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Chu JTW, McCormack J, Jiang Y, Walsh D, Wilson H, Marsh S, Langridge F, Bullen C. Investigating the relationship between prenatal alcohol exposure and children's behavioural and emotional development: analysis of the Growing Up in New Zealand study. Alcohol Alcohol 2024; 59:agae029. [PMID: 38678371 PMCID: PMC11055961 DOI: 10.1093/alcalc/agae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024] Open
Abstract
AIMS To examine the relationship between prenatal alcohol exposure (PAE) and children's behavioural and emotional development in a large generalizable sample of women and their children in Aotearoa New Zealand. METHODS Using data from the Growing Up in New Zealand longitudinal cohort, we investigated the relationship between maternal PAE and behavioural and emotional development in 8-year-old children. We explored secondary outcomes including measures of language, executive function, academic achievement, and adaptive behaviour. RESULTS We found no significant differences in the measures of behavioural and emotional development in children 8 years old based on alcohol consumption. No significant differences in behavioural and emotional development were found based on amount of PAE and when PAE occurred, despite controlling for a range of potential confounding factors, such as neighbourhood deprivation and maternal health measures. PAE was associated with significantly higher scores for parent-rated oral language indicating better oral language. In Māori mothers, PAE was significantly associated with an increased risk of higher scores on two of the Strengths and Difficulties Questionnaire subscales. CONCLUSIONS We did not find an association between PAE and behavioural and emotional development in children aged 8 years. PAE and behavioural and emotional development are difficult to measure accurately, and the moderating variables between them are complex. Future analyses will require larger cohorts of mothers and their children using precise measures of PAE and outcomes to enable more precise estimates of association.
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Affiliation(s)
- Joanna Ting Wai Chu
- Social and Community Health, School of Population Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
- Centre for Arts and Social Transformation, Faculty of Arts and Social Work, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New ZealandNew Zealand
| | - Jessica McCormack
- Food Science, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Yannan Jiang
- Social and Community Health, School of Population Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Daniel Walsh
- Statistics, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Holly Wilson
- Social and Community Health, School of Population Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Samantha Marsh
- Social and Community Health, School of Population Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Fiona Langridge
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
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Wilson DA, Sullivan RM, Smiley JF, Saito M, Raineki C. Developmental alcohol exposure is exhausting: Sleep and the enduring consequences of alcohol exposure during development. Neurosci Biobehav Rev 2024; 158:105567. [PMID: 38309498 PMCID: PMC10923002 DOI: 10.1016/j.neubiorev.2024.105567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Prenatal alcohol exposure is the leading nongenetic cause of human intellectual impairment. The long-term impacts of prenatal alcohol exposure on health and well-being are diverse, including neuropathology leading to behavioral, cognitive, and emotional impairments. Additionally negative effects also occur on the physiological level, such as the endocrine, cardiovascular, and immune systems. Among these diverse impacts is sleep disruption. In this review, we describe how prenatal alcohol exposure affects sleep, and potential mechanisms of those effects. Furthermore, we outline the evidence that sleep disruption across the lifespan may be a mediator of some cognitive and behavioral impacts of developmental alcohol exposure, and thus may represent a promising target for treatment.
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Affiliation(s)
- Donald A Wilson
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, USA.
| | - Regina M Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Child and Adolescent Psychiatry, NYU School of Medicine, New York, NY, USA
| | - John F Smiley
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University Medical Center, New York, NY, USA
| | - Mariko Saito
- Division of Neurochemistry, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University Medical Center, New York, NY, USA
| | - Charlis Raineki
- Department of Psychology, Brock University, St. Catharines, ON, Canada; Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
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Pruner M, Jirikowic T, Baylor C, Astley Hemingway SJ. Developmental, sensory and behavioral outcomes among infants and toddlers with prenatal alcohol exposure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 146:104671. [PMID: 38262190 DOI: 10.1016/j.ridd.2024.104671] [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: 04/11/2022] [Revised: 11/17/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) can disrupt children's neurodevelopment and exert lasting influences on overall child well-being and family functioning. A comprehensive exploration of developmental outcomes in infants/toddlers with PAE seen for a diagnosis on the fetal alcohol spectrum can inform early identification and intervention. AIMS To describe the prevalence and patterns of neurodevelopment, sensory processing, and emotional and behavioral functioning in a clinical sample of infants/toddlers with PAE. METHODS In this retrospective analysis, clinical data from 125 infants/toddlers with PAE, aged 2-42 months, assessed at the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network clinic were analyzed. RESULTS Seventy-four to 87% of infants/toddlers demonstrated delayed development in one or more domains of the Bayley Scales of Infant and Toddler Development (n = 125). Adverse developmental outcomes were significantly correlated with PAE and/or postnatal risk factors. All 93 infants/toddlers with a complete Infant/Toddler Sensory Profile obtained definite difference scores in at least one quadrant/section. Over half of infant/toddlers with a completed Child Behavior Checklist/1½- 5 had total problem scores in the borderline or clinical range. CONCLUSIONS Findings suggest that several domains of child functioning may be vulnerable to the teratogenic impact of PAE, and that these delays are evident in the first years of life. Early screening, ongoing monitoring and comprehensive assessment is needed to facilitate earlier identification and guide clinical intervention.
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Affiliation(s)
- Misty Pruner
- University of Washington, Institute on Human Development and Disability, 1701 NE Columbia Rd, Box 357920, Seattle, WA 98195, USA.
| | - Tracy Jirikowic
- University of Washington, Department of Rehabilitation Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
| | - Carolyn Baylor
- University of Washington, Department of Rehabilitation Medicine, 325 Ninth Avenue, Box 359612, Seattle, WA 98104, USA
| | - Susan J Astley Hemingway
- University of Washington, Department of Epidemiology, 3980 15th Ave NE, Box 351619, Seattle, WA 98195, USA; University of Washington, School of Medicine, Department of Pediatrics, 1959 NE Pacific Street, Box 356340, Seattle, WA 98195, USA
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Maxwell JR, DiDomenico J, Roberts MH, Marquez LE, Rai R, Weinberg J, Jacobson SW, Stephen J, Bakhireva LN. Impact of low-level prenatal alcohol exposure and maternal stress on autonomic regulation. Pediatr Res 2024; 95:350-358. [PMID: 37674025 PMCID: PMC11089775 DOI: 10.1038/s41390-023-02799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) impacts the neurodevelopment of the fetus, including the infant's ability to self-regulate. Heart rate variability (HRV), that is, the beat-to-beat variability in heart rate, is a non-invasive measurement that can indicate autonomic nervous system (ANS) function/dysfunction. METHODS The study consisted of a subset of our ENRICH-2 cohort: 80 participants (32 PAE and 48 Controls) who had completed three visits during pregnancy. The participants completed a comprehensive assessment of PAE and other substances throughout pregnancy and assessments for stress, anxiety, and depression in the third trimester. At 24 h of age, infant HRV was assessed in the hospital during the clinically indicated heel lance; 3- to 5-min HRV epochs were obtained during baseline, heel lancing, and recovery episodes. RESULTS Parameters of HRV differed in infants with PAE compared to Controls during the recovery phase of the heel lance (respiratory sinus arrhythmia (RSA) and high-frequency (HF), p < 0.05). Increased maternal stress was also strongly associated with abnormalities in RSA, HF, and low-frequency / high-frequency (LF/HF, p's < 0.05). CONCLUSIONS Alterations in ANS regulation associated with PAE and maternal stress may reflect abnormal development of the hypothalamic-pituitary-adrenal axis and have long term implications for infant responsiveness and self-regulation. IMPACT Previous studies have focused on effects of moderate to heavy prenatal alcohol exposure (PAE) on autonomic dysregulation, but little is known about the effects of lower levels of PAE on infant self-regulation and heart rate variability (HRV). Prenatal stress is another risk factor for autonomic dysregulation. Mild PAE impacts infant self-regulation, which can be assessed using HRV. However, the effect of prenatal stress is stronger than that of mild PAE or other mental health variables on autonomic dysregulation.
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Affiliation(s)
- Jessie R Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, Mexico.
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, Mexico.
| | - Jared DiDomenico
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Melissa H Roberts
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Lidia Enriquez Marquez
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Rajani Rai
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Sandra W Jacobson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Julia Stephen
- The Mind Research Network, a Division of Lovelace Biomedical Research Institute, University of New Mexico, Albuquerque, NM, Mexico
| | - Ludmila N Bakhireva
- Substance Use Research and Education (SURE) Center, College of Pharmacy, University of New Mexico, Albuquerque, NM, Mexico
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Prado-Galbarro FJ, Sanchez-Piedra C, Martínez-Núñez JM. Effect of prevalence of alcohol consumption and tobacco use in Mexican municipalities on early childhood development. CAD SAUDE PUBLICA 2023; 39:e00112422. [PMID: 38088737 PMCID: PMC10715566 DOI: 10.1590/0102-311xen112422] [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: 06/20/2022] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023] Open
Abstract
One of the most critical time periods in childhood is from birth to five years of age. Children exposed to alcohol and/or tobacco via family members and neighborhood are at risk for childhood developmental delays. This study evaluated the association of early childhood development with the prevalence of alcohol consumption and tobacco use in Mexican municipalities. This is a cross-sectional study. Early childhood development information from 2,345 children aged from 36 to 59 months was obtained from the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM). Data on alcohol consumption and tobacco use come from the 2016 Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (ENCODAT). Multilevel logistic models were fitted to evaluate the association of the prevalence of alcohol consumption and tobacco use with the inadequacy of early childhood development. Children living in municipalities with high prevalence of alcohol consumption (OR = 13.410; 95%CI: 2.986; 60.240) and tobacco use (OR = 15.080; 95%CI: 2.040; 111.400) were less likely to be developmentally on track regarding early childhood development after adjustment for individual variables related to the child's development and other environmental variables at municipal level. Childhood exposure to alcohol and tobacco in the neighborhood may directly contribute to inadequate early childhood development. These findings suggest that there is an urgent need to develop effective interventions aimed at reducing alcohol consumption and tobacco use in municipalities to ensure adequate early childhood development.
