Article

Risk Factors for Adverse Life Outcomes in Fetal Alcohol Syndrome and Fetal Alcohol Effects

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Abstract

Clinical descriptions of patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) suggest major problems with adaptive behavior. Five operationally defined adverse outcomes and 18 associated risk/protective factors were examined using a Life History Interview with knowledgeable informants of 415 patients with FAS or FAE (median age 14 years, range 6-51; median IQ 86, range 29-126). Eighty percent of these patients were not raised by their biological mothers. For adolescents and adults, the life span prevalence was 61% for Disrupted School Experiences, 60% for Trouble with the Law, 50% for Confinement (in detention, jail, prison, or a psychiatric or alcohol/drug inpatient setting), 49% for Inappropriate Sexual Behaviors on repeated occasions, and 35% for Alcohol/Drug Problems. The odds of escaping these adverse life outcomes are increased 2- to 4-fold by receiving the diagnosis of FAS or FAE at an earlier age and by being reared in good stable environments.

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... Research has illustrated that persons with FASD are overrepresented in the criminal justice context (Allely & Mukherjee, 2019;Brintnell et al., 2019;Brown et al., 2011;Fast & Conry, 2009;MacPherson et al., 2011;MacSween, 2012;Streissguth et al., 1996Streissguth et al., , 2004. This may be due to a combination of neurocognitive deficits, background factors, and other traits commonly associated with FASD-related disability (Burd et al., 2010;Flannigan, Pei, Rasmussen, et al., 2018;Johansen-Hill, 2019;Passmore et al., 2018). ...
... Early onset of delinquency (e.g., theft, running away from home, substance use, and truancy) and frequent participation in such acts • Corrado & Freedman, 2011• Fast et al., 1999 • • Streissguth et al., 1996Streissguth et al., , 2004 Substantial involvement with the criminal justice system and allegiance to antisocial peers • Corrado & Freedman, 2011• Streissguth et al., 2004• Thomas et al., 1998 Internalizing and externalizing behavioral issues • Fagerlund et al., 2011• Khoury et al., 2018• Tsang et al., 2016 Displaying lower levels of moral maturity or lack of empathy largely contributing to antisocial behavior or criminality • Brown, Cich, & Singh, 2017• Corrado & Freedman, 2011• Green, 2007• Olson et al., 2007• Rogers et al., 2013• Scott & Dewane, 2007• Schonfeld et al., 2005 Lack of impulse control often resulting in perceived defiance to legal authorities • Fast & Conry, 2009• Passmore et al., 2016• Perske, 1994 T A B L E 5 Common rule-breaking and criminal justice involvement behaviors amongst individuals with FASD deficit is a necessary skill (Mukherjee et al., 2015). Social and community workers have indicated a number of barriers when working with persons having FASD including a lack of understanding (Bagley, 2019;Petrenko et al., 2014Petrenko et al., , 2019. ...
... Early onset of delinquency (e.g., theft, running away from home, substance use, and truancy) and frequent participation in such acts • Corrado & Freedman, 2011• Fast et al., 1999 • • Streissguth et al., 1996Streissguth et al., , 2004 Substantial involvement with the criminal justice system and allegiance to antisocial peers • Corrado & Freedman, 2011• Streissguth et al., 2004• Thomas et al., 1998 Internalizing and externalizing behavioral issues • Fagerlund et al., 2011• Khoury et al., 2018• Tsang et al., 2016 Displaying lower levels of moral maturity or lack of empathy largely contributing to antisocial behavior or criminality • Brown, Cich, & Singh, 2017• Corrado & Freedman, 2011• Green, 2007• Olson et al., 2007• Rogers et al., 2013• Scott & Dewane, 2007• Schonfeld et al., 2005 Lack of impulse control often resulting in perceived defiance to legal authorities • Fast & Conry, 2009• Passmore et al., 2016• Perske, 1994 T A B L E 5 Common rule-breaking and criminal justice involvement behaviors amongst individuals with FASD deficit is a necessary skill (Mukherjee et al., 2015). Social and community workers have indicated a number of barriers when working with persons having FASD including a lack of understanding (Bagley, 2019;Petrenko et al., 2014Petrenko et al., , 2019. ...
Article
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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.
... Individuals with fetal alcohol spectrum disorder (FASD) experience a range of neurodevelopmental (ND) challenges stemming from prenatal alcohol exposure (PAE), 1 as well as notable social and environmental adversity across the lifespan. [2][3][4][5][6][7] Most individuals with FASD have cooccurring mental health difficulties, [7][8][9] and many struggle with substance use. 5,10,11 Combined, the biopsychosocial vulnerabilities associated with PAE/FASD can increase risk for negative outcomes, and one of the most concerning of these is elevated risk for suicidality. ...
... Individuals with fetal alcohol spectrum disorder (FASD) experience a range of neurodevelopmental (ND) challenges stemming from prenatal alcohol exposure (PAE), 1 as well as notable social and environmental adversity across the lifespan. [2][3][4][5][6][7] Most individuals with FASD have cooccurring mental health difficulties, [7][8][9] and many struggle with substance use. 5,10,11 Combined, the biopsychosocial vulnerabilities associated with PAE/FASD can increase risk for negative outcomes, and one of the most concerning of these is elevated risk for suicidality. ...
... 29 This developmental period is associated with increased complexity and difficulty for individuals with PAE/FASD, who are often exposed to many adverse life experiences. 5,7,30 This life stage also coincides with a transition from youth to adult services, where there is limited access to, and availability of, FASD-informed supports. Additionally, there are increased expectations of responsibility and independence at this life stage, which may not be appropriate given potential discrepancies between the chronological age and level of functioning experienced by individuals with PAE/FASD. ...
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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 ( M age = 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.
... While some researchers have worked to establish prevalence rates of FASD in the general population, few researchers have examined the exact number of individuals with FASD who are involved with the justice system. Streissguth et al. (2004) found that 60% of a sample of youth and adults with FASD, in a 25-year follow-up study, had contact with the criminal justice system due to committing offences, which is 30 times higher than the general population (Clarren et al., 2015;Flannigan et al., 2018aFlannigan et al., , 2018bPopova et al., 2017;Streissguth et al., 2004). A recent case ascertainment study of a Northern Canadian adult correctional population found a confirmed FASD rate of 17.5% (McLachlan et al., 2019). ...
... While some researchers have worked to establish prevalence rates of FASD in the general population, few researchers have examined the exact number of individuals with FASD who are involved with the justice system. Streissguth et al. (2004) found that 60% of a sample of youth and adults with FASD, in a 25-year follow-up study, had contact with the criminal justice system due to committing offences, which is 30 times higher than the general population (Clarren et al., 2015;Flannigan et al., 2018aFlannigan et al., , 2018bPopova et al., 2017;Streissguth et al., 2004). A recent case ascertainment study of a Northern Canadian adult correctional population found a confirmed FASD rate of 17.5% (McLachlan et al., 2019). ...
... Many individuals with FASD have mental health challenges (Himmelreich et al., 2020) and rates of comorbid mental disorders are as high as 90% in this population (Pei et al., 2011;Streissguth et al., 2004). ADHD co-occurs at a high rate with FASD, where individuals with FASD are reported to be 10 times more likely to have ADHD than the general population (Popova et al., 2016). ...
Article
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Fetal alcohol spectrum disorder (FASD) is prevalent among individuals involved in the justice system. However, many of the characteristics of justice-involved individuals with FASD remain unknown. We assessed patients in a forensic mental health hospital (n = 26) for FASD before their release. The two objectives were to establish the prevalence of FASD in this unique environment and to describe the mental health and neurocognitive characteristics of individuals with FASD compared to patients with complex needs and those without FASD. The prevalence of FASD was 46%. We found the FASD group to have more than six impaired brain domains, greater than the other groups, and a higher prevalence of ADHD. Given the high prevalence of FASD reported in this study, along with the complexities and adversities associated with FASD and criminal justice involvement, this is a population that requires screening, assessment, and intervention.
... FASD stems from prenatal alcohol exposure (PAE) and is characterized by cognitive, behavioral, emotional, social, and adaptive difficulties along with many co-occurring physical and mental health concerns (Popova et al., 2016;Himmelreich et al., 2020). Without adequate support, individuals with FASD can experience a range of negative outcomes, but positive trajectories may be encouraged through early diagnosis, intervention, and highquality caregiving environments (Streissguth et al., 2004). ...
... Beginning early in life, exposure to adverse experiences such as caregiving disruption, death of a parent, abuse and neglect, and exposure to familial substance use, violence, mental health problems, and criminal justice system involvement, are well-documented in this population (Coggins et al., 2007;Koponen et al., 2009;McLachlan et al., 2015McLachlan et al., , 2016Kambeitz et al., 2019). Adverse experiences continue throughout the lifespan for individuals with FASD, with high rates of problems with school, employment, housing, independence, victimization, and legal involvement (Streissguth et al., 2004;Rangmar et al., 2015;McLachlan et al., 2020). Although environmental adversity is common for individuals across disability groups (Austin et al., 2016), including those with developmental disabilities (Emerson, 2014;Reichman et al., 2018), it is especially pervasive, chronic, and complex among those with FASD (McLachlan et al., 2015(McLachlan et al., , 2020Kambeitz et al., 2019;Flannigan et al., 2021a). ...
... Although co-occurring mental health issues are common for individuals with various developmental disabilities (Cooper et al., 2007;Simonoff et al., 2008), the rates of comorbidity tend to be higher among those with FASD. It is estimated that 90% or more of individuals with FASD experience co-occurring neurodevelopmental and mental health diagnoses (Streissguth et al., 2004;Pei et al., 2011;Weyrauch et al., 2017;Temple et al., 2019). Compared to the general population, individuals with FASD are reported to be 10 times more likely to have ADHD, 20 times more likely to have substance use problems, and 25 times more likely to be diagnosed with a psychotic disorder (Popova et al., 2016;Weyrauch et al., 2017). ...
Article
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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.
... A widely used measure of adaptive functioning is the Vineland Adaptive Behavior Scales (VABS; Sparrow et al., 2016), which breaks down adaptive behaviors into three main domains: (1) communication, (2) daily living skills, and (3) socialization. Individuals with prenatal alcohol exposure display deficits in all three areas of the VABS (Crocker et al., 2009;Fagerlund et al., 2012;Jirikowic et al., 2008;Streissguth et al., 1991Streissguth et al., , 2004. Impairments in adaptive skills persist into adulthood and are greater than what would be predicted with IQ scores (Carr et al., 2010;Streissguth et al., 2004). ...
... Individuals with prenatal alcohol exposure display deficits in all three areas of the VABS (Crocker et al., 2009;Fagerlund et al., 2012;Jirikowic et al., 2008;Streissguth et al., 1991Streissguth et al., , 2004. Impairments in adaptive skills persist into adulthood and are greater than what would be predicted with IQ scores (Carr et al., 2010;Streissguth et al., 2004). ...
... The adaptive behavior impairments, as discussed above, are in part related to the challenges that alcohol-exposed individuals experience in home, school, and community settings (Rangmar et al., 2017;Streissguth et al., 2004). Parents indicate significant behavior problems for children with prenatal alcohol exposure (Franklin et al., 2008;Mattson & Riley, 2000;Vaurio et al., 2011), which are present for individuals with and without the facial dysmorphology (Mattson & Riley, 2000) and are not entirely explained by the diminished intellectual functioning commonly observed (Mattson & Riley, 2000;Vaurio et al., 2011). ...
