE for young people participating in the study was challenging.MethodsAn interview with the birth mother or other responsible adult for young people sentenced to detention in Western Australia was conducted as part of the FASD assessment. The Alcohol Use Disorders Identification Test consumption subset (AUDIT‐C), other relevant questions, and documentary evidence were used to assess PAE. PAE was categorized according to the Australian Guide to the Diagnosis of FASD: no PAE reported, confirmed or confirmed high‐risk, or unknown.ResultsAmong the 101 participants, information on PAE was unable to be obtained for 13 (13%) young people. Of the remaining 88 participants with information of PAE, 41 reported no PAE and 47 had confirmed PAE.ConclusionsAccurately assessing prenatal alcohol consumption is challenging in any setting, but it is exceptionally challenging when assessed 13 to 17 years retrospectively as part of a FASD assessment for a young person sentenced to detention. Recording and recoding detailed qualitative responses was required to provide an accurate assessment of PAE using the AUDIT‐C. Standardized recording of PAE in antenatal and birth records would facilitate later assessments for FASD and provide opportunities for advice and support for women who continue to drink during pregnancy.

Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings

ABSTRACTDiagnostic assessment in Fetal Alcohol Spectrum Disorder (FASD) is informed by multidisciplinary assessment incorporating objective (i.e., test measures) and subjective means, such as parent and teacher behavior ratings. The purpose of this study was to extend our previous neuropsychological test findings by identifying parent and teacher ratings of academic achievement, attention, executive functioning, and adaptive functioning as predictors of an FASD diagnosis. The charts of 315 children and adolescents with prenatal alcohol exposure (PAE) who underwent assessment for FASD were retrospectively reviewed. Direct logistic regressions analyzed the contribution of different ratings on the likelihood of an FASD diagnosis. The results suggest that a number of rating measures do contribute toward accurately differentiating those with FASD from within a PAE population, including teacher ratings of learning problems, inattention, and adaptive skills. The classification accuracy for each regression was clinically significant (59.1–70.8%). Children with worse ratings on these variables are approximately 1.5 to 2 times more likely to receive an FASD diagnosis. Only teacher ratings (not parent) significantly contributed to whether a diagnosis was made, suggesting that teacher observational rating scales are a critical component of an FASD assessment. Together with our previous research examining neuropsychological evaluation and FASD diagnostic assessment, this study helps to further guide decisions to streamline care in multidisciplinary assessment and intervention planning.

Profile of children diagnosed with a fetal alcohol spectrum disorder: A retrospective chart review.

Fetal alcohol spectrum disorder (FASD) is a significant public health concern, and growing recognition in Australia led to the establishment of a specialist service for young children. The aim of the current study was to report on the diagnostic profile of a group of children who attended the service, to document the extent to which there were comorbid diagnoses and to provide information on the neurocognitive functioning of the children. This study was a retrospective chart review conducted by the diagnostic service. A pre-formulated tool to extract the diagnostic data from the client files was designed, a chart review was performed, and the required data was extracted. FASD diagnoses were made using the 4-Digit Diagnostic Code. Thirty-one families participated, and the majority of children were diagnosed with static encephalopathy (alcohol exposed) or neurobehavioral disorder (alcohol exposed) (11 children each; 36%). Only one child was diagnosed with fetal alcohol syndrome (alcohol exposed), and five children were diagnosed with partial fetal alcohol syndrome (alcohol exposed). Twenty-six children (84%) had a comorbid diagnosis, with 19 (61%) having a comorbid diagnosis of attention deficit hyperactivity disorder. While the majority of children were not found to display growth deficiency or significant facial features, 18 children (58%) had significant central nervous system dysfunction. The current study demonstrates that with the relevant training and expertise, assessment and diagnosis of FASD can be embedded within the existing health services available in Australia. [Reid N, Shelton D,Warner J, O'Callaghan F, Dawe S. Profile of children diagnosed with a fetal alcohol spectrum disorder: A retrospective chart review. Drug Alcohol Rev 2017;00:000-000].

Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment

ABSTRACTA variety of neurodevelopmental impairments related to fetal alcohol spectrum disorder (FASD) diagnoses have been consistently documented. However, it is not clear whether such variables are predictive of a diagnosis. The purpose of the present study is to use logistic regressions to identify predictors of FASD in neuropsychological assessment. Charts of 180 children and adolescents with prenatal alcohol exposure (PAE) who underwent psychological and diagnostic assessment for FASD were retrospectively reviewed. A total of 107 received an FASD diagnosis (the PAE-FASD group) and 73 did not (the PAE group). Following preliminary analyses, direct logistic regressions were performed to assess the contribution of different neuropsychological testing measures on the likelihood of a child or adolescent receiving an FASD diagnosis. The results indicate that the classification accuracy of the PAE-FASD and PAE groups is clinically significant across models of intelligence, academic achievement, memory, and executive functioning. Classification rates across the various models range from 67.1% to 75.5%, with models incorporating 10 intelligence subtests or 3 academic subtests emerging as superior to those using broad indices of intelligence and/or individual subtests of memory or executive functioning. A “test battery” model incorporating verbal intelligence, verbal/auditory working memory (digit span), basic reading and spelling skills, math calculations, delayed story recall, and spatial planning and problem-solving yielded a classification rate of 74.7%. These results suggest that neuropsychological testing is a critical component of FASD assessment and help guide decisions to maximize the efficiency and efficacy of the diagnostic process and treatment recommendations.