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Affiliation(s)
- Francisco-Javier Prado-Galbarro
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana-Unidad Xochimilco, Ciudad de México, México
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Carlos Sanchez-Piedra
- Agencia de Evaluación de Tecnologías Sanitarias, Instituto de Salud Carlos III, Madrid, España
| | - Juan-Manuel Martínez-Núñez
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana-Unidad Xochimilco, Ciudad de México, México
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Holman PJ, Raineki C. Prenatal alcohol exposure and early-life adversity: A translational perspective for dissecting compounding impacts. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2227-2230. [PMID: 38151784 DOI: 10.1111/acer.15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Parker J Holman
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
| | - Charlis Raineki
- Department of Psychology, Brock University, St. Catharines, Ontario, Canada
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Reid N, Kent N, Hewlett N, Bagley K, Tsang TW, Goldsbury S, Williams R, Akison L, Holland L, Vanderpeet C, Doyle M, Boaden N, Hayes N. Factors to be considered as part of a holistic assessment for fetal alcohol spectrum disorder: A scoping review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2007-2021. [PMID: 38226745 DOI: 10.1111/acer.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 01/17/2024]
Abstract
We undertook a scoping review to identify the factors outside of current fetal alcohol spectrum disorder (FASD) diagnostic criteria to be considered as part of a holistic assessment process. This included physical, social, cultural, mental health and wellbeing factors to inform targeted recommendations and supports to improve outcomes for individuals with FASD. Evidence from this review will be used to inform the revision of the Australian Guide to the Diagnosis of FASD. Six electronic databases were searched. Studies were eligible if they included factors outside of the diagnostic criteria that cover dysmorphology, growth restriction, neurodevelopmental impairments. Data charting and content analysis were performed to synthesize the results. One hundred twenty-one studies were included that spanned 12 key areas These included physical health, sleep, adverse postnatal experiences, substance use/other risk-taking behaviors, contact with the criminal justice system, mental health, First Nations cultural considerations, transition to adult roles, involvement with the out-of-home care system, feeding and eating, strengths/interests/external resources and incontinence. Areas to be considered as part of a holistic assessment and diagnostic process spanned individual, family, and system level factors. Results provide guidance for clinicians on the wide range of factors that could influence long-term health, development, and wellbeing for individuals with prenatal alcohol exposure and FASD. In practice, this guidance can be used to inform an individualized assessment process to facilitate tailored recommendations and supports to best meet the complex needs of individuals living with FASD and their families.
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Affiliation(s)
- Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nykola Kent
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Nicole Hewlett
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- The First Nations Cancer & Wellbeing Research Team, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Kerryn Bagley
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Sydney Children's Hospital Network, Kids Research, Westmead, New South Wales, Australia
| | - Sarah Goldsbury
- Māori/Indigenous Health Innovation, University of Otago Christchurch, Christchurch, New Zealand
| | - Robyn Williams
- Curtin Medical School, Curtin University, Bentin, Western Australia, Australia
| | - Lisa Akison
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Lorelle Holland
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Michael Doyle
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nirosha Boaden
- School of Social Work, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Queensland University of Technology, Brisbane, Queensland, Australia
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Orton SM, Millis K, Choate P. Epigenetics of Trauma Transmission and Fetal Alcohol Spectrum Disorder: What Does the Evidence Support? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6706. [PMID: 37681846 PMCID: PMC10487479 DOI: 10.3390/ijerph20176706] [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: 07/20/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) results from teratogenic impacts of alcohol consumption during pregnancy. Trauma and prenatal alcohol exposure (PAE) can both cause neurodevelopmental impairment, and it has been proposed that FASD can amplify effects of trauma. Certain PAE and trauma effects are mediated via epigenetic mechanisms. The objective of this review is to present the current evidence for epigenetics in trauma transmission as it relates to FASD, to help bridge a potential knowledge gap for social workers and related health professionals. We include a primer on epigenetic mechanisms and inheritance, followed by a summary of the current biomedical evidence supporting intergenerational and transgenerational epigenetic transmission of trauma, its relevance to FASD, the intersection with social transmission, and finally the application to social work. We propose potential models of transmission, considering where social and epigenetic pathways may intersect and/or compound across generations. Overall, we aim to provide a better understanding of epigenetic-trauma transmission for its application to health professions, in particular which beliefs are (and are not) evidence-based. We discuss the lack of research and challenges of studying epigenetic transmission in humans and identify the need for public health interventions and best practices that are based on the current evidence.
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Affiliation(s)
- Sarah M. Orton
- Faculty of Science and Technology, Department of Biology, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Kimberly Millis
- Faculty of Science and Technology, Department of Biology, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Peter Choate
- Faculty of Health, Community & Education, Department of Child Studies and Social Work, Mount Royal University, Calgary, AB T3E 6K6, Canada;
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Rockhold MN, Kautz-Turnbull C, Handley ED, Petrenko CLM. The trauma experiences of children with fetal alcohol spectrum disorders: Developmental outcomes utilizing a threat/deprivation child adversity framework. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1722-1735. [PMID: 37423769 DOI: 10.1111/acer.15144] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorders (FASD) experience heightened rates of childhood trauma and adversity. Research has examined the negative impact adverse childhood experiences have on developmental outcomes. This study aims to take the field a step further by examining the details of traumatic events, including duration, perpetrator, whether the event significantly impacted the child, and trauma subtype. Subtype is examined using threat/deprivation dimensions and their relation to child behavior and the caregiver-child relationship. METHODS A sample of 84 children aged 4-12 with FASD, all in out-of-home placements, and their families took part in an emotion coaching intervention study. At baseline, caregivers completed questionnaires assessing child trauma, child emotion regulation and behavior, caregiver emotion socialization, and caregiver-child relationships. We used analysis of covariance to examine the differing impacts of threat, deprivation, and a combination of the two on behavioral outcomes, while controlling for age. We also used Pearson's r correlations, controlling for age, to examine whether the duration of threat or deprivation exposure was related to child outcomes. RESULTS Descriptive statistics showed that 87.5% of individuals experienced three or more subtypes of trauma. The average duration of all subtypes was 1.62 years, with a mean onset of 3.94 years. Biological parents were the most common perpetrator. There were significantly worse behavioral and caregiver-child relationship outcomes for children experiencing a combination of threat and deprivation trauma. A r correlations, controlling for age, demonstrated longer duration of deprivation was associated with greater cognitive difficulties. CONCLUSIONS We found unique patterns of behavior in children with FASD when analyzing the impact of traumatic experiences through a threat/deprivation framework. The combination of both threat and deprivation experiences leads to worse outcomes overall. Additionally, vital details surrounding the traumatic experiences point to crucial areas for intervention, including caregiver-child relationships.
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MacEachern SJ, Kar P, Nakhid D, Mitevska E, Tortorelli C, Forkert ND, Lebel C, McMorris CA, Gibbard WB. Factors predicting general health concerns and atypical behaviours in children with prenatal alcohol exposure and other adverse exposures. Front Pediatr 2023; 11:1146149. [PMID: 37292380 PMCID: PMC10244621 DOI: 10.3389/fped.2023.1146149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023] Open
Abstract
Background Prenatal alcohol exposure (PAE) can have significant negative consequences on the health outcomes of children. Children with PAE often experience other prenatal and postnatal adverse exposures. Increased rates of general health concerns and atypical behaviours are seen in both children with PAE as well as with other patterns of adverse exposures, although these have not been systematically described. The association between multiple adverse exposures and adverse health concerns and atypical behaviours in children with PAE is unknown. Methods Demographic information, medical history, adverse exposures, health concerns, and atypical behaviours were collected from children with confirmed PAE (n = 22; 14 males, age range = 7.9-15.9 years) and their caregivers. Support vector machine learning classification models were used to predict the presence of health concerns and atypical behaviours based on adverse exposures. Associations between the sums of adverse exposures, health concerns, and atypical behaviours were examined using correlation analysis. Results All children experienced health concerns, the most common being sensitivity to sensory inputs (64%; 14/22). Similarly, all children engaged in atypical behaviours, with atypical sensory behaviour (50%; 11/22) being the most common. Prenatal alcohol exposure was most important factor for predicting some health concerns and atypical behaviours, and alone and in combination with other factors. Simple associations between adverse exposures could not be identified for many health concerns and atypical behaviours. Conclusion Children with PAE and other adverse exposures experience high rates of health concerns and atypical behaviours. This study demonstrates the complex effects of multiple adverse exposures on health and behaviour in children.