Article
Background This study aimed to develop an efficient and easily calculable risk score that can be used to identify an individual’s risk of having been exposed to alcohol prenatally. Methods Data for this study were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, Phases 2 and 3. Two cohorts (ages 5-17 yrs.) completed a comprehensive neurobehavioral battery and a standard dysmorphology exam: a development cohort (DC; n =325) and a comparative cohort (CC; n = 523). Both cohorts included two groups: those with histories of heavy prenatal alcohol exposure (AE-DC, n = 121; AE-CC, n = 177) and a control group that included subjects with minimal or no prenatal alcohol exposure (CON-DC, n = 204; CON-CC, n = 346). Behavioral assessments and physical exam data were combined using regression techniques to derive a risk score indicating the likelihood of prenatal alcohol exposure. Subjects were then divided into two subgroups: 1) low-risk, and 2) high-risk. Chi-square (χ²) determined classification accuracy and an ROC was produced to assess the predictive accuracy. Correlations between risk scores and IQ and executive function (EF) scores were calculated. Results Subjects were accurately classified in the DC (χ²= 78.61, p <.001) and CC (χ² = 86.63, p <.001). The classification model also performed well in the DC (ROC = .835 [SE = 0.024, p <.001]) and CC (ROC = .786 [SE = .021, p <.001]. In the AE-CC and CON-CC, modest but significant associations between the risk score and EF (AE-CC: r = -.20, p = .034; CON-CC: r = -.28, p <.001) and IQ (AE-CC: r = -.20, p = .034; CON-CC: r = -.28, p <.001) were found. Conclusion (s) The risk score significantly distinguished alcohol-exposed from control subjects and correlated with important cognitive outcomes. It has significant clinical potential and could be easily deployed in clinical settings.
... Although, by definition, all individuals with FASD experience significant and pervasive brain impairment (Cook et al., 2015), the scope and nature of the disability is highly variable, and individuals with FASD often demonstrate unique needs, challenges, and strengths. FASD is also associated with a high degree of postnatal environmental adversity, including trauma, abuse, instability, and ongoing victimization (McLachlan et al., 2020;Price et al., 2017;Streissguth et al., 2004). Without adequate services and supports, these complex challenges can extend throughout the lifespan. ...
... Without adequate services and supports, these complex challenges can extend throughout the lifespan. Adolescents and adults with FASD often experience problems with school and employment, independence, housing, parenting, legal issues, and mental health and substance use (McLachlan et al., 2020;Streissguth et al., 2004). FASD can also place substantial demands and stressors on caregivers and families (Bobbitt et al., 2016;Domeij et al., 2018). ...
... Early identification of FASD and access to appropriate services and supports are important for mitigating the negative outcomes associated with FASD (Streissguth et al., 2004). Due to the complex challenges and experiences of individuals with FASD, service needs often span across disciplines and evolve over the life course (Brownell et al., 2013;Masotti et al., 2015;Pei et al., 2017a). ...
Article
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Fetal alcohol spectrum disorder (FASD) is one of the most common neurodevelopmental disabilities in North America. Stemming from the brain-and body-based impacts of prenatal alcohol exposure, individuals with FASD experience a range of challenges with physical, cognitive, behavioural, and social-emotional functioning. Most individuals with FASD require ongoing assistance to support day-today living and protect against negative life outcomes. Service needs for individuals with FASD often span across multiple areas of functioning, necessitating a range of supports from various disciplines and sectors. The complexity of needs experienced by individuals with FASD underscores the importance of integrated services, however, there is currently a lack of research on integrated service delivery approaches in the FASD population. The Alberta FASD Service Network model is a unique integrated FASD service delivery approach established in 2007 which facilitates the delivery of coordinated FASD supports and programs across Alberta. The aim of the current study was to review the evidence pertaining to this model. We identified 45 relevant documents, the findings of which were synthesized to better understand the aims and scope, impacts, and challenges of the Alberta FASD Service Network model and inform future work in FASD research, practice, and policy.
... Pei et al. [17] and Jirikowic et al. [18] suggested that because the needs of individuals with FASD are diverse, their assessment and management should be personalized. Most importantly, early diagnosis and intervention could minimize the impact of some of the problems that arise from prenatal alcohol exposure [19][20][21][22][23][24]. Reid et al. [22] showed that there is growing evidence supporting The World Health Organization (WHO) recognizes FASD as a public health issue and has developed a guideline for the identification and management of substance use and substance use disorders in pregnancy [7]. ...
... Pei et al. [17] and Jirikowic et al. [18] suggested that because the needs of individuals with FASD are diverse, their assessment and management should be personalized. Most importantly, early diagnosis and intervention could minimize the impact of some of the problems that arise from prenatal alcohol exposure [19][20][21][22][23][24]. Reid et al. [22] showed that there is growing evidence supporting the effectiveness of FASD management interventions in improving outcomes for early to middle childhood. ...
... This is because the issues of FASD are life long and multifaceted (containing educational, social and medical), which can manifest in primary and secondary disabilities [5]. Therefore, there is a need to develop multifaceted interventions-as FASD affects individuals across the life span [24]-and management interventions for the management of secondary disabilities in adolescents and adults with FASD. This is because it has been reported that early and age/culturally-appropriate interventions showed promising outcomes for the management of FASD [22]. ...
Article
Background The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The scoping review aims to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. Methods We conducted a scoping review searching databases such as Ebsco Host (Academic Search Complete, ERIC, SoINDEX, Health Source: Nursing/Academic Edition, CINAHL, Medline and Psych-ARTICLES), SAGE Journals, Sabinet and PubMed. Two reviewers independently screened studies for eligibility and used the Effective Public Health Project assessment tool to assess the methodological rigour of the included studies. A framework approach to data analysis was done and a narrative approach was used to synthesise and report on the findings. Results Thirty-two prevention intervention studies and 41 management intervention studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. Conclusions The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions. Key messages There are effective interventions for the prevention and management of FASD, however, the interventions were not distributed according to the burden of FASD in different regions. There is a great need to share and implement context/culturally appropriate interventions for the prevention and management of FASD among regions.
... IQs in FASD typically fall in the low average to borderline ranges (Kodituwakku, 2009), with some IQs seen in the high average and superior ranges (Streissguth et al., 1996;Weyrauch et al., 2017). Despite significantly higher IQs on average in FASD compared to ID, people with FASD tend to function as if they had ID in terms of everyday adaptive behavior (Doyle et al., 2019;Greenspan et al., 2016;Streissguth et al., 1991Streissguth et al., , 2004. The reason for this anomaly is executive dysfunction, which directly predicts impaired adaptive behavior in FASD (Schonfeld et al., 2006;Ware et al., 2012). ...
... Just as executive dysfunction impairs behavior in important adaptive domains throughout life for those with FASD, such dysfunction also can explain the high rate of violence and other adverse outcomes in this population (Khoury et al., 2015;Streissguth et al., 1996Streissguth et al., , 2004. While environmental structure (sometimes referred to in FASD as the "external brain") can compensate for EF deficits to reduce risk of violence (Doctor, 2000;Kapasi et al., 2021;Novick Brown, in press;Novick Brown & Connor, 2014;Pedruzzi et al., 2021), it has been our experience in capital cases that violent acts in people with FASD often reflect a breakdown in baseline executive capacity due to contextual complexity. ...
... Substance abuse was a significant risk factor for trouble with the law: of adolescents and adults with substance abuse problems, nearly 85% had arrest histories. Since the secondary disabilities study, other studies have found similar results, albeit with some variability (Burd et al., 2007;Clark et al., 2004;Popova et al., 2011;Rangmar et al., 2015;Spohr et al., 2007;Streissguth et al., 2004;Temple et al., 2011). ...
Article
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There is a biological basis for diminished criminal responsibility in offenders with fetal alcohol spectrum disorders (FASD) just as there is in those with intellectual disability. Functional limitations affecting cognition in both neurodevelopmental conditions stem directly from structural brain damage at a gross and molecular level, which usually impairs executive functioning among other cognitive skills. Executive functioning, which includes reasoning and impulse control, is the only neural system in the brain that involves conscious thought. With respect to the law, impaired reasoning or rationality is an aspect of mens rea (“guilty mind”). When rationality is impaired by prenatal alcohol exposure, acts driven by strong emotion and urges can occur, which has obvious implications regarding criminal responsibility. The Atkins decision by the U.S. Supreme Court reflects the rationale that organically based brain dysfunction in executive skills reduces criminal culpability. We argue that people with FASD who have similar brain dysfunction likewise have reduced criminal responsibility.
... Despite increased awareness and recognition of how neurocognitive deficits associated with FASD are related to an elevated risk of offending (Reid et al., 2020), very few studies have investigated the patterns of offending behaviour in this clinical population. In 2004, Streissguth et al. (2004) published a seminal paper on the longitudinal adverse life outcomes for participants diagnosed with foetal alcohol syndrome and foetal alcohol effects. This study found that 60% of adolescents and adults in the study had trouble with the law, and the number of individuals convicted increases with age. ...
... Our study found that justice-involved individuals with FASD were charged with different types of offences, consistent with results from past studies (Mela et al., 2020;Streissguth et al., 2004). These offences were (from highest proportion of individuals with FASD to lowest proportion of individuals with FASD): theft and related offences, burglary, property damage, public order offences, acts intended to cause injury, offences against justice procedures (i.e. ...
... stealing of money, property, vehicles) were the most common offending behaviour represented in individuals with FASD, with more than half of the FASD cohort being charged with this offence. Stealing being the most common offence in individuals with FASD is a finding that aligns with past research (Mela et al., 2020;Streissguth et al., 2004). This is unsurprising given that past studies show that most shoplifting and vehicle thefts are opportunistic crimes (B€ assmann, 2011;Felson & Clarke, 1998). ...
... Addiction or substance abuse Baer et al., 2003Flannigan et al., 2018Hughes et al., 2016LaDue, 1993 LaDue & Dunne, 1997 Olson et al., 1994Popova et al., 2015Rojas & Gretton, 2007Streissguth et al., 1988Streissguth et al., 1994Streissguth et al., 2004 Aggressiveness or violent (often triggered through stress or sensory overload and a result in lack of impulse control) Corrigan et al., 2018Mccreight, 1997Page, 2001Popova et al., 2011Popova et al., 2015Rasmussen et al., 2008Streissguth et al., 2004 Poor judgment LaDue, 1993 ...
... Addiction or substance abuse Baer et al., 2003Flannigan et al., 2018Hughes et al., 2016LaDue, 1993 LaDue & Dunne, 1997 Olson et al., 1994Popova et al., 2015Rojas & Gretton, 2007Streissguth et al., 1988Streissguth et al., 1994Streissguth et al., 2004 Aggressiveness or violent (often triggered through stress or sensory overload and a result in lack of impulse control) Corrigan et al., 2018Mccreight, 1997Page, 2001Popova et al., 2011Popova et al., 2015Rasmussen et al., 2008Streissguth et al., 2004 Poor judgment LaDue, 1993 ...
... Malbin, 2014 Mccreight, 1997Olson et al., 1994Popova et al., 2011Popova et al., 2015Streissguth et al., 1988Streissguth et al., 2004Impulsivity Baumbach, 2002Coriale et al., 2013Eguiagaray et al., 2016Fast & Conry, 2004Mccreight, 1997O'Malley & Nanson, 2002Popova et al., 2011Rasmussen et al., 2008Spohr et al., 2007Streissguth et al., 1991 T A B L E 2 Behavior and traits common to FASD resulting in criminal justice entrenchment (Continues) graf et al., 2013; Mayo Foundation for Medical Education and Research, 2018). Indications of FASD may require a consult with a neurologist, developmental pediatrician, genetic specialist, or related specialist (Cook et al., 2016;John Hopkins Children's Hospital, n.d;Landgraf et al., 2013;Mayo Foundation for Medical Education and Research, 2018). ...
Article
Full-text available
Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over‐representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety‐provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre‐existing impairment. This article serves as a beginner’s guide for professionals working in criminal justice settings by (a) providing research‐based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.