A qualitative evaluation of caregivers’ experiences, understanding and outcomes following diagnosis of FASD

IntroductionThe effects of prenatal exposure to alcohol are wide-ranging and pervasive in nature. In response to growing concerns about the lifelong disabilities related to prenatal alcohol exposure, a fetal alcohol spectrum disorder (FASD) diagnostic clinic was established in 2012. This was the first multi-disciplinary service operating permanently within an Australian health service. The current study aimed to explore the lived experience of the diagnostic process for caregivers of children with FASD. MethodsTwelve caregivers were approached and ten participated in audiotaped interviews about caring for a child with FASD. Qualitative analysis was undertaken on transcribed interviews using NVivo 10 for thematic analysis. ResultsThe major themes that emerged were: a desire for future support for their child although uncertainty about how this support could be accessed; an understanding of FASD prior to assessment but a concerted concern that this condition was not recognised as a disability across educational and related settings; that a formal assessment process provided validation for caregiver concerns and that caregivers felt respected and understood by the clinical team during this process. DiscussionThese findings highlight the concerns of caregivers, emphasising both the importance of diagnostic services and the need for provision of further support beyond diagnosis for a child with FASD. What does this paper add?This study provides information on the lived experiences of caregivers who attended the first multi-disciplinary FASD assessment and diagnostic service in Australia. This study provides valuable insight into the ongoing difficulties that families are experiencing following diagnosis in the current Australian context.

FETAL ALCOHOL SPECTRUM DISORDER: COST OF SCREENING AND DIAGNOSIS IN CANADA

IntroductionsPrenatal alcohol exposure can lead to a myriad of adverse health outcomes for the child, including Fetal Alcohol Spectrum Disorder (FASD). Unfortunately, for a number of reasons, FASD is underdiagnosed...

Using Telehealth for Assessment of Fetal Alcohol Spectrum Disorder: The Experience of Two Canadian Rural and Remote Communities

Telehealth has been used for fetal alcohol spectrum disorder (FASD) diagnostic assessment in select Manitoban communities since 2000. The purpose of this study was to evaluate the FASD telehealth program within two rural and remote Northern Manitoban communities by comparing community practices from the perspective of professionals working with the FASD diagnostic clinics in these communities. Recommendations for the further development of FASD assessment by telehealth were made to further improve current implementation and guide expansion of the FASD telehealth program within the province. Semistructured interviews were conducted from October 19 to December 11, 2009. Participants (N = 26) were comprised of professionals, including those in the education, social services, and health sectors. Two themes emerged from the data and covered the perceived strengths and drawbacks with the program, and meaningful suggestions to improve the service. Participants regarded the FASD telehealth program as successful and useful, especially given the remote location of the communities and the lack of on-site services. Recommendations addressing the barriers pertaining to the process were made from the study's findings and available scientific literature. This study will provide a solid basis for the successful further development of the FASD telehealth programs.

International survey of diagnostic services for children with Fetal Alcohol Spectrum Disorders

BackgroundEarly diagnosis and intervention for children with Fetal Alcohol Spectrum Disorder (FASD) reduces the risk of developing a range of secondary social, emotional and behavioural problems and provides an opportunity for prevention of further alcohol exposed pregnancies. The objective of this study was to describe specialist clinical service provision for the diagnosis and assessment of children exposed to alcohol in pregnancy.MethodsFetal Alcohol Spectrum Disorder (FASD) diagnostic clinics were identified through literature and internet searches. Clinics were sent a questionnaire asking for information on the clinic population, clinic staff, assessment process and other services provided.ResultsQuestionnaires were completed for 34 clinics: 29 were in North America, 2 in Africa, 2 in Europe and 1 in South America. No clinics were identified in Asia or Australasia. There was a variety of funding sources, services offered, clinic populations, staff and methods of assessment. Thirty-three clinics had a multi-disciplinary team. In 32 clinics, at least one member of the team had specialist training in assessment of FASD. Neurobehavioural assessment was completed in 32 clinics. Eleven clinics used more than one set of diagnostic criteria or an adaptation of published criteria.ConclusionDiagnostic services are concentrated in North America. Most responding clinics are using a multidisciplinary approach with neurobehavioural assessment as recommended in published guidelines. Agreement on diagnostic criteria would enable comparison of clinical and research data, and enhance FASD research particularly for intervention trials.