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Affiliation(s)
- Sarah J. MacEachern
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Preeti Kar
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Daphne Nakhid
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Elena Mitevska
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Nils D. Forkert
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Lebel
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carly A. McMorris
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - W. Ben Gibbard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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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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Nissinen NM, Rangmar J, Autti-Rämö I, Gissler M, Kahila H, Raitasalo K, Sarkola T. Financial difficulties among youth prenatally exposed to substances: a longitudinal register-based cohort study. DRUGS: EDUCATION, PREVENTION AND POLICY 2023. [DOI: 10.1080/09687637.2023.2176285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Niina-Maria Nissinen
- Faculty of Social Sciences, Health Sciences Unit, Tampere University, Tampere, Finland
| | - Jenny Rangmar
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ilona Autti-Rämö
- Division of Child Neurology, University of Helsinki, Children’s Hospital, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Hanna Kahila
- Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Kirsimarja Raitasalo
- Department of Public Health and Welfare, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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13
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Curran WC, Danbrook MC. Hearing the voice of child welfare social workers: planning safe care for a child with or suspected of having fetal alcohol spectrum disorders (FASDs). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-04-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose
In the early 1970s, clinical evidence emerged documenting causal links between prenatal alcohol exposure (PAE) and children’s behaviors as observed by child welfare social workers (CWSWs). Unfortunately, fetal alcohol spectrum disorders (FASD) remain on the margins of public health priorities. The purpose of this study was to elicit the views of child welfare social workers when responding to case of or suspected FASD.
Design/methodology/approach
A sample (N = 18) of CWSWs, allied health professionals and foster parents were interviewed.
Findings
Findings indicate that social workers struggle with their statutory duty to plan safe care for children with or suspected of having FASD. Emergent themes include struggling with advocacy, professional devaluation and lack of procedural guidance.
Practical implications
Social workers need a clear pathway and FASD knowledge to guide their interventions and enhance their capacity to advocate for affected children.
Originality/value
An abundance of research documents the direct effect of PAE on physical, cognitive and behavioral outcomes. However, few studies focus on the critical interface of children with an FASD entering public care and the social workers responsible for planning their safe care. This study sought to document social workers’ response to this vulnerable cohort of children.
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Chu JTW, McCormack J, Marsh S, Wells A, Wilson H, Bullen C. Impact of prenatal alcohol exposure on neurodevelopmental outcomes: a systematic review. Health Psychol Behav Med 2022; 10:973-1002. [PMID: 36238426 PMCID: PMC9553152 DOI: 10.1080/21642850.2022.2129653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Prenatal exposure to alcohol (PAE) represents a significant public health concern. Previous research linking PAE to neurodevelopmental outcomes has been mixed and often has limited focus on residual confounding or moderating factors. Methods A systematic review of prospective cohort studies (n = >1000) assessing the impact of PAE on neurodevelopmental outcomes was undertaken (neurophysiology, motor skills, cognition, language, academic achievement, memory, attention, executive function, affect regulation, and adaptive behaviour, social skills, or communication). Electronic searches of EMBASE, Medline, CINAHL, and Psychinfo were conducted in May 2021. A quality assessment was conducted using an adapted version of the Newcastle-Ottawa Scale (NOS). Results Thirty longitudinal cohort studies met the inclusion criteria. Evidence of the impact of PAE was mixed across domains. We found no evidence that PAE affects executive function, but there were impacts on motor skills, cognition, language, academic achievement, attention, affect regulation, and adaptive behaviour. The most consistent adverse effect was on affect regulation (nine out of thirteen studies, six of which found an association between heavy alcohol consumption or binge drinking during pregnancy). We found no protective factors. Few studies controlled for variables in the postnatal environment. Discussion This review was unable to conclude a safe level of alcohol consumption during pregnancy. Methodological improvements are needed to improve the quality and consistency in which PAE is studied. Further research into residual confounding variables is vital, including a greater focus on the postpartum environment.
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Affiliation(s)
- Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jessica McCormack
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alesha Wells
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Holly Wilson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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15
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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16
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Koponen AM, Nissinen NM, Gissler M, Autti-Rämö I, Kahila H, Sarkola T. Adverse childhood experiences and neurodevelopmental disorders among youth with and without prenatal substance exposure: A longitudinal matched register-based cohort study. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 40:176-198. [PMID: 37063820 PMCID: PMC10101169 DOI: 10.1177/14550725221110190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Previous research has shown an association between adverse childhood experiences (ACEs) and secondary mental health problems in youth with prenatal substance exposure (PSE), but the association between ACEs and neurodevelopmental disorders is less clear. Methods: This longitudinal register-based cohort study investigated relationships between health at birth, ACEs (out-of-home care (OHC) and maternal adversities), and neurodevelopmental disorders among youth with PSE (alcohol/drugs, n = 615) and matched unexposed controls ( n = 1787). Hospital medical records and register data were merged and analysed using Cox regression models. Results: Conduct and emotional disorders (International Statistical Classification of Diseases and Related Health Problems ICD-10, F90–F94) were more common among the exposed than the controls but only when the exposed and controls with no OHC were compared. The difference appeared in hyperkinetic disorders (ADHD, F90), mixed disorders of conduct and emotions (F92) and emotional disorders with onset specific to childhood (F93). Among the exposed and controls with OHC, over 40% had received an F90–F94 diagnosis. Regarding specific developmental disorders (F80–F83, e.g., impairments in speech and language and scholastic skills) the moderate difference between the exposed and controls attenuated after adjustment for OHC. Again, the rates were highest among the exposed with OHC and the controls with OHC. OHC and maternal risks were interrelated and, together with male sex and low birth weight, were associated with neurodevelopmental disorders both among the exposed and controls and decreased the difference between them. Conclusions: A strong association between ACEs and neurodevelopmental disorders was found. Brain research is needed to examine whether ACEs worsen neurodevelopmental outcomes caused by PSE.
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Affiliation(s)
- Anne M. Koponen
- Folkhälsan Research Center; and University of Helsinki, Helsinki, Finland
| | | | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Turku, Turku, Finland; Academic Primary Health Care Centre, Stockholm, Sweden; and Karolinska Institutet, Stockholm, Sweden
| | | | - Hanna Kahila
- Helsinki University Central Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki; Helsinki University Hospital, Helsinki, Finland; and Minerva Foundation Institute for Medical Research, Helsinki, Finland
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17
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Tan GKY, Symons M, Fitzpatrick J, Connor SG, Cross D, Pestell CF. Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia. BMC Pediatr 2022; 22:587. [PMID: 36217109 PMCID: PMC9549627 DOI: 10.1186/s12887-022-03654-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders. Methods Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law. Results Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores. Conclusion ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03654-y.
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Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia. .,Patches Australia, Subiaco, Australia. .,Telethon Kids Institute (TKI), Nedlands, Australia.
| | - Martyn Symons
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - James Fitzpatrick
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Patches Australia, Subiaco, Australia
| | | | - Donna Cross
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
| | - Carmela F Pestell
- School of Psychological Science (M304), The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute (TKI), Nedlands, Australia
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18
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Kautz-Turnbull C, Adams TR, Petrenko CLM. The Strengths and Positive Influences of Children With Fetal Alcohol Spectrum Disorders. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:355-368. [PMID: 36018765 PMCID: PMC9428943 DOI: 10.1352/1944-7558-127.5.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/20/2021] [Indexed: 06/12/2023]
Abstract
People with disabilities have not been adequately represented in strengths-based research. This study is the first to examine strengths and positive influences of young children with fetal alcohol spectrum disorder (FASD). Thirty adoptive and relative caregivers of children with FASD reported their children's strengths and positive influences and completed measures on family functioning. Using a conversion mixed design, we described themes in strengths and influences, degree of caregiver positivity and relationships with child and family functioning. Caregivers reported wide-ranging strengths and positive influences. Frequency of adaptive strengths correlated with measures of family functioning, but thematic strengths and positive influences did not. Strengths and positive influences are distinct from measures of functioning and are not well captured in deficit-focused research.
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Affiliation(s)
- Carson Kautz-Turnbull
- Carson Kautz-Turnbull, Tangeria R. Adams, and Christie L. M. Petrenko, Mt. Hope Family Center, University of Rochester
| | - Tangeria R Adams
- Carson Kautz-Turnbull, Tangeria R. Adams, and Christie L. M. Petrenko, Mt. Hope Family Center, University of Rochester
| | - Christie L M Petrenko
- Carson Kautz-Turnbull, Tangeria R. Adams, and Christie L. M. Petrenko, Mt. Hope Family Center, University of Rochester
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19
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Tan GKY, Pestell CF, Fitzpatrick J, Cross D, Adams I, Symons M. Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2022; 30:514-535. [PMID: 37484511 PMCID: PMC10360980 DOI: 10.1080/13218719.2022.2059028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.