... Individuals with FASD present with numerous challenges, which typically include a range of mild to severe impairment in executive functioning, intellectual ability, learning, academic achievement, memory, attention, language, and adaptive functioning (for a review, see Mattson et al. (2019)). Furthermore, individuals with FASD appear to be at greater risk of being exposed to abuse, neglect, and domestic violence; being raised in a non-biological home or by a single parent; experiencing multiple living arrangements; being raised in a low-income household; and having parents with substance abuse or mental health problems (Kambeitz et al. 2019;McLachlan et al. 2015;Streissguth et al. 2004). This frequent co-occurrence of neurodevelopmental disability and environmental adversity has led some to describe FASD as a disorder of "double jeopardy" (Coggins et al. 2007). ...
... This frequent co-occurrence of neurodevelopmental disability and environmental adversity has led some to describe FASD as a disorder of "double jeopardy" (Coggins et al. 2007). The interaction between these two broad categories of vulnerability may contribute to the host of poor outcomes associated with FASD, including educational disruption (e.g., academic failure, major behavioral issues, suspension, expulsion), challenges with employment and independent living, justice involvement, substance abuse (Clark et al. 2004;McLachlan et al. 2020;Streissguth et al. 2004), and neurodevelopmental comorbidity (Kambeitz et al. 2019). Mental health comorbidity is also common, with up to 90% of clinically referred individuals with FASD reporting at least one concurrent mental health diagnosis (Pei et al. 2011). ...
... The first studies of resilience in FASD reflected a lens that focused on identifying factors that helped individuals with FASD avoid poor outcomes. In a landmark longitudinal study of 415 individuals with FASD, Streissguth et al. (2004) found that several protective factors were related to lower rates of negative life outcomes: living in a stable home environment, not being exposed to violence, receiving services, and being diagnosed before age six. The individual qualities of low IQ and higher diagnostic severity (i.e., poorer cognitive functioning) were also found to be protective, which is the opposite of what is usually found in the broader resilience literature (Masten and Cicchetti 2016). ...
Article
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The purpose of this study was to describe the profile of individual, relational, and contextual resilience resources reported by youth with FASD and their caregivers and examine how these resources related to early childhood adversity, potential protective factors, and concurrent emotional and behavioral functioning. Nineteen youth with FASD (aged 13 to 23 years) and their caregivers (foster or adoptive parents) completed the Child and Youth Resilience Measure (CYRM-28), the Behavioral Assessment System for Children (BASC-2), and a detailed developmental history questionnaire. Youth with FASD were reported to have comparable relational resilience resources to a typically developing reference group, but lower contextual resources compared to the reference group. Caregivers reported youth to have low individual resilience resources, but youth with FASD reported individual resources commensurate with the normative reference group. Early childhood adversity, age, sex, and IQ were not significantly associated with resilience resources. However, earlier age of stable caregiving placement and earlier age at FASD diagnosis were associated with greater caregiver-reported relational and contextual resilience resources. Finally, higher youth- and caregiver-reported individual resources were associated with less mental health symptomology, and higher youth- and caregiver-reported individual and contextual resources were associated with better adaptive functioning behavior. These findings complement previous research documenting the necessity of ensuring early stable relationships for youth with FASD and permitting timely access to diagnostic services. The results also highlight the need to better understand and strengthen individual and contextual resources.
... Consider for example the oft-cited but dated literature indicating that individuals with FASD are 50%-60% more likely to have justice involvement and detention and present increased risk for inappropriate sexual activities as well as drug/alcohol abuse (Streissguth et al., 2004). This research, and other similar pieces (see e.g., Streissguth & O'Malley, 2000;Streissguth et al., 1996), laid the foundation for additional research on FASD that focused on justice outcomes (Fast & Conry, 2009;Fast et al., 1999;Longstaffe et al., 2018;Wyper & Pei, 2016) in which FASD was taken up in current risk regimes (McLachlan et al., 2018;Pei & Burke, 2018) including burden/cost considerations (Popova et al., 2015;Thanh & Jonsson, 2015). ...
... Returning to the Streissguth et al. (2004) findings, research indicates that persons living with FASD are less likely to be raised by their biological parents than those without FASD. Research also tells us that racialized minorities are overrepresented in the child welfare system (Fluke et al., 2010;Ma et al., 2018). ...
Article
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In 2008, the Truth and Reconciliation Commission of Canada engaged in a public project of national reconciliation to address the ongoing impacts of settler colonialism including the disproportionate number of Indigenous adults and youth who are held in remand facilities awaiting trial or sentence as well as those who are convicted and sentenced to periods of incarceration. Efforts to further reconciliation by reducing Indigenous incarceration rates have relied largely on the courts and their application of a sentencing principle rooted in the Supreme Court’s ruling in R. v. Gladue [1999] 1 SCR 688. In this article, we argue that the Gladue sentencing principle is being fundamentally undermined in the courts through risk models that actively displace the very context that Gladue reports seek to illuminate. Included in the analysis are the compounding impacts facing Indigenous individuals struggling with a complex disability like Fetal Alcohol Spectrum Disorder.
... Le disabilità primarie sono quelle che riflettono i principali danni morfologici e neuropsicologici dello spettro dei disordini feto alcolici, per cui il neonato ha dei dismorfismi facciali tipici: microcefalia (circonferenza cranica al di sotto del quinto percentile; linee palpebrale breve; filtro nasale piatto e allungato; labbro superiore sottile (Streissguth et al., 2004). In generale, è un bambino piccolo che rimarrà di dimensione modeste, con deficit di crescita staturo-ponderale pre e post natale. ...
... Come accennato nei capitoli precedenti, la diagnosi precoce è di fondamentale importanza perché permette di pianificare un piano di intervento in grado di ridurre il rischio di disabilità secondarie. Non sempre la diagnosi è possibile nei primi mesi di vita, cosa che permetterebbe di seguire la crescita del bambino e prendere in carico da subito la famiglia (Streissguth et al., 2004). È certo che l'intervento precoce, comunque prima dei 6 anni di vita, permette di avviare un trattamento sufficientemente adeguato, tale da far diminuire notevolmente le disabilità secondarie in età adolescenziale e in età adulta. ...
Technical Report
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The use of ethyl alcohol during pregnancy and subsequent foetal exposure to this teratogen can cause developmental disorders of the foetus, such as growth retardation, craniofacial abnormalities, organ malformations and neurobehavioural abnormalities. These clinical manifestations are known as Foetal Alcohol Spectrum Disorder, whose most severe expression is Foetal Alcohol Syndrome. These are transparent and permanent disabilities still poorly known in our country. In this report, the leading experts in these pathologies clarify how to carry out preventive interventions in pregnant women and in the community on the risks of gestational alcohol, how to make an early diagnosis in newborns in which there is suspicion of exposure in order to quickly intervene with a targeted treatment to minimize secondary disabilities in people affected by the spectrum or the fully expressed syndrome and to guarantee a peaceful, safe life path with the greatest possible autonomy.
... A secondary disability is a condition that a person is not born with but might get by having FASD. Inappropriate sexual behaviors are a commonly observed secondary disability (Novick, 1997;Streissguth et al., 1996;Streissguth et al., 2004), some of which may rise to the level of criminal sexual acts (Mela et al., 2020;Streissguth et al., 1996). ...
... When the primary and secondary disabilities associated with FASD involve impairments in various areas of cognitive and adaptive functioning that mimic but not actually represent symptoms of paraphilic conditions and personality disorders (Anderson, Harding, Reid, & Pei, 2018;Novick, 1997;Streissguth et al., 1996;Streissguth et al., 2004), the applicable diagnosis per the DSM-5 (American Psychiatric Association, 2013) would be neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE), which falls under the placeholder category other specified neurodevelopmental disorder and is coded as 315.8. While ND-PAE satisfies the acquired or congenital condition element of an SVP mental disorder, SVP evaluators would be hard pressed to reasonably conclude ND-PAE affects emotional or volitional control that predisposes persons to commit acts of sexual violence because science lacks to support such a link. ...
Article
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Prenatal alcohol exposure produces a broad range of primary disabilities that lead to adverse life course outcomes in children raised in adverse environments. Inappropriate sexual behaviors are a commonly occurring secondary disability, with a large minority of individuals with fetal alcohol spectrum disorder (FASD) displaying sexual aggression. Adults with FASD who commit repeated criminal sexual acts may be subject to legal proceedings for indefinite involuntary civil confinement as sexually violent predators/persons (SVP) in certain jurisdictions in the United States. Studies about the diagnostic practices among psychologists and psychiatrists retained by states to evaluate individuals as SVP do not recognize FASD as a mental disorder, despite the likelihood that hundreds of individuals petitioned for involuntary commitment suffer from FASD. Establishing an FASD diagnosis may provide exculpatory evidence to refute a government petition that an individual suffers from a mental condition that affects emotional or volitional capacity by predisposing the person to committing criminal sexual behavior. This article provides a framework for identifying, assessing, and deciding whether individuals with the FASD diagnosis suffer from the legally defined mental disorder that is necessary to indefinitely confine individuals as SVP.
... Consequent to this, coordination and self-regulation may be affected (SIGN, 2019). This could result in behavioural problems highlighted as aggressive, violent and sexualised behaviours, which may culminate in frequent encounters with the criminal justice system (CJS; Streissguth et al., 2004). ...
... Several risk factors are associated with the criminal justice encounters of the FASD population, and these risk factors are identified as, but not limited to, low social economic status, placement instabilities and substance misuse (Streissguth et al., 2004). These risk factors overlap with the pathways to offending proposed by Corrado and Freedman (2011), which include prenatal risk, childhood maltreatment, extreme child temperament and personality disorder pathways. ...
Article
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Individuals with foetal alcohol spectrum disorders (FASD) are estimated to be 19 times more likely to encounter the criminal justice system (CJS) in comparison to individuals without FASD. During encounters with the CJS, investigative interviews are employed to obtain accurate information from suspects, victims or witnesses of crime. A systematic search using PRISMA guidelines was performed to identify empirical studies published that have explored the questioning of the FASD population within the CJS and the vulnerabilities of FASD-impacted individuals during investigative interviewing. A total of 383 studies were identified from the databases searched and 7 further studies were identified from Google Scholar. After deduplication, abstract and title screening, the full text of 23 studies were assessed for inclusion and 5 were included in the narrative synthesis of results. Two papers were empirical studies focussed on the performance of FASD-impacted individuals during investigative interviewing. Whilst the first study found the FASD population susceptible to suggestions, the second (a case study), identified the ploys employed during investigative interviewing to obtain a confession. Three papers studied the wider vulnerabilities of FASD-impacted individuals and found diminished psycho-legal abilities, increased risk of recidivism and biological, psychological and social factors that render FASD-impacted individuals vulnerable to CJS encounters. Despite the greater likelihood of CJS encounters, the result of this review highlights the slim evidence base useful to establish the vulnerabilities of FASD-impacted individuals within the CJS.
... Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder stemming from prenatal alcohol exposure (PAE), resulting in life-long impacts on an individual's physical, cognitive, behavioral, and social-emotional functioning (Cook et al., 2016). Compounding the neurodevelopmental impacts of PAE, it is also common for individuals with FASD to experience environmental adversity across the lifespan (Flannigan et al., 2021;McLachlan, Flannigan et al., 2020;Streissguth et al., 2004). The characteristics and experiences associated with alcohol use during pregnancy, and FASD, can affect multiple generations (Kvigne et al., 2003(Kvigne et al., , 2008Popova et al., 2020;Singal et al., 2017). ...
... Among the most concerning negative life outcomes experienced by individuals with FASD is contact with the justice system (McLachlan, Flannigan et al., 2020;Streissguth et al., 2004). Both youth and adults with FASD are reported to be over-represented in forensic and correctional contexts (Fast et al., 1999;McLachlan et al., 2019;Popova et al., 2011;Streissguth et al., 1996). ...
Article
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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.