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Affiliation(s)
- Grace Kuen Yee Tan
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Carmela F. Pestell
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
| | - James Fitzpatrick
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Donna Cross
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
| | - Isabelle Adams
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Patches Australia, Nedlands, WA, Australia
| | - Martyn Symons
- School of Psychological Science, University of Western Australia (UWA), Perth, WA, Australia
- Telethon Kids Institute (TKI), Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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20
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The Universal and Primary Prevention of Foetal Alcohol Spectrum Disorders (FASD): A Systematic Review. JOURNAL OF PREVENTION 2022; 43:297-316. [PMID: 35286547 PMCID: PMC9114092 DOI: 10.1007/s10935-021-00658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/24/2022]
Abstract
AbstractFoetal alcohol spectrum disorder (FASD) comprises multiple neurodevelopmental disorders caused by alcohol consumption during pregnancy. With a global prevalence rate of 7.7 per 1000 population, FASD is a leading cause of prenatal developmental disorders. The extent of physical, mental, and social consequences for individuals with FASD can be vast and negatively affect their social environment, daily life, school, relationships, and work. As treatment for FASD is labour- and cost-intensive, with no cure available, prevention is key in reducing FASD prevalence rates. As most systematic reviews conducted so far have focused on specific FASD risk groups, we investigated the effectiveness of universal FASD prevention and primary preventive strategies. We identified a total of 567 potentially pertinent records through PubMed, Cochrane Library, EBSCO, PubPsych, and DAHTA published from 2010 to May 2020, of which 10 studies were included in this systematic review. Results showed a substantial heterogeneity in the studies’ quality, although all preventive measures, except one, proved effective in both increasing knowledge and awareness of FASD, as well as decreasing the risk of an alcohol exposed pregnancy. Limiting factors such as small sample sizes and a lack of behavioural change testing require further studies to support existing evidence for FASD prevention and its implementation, as well as detecting the best course of action for FASD prevention when creating and implementing prevention and intervention approaches.
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21
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Flannigan K, McMorris C, Ewasiuk A, Badry D, Mela M, Ben Gibbard W, Unsworth K, Cook J, Harding KD. Suicidality and Associated Factors Among Individuals Assessed for Fetal Alcohol Spectrum Disorder Across the Lifespan in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:361-370. [PMID: 34738837 PMCID: PMC9065486 DOI: 10.1177/07067437211053288] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals with fetal alcohol spectrum disorder (FASD) experience a range of complex neurodevelopmental, psychological, and socioenvironmental vulnerabilities. There is growing evidence that suicidal ideation, attempts, and death by suicide are significant concerns within this population. In this study, we (1) determined the rate of suicidal ideation/attempts in a large group of individuals with prenatal alcohol exposure (PAE) who were assessed for FASD in Canada and (2) investigated the associations between suicidal ideation/attempts and select demographic and biopsychosocial factors in this group. METHOD A secondary analysis of data from Canada's National FASD Database, a national repository of clinical information gathered through FASD assessment and diagnostic clinics across the country, was conducted. Descriptive analyses, chi-square/Fisher's exact tests, and binary logistic regression were used to examine demographic and biopsychosocial variables and their associations with suicidality. RESULTS In our sample of 796 participants (Mage = 17.7 years, range = 6-59; 57.6% male) assessed for FASD, 25.9% were reported to experience suicidal ideation/attempts. Numerous demographic and biopsychosocial factors were found to be significantly associated with suicidal ideation/attempts. The strongest associations with suicidal ideation/attempts were substance use, history of trauma/abuse, and impaired affect regulation. CONCLUSIONS With this study, we contribute to the emerging evidence of elevated risk of suicidality among individuals with PAE/FASD and improve our understanding of factors that may exacerbate this risk. Findings have relevance for improving screening, prevention, and proactive treatment approaches for individuals with PAE and FASD, their families, and wider support systems.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia
| | - Carly McMorris
- Werklund School of Education, 2129University of Calgary, Calgary, Alberta.,70401Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta
| | - Amanda Ewasiuk
- CASA Child, Adolescent, and Family Mental Health, Edmonton, Alberta
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,Faculty of Social Work, 2129University of Calgary, Calgary, Alberta
| | - Mansfield Mela
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - W Ben Gibbard
- 70401Cumming School of Medicine, 2129University of Calgary, Calgary, Alberta
| | - Kathy Unsworth
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,The Society of Obstetricians and Gynaecologists of Canada; Department of Obstetrics and Gynaecology, 12365University of Ottawa, Ottawa, Onatrio
| | - Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia.,Department of Psychology, Laurentian University, Sudbury, Ontario
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22
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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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23
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Khalifa N, Magee T, Shirazi S, Salman S, Yang CC, Mela M. The neurocognitive profiles of justice involved people with foetal alcohol spectrum disorder: A systematic review. BEHAVIORAL SCIENCES & THE LAW 2022; 40:87-111. [PMID: 34865240 DOI: 10.1002/bsl.2550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Foetal alcohol spectrum disorder (FASD) is highly prevalent in criminal justice settings. Despite increased awareness of the neurocognitive deficits among justice-involved individuals with FASD, no systematic evaluation of the literature in the field has been conducted to date. We aimed to conduct a systematic review of the literature on the neurocognitive profiles of justice-involved individuals with FASD, by searching five key electronic databases, dissertations database, and Google scholar, up to January 2021. The findings indicate that when contrasted with comparison groups, justice-involved individuals with FASD display significant impairment in a greater number of neurocognitive domains including intellectual capacity, executive function, language, academic achievements, motor skills, and adaptive living skills. The relatively small number of the studies included in the review, along with the confounding effects of comorbidities among study participants, precludes drawing firm conclusions about the true extent and implications of neurocognitive deficits in this population. To advance the field further, there is an urgent need to conduct robust studies involving larger samples of justice-involved individuals with FASD and suitable comparison groups. Advancing knowledge in the field can have important implications for understanding of the antecedents of offending behaviour in this population, and informing strategies for early identification and intervention.
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Affiliation(s)
- Najat Khalifa
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Taylor Magee
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Shayan Shirazi
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shamir Salman
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cheng-Chang Yang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Mansfield Mela
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- The Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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24
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Flannigan K, Tremblay M, Potts S, Nelson M, Brintnell S, O'Riordan T, Rasmussen C, Pei J. Understanding the needs of justice-involved adults with fetal alcohol spectrum disorder in an Indigenous community. BEHAVIORAL SCIENCES & THE LAW 2022; 40:129-143. [PMID: 34904275 DOI: 10.1002/bsl.2554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience a range of neurodevelopmental challenges, often compounded by social and environmental adversity. One of the most concerning outcomes that can be associated with FASD is involvement in the justice system, where individuals with FASD are vastly over-represented. Individuals with FASD who are both justice-involved and Indigenous experience added layers of marginalization. In this community-based study, we explored the needs of 16 adults who participated in an FASD-informed restorative justice program in an Indigenous community in Alberta, Canada. Clinical record reviews and client interviews were used to gather information. Diverse needs were identified, including pervasive neurodevelopmental difficulties, notable physical and mental health challenges, complex experiences of psychosocial trauma, and varied criminogenic needs. This study increases our understanding of the unique and complex biopsychosocial and criminogenic needs of Indigenous justice-involved adults with FASD. Such an understanding is a first step in developing tailored interventions for individuals with FASD and has important practice and policy implications for supporting positive outcomes. For Indigenous individuals with FASD, intervention efforts should be integrated within the community context to promote collective healing.
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Affiliation(s)
- Katherine Flannigan
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada
| | - Melissa Tremblay
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Potts
- Yellowhead Tribal Community Corrections Society, Edmonton, Alberta, Canada
| | - Monty Nelson
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon Brintnell
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Teresa O'Riordan
- Yellowhead Tribal Community Corrections Society, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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25
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Coles CD, Grant T, Kable JA, Stoner S, Perez A. Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts. Alcohol Clin Exp Res 2022; 46:232-242. [PMID: 35157325 PMCID: PMC8867925 DOI: 10.1111/acer.14761] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although the effects of prenatal alcohol exposure (PAE) have been studied extensively, there is relatively little information available on adult mental health functioning among exposed individuals. The current study compares the self-reported midlife mental health status of individuals who were prenatally exposed to alcohol and diagnosed in childhood with the effects of this exposure with that of unexposed individuals. METHODS Participants (N = 292) were recruited from two longitudinal cohorts in Atlanta and Seattle and asked to complete an Adult Health Questionnaire that surveyed their current health and mental health status. The questionnaire was completed either in-person or remotely and included questions about current symptoms of depression and anxiety and mental health disorder diagnoses. The analysis compared a Nonexposed Contrast group to those in two exposure groups: (1) Alcohol Exposed with Fetal Alcohol Effect but not meeting criteria for Fetal Alcohol Syndrome (FAS) and (2) Alcohol Affected and meeting criteria for FAS. RESULTS Both alcohol-exposed groups reported higher levels of current depressive symptoms and a higher prevalence of diagnoses of depression, anxiety, bipolar disorder, and/or attention deficit/hyperactivity disorder. No differences were noted for psychotic disorders. PAE was also associated with greater environmental stressors, including higher levels of adverse childhood events and lower current socioeconomic status. Path analyses suggested that PAE was indirectly related to mood disorders with its effects being mediated by other environmental factors. CONCLUSIONS PAE is associated with greater rates of mental health disorders in middle adulthood. These outcomes appear to result from multiple stressors that affect individuals made vulnerable by their early alcohol exposure. Clinical outcomes could be improved by prevention efforts directed at preventing prenatal alcohol use and reducing environmental stressors later in life, and by the early identification of PAE and its effects.