... Children with a history of PAE are at increased risk of exposure to traumatic childhood experiences such as abuse and neglect, as well as increased incidence of neurodevelopmental disorders affecting areas of language, attention, memory and intelligence (Price et al., 2017). Additionally, children with FASD are at increased risk of developing externalizing disorders, such as conduct disorder, attention deficit hyperactivity disorder (ADHD) and other impulse control disorders, with a high prevalence of disrupted education, offending behaviour, sexually inappropriate behaviours and substance use problems (Fast & Conry, 2009;Streissguth et al., 2004). ...
... Research using multiple approaches in custodial and community samples produced similar FASD prevalence rates among justice-involved individuals (Fast et al., 1999;Mela et al., 2020). Epidemiological studies show that up to 60% of adolescents and adults with FASD have a history of contact with the criminal justice system (Clarren et al., 2015;Popova et al., 2017;Streissguth et al., 2004). This over-representation of FASD in the criminal justice system is understood to reflect the nature of neurocognitive deficits and high rates of psychosocial adversities among people with FASD (Currie et al., 2016;Flannigan et al., 2018). ...
Article
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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.
... According to the same meta-analysis, youth with FASD are 19 times more likely to be incarcerated than youth without FASD (2, 5, 7). Streissguth et al. describe higher rates of disrupted school experience, trouble with law, inappropriate sexual behavior, alcohol and drug problems for FASD patients (8). ...
... All data regarding study groups were blinded prior to measurements and statistical evaluation. Since children with FAS show a delayed developmental trajectory, we chose to include slightly (but not statistically significant) younger children as controls in order to optimize comparability (8,38,39). Thus, the included children were similar in terms of parameters such as body length or weight. ...
Article
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IntroductionThe fetal alcohol spectrum disorder (FASD) is a complex and heterogeneous disorder, caused by gestational exposure to alcohol. Patients with fetal alcohol syndrome (FAS—most severe form of FASD) show abnormal facial features. The aim of our study was to use 3D- metric facial data of patients with FAS and identify machine learning methods, which could improve and objectify the diagnostic process.Material and Methods Facial 3D scans of 30 children with FAS and 30 controls were analyzed. Skeletal, facial, dental and orthodontic parameters as collected in previous studies were used to evaluate their value for machine learning based diagnosis. Three machine learning methods, decision trees, support vector machine and k-nearest neighbors were tested with respect to their accuracy and clinical practicability.ResultsAll three of the above machine learning methods showed a high accuracy of 89.5%. The three predictors with the highest scores were: Midfacial length, palpebral fissure length of the right eye and nose breadth at sulcus nasi.Conclusions With the parameters right palpebral fissure length, midfacial length and nose breadth at sulcus nasi, machine learning was an efficient method for the objective and reliable detection of patients with FAS within our patient group. Of the three tested methods, decision trees would be the most helpful and easiest to apply method for everyday clinical and private practice.
... Prevalence rates of FASD are 32 times greater among children in foster or residential care than the general population, and individuals with FASD are 9.22 times more likely to receive special education funding and 3.06 times more likely to repeat a grade [30] [38]. Overall, 61% of patients diagnosed with FASD have some form of disrupted school experience [39]. Life span prevalence rates for individuals with FASD are 60% ...
... for trouble with the law, 50% for confinement, and 49% for repeated inappropriate sexual behaviors. Children with FASD are 19 times more likely to be in-Open Journal of Pediatrics carcerated in a given year and are 21 times more likely to develop a substance use disorder [24] [39]. ...
... Parents reported many barriers to accessing the correct support for their child, expressing frustration and distress. Schools failing to detect that a child may need assessment or extra support increases the risk that the individual will present to services later with complex secondary mental and physical health issues that may have been preventable (APA, 2013;Streissguth et al., 2004). Long-term lack of support can lead to increased risk of interaction with the criminal justice service, children's services and hospital admissions (Bradshaw et al., 2015;Streissguth et al., 2004). ...
... Schools failing to detect that a child may need assessment or extra support increases the risk that the individual will present to services later with complex secondary mental and physical health issues that may have been preventable (APA, 2013;Streissguth et al., 2004). Long-term lack of support can lead to increased risk of interaction with the criminal justice service, children's services and hospital admissions (Bradshaw et al., 2015;Streissguth et al., 2004). Therefore, failing to detect and support DDs is likely to have significant multi-service cost implications in the long term. ...
Article
Full-text available
Three of the most prevalent developmental disorders (DDs) are autism spectrum disorder (ASD), attention‐deficit/hyperactivity disorder (ADHD) and fetal alcohol spectrum disorder (FASD). As part of a study screening for DDs in Greater Manchester, UK, a unique opportunity was taken to explore parents' experiences of receiving reports about their child's previously unrecognised DD. Six parents out of a possible 16 took part in interviews, which were analysed thematically. Findings drawn from parental responses revealed a number of barriers to accessing support for their child's additional needs, including perceived resistance from schools, particularly for quiet, well‐behaved girls, and difficulty in accessing assessment or referrals. There needs to be greater awareness of additional needs in children without externalising behaviours, the presence of gender‐specific differences in the presentation of DDs, and FASD as a commonly occurring DD. Ultimately, better support for children with DDs would reduce the burden of unmet needs for the children and their families, and for wider services.
... Accurate diagnosis is critical to obtaining effective, timely treatment and support, optimizing the developmental trajectory of a child, and avoiding negative secondary outcomes (Chasnoff, Wells, & King, 2015;Streissguth et al., 2004). When the characteristic facial dysmorphology of fetal alcohol syndrome (FAS) is not present, documentation of PAE is often required for diagnosis. ...
... Neurobehavioral deficits may be similar in severity regardless of dysmorphology and persist throughout the life of the person with FASD (Mattson et al., 2010;Mattson, Bernes, & Doyle, 2019;Mattson, Riley, Gramling, Delis, & Jones, 1998). In addition, these children may be at higher risk for negative secondary disabilities due to missed diagnosis and failure to access appropriate treatment as well as lack of recognition of limitations by persons interacting with them ( Streissguth et al., 2004). ...
Article
Background: Prenatal alcohol exposure (PAE), leading to fetal alcohol spectrum disorders (FASD), is a serious public health issue in the United States and globally. Diagnosis of FASD is crucial in obtaining appropriate care, but it is not always possible when PAE cannot be documented. Methods: Deciduous teeth from a child with known PAE and a child with known absence of PAE were analyzed using liquid chromatography-isotope dilution tandem mass spectrometry (LC-IDMS/MS) in a multiple-reaction monitoring mode for direct markers and LC-high resolution MS in positive and negative mode with hydrophilic interaction liquid chromatography and reverse-phase chromatography, respectively, for indirect markers. Results: Direct markers of PAE (ethyl glucuronide and ethyl sulfate) were detected in prenatal and postnatal dentine from a case tooth but not from a control tooth. Indirect biomarker analysis indicated a dysregulation of amino acids and an increase in cholesterol sulfate in the case compared to the control tooth. Conclusions: This proof-of-concept study demonstrates for the first time that direct biomarkers of PAE are detectable and measurable in deciduous teeth which begin forming in utero and are typically naturally shed between 5 and 12 years of age. Further examination of these novel biomarkers may allow diagnosis of FASD where documentation of PAE is otherwise unavailable. Furthermore, because teeth grow incrementally, defined growth zones can be sampled allowing for identification of gestational timing of PAE to help better understand mechanisms underlying alcohol's disruption of perinatal development.
... 31 Disengagement from school is also a risk factor for engagement with the justice system. 2,32 To help provide children with improve the Australian FASD diagnostic guide, and it will be essential to continue to consider the perspectives of clinicians that have actively used the guide in this updating process. 26 ...
... Individuals with FASD are diverse, with differing patterns of physical, cognitive, behavioral, and social-emotional functioning between individuals (Mattson et al., 2019). Great strides have been made over the last several decades to identify the negative neurodevelopmental impacts of PAE and the high rates of adversity experienced by individuals with FASD across their lifespan (Garrison et al., 2019;McLachlan et al., 2020;Price et al., 2017;Streissguth et al., 2004). Important research has also been conducted to explore the experiences and needs of individuals with FASD and their families, but there remains a significant gap in research on strengths (Domeij et al., 2018;Skorka et al., 2020). ...
Article
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 as well as the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also helped to support advocacy efforts and highlight the necessity of FASD services and supports. However, with this 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, and there is a critical need to shift the direction of the field. The current study was a narrative review of the literature on strengths in FASD. Our goals were 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 fulfillment and wellbeing. 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 indicated 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.
... Flow of participants through the study. SFA, small for age; SEN, on school educational needs register; LAC, "looked-after child," that is, in the care of the local authority; PrevLAC, previously looked-after child, that is, adopted TA B L E 2 Screening and assessment data by school & Feldmann, 2012;Landgren, et al., 2019;Rangmar et al., 2015;Streissguth, et al., 2004). ...
Article
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Background Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school. Methods A 2-phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8–9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen-positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties. Results Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis. Conclusions FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD.
... 14 Zihin engelli çocuklar diğer çocuklar gibi yemek yeme, konuşma ve yürüme gibi aktiviteleri aynı seviyede yapamayabilirler. 15 Engelli gruplar arasında özel gereksinimi fazla olan grubun zihinsel engelliler olduğu bildirilmiştir. 1,6,16 Zihinsel engelli çocuğu olan ailelerde stres yapan durumların başında çocuğun gelişimi, sağlık durumu ve anne-babaya bağımlılık olduğu bildirilmiştir. ...
... Based on the results published in the selected studies, FAE represents a leading cause of preventable birth defects and developmental disability in newborns. As reported by Streissguth et al. [21], subjects with FAS or FAE showed arithmetic disability and specific problems with adaptive behavior. Similar results were reported by McLachlan et al. [26] who described an impairment in at least one psycholegal ability and brain impairment in FASD subjects. ...
Article
Full-text available
Prenatal alcohol exposure is considered one of the main causes of preventable birth disorders; however, it represents the main form of developmental delay in the world. Among the so-called secondary disabilities related to fetal alcohol spectrum disorder (FASD), there is a close connection with criminal behavior. This systematic review aims to provide up-to-date information about the relationship between FASD subjects and criminal justice analyzing different aspects. In light of the results of this review, a further goal is to provide several suggestions in order to reduce the public cost impact of FASD. A systematic review of the literature was conducted according to the PRISMA guidelines, producing 20 articles that met the inclusion criteria. Based on the results published in the selected studies, fetal alcohol syndrome (FAS) is a leading cause of preventable birth disorders and developmental disabilities in newborns. Moreover, these subjects seem to be more inclined to criminal acts compared to others. In conclusion, it should be pointed out that FASD entails high public health costs, both regarding the support measures provided to the affected individual and to their family, as well as the cost and social impact of any criminal offenses committed.
... Epidemiological studies have revealed that the prevalence of drug and alcohol abuse in adults born with fetal alcohol syndrome disorder is substantially higher (46%) than the lifetime prevalence of alcohol (18.2%) and drug (10.3%) abuse in the general adult population (Streissguth et al., 2004;Compton et al., 2007). It is believed that the organizational deficits in brain circuitries induced by in-utero alcohol exposure increase the likelihood of addiction later in life (Bariselli and Lovinger, 2021). ...
Article
Full-text available
Addiction is a chronically relapsing neuropsychiatric disease that occurs in some, but not all, individuals who use substances of abuse. Relatively little is known about the mechanisms which contribute to individual differences in susceptibility to addiction. Neural gene expression regulation underlies the pathogenesis of addiction, which is mediated by epigenetic mechanisms, such as DNA modifications. A growing body of work has demonstrated distinct DNA epigenetic signatures in brain reward regions that may be associated with addiction susceptibility. Furthermore, factors that influence addiction susceptibility are also known to have a DNA epigenetic basis. In the present review, we discuss the notion that addiction susceptibility has an underlying DNA epigenetic basis. We focus on major phenotypes of addiction susceptibility and review evidence of cell type-specific, time dependent, and sex biased effects of drug use. We highlight the role of DNA epigenetics in these diverse processes and propose its contribution to addiction susceptibility differences. Given the prevalence and lack of effective treatments for addiction, elucidating the DNA epigenetic mechanism of addiction vulnerability may represent an expeditious approach to relieving the addiction disease burden.