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Affiliation(s)
- Claire D. Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Therese Grant
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Julie A. Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Susan Stoner
- Fetal Alcohol and Drug Unit, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Alexandra Perez
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - CIFASD
- Collaborative Initiative on Fetal Alcohol Spectrum Disorders
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Reid N, Crawford A, Petrenko C, Kable J, Olson HC. A Family-Directed Approach for Supporting Individuals with Fetal Alcohol Spectrum Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2022. [DOI: 10.1007/s40474-021-00241-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D, McFarlane A. Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder. Front Psychol 2022; 12:778471. [PMID: 35145454 PMCID: PMC8821085 DOI: 10.3389/fpsyg.2021.778471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- *Correspondence: Katherine Flannigan,
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn McLachlan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Kelly Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Audrey McFarlane
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
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Harding KD, Turner K, Howe SJ, Bagshawe MJ, Flannigan K, Mela M, McMorris CA, Badry D. Caregivers' experiences and perceptions of suicidality among their children and youth with fetal alcohol spectrum disorder. Front Psychiatry 2022; 13:931528. [PMID: 36117649 PMCID: PMC9471421 DOI: 10.3389/fpsyt.2022.931528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with Fetal Alcohol Spectrum Disorder (FASD) experience a range of biopsychosocial vulnerabilities that can increase the possibility of adverse life outcomes, including a heightened risk of suicidality. In this study, we explored the lived experiences of caregivers of children and youth with FASD and suicidality, including their perceptions of their child and youth's suicidal experiences. Between March and June 2021, six comprehensive, semi-structured interviews were conducted with five caregivers of children and youth with FASD (Mage = 14.5 years, range 11-22) who were currently experiencing suicidality or had a history of suicidality. Data were analyzed using interpretative phenomenological analysis and then developed into a composite vignette informed and organized by the social-ecological suicide prevention model (SESPM). The composite vignette revealed the narratives of families living with and caring for children and youth with FASD who experience suicidality in relation to the complex and intersectional individual, relational, community, and societal level contextual and protective factors. Findings from this study highlight the critical need for comprehensive FASD-informed suicide prevention and intervention approaches to promote the mental health and wellbeing of children and youth with FASD and their caregivers.
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Affiliation(s)
- Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Kailyn Turner
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Stephanie J Howe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Mercedes Jayne Bagshawe
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
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Midon MZ, Gerzon LR, Almeida CSD. Crack and motor development of babies living in an assistance shelter. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2019159.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: The baby motor development happens naturally with the complex interaction of the body, performing tasks in its context. When the body suffers negative external influence, such as the use of drugs by the mother during pregnancy, and develops in an environment different from home, such as shelters, it is questionable how the motor development would be. Objective: To evaluate the motor development of babies living in welfare shelters, children of crack users during pregnancy; to verify if there is an association of motor delay in these babies; and to describe the environment in which they were inserted. Methods: This is a cross-sectional study, with a convenience sample. There were 29 babies between three and 16 months old. Twenty-two of them were exposed to crack during pregnancy (Crack Group) and the remaining seven were not (Non-Crack Group). All were living in a specific shelter. To assess broad motor development, the Alberta Infant Motor Scale (AIMS) was used. The Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) was used to assess home environment opportunities. Results: In the crack group, the developmental delay was confirmed in 36.4% cases and suspected in 18.2%. Most babies in the crack group were typical (45.5%). There was no statistically significant association between crack group and developmental delay, nor with age and sex. Conclusion: The development of babies in the crack group was similar to the non-crack group and the opportunities in the environment were reasonable for the baby development.
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Flannigan K, Wrath A, Ritter C, McLachlan K, Harding KD, Campbell A, Reid D, Pei J. Balancing the story of fetal alcohol spectrum disorder: A narrative review of the literature on strengths. Alcohol Clin Exp Res 2021; 45:2448-2464. [PMID: 34716704 PMCID: PMC9299043 DOI: 10.1111/acer.14733] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/27/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain‐ and body‐based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths‐based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths‐based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well‐being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self‐awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory‐driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population.
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Affiliation(s)
| | - Andrew Wrath
- Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Chantel Ritter
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Kaitlyn McLachlan
- Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Kelly D Harding
- Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, Laurentian University, Sudbury, Ontario, Canada
| | - Alanna Campbell
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Dorothy Reid
- Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Jacqueline Pei
- Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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31
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Kautz-Turnbull C, Petrenko CLM. A meta-analytic review of adaptive functioning in fetal alcohol spectrum disorders, and the effect of IQ, executive functioning, and age. Alcohol Clin Exp Res 2021; 45:2430-2447. [PMID: 34694016 DOI: 10.1111/acer.14728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Fetal alcohol spectrum disorders (FASD) are highly prevalent developmental disabilities associated with prenatal alcohol exposure. In addition to varied strengths and unique talents, people with FASD experience significant challenges, including in adaptive functioning. Adaptive functioning refers to skills related to everyday life such as communication, practical skills, and social skills. For the current review, we aimed to understand how adaptive functioning in FASD compares to that of alcohol nonexposed individuals and those with attention deficit-hyperactivity disorder (ADHD). Additionally, we investigated how this relationship may change based on IQ, executive functioning, and age. METHOD The current review was registered in the International Prospective Register of Systematic Reviews. Studies were eligible for inclusion if they measured adaptive functioning and included an FASD group and at least one eligible comparison group. Articles available in May 2021 in PubMed, PsycInfo, Scopus, and ProQuest Dissertations were searched. Publication bias was assessed using Egger's regression and three-level random effects models were computed for all domains of adaptive functioning. Possible moderation by IQ, executive functioning, and age were investigated when heterogeneity analyses were significant. A post hoc moderation analysis of recruitment method was also completed. RESULTS Thirty studies were included. Individuals with FASD had significantly lower adaptive functioning than other groups, with effect sizes ranging from 1.04 to 1.35 compared to alcohol nonexposed groups and from 0.30 to 0.43 compared to ADHD groups. No significant moderating effects were found for IQ or age; executive functioning significantly moderated communication skills in FASD compared to the alcohol nonexposed group. Recruitment method significantly affected this relationship, with larger effect sizes on average found for clinically identified samples than at-risk or population samples. CONCLUSIONS Individuals with FASD have impairments in adaptive functioning relative to alcohol nonexposed and ADHD groups, regardless of IQ, executive functioning, or age. Limitations of the review include small sample sizes in some comparisons and a limited age range.
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Abstract
INTRODUCTION Fetal alcohol spectrum disorder (FASD) is one of the most common neurodevelopmental disorders in North America. It is a complex disability, associated with challenges in cognitive, behavioural and socialemotional functioning, as well as an increased risk of physical and mental health comorbidities, and difficulties in daily living across the lifespan. Previous attempts to characterise the profile of this population have been hampered by differences in data collected across studies, regional discrepancies in terminology and definitions, and a lack of tools to integrate comprehensive datasets. METHODS AND ANALYSIS The goals of this study are to use the Canadian National FASD Database, a national repository of FASD assessment-related information, to better understand the functional profile, comorbidities, intervention needs and difficulties in daily living experienced by individuals assessed for FASD across the lifespan. We will also examine what factors may be the most sensitive predictors of receiving an FASD diagnosis. Data will be analysed from over 3500 records collected between 2010 and 2021 (ongoing) from 26 FASD diagnostic clinics in seven provinces and territories. Data collection is ongoing, and analysis will be performed on a biannual basis to continue to hone our understanding of the profiles, needs and outcomes of individuals assessed for FASD in Canada. This research is critical for refining FASD assessment and diagnostic practice, enabling accurate and early identification of individuals with FASD, and connecting individuals with FASD and their families to comprehensive and effective services and resources to support healthy developmental trajectories. ETHICS AND DISSEMINATION Ethics approval for the National FASD Database Project was obtained from the Ottawa Health Science Network Research Ethics Board. As new knowledge is gained from this project, findings will be disseminated through publications, presentations and feedback to participating clinics, with the ultimate goal of informing FASD research, practice and policy.
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Affiliation(s)
- Jocelynn Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Kathy Unsworth
- The Canada FASD Research Network, Ottawa, Ontario, Canada
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Op den Kelder R, Van den Akker AL, Ensink JBM, Geurts HM, Overbeek G, de Rooij SR, Vrijkotte TGM, Lindauer RJL. Longitudinal Associations Between Trauma Exposure and Executive Functions in Children: Findings from a Dutch Birth Cohort Study. Res Child Adolesc Psychopathol 2021; 50:295-308. [PMID: 34482489 PMCID: PMC8885557 DOI: 10.1007/s10802-021-00847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
This study is the first to distinguish two possible predictive directions between trauma exposure and executive functioning in children in a community sample. The sample consists of 1006 children from two time points with a seven years’ time interval of a longitudinal Dutch birth cohort study, the ABCD-study (Van Eijsden et al., 2011). We analyzed the longitudinal associations between trauma exposure and executive functioning using structural equation modeling. The results demonstrated that (after controlling for prenatal substance exposure and mothers’ educational level) trauma exposure before age 5 is predictive of poorer executive functioning at age 12 and trauma exposure between age 6 and 12. However, the association between executive functioning at age 5 and trauma exposure between age 6 and 12 was not statistically significant. Our results indicate that early life trauma exposure has a long term impact on later executive functioning and not the other way around. On top of that, trauma exposure seems to accumulate across childhood when children are exposed to a traumatic event before the age of 5. When looking at the potential moderating role of parenting behavior we found no evidence for such a moderating effect of parenting behavior. Our findings showed that children exposed to trauma early in life may experience problems in executive functioning later in life and they seem at higher risk for cumulative trauma exposure. Clinical practice should take this into account in both the way they provide (early) mental health care and in prevention and recognition of early trauma exposure.