... D'autre part, selon une étude menée en 2004 sur 415 patients adolescents ou adultes classés comme SAF ou EAF (« Effets d'Alcoolisation Foetale »), c'est-à-dire les patients ne présentant pas tous les symptômes d'un SAF mais seulement quelques-uns, les déficits cognitifs cités ci-dessus vont contribuer à l'apparition de problèmes comportementaux à l'âge adulte. En effet, 61% ont été exclus ou ont abandonné le système scolaire, 60% ont des problèmes de délinquance, 50% ont des problèmes avec la justice, 49% ont eu un comportement sexuel déviant et 35% ont eu un usage abusif de substances psychoactives (Streissguth et al., 2004). Cette étude montre qu'une alcoolisation au cours du développement foetal peut entrainer des problèmes à très long terme et ce quel que soit, apparemment, la dose ingérée. ...
Thesis
L’éthanol, molécule tératogène, affecte le développement et la maturation du système nerveux central qui s’étendent depuis la vie fœtale jusqu’à la fin de l’adolescence. L’exposition à l’alcool pendant la vie fœtale entraîne des déficits d’apprentissages irréversibles et à l’adolescence, les alcoolisations de type Binge Drinking induisent également des pertes de mémoire. Cependant les mécanismes cellulaires dans ces deux cas d’expositions sont encore mal connus. L’hippocampe, une structure cérébrale, est impliqué dans la mémoire et les apprentissages par le biais des phénomènes de plasticité synaptique entre les neurones. Ici, nous avons étudié les effets de l’éthanol i) pendant la vie fœtale et ii) à l’adolescence sur la plasticité synaptique dans l’hippocampe de rat adolescent à l’aide de techniques d’électrophysiologie, de pharmacologie et de biochimie. Nous montrons que le glutamate et le GABA sont fortement impliqués dans la perturbation à long terme de la plasticité synaptique après alcoolisation fœtale. A l’adolescence, seul le glutamate est perturbé après un binge drinking, entraînant l’abolition rapide et prolongée de la plasticité synaptique ainsi que des déficits d’apprentissages. De manière intéressante, un diurétique, la bumétanide, restaure les perturbations après alcoolisation fœtale. L’éthanol pendant le développement cérébral perturbe les apprentissages en induisant un déséquilibre entre excitation et inhibition au sein du réseau neuronal de l’hippocampe
... There is a critical need for early evaluation and diagnosis for children with suspected prenatal alcohol exposure. Because the adverse effects of prenatal alcohol exposure are sustained throughout the lifetime (Streissguth et al., 2004), it is imperative that diagnosis and developmental support begins as early as possible. While alcohol is the teratogenic agent leading to a diagnosis within the FASD continuum, other early life indicators may help to better identify children at highest risk for an FASD diagnosis (Carter et al., 2016;Hasken et al., 2021;Kalberg et al., 2019). ...
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Background Mothers of children with fetal alcohol spectrum disorders tend to have lower weight compared to other mothers. Yet how alcohol and maternal weight may predispose infants to poorer physical growth and neurodevelopmental trajectories is relatively unexplained. Methods South African mothers (n=406) were recruited prenatally and their offspring were provided standardized dysmorphology and neurodevelopment examinations at 6 weeks and 9 months of age. Maternal weight was obtained postpartum and linear mixed modeling determined whether postpartum maternal weight and prenatal alcohol exposure significantly influenced infant growth, dysmorphology, and neurodevelopment within the first year of life. Results Postpartum maternal weight was positively associated with birth length, weight, and head circumference centile, but the rate of growth from birth to nine months was similar among all infants. Maternal weight was inversely associated with dysmorphology. Many infants in this population were performing within the borderline or extremely low range. Higher maternal weight was associated with significantly better cognitive and motor performance at 6 weeks; however, the rate of developmental growth was similar among all infants, regardless of postpartum maternal weight. Conclusion Higher postpartum maternal weight may be a protective factor but does not eliminate the adverse effects of alcohol on infant growth and dysmorphology. Regardless of maternal weight, alcohol remains a powerful teratogen and moderate to high use prenatally can result in adverse infant physical and neurocognitive development.
... Fetal alcohol spectrum disorder (FASD) is a complex neurodevelopmental condition that arises from prenatal alcohol exposure and is characterised by a broad spectrum of lifelong physical, cognitive, and behavioural difficulties [1]. Individuals with FASD often have multiple comorbidities and without timely intervention, can experience adverse outcomes and secondary conditions, including disengagement from school, mental health and substance abuse disorders, limited ability to live and work independently and involvement with the legal system [2,3]. The global prevalence of FASD among young people in the general population is estimated to be approximately 7.7 per 1000 population [4], making FASD one of the most common preventable causes of developmental disability. ...
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Since the 2016 release of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder (FASD), considerable progress has been made in the identification and diagnosis of the disorder. As part of a larger process to review and update the Guide, the aim of this study was to identify review priorities from a broad range of stakeholders involved in the assessment and diagnosis of FASD. Sixty-two stakeholders, including healthcare practitioners, researchers, other specialists, individuals with cultural expertise, lived experience and consumer representatives completed an online survey asking them to describe up to five priorities for the review of the Australian Guide to the Diagnosis of FASD. A total of 267 priorities were described. Content analysis of responses revealed priority areas relating to diagnostic criteria (n = 82, 30.7%), guideline content (n = 91, 34.1%), guideline dissemination (n = 15, 5.6%) and guideline implementation (n = 63, 23.6%). Other considerations included prevention and screening of FASD (n = 16, 6%). Engaging stakeholders in setting priorities will ensure the revised Australian Guide can be as relevant and meaningful as possible for the primary end-users and that it meets the needs of individuals with lived experience who will be most affected by the diagnosis.
... Furthermore, postpartum neglect may reinforce the impact of neurological damage induced by ethanol exposure in the offspring. It is generally accepted that the neglect or abuse of children in the early developmental period is a risk factor for anxiety, depression, and neurobehavioral diseases in adolescence (Streissguth et al. 2004). These psychiatric disorders might be associated with long-lasting changes in the hypothalamus-pituitary-adrenal (HPA) activation. ...
Article
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Both prenatal ethanol and early-life stress have been shown to induce reduced risk-taking and explorative behavior as well as cognitive dysfunction in the offspring. In this study, we examined the effect of combined exposure to ethanol and early stress on maternal care, exploratory behavior, memory performances, and oxidative stress in male offspring. Pregnant rats were exposed to ethanol (4 g/kg) from gestational day (GD) 6–to postnatal day (PND) 14 and limited nesting material (LNS) from PND0-PND14 individually or in combination. Maternal behavior was evaluated during diurnal cycle. The level of corticosterone hormone and markers of oxidative stress were evaluated in the pups. Risk-taking and explorative behavior were assessed with the elevated-plus maze (EPM) test and cognitive behavior with the Morris water maze (MWM), novel object recognition (NORT), and object location memory (OLM) tests. In the mothers, perinatal alcohol or LNS either alone or in combination decreased maternal behavior. In the offspring, the combination of the two factors significantly increased the pup’s plasma corticosterone concentration in comparison with ethanol and LNS alone. Reduced risk-taking behavior was observed in the ethanol, LNS and ethanol + LNS groups compared with the control group, and this was amplified in the co-exposure of ethanol and LNS groups. The MWM, NORT, and OLM tests revealed spatial and recognition memory impairment in the ethanol and LNS groups. This impairment was more profound in the co-exposure of ethanol and LNS. Also, we observed a significant decrease in superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities and an increase in malondialdehyde (MDA) level in the hippocampus of ethanol and LNS co-exposed animals as compared with individual exposure of ethanol and LNS. While each factor independently produced similar outcomes, the results indicate that the dual exposure paradigm could significantly strengthen the outcomes.
... 15,16 Importantly, alterations in HPA regulation and responsiveness have been well described in individuals with FASD 17 and in PAE animal models. 18 As well, children with FASD are at a heightened risk of experiencing early-life stress due to foster care placements, childhood abuse and neglect, and other adverse early life circumstances, 19,20 which are known to impact both HPA 21 and immune 22 function. Investigations into altered HPA-immune interactions are thus particularly relevant for elucidating mechanisms underlying the increase in autoimmune disorders following PAE. ...
Article
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Background There are known environmental risk factors associated with rheumatoid arthritis; however, less is known regarding how the prenatal environment impacts later-life risk for rheumatoid arthritis. Based on preliminary clinical data suggesting that individuals with fetal alcohol spectrum disorder (FASD) are at higher risk for autoimmune disorders, this study investigated the modulatory impact of prenatal alcohol exposure (PAE) on the inflammatory disease profile in an adjuvant-induced arthritis rat model. Methods Pregnant rats received liquid ethanol or control diet throughout gestation. To model the increased exposure to stressors often experienced by individuals with FASD, adolescent offspring were exposed to chronic mild stress (CMS) or remained undisturbed. In adulthood, experimental arthritis was initiated and rats terminated either at the peak or following resolution from inflammation to assess endocrine, immune, and histopathological outcomes. Findings PAE rats had an increased incidence and severity of, and impaired recovery from, arthritis. Increased joint damage was observed in PAE animals, even in the face of apparent recovery from the clinical signs of arthritis, while it appeared that oestradiol may have a protective role. Moreover, with the combination of PAE and adolescent stress, increased macrophage density was detected in the synovium of PAE but not control rats. Interpretation These findings demonstrate that PAE alters the severity and course of arthritis, highlighting the potential immunomodulatory impact of adverse prenatal exposures. In particular, these data have implications for understanding preliminary data that suggest a heightened propensity for autoimmune disorders in individuals with FASD.
... Previous research has documented the importance of the family environment in effective support of individuals with FASD [14,15]. There is also acknowledgement that parenting programs must take a family-centered approach where both the child's and family's strengths and needs are understood and supported [16]. ...
Article
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Purpose of the Review The current review proposes a theoretical framework to support professionals in collaborating with families in the provision of services for children with fetal alcohol spectrum disorders (FASD). Existing models of family-directed care and family contextual factors relevant to planning interventions were reviewed. This information was adapted and integrated in the context of available evidence regarding the provision of evidence-based approaches for children with FASD and their families. Recent Findings The proposed theoretical framework integrates a family-directed approach to brain injury model, which includes key components of hope, family expertise, and education/skill building with the social economy model of excluded families. This provides a comprehensive approach to supporting the complex needs of children with FASD and their families. Conclusions Specialist services for children with FASD and their families are significantly limited around the world. The proposed model provides a theoretical framework for educating and supporting practitioners and family members, to facilitate collaborative service provision for children with FASD and their families.
... 88 FASD can be associated with an increased risk of physical health conditions, 89 poor mental health, substance misuse and involvement in the criminal justice system. 90 These lifelong consequences are extremely costly to the individual, family, health, education, disability and justice systems. 91 92 The Australian Guide to the assessment and diagnosis of FASD 87 recommends early intervention, however early diagnosis and provision of appropriate treatment strategies are underdeveloped. ...
Article
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Introduction Neurodevelopmental disorders (NDD), including cerebral palsy (CP), autism spectrum disorder (ASD) and foetal alcohol spectrum disorder (FASD), are characterised by impaired development of the early central nervous system, impacting cognitive and/or physical function. Early detection of NDD enables infants to be fast-tracked to early intervention services, optimising outcomes. Aboriginal and Torres Strait Islander infants may experience early life factors increasing their risk of neurodevelopmental vulnerability, which persist into later childhood, further compounding the health inequities experienced by First Nations peoples in Australia. The LEAP-CP prospective cohort study will investigate the efficacy of early screening programmes, implemented in Queensland, Australia to earlier identify Aboriginal and Torres Strait Islander infants who are ‘at risk’ of adverse neurodevelopmental outcomes (NDO) or NDD. Diagnostic accuracy and feasibility of early detection tools for identifying infants ‘at risk’ of a later diagnosis of adverse NDO or NDD will be determined. Methods and analysis Aboriginal and/or Torres Strait Islander infants born in Queensland, Australia (birth years 2020–2022) will be invited to participate. Infants aged < 9 months corrected age (CA) will undergo screening using the (1) General Movements Assessment (GMA); (2) Hammersmith Infant Neurological Examination (HINE); (3) Rapid Neurodevelopmental Assessment (RNDA) and (4) Ages and Stages Questionnaire-Aboriginal adaptation (ASQ-TRAK). Developmental outcomes at 12 months CA will be determined for: (1) neurological (HINE); (2) motor (Peabody Developmental Motor Scales 2); (3) cognitive and communication (Bayley Scales of Infant Development III); (4) functional capabilities (Paediatric Evaluation of Disability Inventory-Computer Adaptive Test) and (5) behaviour (Infant Toddler Social and Emotional Assessment). Infants will be classified as typically developing or ‘at risk’ of an adverse NDO and/or specific NDD based on symptomology using developmental and diagnostic outcomes for (1) CP (2) ASD and (3) FASD. The effects of perinatal, social and environmental factors, caregiver mental health and clinical neuroimaging on NDOs will be investigated. Ethics and dissemination Ethics approval has been granted by appropriate Queensland ethics committees; Far North Queensland Health Research Ethics Committee (HREC/2019/QCH/50533 (Sep ver 2)-1370), the Townsville HHS Human Research Ethics Committee (HREC/QTHS/56008), the University of Queensland Medical Research Ethics Committee (2020000185/HREC/2019/QCH/50533) and the Children’s Health Queensland HHS Human Research Ethics Committee (HREC/20/QCHQ/63906) with governance and support from local First Nations communities. Findings from this study will be disseminated via peer-reviewed publications and conference presentations. Trial registration number ACTRN12619000969167.
... Few studies to date have matched the typically developed controls with the PAE group on these contextual factors. Streissguth et al. (2004) showed that adverse life experiences and lack of access to appropriate services predicted unfavorable outcomes for those with FASD, while early identification/diagnosis, access to services, and a stable/nurturing home were protective. Moreover, besides the factors mentioned above, individuals with FASD are more likely to develop secondary conditions as a result of the condition that they are born with, such as mental health problems and alcohol problems . ...
Article
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Prenatal alcohol exposure (PAE) interferes with neurodevelopment. The brain is particularly susceptible to the adverse consequences of prenatal alcohol exposure, and numerous studies have documented changes to brain anatomy and function, as well as consequences for cognition, behavior, and mental health. Studies in typically developing individuals have shown that the brain undergoes dynamic developmental processes over an individual’s lifespan. Furthermore, magnetic resonance imaging (MRI) studies in other neurodevelopmental and psychiatric disorders have shown that their developmental trajectories differ from the typical pattern. Therefore, to understand long-term clinical outcomes of fetal alcohol spectrum disorders (FASD), it is necessary to investigate changes in neurodevelopmental trajectories in this population. Here we review studies that have used MRI to evaluate changes in brain structure and function over time via cross-sectional or longitudinal methods in individuals with PAE. Research demonstrates that individuals with PAE have atypical cortical and white matter microstructural developmental trajectories through childhood and adolescence. More research is needed to understand how factors such as sex and postnatal experiences may further mediate these trajectories. Furthermore, nothing is known about the trajectories beyond young adulthood.
Article
This article summarizes four federal criminal cases that illustrate how suggestibility can impact defendants with FASD in the criminal justice system. Four cases were identified via a Google Scholar search of “suggestibility” and “fetal alcohol” in the federal case law database. These cases are illustrative of how FASD can affect legal defendants, including vulnerability to peer pressure, being easily manipulated, insufficient comprehension of legal proceedings, difficulty in assisting legal counsel, learning impairment, acquiescence or higher levels of suggestibility, and difficulty understanding consequences. The cases presented here provided the most comprehensive discussion of FASD and suggestibility issues but are by no means an exhaustive review of case law. Because defendants with FASD are the focal point of this article, we intentionally excluded cases involving eyewitness suggestibility, the suggestibility of child witnesses, and the suggestibility of those under hypnosis. Therefore, this review has been developed to explicate and illustrate problems common to FASD defendants within legal settings, especially regarding risk for suggestibility. The information provided from this discussion may better guide legal professionals who regularly come into contact with persons affected by FASD on how to more readily detect this neurodevelopmental condition and mitigate the likelihood of injustice during criminal proceedings. Additionally, we include suggestions on how to attenuate miscarriages of justice as a result of faulty confessions, wrongful convictions, and vulnerability of suggestibility in persons affected by FASD.
Article
Introduction: Limited research has been conducted on suicidality among individuals with FASD. The purpose of this scoping review was to understand (1) how suicidality has been measured; (2) what proportion of individuals experience suicidality across the lifespan; and (3) what contextual factors are associated with suicidality. Method: We conducted a scoping review of the literature on FASD and suicidality. Twenty-eight articles and gray literature sources were included. Results: We identified an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. Most studies were Canadian, published within the last 10 years, and focused on adolescents and adults in clinical settings. Only six studies were specifically designed to examine suicidality in FASD. Conclusion: This review provides a foundational understanding of suicidality in FASD with important implications for research, policy, and practice. Rates of suicidality across the lifespan are high, underscoring the need for evidence-based approaches to screening, prevention, and treatment.
Article
Despite recent approval of pharmaceutical-grade cannabis products for the treatment of childhood epilepsy, some families continue to use artisanal cannabis products as a way to manage seizures in their children. However, such products are typically of unknown composition and quality, and may therefore pose an unpredictable health risk to the child. In the present analysis, 78 samples of cannabis products collected (as part of a previous study) from families of children with epilepsy (average age 8.8 ± 4.6 years) were analyzed for heavy metals (arsenic, cadmium, lead, and mercury), residual solvents (panel of 19 solvents) and pesticides (panel of 57 pesticides). Due to small sample volumes obtained, only a subset of samples was used in each analysis. Results showed that no cannabis sample exceeded the toxicity limits for heavy metals (n = 51 samples tested). Of the 58 cannabis samples tested for residual solvents, 17 (29%) contained concentrations of ethanol or isopropanol above the generally accepted limit of 5000 parts per million. With the volumes consumed, it was thought unlikely that children were consuming hazardous amounts of residual solvents, although this could not be ruled out in every case. Most samples (n = 31 samples tested) yielded inconclusive results for the pesticides, although one sample contained concentrations of bifenthrin that were 4.9 times higher than the acceptable limit. Overall, these results highlight the need for improved access to quality-assured cannabis products and the education of doctors, patients, and artisanal manufacturers around the contaminant exposure risk in unregulated cannabis products.
Article
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 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 (PROSPERO). 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 of IQ, executive functioning, and age were investigated if 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 relative to other groups, with effect sizes ranging from 1.04-1.35 compared to nonexposed groups and .30-.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 nonexposed group. Recruitment method significantly affected this relationship, with larger effect sizes on average found for clinically-identified samples compared to at-risk or population samples. Conclusions Individuals with FASD have impairments in adaptive functioning relative to nonexposed and ADHD groups, regardless of IQ, executive functioning, or age. Limitations include low sample sizes in some comparisons and limited age range.
Article
Background:Fetal alcohol spectrum disorder (FASD) is a common form of developmental disability but may be poorly understood by professionals working with people with FASD. The aim of the research is to understand the FASD knowledge, attitudes, awareness, and practices among people employed by the education sector in Aotearoa New Zealand and identify gaps in knowledge. Methods: We conducted an online survey of New Zealand Education professionals. The survey focused on the following areas: Awareness of FASD; Knowledge and beliefs about FASD; Impact of FASD on professional practice; and Training needs. Results: Of the 419 participants, most had some knowledge of FASD and its effects on learning; however, there are still gaps that need to be addressed so educators can provide support to individuals living with FASD. Conclusion: There is a need to improve workforce capacity and develop guidelines that address the needs of front-of-line staff working with children with FASD in education settings.
Article
Zusammenfassung Ziel der Studie Fetale Alkoholspektrum-Störungen sind nicht nur häufig, sie sind aufgrund des hohen Risikos für psychiatrische Komorbiditäten auch im Erwachsenenalter klinisch relevant. Die diagnostische Abklärung im Erwachsenenalter ist die Voraussetzung für eine zielgerichtete Behandlung und bedarfsgerechte Unterstützung. Methodik In einer Metropolenregion wurde zwischen Mai 2015 und Juli 2020 bei 80 Personen der Verdacht auf eine FASD diagnostisch abgeklärt. Die Ergebnisse dieser interdisziplinären Diagnostik wurden systematisch ausgewertet und die klinischen Charakteristika der Personen mit bzw. ohne FASD analysiert. Ergebnisse Bei ca. 70% der Inanspruchnahmepopulation wurde eine Diagnose aus dem FAS-Spektrum gestellt. Personen mit FASD zeigten häufiger eine Lernbehinderung (50 vs. 33%) oder Intelligenzminderung (40 vs. 10%), während keine Gruppenunterschiede für Alter und Geschlecht bestanden. Psychiatrische Komorbiditäten, insbesondere Depressionen (39%) und Abhängigkeitserkrankungen (31%), waren in beiden Gruppen häufig. Schlussfolgerung Im Rahmen einer multiprofessionellen standardisierten Diagnostik ist die FASD Abklärung auch im Erwachsenenalter möglich und nötig. Die Entwicklung standardisierter und spezifischer Diagnosekriterien für Erwachsene ist sinnvoll.
Article
Children with prenatal alcohol exposure (PAE) often suffer from cognitive and neurobehavioral dysfunction throughout their life, which may rise to a level of concern such that children receive a diagnosis under the fetal alcohol spectrum disorders (FASD) umbrella. Magnetoencephalography (MEG) contributes direct insight into neural processing and functional connectivity measures with temporal precision to understand cortical processing disorders that manifests during development. The impairment of perception may become more consequential among school-aged children with an FASD in the progress of intellectual functioning and behavioral maturation. Fifty participants with the age range of 8-13 years gave informed consent and participate in our study. For each participant, visual responses were recorded using magnetoencephalography (MEG) while performing a prosaccade task with central stimuli (fovea centralis) and peripheral stimuli (left and right of central) presented on a screen, requiring participants to shift their gaze to the stimuli. After source analysis using minimum norm estimation (MNE), we investigated visual responses from each participant by measuring the latency and amplitude of visual evoked fields. Delayed peak latency of the visual response was identified in the primary visual area (calcarine fissure) and visual association areas (v2, v3) in young children with an FASD for both stimulus types (central and peripheral). But the difference in visual response latency was only statistically significant (p ≤ 0.01) to the peripheral (right) stimulus. We also observed reduced amplitude (p ≤ 0.006) of visual evoked response in children with an FASD for the central stimulus type in both primary and visual association areas. So, multiple visual areas show impairment in children with an FASD while visual delay and conduction disturbance is more prominent in response to peripheral stimuli. Children with an FASD also exhibit significantly reduced amplitude of neural activation to central stimuli. These sensory deficits may lead to slow cognitive processing speed through continued intra-cortical network disturbance in children with an FASD.
Article
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.