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Affiliation(s)
- R Op den Kelder
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Levvel Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
| | - A L Van den Akker
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Research Institute of Child Development and Education/Research Priority Area YIELD, University of Amsterdam, Amsterdam, The Netherlands
| | - J B M Ensink
- Levvel Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H M Geurts
- Department of Psychology (Brain and Cognition)/ Research Priority Area YIELD, University of Amsterdam, Amsterdam, The Netherlands
| | - G Overbeek
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Research Institute of Child Development and Education/Research Priority Area YIELD, University of Amsterdam, Amsterdam, The Netherlands
| | - S R de Rooij
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bio-Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T G M Vrijkotte
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J L Lindauer
- Levvel Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Kippin NR, Leitão S, Watkins R, Finlay‐Jones A. Oral and written communication skills of adolescents with prenatal alcohol exposure (PAE) compared with those with no/low PAE: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:694-718. [PMID: 34137136 PMCID: PMC9292204 DOI: 10.1111/1460-6984.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/21/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is associated with growth deficits and neurodevelopmental impairment including foetal alcohol spectrum disorder (FASD). Difficulties with oral and written communication skills are common among children with PAE; however, less is known about how communication skills of adolescents who have PAE compare with those who do not. Adolescence is a critical time for development, supporting the transition into adulthood, but it is considered a high-risk period for those with FASD. AIMS We conducted a systematic review to synthesize evidence regarding oral and written communication skills of adolescents with PAE or FASD and how they compare with those with no PAE. METHODS & PROCEDURES A comprehensive search strategy used seven databases: Cochrane Library, Cinahl, Embase, Medline, PsycInfo, Eric and Web of Science. Included studies reported on at least one outcome related to oral and written communication for a PAE (or FASD) group as well as a no/low PAE group, both with age ranges of 10-24 years. Quality assessment was undertaken. MAIN CONTRIBUTION Communication skills most often assessed in the seven studies included in this review were semantic knowledge, semantic processing, and verbal learning and memory. These communication skills, in addition to reading and spelling, were commonly weaker among adolescents with PAE compared with those with no/low PAE. However, the findings were inconsistent across studies, and studies differed in their methodologies. CONCLUSIONS & IMPLICATIONS Our results emphasize that for adolescents with PAE, communication skills in both oral and written modalities should be comprehensively understood in assessment and when planning interventions. A key limitation of the existing literature is that comparison groups often include some participants with a low level of PAE, and that PAE definitions used to allocate participants to groups differ across studies. WHAT THIS PAPER ADDS What is already known on the subject PAE and FASD are associated with deficits in oral and written communication skills. Studies to date have mostly focused on children with a FASD diagnosis as well as combined groups of children and adolescents with FASD or PAE. There is a gap in what is known about oral and written communication skills of adolescents, specifically, who have PAE or FASD. This has implications for the provision of assessment and supports during a period of increased social and academic demands. What this study adds to existing knowledge This review provides systematic identification, assessment and synthesis of the current literature related to oral and written communication skills of adolescents with PAE compared with those with no/low PAE. The review revealed a small knowledge base with inconsistent methodologies and findings across studies. However, the findings overall highlight that adolescents with PAE have weaker skills in oral and written language than those with no/low PAE. Results are discussed in relation to education, social and emotional well-being, and forensic contexts. What are the potential or actual clinical implications of this work? Findings emphasize that for adolescents with PAE, comprehensive assessment of both oral and written communication skills, through both standardized and functional tasks, should be undertaken. Speech-language pathologists have a key role in assessment with individuals who have PAE.
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Affiliation(s)
- Natalie R. Kippin
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- Curtin School of Allied HealthCurtin UniversityPerthWAAustralia
| | - Suze Leitão
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- Curtin School of Allied HealthCurtin UniversityPerthWAAustralia
| | - Rochelle Watkins
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
| | - Amy Finlay‐Jones
- Telethon Kids InstitutePerth Children's HospitalPerthWAAustralia
- School of PsychologyCurtin UniversityPerthWAAustralia
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35
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Alberry B, Laufer BI, Chater-Diehl E, Singh SM. Epigenetic Impacts of Early Life Stress in Fetal Alcohol Spectrum Disorders Shape the Neurodevelopmental Continuum. Front Mol Neurosci 2021; 14:671891. [PMID: 34149355 PMCID: PMC8209299 DOI: 10.3389/fnmol.2021.671891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/30/2021] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Bonnie Alberry
- Department of Biology, Faculty of Science, The University of Western Ontario, London, ON, Canada
| | - Benjamin I Laufer
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA, United States.,Genome Center, University of California, Davis, Davis, CA, United States.,MIND Institute, University of California, Davis, Davis, CA, United States
| | - Eric Chater-Diehl
- Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shiva M Singh
- Department of Biology, Faculty of Science, The University of Western Ontario, London, ON, Canada
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Teacher-Reported Prevalence of FASD in Kindergarten in Canada: Association with Child Development and Problems at Home. J Autism Dev Disord 2021; 51:433-443. [PMID: 32472249 PMCID: PMC7835185 DOI: 10.1007/s10803-020-04545-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention.
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Holman PJ, Raineki C, Chao A, Grewal R, Haghighat S, Fung C, Morgan E, Ellis L, Yu W, Weinberg J. Altered social recognition memory and hypothalamic neuropeptide expression in adolescent male and female rats following prenatal alcohol exposure and/or early-life adversity. Psychoneuroendocrinology 2021; 126:105146. [PMID: 33517167 PMCID: PMC7969453 DOI: 10.1016/j.psyneuen.2021.105146] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
Prenatal alcohol exposure (PAE) and early-life adversity (ELA) both negatively impact social neurobehavioral development, including social recognition memory. Importantly, while individuals with PAE are more likely to experience ELA, relatively few studies have assessed the interaction of these two early insults on adolescent social behavior development. Here, we combine animal models of PAE and ELA to investigate both their unique and interactive effects on social neurobehavioral function in early and late adolescent male and female rats. Behavioral testing was followed by assessment of hypothalamic expression of oxytocin (OT) and vasopressin (AVP), key neuropeptides in the regulation of social behavior. Our results indicate that PAE and ELA have unique sex- and age-specific effects on social recognition memory and OT/AVP expression, with more pronounced neurobehavioral changes observed in males than in females in both early and late adolescence. Specifically, ELA impaired social recognition in early adolescent females regardless of prenatal treatment, while males showed deficits in both early and late adolescence in response to unique and interactive effects of PAE and ELA. Neurobiological data suggest that these perinatal insults differentially impact the OT and AVP systems in a sexually dimorphic manner, such that the OT system appears to be particularly sensitive to PAE in males while the AVP system appears to be more vulnerable to ELA in females. Taken together, our data provide novel insight into how the early postnatal environment may mediate outcomes of PAE as well as the power of animal models to interrogate the relationship between these pre- and postnatal insults.
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Affiliation(s)
- Parker J. Holman
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada,Corresponding author: Parker J. Holman, M.S.Ed., Ph.D., Department of Cellular and Physiological Sciences, University of British Columbia, 2350 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada, , Phone: +1 (604) 822-4554, FAX: +1 (604) 822-2316
| | - Charlis Raineki
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada,Department of Psychology, Brock University, St. Catharines, Canada
| | - Amanda Chao
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Riley Grewal
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Sepehr Haghighat
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Cecilia Fung
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Erin Morgan
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Linda Ellis
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Wayne Yu
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, Canada
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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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Nissinen NM, Gissler M, Sarkola T, Kahila H, Autti-Rämö I, Koponen AM. Completed secondary education among youth with prenatal substance exposure: A longitudinal register-based matched cohort study. J Adolesc 2020; 86:15-27. [PMID: 33264707 DOI: 10.1016/j.adolescence.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The dual impact of prenatal substance exposure (i.e. alcohol/drugs) and adverse postnatal caregiving environment on offspring secondary education completion is an understudied research area. The aim was to investigate the influence of childhood adversities, out-of-home care, and offspring's mental and/or behavioural disorders on secondary education completion among prenatally exposed offspring in comparison to matched unexposed offspring. METHODS This is a longitudinal register-based matched cohort study in Finland including offspring with a history of prenatal substance exposure and a matched unexposed cohort. The study sample included 283 exposed and 820 unexposed offspring aged 18-23 years. RESULTS The results showed a time lag in secondary education completion and lower educational attainment overall among exposed compared with unexposed (37.8% vs. 51.0%, respectively). The results from the multivariate logistic regression models showed that the differences in the secondary education completion between exposed and unexposed were diminished in the presence of covariates. A cumulative childhood adversity score and out-of-home care were not associated with secondary education completion in the multivariate models, whereas the different domains of offspring's mental and/or behavioural disorders including psychiatric disorders (AOR 0.65, 95% CI 0.45-0.96), neuropsychological disorders (AOR 0.35, 95% CI 0.23-0.54) and dual psychiatric and neuropsychological disorder (AOR 0.29, 95% CI 0.18-0.48) showed an independent negative effect on secondary education completion. CONCLUSIONS Inferior educational outcomes may not be directly linked with prenatal substance exposure but may rather reflect the extent of evolving offspring's mental and/or behavioural disorders over time influenced by childhood adversities.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, And Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynecology, University of Helsinki, And Helsinki University Central Hospital, Helsinki, Finland
| | - Ilona Autti-Rämö
- Council for Choices in Health Care in Finland, Department for Steering of Healthcare and Social Welfare, Ministry of Social Affairs and Health, Helsinki, Finland; University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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Mughal R, Hill CM, Joyce A, Dimitriou D. Sleep and Cognition in Children with Fetal Alcohol Spectrum Disorders (FASD) and Children with Autism Spectrum Disorders (ASD). Brain Sci 2020; 10:brainsci10110863. [PMID: 33207724 PMCID: PMC7697116 DOI: 10.3390/brainsci10110863] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/30/2022] Open
Abstract
Children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing peers. However, little is known about the association between sleep and the cognitive phenotype in these clinical populations. Structural damage affecting cortical and subcortical connectivity occurs as a result of prenatal alcohol exposure in children with FASD, whilst it is believed an abundance of short-range connectivity explains the phenotypic manifestations of childhood ASD. These underlying neural structural and connectivity differences manifest as cognitive patterns, with some shared and some unique characteristics between FASD and ASD. This is the first study to examine sleep and its association with cognition in individuals with FASD, and to compare sleep in individuals with FASD and ASD. We assessed children aged 6–12 years with a diagnosis of FASD (n = 29), ASD (n = 21), and Typically Developing (TD) children (n = 46) using actigraphy (CamNTech Actiwatch 8), digit span tests of working memory (Weschler Intelligence Scale), tests of nonverbal mental age (MA; Ravens Standard Progressive Matrices), receptive vocabulary (British Picture Vocabulary Scale), and a choice reaction time (CRT) task. Children with FASD and ASD presented with significantly shorter total sleep duration, lower sleep efficiency, and more nocturnal wakings than their TD peers. Sleep was significantly associated with scores on the cognitive tests in all three groups. Our findings support the growing body of work asserting that sleep is significant to cognitive functioning in these neurodevelopmental conditions; however, more research is needed to determine cause and effect.