Chapter
Fetal alcohol spectrum disorders (FASD) are highly prevalent neurodevelopmental disorders associated with prenatal alcohol exposure (PAE). Research on FASD has generally focused on challenges faced by this population while insight into strengths and quality of life has lagged. We introduce the “From Surviving to Thriving” model, which proposes a paradigm shift toward a strengths-based, holistic intervention approach to support thriving in people with FASD. Based on a focused intervention review, existing interventions for FASD incorporate many elements that are consistent with a strengths-based framework, such as inclusion of environmental accommodations and fortification of natural supports. However, a comprehensive strengths-based framework has yet to be fully realized, tested, or adopted in community settings. Important areas of growth remain and notable systems-level barriers need to be addressed. We propose six directions to advance interventions for FASD toward a more person-centered, strengths-based approach. These involve reduction of stigma, improved measurement of strengths and thriving, utilization of strengths-based frameworks, community knowledge translation, adaptation of existing, effective models for FASD, and increased efforts to reach underserved populations.
Article
Mütterlicher Alkoholkonsum während der Schwangerschaft kann zu neurokognitiven Beeinträchtigungen und morphologischen Veränderungen beim Kind führen, die unter dem Oberbegriff „Fetale Alkoholspektrumstörung“ (FASD) zusammengefasst werden. Die FASD geht mit erheblichen Einschränkungen der selbstständigen Alltags- und Lebensgestaltung einher – im Kindes- und Jugendalter ebenso wie im Erwachsenenalter.
Article
Fetal alcohol spectrum disorders (FASD) are a group of conditions associated with the effects of prenatal alcohol exposure and characterized by somatic and neuropsychological alterations. On the other hand, autism spectrum disorder (ASD) is characterized by a multifaceted neurobehavioral syndrome. Since alcohol can affect every stage of brain development, some authors hypothesized that in utero alcohol exposure might be linked to an increased risk of ASD in subjects with genetic vulnerability. The present review aimed to summarize the available literature on the possible association between FASD and ASD, also focusing on the reported clinical overlaps and on the possible shared pathogenic mechanisms. Studies in this field have stressed similarities and differences between the two conditions, leading to controversial results. The available literature also highlighted that both the disorders are often misdiagnosed or underdiagnosed, stressing the need to broaden the perspective, paying specific attention to milder presentations and sub-syndromic traits.
Article
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We critique published incidences for fetal alcohol syndrome (FAS) and present new estimates of the incidence of FAS and the prevalence of alcohol-related neurodevelopmental disorder (ARND). We first review criteria necessary for valid estimation of FAS incidence. Estimates for three population-based studies that best meet these criteria are reported with adjustment for underascertainment of highly exposed cases. As a result, in 1975 in Seattle, the incidence of FAS can be estimated as at least 2.8/1000 live births, and for 1979–81 in Cleveland, ∼4.6/1,000. In Roubaix, France (for data covering periods from 1977–1990), the rate is between 1.3 and 4.8/1,000, depending on the severity of effects used as diagnostic criteria. Utilizing the longitudinal neurobehavioral database of the Seattle study, we propose an operationalization of the Institute of Medicine's recent definition of ARND and estimate its prevalence in Seattle for the period 1975–1981. The combined rate of FAS and ARND is thus estimated to be at least 9.1/1,000. This conservative rate—nearly one in every 100 live births—confirms the perception of many health professionals that fetal alcohol exposure is a serious problem.Teratology 56:317–326, 1997. © 1997 Wiley-Liss, Inc.
Article
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We critique published incidences for fetal alcohol syndrome (FAS) and present new estimates of the incidence of FAS and the prevalence of alcohol-related neurodevelopmental disorder (ARND). We first review criteria necessary for valid estimation of FAS incidence. Estimates for three population-based studies that best meet these criteria are reported with adjustment for underascertainment of highly exposed cases. As a result, in 1975 in Seattle, the incidence of FAS can be estimated as at least 2.8/1000 live births, and for 1979-81 in Cleveland, approximately 4.6/1,000. In Roubaix, France (for data covering periods from 1977-1990), the rate is between 1.3 and 4.8/1,000, depending on the severity of effects used as diagnostic criteria. Utilizing the longitudinal neurobehavioral database of the Seattle study, we propose an operationalization of the Institute of Medicine's recent definition of ARND and estimate its prevalence in Seattle for the period 1975-1981. The combined rate of FAS and ARND is thus estimated to be at least 9.1/1,000. This conservative rate--nearly one in every 100 live births--confirms the perception of many health professionals that fetal alcohol exposure is a serious problem.
Article
THERE has been concern since antiquity that the ingestion of alcohol by the pregnant woman could damage her unborn child. Modern scientific warnings about gestational alcoholism began with Sullivan in 1899,¹ Rouquette in 1957,² and Lemoine et al in 1967,³ who all noted the increased rates of stillbirth, growth deficiency, and malformations among the offspring of alcoholic women. Alcohol teratogenesis was brought to widespread public attention by Jones et al⁴ in 1973. These authors believed that alcohol could produce a specific recognizable pattern of malformation, which they termed "fetal alcohol syndrome" (FAS). Over the last eight years, maternal consumption of alcohol has become recognized through extensive human and animal studies as a major fetal health hazard—a leading known cause of mental retardation. Syndrome Recognition Variability in phenotype occurs in most dysmorphic syndromes. By clinical appearance alone, both false-positive and false-negative cases are found in conditions that
Article
A 5-year, fetal alcohol syndrome (FAS) primary prevention study was conducted in Washington State to: (1) assess the feasibility of using a FAS diagnostic and prevention clinic as a centre for identifying and targeting primary prevention intervention to high-risk women; (2) generate a comprehensive, lifetime profile of these women; (3) identify factors that have enhanced and/or hindered their ability to achieve abstinence. The results of this study are presented in two parts. Objective 1 is summarized in the preceding paper and objectives 2 and 3 are summarized here. Comprehensive interviews were conducted with 80 women, who had given birth to a child diagnosed with FAS, to document their sociodemographics, reproductive and family planning history, social and healthcare utilization patterns, adverse social experiences, social support network, alcohol use and treatment history, mental health, and intelligence quotient (IQ). These high-risk women were diverse in racial, educational and economic backgrounds, were often victims of abuse, and challenged by mental health issues. Despite their rather harsh psychosocial profile, many demonstrated the ability to overcome their alcohol dependence over time. Relative to the women who had not achieved abstinence, the women who had achieved abstinence had significantly higher IQs, higher household incomes, larger more satisfactory social support networks, were more likely to report a religious affiliation, and were more likely to be receiving mental health treatment for their mental health disorders. The rate of unintended pregnancies and alcohol-exposed pregnancies was substantial. Key barriers to achieving effective family planning were maternal alcohol and drug use, lack of access to birth control and lack of support by their partner to use birth control. A FAS diagnostic and prevention clinic can be used to identify women at high risk for producing children damaged by prenatal alcohol exposure. Primary prevention programmes targeted to this population could lead to measurable reductions in the incidence of FAS.
Verifying the diagnosis of FAS in a specific patient is often difficult. Future diagnostic aids may include weighted checklists, laboratory and imaging studies, and psychological profiles.
Article
Grundproblematik und Fragestellung: Alkoholkrankheit in der Schwangerschaft verursacht beim Kind eine Alkoholembryopathie oder Alkoholeffekte. Bisher ist wenig über die körperlichen, geistigen und sozialen Langzeitfolgen und die Dysmorphologie bei Erwachsenen bekannt. Patienten und Methodik: Prospektiv wurden seit 1974 die Krankengeschichten von 52 Kindern, deren Mütter alkoholkrank waren, von der Geburt bis zum Erwachsenenalter ambulant verfolgt. Länge, Gewicht und Kopfumfang wurden in Perzentilen der Norm erfaßt, die schulische Entwicklung aus Zeugnissen und Testungen, die berufliche und soziale aus Fragen an Sorgeberechtigte und aus strukturierten Interviews gewonnen. Ergebnisse: Die initialen Wachstumsstörungen setzen sich in 26 % als Untergewicht, in 30 % als Minderwuchs und in 46 % als Mikrozephalie fort. Die Patienten lebten überwiegend in Pflegefamilien, besuchten zu 56 % Sonderschulen und in keinem Fall eine Oberschule. In jedem Fall bestanden komplexe Hirnfunktionsstörungen ohne Nachweis eines spezifischen Musters. In 37 von 52 Fällen wurden einfache Berufe ohne Lehre ausgeübt; selbständig lebten bisher 6 von 52 Patienten. Folgerungen: Bei pränataler mütterlicher Alkoholkrankheit sind besonders die anhaltenden neurotoxischen Schäden bei Kindern und Erwachsenen bedeutsam. Die Diagnose der Alkoholeffekte ist bei Erwachsenen schwierig.
Article
One of the most severe consequences of maternal ethanol consumption is the damage to the developing central nervous system, which is manifested by long-term cognitive and behavioral deficits in the offspring. Prenatal exposure to ethanol affects many crucial neurochemical and cellular components of the developing brain. Ethanol interferes with all of the stages of brain development, and the severity of the damage depends on the amount of ethanol intake and level of exposure. Experimental observations also indicate that the toxic effects of ethanol are not uniform: some brain regions are more affected than others and, even within a given region, some cell populations are more vulnerable than others. The neocortex, the hippocampus, and the cerebellum are the regions in which the neurotoxic effects of ethanol have been associated with the behavioral deficits. At the cellular level, ethanol disrupts basic developmental processes, including interference with division and proliferation, cell growth, and differentiation and the migration of maturing cells. Alterations in astroglia development and in neuronalglial interactions may also influence the development of the nervous system. An impairment of several neurotransmitter systems and/or their receptors, as well as changes in the endocrine environment during brain development, are also important factors involved in the behavioral dysfunctions observed after prenatal ethanol exposure. Finally, some molecular mechanisms of ethanol-induced behavioral dysfunctions will be discussed.
Article
Within an interdisciplinary research project, the long-term outcome of children with fetal alcohol syndrome was studied. Methods for the assessment of psychopathology, behavior, and intelligence included psychiatric interviews, behavior checklists for parents and teachers, and intelligence tests. The children were assessed during preschool age, early school age (6 to 12 years), and late school age (≥ 13 years). An excess of psychopathology, (including hyperkinetic disorders, emotional disorders, sleep disorders, and abnormal habits and sterotypies) with a strong persistence over time was found. Cognitive functioning was marked by a large proportion of mentally retarded children and also did not change considerably over time. This long-term outcome study reflects the handicapping effects of fetal alcohol syndrome.
Article
This article describes flexible statistical methods that may be used to identify and characterize nonlinear regression effects. These methods are called "generalized additive models". For example, a commonly used statistical model in medical research is the logistic regression model for binary data. Here we relate the mean of the binary response ¯ = P (y = 1) to the predictors via a linear regression model and the logit link function: log
Article
The potential teratogenic effects of alcohol have been suspected for centuries, but it was not until the work of Lemoine in 1968 and the independent observations of Jones and Smith in 1973 that a distinct, dysmorphic condition associated with maternal, gestational alcoholism was described in medical literature. Yet in spite of the growing awareness of the clinical manifestations of the fetal alcohol syndrome, recognition has been minimal in many areas where alcoholism rates might suggest a sizable number of affected offspring. Consequently, the purpose of this article is to summarize the clinical features of ethyl alcohol teratogenesis to aid in the early recognition of those affected and to facilitate appropriate family preventive counseling and patient management.
Article
Forty-one patients with the fetal alcohol syndrome, including 11 whose cases were previously reported, were studied. These children have a pattern of defects including prenatal and postnatal growth deficiency, small head size with mental subnormality, and facial abnormalities allowing for recognition of the disorder in infancy. The same pattern of abnormalities has been independently reported from France in a series of 127 offspring of chronic alcoholics. (JAMA 235:1458-1460, 1976)
Article
Thirty years after recognition of the fetal alcohol syndrome, a study of 105 affected individuals who reached adulthood provides insight into the long-term outcome of this condition. The typical facial dysmorphism undergoes odd changes, often with a long face and a bulky nose and chin, in contrast to the appearance of affected infants. The growth failure becomes slightly less marked. The malformations, which occur in 3/4 of severe forms, increase the disability although function is sometimes better than expected. In contrast, the microcephaly becomes more pronounced. This explains the psychic disorders which are the main prognostic factor: mental retardation in the most severely affected patients or severe learning disabilities and, in every case, behavior disorders and marked instability. Similar disorders are often found in siblings with no apparent dysmorphism underlining the extent of the problem and the urgent need for prophylaxis. Some of the observations made in adults, confronted to embryologic data, lead to useful inferences with respect to prophylaxis.
Article
Fetal alcohol syndrome is a specific recognizable pattern of malformation. Manifestations in 61 adolescents and adults suffering from alcohol teratogenesis are presented. After puberty, the faces of patients with fetal alcohol syndrome or fetal alcohol effects were not as distinctive. Patients tended to remain short and microcephalic, although their weight was somewhat closer to the mean. The average IQ was 68, but the range of IQ scores widely varied. Average academic functioning was at the second- to fourth-grade levels, with arithmetic deficits most characteristic. Maladaptive behaviors such as poor judgment, distractibility, and difficulty perceiving social cues were common. Family environments were remarkably unstable. Fetal alcohol syndrome is not just a childhood disorder; there is a predictable long-term progression of the disorder into adulthood, in which maladaptive behaviors present the greatest challenge to management.
Article
This longitudinal, prospective, population-based study examined the long-term effects of moderate prenatal alcohol exposure on 482 school aged children. Maternal reports of alcohol use obtained during pregnancy were significantly related to child IQ, achievement test scores, and classroom behaviors in second grade children, even after statistical adjustment for appropriate covariates. Consumption of two drinks per day or more on the average was related to a 7-point decrement in IQ in 7-year-old children even after statistically adjusting for appropriate covariates. Low paternal education and more children in the household were identified as environmental factors exacerbating the effect of prenatal alcohol exposure on child IQ. Learning problems were associated with the alcohol "BINGE" pattern of five or more drinks on at least one occasion. This study shows that alcohol use patterns within the social drinking range can have long lasting effects on IQ and learning problems in young school aged children. These patterns should not be interpreted as biologic thresholds. It should also be noted that these are group effects of prenatal alcohol exposure, not necessarily predictable in the individual child, and that for the most part these children were functioning within the normal range of intelligence.
Article
The fetal alcohol syndrome is the third most common recognizable cause of mental retardation in the United States. Many of the features of the fetal alcohol syndrome are secondary to the effect of alcohol on brain development. These include microcephaly, short palpebral fissures, the long smooth philtrum and thin vermilion of the upper lip, joint anomalies, altered palmar crease pattern, and mental retardation. Approximately 40% of babies born to alcoholic women and 11% of babies born to nonalcoholic moderately drinking women have evidence of the prenatal effect of alcohol. Alcohol, like other teratogens, causes a spectrum of defects. Thus, affected children may show great variability from the fullblown fetal alcohol syndrome to much milder effects of alcohol, some of which may not be obvious until school age. A "safe" amount of alcohol probably does not exist for the pregnant woman. Depending on unknown factors, what may be a "safe" amount for some women, may be devastating to the unborn baby of another. Two factors, the severity of the maternal alcoholism and the extent and severity of the pattern of malformation, seem to be most predictive of the ultimate prognosis for children with the fetal alcohol syndrome. Any decision to file child abuse changes against a mother whose baby was prenatally exposed to alcohol should be based on the parents ability to provide a stable home environment and not on whether the baby has features of the fetal alcohol syndrome. The fetal alcohol syndrome, the third most common recognizable cause of mental retardation, is completely preventable. All attempts must be made to educate people regarding the deleterious effect of alcohol.
Article
This study focuses on child characteristics and on the qualities of the caregiving environment that differentiated between offspring of alcoholics who did and those who did not develop serious coping problems by age 18. The 49 subjects (22 male) are members of a multiracial cohort of 698 children born in 1955 on the island of Kauai, Hawaii, who were followed at ages 1, 2, 10 and 18. In this group, males and the offspring of alcoholic mothers had higher rates of psychosocial problems in childhood and adolescence than females and the offspring of alcoholic fathers. Children of alcoholics who developed no serious coping problems by age 18 differed from those who did in characteristics of temperament, communication skills, self-concept and locus of control. They had also experienced fewer stressful life events disrupting their family unit in the first two years of life. Results of the study support a transactional model of human development and demonstrate bidirectionality of child-caregiver effects.
Article
PIP Case histories are presented of 8 unrelated children born to mothers who were chronic alcoholics. These children showed a similar pattern of craniofacial, limb, and cardiovascular defects associated with prenatal-onset growth deficiency and developmental delay. This is the 1st report to document an association between maternal alcoholism and aberrant morphogenesis in the offspring. The mean duration of maternal alcoholism was 9.4 years. 3 of the cases were black, 3 were Native American, and 2 were white. The mean gestational age was 38 weeks. The degree of linear growth deficiency was more severe than the deficit of weight at birth, suggesting that a factor other than maternal undernutrition alone affected prenatal growth. Developmental delay, prenatal and postnatal growth deficiency, and short palbebral fissures were observed in all 8 children. 7 of the 8 children also demonstrated microcephaly and maxillary hypoplasia with relative prognathism. 6 had an altered palmar crease pattern, 5 showed cardiac and joint anomalies, and 4 had epicanthal folds. Although adequate nutrition was provided to the children during hospital admission and/or foster care placement, no catch-up growth was observed. After 1 year, the average linear growth rate was 65% of normal and the average rate of weight gain was only 38% of normal. By 1 year, head circumference fell below the 3rd percentile for height and chronological age in 5 of the 6 children in whom measurements were taken. Fine motor dysfunction was present in 5 of the 6 children tested, and most were delayed in gross motor performance as well. The similarity in pattern of malformation noted among these 8 children suggests a singular mode of etiology related to an as yet unknown effect of maternal alcoholism. Direct ethanol toxicity is the most likely possibility.
Article
Historical reports indicate that the observation of an adverse effect on the fetus of chronic maternal alcoholism is not new. Three additional cases of the fetal alcohol syndrome have been recognised in two newborn infants and a 7-month-old baby. The immutable nature of the prenatal-onset growth deficiency was further confirmed. The first necropsy performed on a patient with fetal alcohol syndrome disclosed serious dysmorphogenesis of the brain, which may be responsible for some of the functional abnormalities and the joint malposition seen in this syndrome.
Article
The epidemiological features of Fetal Alcohol Syndrome (FAS) were examined among American Indians in the southwestern United States. All FAS suspects were screened in specific populations of Navajo, Pueblo, and Plains culture tribes. A total of 115 alcohol‐affected children were identified. The incidence of FAS was found to be highly variable from one cultural group to the next, ranging from 1.3 per 1,000 births (1/749) for the Navajo to 10.3 (1/97) for the Plains. The pattern of age‐specific prevalence indicates an increase over the past fifteen years. The overall rate of mothers who have produced fetal alcohol children was 6.1 per 1,000 women of childbearing age with a range of 4 to 33 per 1,000. These maternal prevalence rates were important for the accurate prediction of public health risk because 25 per cent of all mothers who had produced one affected child had also produced others. The average per mother was 1.3 alcohol‐affected children. Other findings indicate that the mothers of these children led highly disruptive and chaotic lives and were frequently isolated from mainstream social activities. In general, the gross social and cultural patterns of the tribes studied can readily explain the variation in incidence of FAS.
Article
There has been concern since antiquity that the ingestion of alcohol by the pregnant woman could damage her unborn child. Modern scientific warnings about gestational alcoholism began with Sullivan in 1899, Rouquette in 1957, and Lemoine et al in 1967, who all noted the increased rates of stillbirth, growth deficiency, and malformations among the offspring of alcoholic women. Alcohol teratogenesis was brought to widespread public attention by Jones et al in 1973. These authors believed that alcohol could produce a specific recognizable pattern of malformation, which they termed 'fetal alcohol syndrome' (FAS). Over the last eight years, maternal consumption of alcohol has become recognized through extensive human and animal studies as a major fetal health hazard - a leading known cause of mental retardation.
Article
Fetal alcohol syndrome (FAS) is a leading cause of congenital mental retardation but little is known about the long-term development and adolescent outcome of children with FAS. In a 10-year follow-up study of 60 patients diagnosed as having FAS in infancy and childhood, we investigated the long-term sequelae of intrauterine alcohol exposure. We found that the characteristic craniofacial malformations of FAS diminish with time, but microcephaly and, to a lesser degree, short stature and underweight (in boys) persist; in female adolescents body weight normalises. Persistent mental retardation is the major sequela of intrauterine alcohol exposure in many cases, and environmental and educational factors do not have strong compensatory effects on the intellectual development of affected children.
Article
This article reviews flexible statistical methods that are useful for characterizing the effect of potential prognostic factors on disease endpoints. Applications to survival models and binary outcome models are illustrated.
Article
Prenatal alcohol exposure causes a variety of cognitive deficits, notably in mathematics and higher order processes such as abstraction. An exploratory battery was developed to examine specific types of number processing impairments in 29 adolescent and adult patients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) relative to controls matched for age, gender, and educational level. The battery included 11 tests: number reading and writing, exact calculation (addition, multiplication, subtraction), approximate calculation (selecting a plausible result for an operation), number comparison, proximity judgment, and cognitive estimation. The results indicated particular difficulties in calculation and estimation tests, with intact number reading and writing ability. The greatest impairment was found in the cognitive estimation test, which is sensitive to frontal lobe lesions. The patterns of deficit described may reflect either the diffuseness of brain damage incurred from prenatal alcohol exposure, or a cumulative deficit in comprehension which may be important for the acquisition of higher-order mathematical abilities.
Article
To assess general intellectual functioning in children with histories of heavy prenatal alcohol exposure, with or without the facial features and growth deficiencies characteristic of fetal alcohol syndrome (FAS). Forty-seven alcohol-exposed children were recruited on evaluation at a dysmorphology clinic and evaluated as part of a university research project using standard tests of IQ. Thirty-four of the alcohol-exposed patients met the traditional diagnostic criteria for FAS. The other 13 alcohol-exposed children lacked both the pattern of facial features and prenatal or postnatal growth deficiency characteristic of the diagnosis. Compared with normal control subjects matched for age, sex, and ethnicity, both groups of alcohol-exposed children displayed significant deficits in overall IQ measures and deficits on most of the subtest scores. Although those in the nondysmorphic group usually obtained marginally higher IQ scores than those in the FAS group, few significant differences were found between the two alcohol-exposed groups. These results indicate that high levels of prenatal alcohol exposure are related to an increased risk for deficits in intellectual functioning and that these can occur in children without all of the physical features required for a diagnosis of FAS. They also emphasize the need for conducting a thorough history of prenatal alcohol exposure in children with intellectual deficits.
Article
Fetal alcohol syndrome (FAS) is associated with behavioral and cognitive deficits. However, the majority of children born to alcohol-abusing women do not meet the formal criteria for FAS and it is not known if the cognitive abilities of these children differ from those of children with FAS. Using a set of neuropsychological tests, 3 groups were compared: (a) children with FAS, (b) children without FAS who were born to alcohol-abusing women (the PEA group), and (c) normal controls. The results indicated that, relative to controls, both the FAS and the PEA groups were impaired on tests of language, verbal learning and memory, academic skills, fine-motor speed, and visual-motor integration. These data suggest that heavy prenatal alcohol exposure is related to a consistent pattern of neuropsychological deficits and the degree of these deficits may be independent of the presence of physical features associated with FAS.