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Affiliation(s)
- Rabya Mughal
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London WC1H 0AA, UK;
- Correspondence:
| | - Catherine M. Hill
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | - Anna Joyce
- School of Psychotherapy & Psychology, Regent’s University London, London NW1 4NS, UK;
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London WC1H 0AA, UK;
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Flannigan K, Coons-Harding KD, Anderson T, Wolfson L, Campbell A, Mela M, Pei J. A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:2401-2430. [PMID: 33119894 PMCID: PMC7839542 DOI: 10.1111/acer.14490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/18/2020] [Indexed: 12/25/2022]
Abstract
Individuals with fetal alcohol spectrum disorder (FASD) experience remarkably high rates of mental health and substance use challenges, beginning early in life and extending throughout adulthood. Proactive intervention can help to mitigate some of these negative experiences. Although the literature on FASD intervention is growing, there is currently a lack of consolidated evidence on interventions that may improve mental health and substance use outcomes in this population. Informed by a life course perspective, we undertook a systematic review of the literature to identify interventions that improve mental wellness through all developmental stages for people with prenatal alcohol exposure (PAE) and FASD. A total of 33 articles were identified, most of which were focused on building skills or strategies that underlie the well‐being of children with PAE and FASD and their families. Other interventions were geared toward supporting child and family wellness and responding to risk or reducing harm. There was a notable lack of interventions that directly targeted mental health and substance use challenges, and a major gap was also noted in terms of interventions for adolescents and adults. Combined, these studies provide preliminary and emerging evidence for a range of intervention approaches that may support positive outcomes for individuals with FASD across the life course.
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Affiliation(s)
- Katherine Flannigan
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - Kelly D Coons-Harding
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Psychology Department, (KDC-H), Laurentian University, Sudbury, Ontario, Canada
| | - Tara Anderson
- (TA), Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Lindsay Wolfson
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,(LW), Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada
| | - Alanna Campbell
- (AC), Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Mansfield Mela
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Psychiatry, College of Medicine, (MM), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jacqueline Pei
- (KF, KDC-H, LW, MM, JP), Canada FASD Research Network, Vancouver, British Columbia, Canada.,Department of Educational Psychology, (JP), University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, (JP), University of Alberta, Edmonton, Alberta, Canada
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42
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Brown J, Asp E, Carter MN, Spiller V, Bishop-Deaton D. Suggestibility and confabulation among individuals with Fetal Alcohol Spectrum Disorder: A review for criminal justice, forensic mental health, and legal interviewers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 73:101646. [PMID: 33246222 DOI: 10.1016/j.ijlp.2020.101646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/19/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
Fetal Alcohol Spectrum Disorders (FASD) are conditions arising from prenatal alcohol exposure which results in a range of neurodevelopmental deficits in areas including cognition, memory, language, executive functioning, emotional regulation, and adaptive functioning. Deficits in various neurodevelopmental areas can range from mild to severe, depending on many factors including the quantity and timing of alcohol exposure during the prenatal development period. During interviews in criminal justice, forensic mental health, and legal contexts (e.g., criminal investigations, cross examination, victim interviews, interviews for lawsuits, forensic evaluations, pre-sentence investigations), deficits associated with FASD may elevate the risk of suggestibility and confabulation. These issues can result in negative jurisprudence-related outcomes, including impulsive Miranda rights waivers, incorrect assumptions of competency, inaccurate or incomplete information gathering, misinterpretation of intent, witness reliability issues, court ordered treatment completion problems, probation and parole violations, false confessions, and false accusations. The aim of the present article is to explain the context in which these issues can arise and provide criminal justice, forensic mental health, and legal professionals with key guidelines that can assist in minimizing suggestibility and confabulation when interviewing persons with FASD. We hope that the suggestions and strategies presented in this article will reduce potential obstructions of justice and enhance the quality of information obtained from individuals impacted by FASD. A brief discussion is also provided to identify additional research and training opportunities needed to clarify "best practices" for professionals tasked with evaluating the challenges facing this unique population.
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Affiliation(s)
- Jerrod Brown
- American Institute for the Advancement of Forensic Studies, St. Paul, MN, USA.
| | - Erik Asp
- Department of Neurology, University of Iowa, Iowa City, IA, USA; Department of Psychology, Hamline University, St. Paul, MN, USA; Wesley & Lorene Artz Cognitive Neuroscience Research Center, Hamline University, St. Paul, MN, USA
| | - Megan N Carter
- University of Washington, Seattle, WA, USA; Department of Social and Health Services, Special Commitment Center, Steilacoom, WA, USA
| | | | - Deanna Bishop-Deaton
- College of Social and Behavioral Sciences, School of Forensic Psychology, Walden University, USA
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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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Koponen AM, Nissinen NM, Gissler M, Sarkola T, Autti-Rämö I, Kahila H. Cohort profile: ADEF Helsinki - a longitudinal register-based study on exposure to alcohol and drugs during foetal life. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:32-42. [PMID: 32934591 PMCID: PMC7434186 DOI: 10.1177/1455072519885719] [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: 06/11/2019] [Accepted: 09/23/2019] [Indexed: 01/19/2023] Open
Abstract
Purpose: The need for longitudinal studies on prenatal substance exposure (PSE)
extending into adulthood is widely recognised. In particular, studies on the
dual effect of exposure to substances and adverse childhood experiences are
needed. This register-based matched cohort study investigates the effect of
this dual exposure on the health and development of youth with PSE. The
follow-up is from birth to young adulthood. Participants: The exposed youth were born in 1992–2001 to mothers with a significant
substance misuse problem during pregnancy. The mothers were identified in
primary care maternity clinics in the Helsinki metropolitan area and
referred for intensified pregnancy follow-up in a tertiary care setting
(HAL-clinics). Data from hospital medical records were collected for the
mothers during the pregnancy follow-up and linked with register data from
multiple national health and social welfare registers obtained for each
mother–child dyad from birth until the end of 2015–2018. Similar register
data were gathered for three matched mother–child dyads without any evidence
of the mother’s substance misuse in national health and social welfare
registers. The study consists of 615 exposed and 1787 unexposed youth aged
15–24 years. Findings to date: A majority of the exposed youth (64%) had been in out-of-home care at least
once compared with 8% among the unexposed. Outpatient and inpatient hospital
care due to mental or behavioural disorders were two to three times more
common among the exposed than among the unexposed. The exposed had less
often completed secondary school education and had more often needed social
assistance. Future plans: The data comprise a wide range of information on infant health, youth’s
mental and somatic health and development, out-of-home care history, and
mother’s life situation at the delivery and later health. Risk and
protective factors for different long-term developmental outcomes in
adolescence or in young adulthood will be studied.
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Affiliation(s)
- Anne M Koponen
- Folkhälsan Research Center, and University of Helsinki, Finland
| | | | - Mika Gissler
- National Institute for Health and Welfare, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, and Helsinki University Hospital, Finland
| | | | - Hanna Kahila
- Helsinki University Central Hospital, Helsinki, Finland
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McDougall S, Finlay-Jones A, Arney F, Gordon A. A qualitative examination of the cognitive and behavioural challenges experienced by children with fetal alcohol spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103683. [PMID: 32521433 DOI: 10.1016/j.ridd.2020.103683] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION At present it is unclear whether there is a consistent behavioural phenotype for children with Fetal Alcohol Spectrum Disorder (FASD) that can support screening efforts. There has been a dearth of qualitative studies exploring the behavioural phenotype from the perspective of caregivers raising children with FASD. The current study explores the cognitive and behavioural difficulties and impairments experienced by children with FASD aged between four and 12 years from the perspective of caregivers. METHODS Fourteen caregivers of children with FASD participated in telephone interviews. Caregivers were recruited until data saturation occurred. Thematic analysis was undertaken on the transcribed interviews, using NVivo 12. RESULTS Three over-arching themes were identified that consisted of subthemes 1) Self-regulation; behavioural, emotional, and attention; 2) Cognitive abilities; academic abilities and learning and memory; and 3) Adaptive functioning; social skills, communication and language skills, motor skills, and sleep concerns. Multiple subthemes were consistently identified across participants. A further two cross-cutting themes were identified; children behaving young for their age, and inconsistency in behaviour and strategies. DISCUSSION Despite the lack of a consistent behavioural phenotype for FASD, the findings suggest consistency between caregivers in their reports of the difficulties experienced by children with FASD. The implications for early identification and screening tool development are discussed.
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Affiliation(s)
- Stewart McDougall
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia.
| | - Amy Finlay-Jones
- Fetal Alcohol Spectrum Disorders Centre for Research Excellence, Telethon Kids Institute, WA, 6009, Australia
| | - Fiona Arney
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia
| | - Andrea Gordon
- Australian Centre for Child Protection, University of South, GPO Box 2471, Adelaide, SA, 5001 Australia; Justice and Society, University of South Australia, SA, 5000 Australia
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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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Treatment algorithm for the use of psychopharmacological agents in individuals prenatally exposed to alcohol and/or with diagnosis of fetal alcohol spectrum disorder (FASD). JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e1-e13. [PMID: 32757546 DOI: 10.15586/jptcp.v27i3.681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/31/2022]
Abstract
Psychotropic medication treatment of individuals who have experienced prenatal alcohol exposure (PAE) has lagged behind psychosocial interventions. Multiple psychotropic medications are often prescribed for those diagnosed with a range of neurodevelopmental disabilities and impairments of PAE (neurodevelopmental disorder associated with prenatal alcohol exposure and/or fetal alcohol spectrum disorder [ND-PAE/FASD]). Despite the diverse comorbid mental disorders, there are no specific guidelines for psychotropic medications for individuals with ND-PAE/FASD. When prescribed, concerned family members and caregivers of individuals with ND-PAE/FASD reported that polypharmacy, which was typical and adverse effects render the psychotropic medications ineffective. The objective of this work was to generate a treatment algorithm for the use of psychopharmacological agents specifically for individuals with ND-PAE/FASD. The development of decision tree for use to prescribe psychotropic medications incorporated findings from previous research and the collective clinical experience of a multidisciplinary and international panel of experts who work with individuals with ND-PAE/FASD, including an algorithm specialist. After multiple meetings and discussions, the experts reached consensus on how best to streamline prescribing along neurodevelopmental clusters. These were subdivided into four ligand-specific, receptor-acting medication targets (hyperarousal, emotional dysregulation, hyperactive/neurocognitive, and cognitive inflexibility). Each cluster is represented by a list of common symptoms. The experts recommended that prescribers first ensure adequate psychosocial and environmental, including sufficient dietary, exercise, and sleep support before prescribing psychotropic medications. Treatment then progresses through three steps of psychotropic medications for each cluster. To support established treatment goals, the most function impairing clusters are targeted first.
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Andre QR, McMorris CA, Kar P, Ritter C, Gibbard WB, Tortorelli C, Lebel C. Different brain profiles in children with prenatal alcohol exposure with or without early adverse exposures. Hum Brain Mapp 2020; 41:4375-4385. [PMID: 32659051 PMCID: PMC7502833 DOI: 10.1002/hbm.25130] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 12/29/2022] Open
Abstract
Prenatal alcohol exposure (PAE) can alter brain development and impact mental health outcomes, and often occurs in conjunction with postnatal adversity (e.g., maltreatment). However, it is unclear how postnatal adverse exposures may moderate mental health and brain outcomes in children with PAE. T1‐weighted and diffusion magnetic resonance imaging were obtained from 66 participants aged 7–16 years. Twenty‐one participants had PAE and adverse postnatal exposures (PAE+), 12 had PAE without adverse postnatal exposures (PAE−), and 33 were age‐ and gender‐matched controls unexposed to either prenatal alcohol or postnatal adversity. Internalizing and externalizing mental health symptoms were assessed using the Behavioral Assessment System for Children II, Parent‐Rating Scale. ANCOVAs were used to compare mental health symptoms, limbic and prefrontal cortical volumes, and diffusion parameters of cortico‐limbic white matter tracts between groups, and to assess brain‐mental health relationships. Both PAE groups had worse externalizing behavior (higher scores) than controls. The PAE− group had lower fractional anisotropy (FA) in the bilateral cingulum and left uncinate fasciculus, and smaller volumes in the left anterior cingulate cortex than controls and the PAE+ group. The PAE− group also had higher mean diffusivity (MD) in the left uncinate than the PAE+ group, and smaller right anterior cingulate and superior frontal gyrus volumes than controls. These findings show different brain structure and mental health symptom profiles in children with PAE with and without postnatal adversity, highlighting the need to consider adverse postnatal exposures in individuals with PAE.
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Affiliation(s)
- Quinn R Andre
- Medical Science, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Carly A McMorris
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,School & Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Preeti Kar
- Medical Science, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Chantel Ritter
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,School & Applied Child Psychology, University of Calgary, Calgary, Alberta, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Christina Tortorelli
- Department of Child Studies and Social Work, Mount Royal University, Calgary, Alberta, Canada
| | - Catherine Lebel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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McLachlan K, Flannigan K, Temple V, Unsworth K, Cook JL. Difficulties in Daily Living Experienced by Adolescents, Transition-Aged Youth, and Adults With Fetal Alcohol Spectrum Disorder. Alcohol Clin Exp Res 2020; 44:1609-1624. [PMID: 32472600 DOI: 10.1111/acer.14385] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with fetal alcohol spectrum disorder (FASD) experience a range of problems in their cognitive, affective, and physical functioning following prenatal alcohol exposure (PAE), in addition to multiple complex difficulties in daily living that impact well-being. Using the Canadian National FASD Database, we sought to profile a range of difficulties in daily living, along with risk factors, in a large cross-sectional cohort of adolescents, transition-aged youth, and adults with PAE, of which a subset was ultimately diagnosed with FASD. METHODS We summarized data for 9 current difficulties in daily living reported at the time of diagnostic assessment for 726 individuals with PAE assessed at 26 FASD diagnostic clinics across Canada, including 443 adolescents (12 to 17 years), 135 transition-aged youth (18 to 24 years), and 148 adults (25 to 60 years). Difficulties included problems related to school disruption, employment, independent living needs, supportive or sheltered housing, legal problems with victimization, legal problems with offending, incarceration, alcohol misuse, and other substance misuse. Risk factors included age, gender, living placement, postnatal trauma, and neurodevelopmental impairment. RESULTS Across the full PAE sample, adolescents, transition-aged youth, and adults presented with high rates of difficulties in daily living, including independent living support needs (63%), alcohol misuse (38%), other substance misuse (46%), employment problems (37%), legal problems with offending (30%), assisted or sheltered housing (21%), school disruption (18%), legal problems with victimization (4%), and incarceration (3%). Difficulty rates were similar for those with FASD irrespective of diagnosis (e.g., with or without sentinel facial features), but rates greater for adults, and those with low overall intellectual functioning (IQ < 70). Controlling for age and IQ, cumulative difficulty was independently associated with gender, living placement, and neurodevelopmental impairment. CONCLUSIONS Adolescents, transition-aged youth, and adults with FASD experienced a range of substantial and complex difficulties at the time of their diagnostic assessment, signaling a high level of service needs. These findings underscore the importance of developmentally informed assessment continued through childhood, as well as ongoing functional and needs-based service provision as youth with FASD transition to adulthood and beyond.
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Affiliation(s)
- Kaitlyn McLachlan
- From the, Department of Psychology (KM), University of Guelph, Guelph, Ontario, Canada
| | - Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network (KF, KU), Vancouver, British Columbia, Canada
| | | | - Kathy Unsworth
- Canada Fetal Alcohol Spectrum Disorder Research Network (KF, KU), Vancouver, British Columbia, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada (JC), Ottawa, Ontario, Canada.,Department of Obstetrics, Gynaecology and Newborn Care (JC), University of Ottawa, Ottawa, Ontario, Canada
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50
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Caregiver-reported physical health status of children and young people with fetal alcohol spectrum disorder. J Dev Orig Health Dis 2020; 12:420-427. [PMID: 32513328 DOI: 10.1017/s2040174420000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While fetal alcohol spectrum disorder (FASD) has primarily been thought of as a neurodevelopmental condition, research is beginning to highlight its 'whole-body' implications. Accordingly, the current study sought to provide a snapshot of potential health issues. Caregivers of children (median age of 12 years) with an FASD diagnosis were invited to participate in an online survey. Information relating to sample demographics, FASD status of the child and health outcomes were collected. The prevalence of health conditions reported in the FASD sample was compared against national prevalence data. Multiple linear regression utilising a stepwise approach was used to investigate potential predictors of the number of diagnosed health conditions. Survey data were from an international cohort (n = 197), with the majority of respondents based in Australia (40.2%) or the United States (27.7%). The most commonly reported diagnosed health conditions were eye conditions (44.7%), asthma (34.5%), heart conditions (34.0%) and skin conditions (27.4%). Binomial testing indicated the proportion of children diagnosed with these disorders was generally higher in the current FASD population, compared to national prevalence data. Indicators of metabolic dysfunction including diabetes and obesity were not significantly different compared to national prevalence data. Age of FASD diagnosis, existence of comorbid mental health conditions and the primary caregiver being in paid work were identified as being associated with the prevalence of diagnosed health conditions. Overall, the study has provided an up-to-date snapshot of health problems reported in a sample of children with FASD, confirming their increased risk of adverse health outcomes.
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