ADHD and fetal alcohol spectrum disorders (FASD).

This multi-author book will discuss the history and clinical presentation of Foetal Alcohol Spectrum Disorders(FASD) i.e Fetal Alcohol Syndrome (FAS) and Alcohol Related Neurodevelopmental Disorder (ARND). These developmental neuropsychiatric disorders result from prenatal exposure to alcohol during any gestational period of pregnancy. The book will particularly address the co-occurring presence of ADHD in patients with FASD. ADHD is the most frequent neuropsychiatric presentation of FASD throughout the lifespan and it is particularly difficult to manage because the underlying pathophysiology is related to prenatal neurotoxic brain injury. Although prenatal alcohol exposure , and the resulting FASD, is recognised as the commonest preventable cause of intellectual disability, many clinicians and educators are not aware that 75 to 80% of the patients with FASD have I.Q.s over 70. Thus, the neuropsychiatric presentation of FASD can often be unrecognised or misunderstood. FASD are the true clinical ' masqueraders' and ADHD is their most likely disguise! The authors are all experienced professionals from a wide range of disciplines working throughout the USA and Canada. They have been involved in the diagnosis, research and management of FASD for many years and this book will bring their collective knowledge regarding management from infancy to adulthood to an inter-professional audienceThis resource was contributed by The National Documentation Centre on Drug Use.

Fetal Alcohol Spectrum Disorder Primary Prevention through FASD Diagnosis: Identification of High-Risk Birth Mothers through the Diagnosis of their Children. Follow-up Study

Thesis (Master's)--University of Washington, 2016-08

Fetal alcohol spectrum disorders in Finnish children and adolescents : diagnosis, cognition, behavior, adaptation and brain metabolic alterations

Alcohol consumption during pregnancy can potentially affect the developing fetus in devastating ways, leading to a range of physical, neurological, and behavioral alterations most accurately termed Fetal Alcohol Spectrum Disorders (FASD). Despite the fact that it is a preventable disorder, prenatal alcohol exposure today constitutes a leading cause of intellectual disability in the Western world. In Western countries where prevalence studies have been performed the rates of FASD exceed, for example, autism spectrum disorders, Down’s syndrome and cerebral palsy. In addition to the direct effects of alcohol, children and adolescents with FASD are often exposed to a double burden in life, as their neurological sequelae are accompanied by adverse living surroundings exposing them to further environmental risk. However, children with FASD today remain remarkably underdiagnosed by the health care system. This thesis forms part of a larger multinational research project, The Collaborative Initiative on Fetal Alcohol Spectrum Disorders (the CIFASD), initiated by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) in the U.S.A. The general aim of the present thesis was to examine a cohort of children and adolescents growing up with fetal alcohol-related damage in Finland. The thesis consists of five studies with a broad focus on diagnosis, cognition, behavior, adaptation and brain metabolic alterations in children and adolescents with FASD. The participants consisted of four different groups: one group with histories of prenatal exposure to alcohol, the FASD group; one IQ matched contrast group mostly consisting of children with specific learning disorder (SLD); and two typically-developing control groups (CON1 and CON2). Participants were identified through medical records, random sampling from the Finnish national population registry and email alerts to students. Importantly, the participants in the present studies comprise a group of very carefully clinically characterized children with FASD as the studies were performed in close collaboration with leading experts in the field (Prof. Edward Riley and Prof. Sarah Mattson, Center for Behavioral Teratology, San Diego State University, U.S.A; Prof. Eugene Hoyme, Sanford School of Medicine, University of South Dakota, U.S.A.). In the present thesis, the revised Institute of Medicine diagnostic criteria for FASD were tested on a Finnish population and found to be a reliable tool for differentiating among the subgroups of FASD. A weighted dysmorphology scoring system proved to be a valuable additional adjunct in quantification of growth deficits and dysmorphic features in children with FASD (Study 1). The purpose of Study 2 was to clarify the relationship between alcohol-related dysmorphic features and general cognitive capacity. Results showed a significant correlation between dysmorphic features and cognitive capacity, suggesting that children with more severe growth deficiency and dysmorphic features have more cognitive limitations. This association was, however, only moderate, indicating that physical markers and cognitive capacity not always go hand in hand in individuals with FASD. Behavioral problems in the FASD group proved substantial compared to the typically developing control group. In Study 3 risk and protective factors associated with behavioral problems in the FASD group were explored further focusing on diagnostic and environmental factors. Two groups with elevated risks for behavioral problems emerged: length of time spent in residential care and a low dysmorphology score proved to be the most pervasive risk factor for behavioral problems. The results underscore the clinical importance of appropriate services and care for less visibly alcohol affected children and highlight the need to attend to children with FASD being raised in institutions. With their background of early biological and psychological impairment compounded with less opportunity for a close and continuous caregiver relationship, such children seem to run an especially great risk of adverse life outcomes. Study 4 focused on adaptive abilities such as communication, daily living skills and social skills, in other words skills that are important for gradually enabling an independent life, maintain social relationships and allow the individual to become integrated into society. The results showed that adaptive abilities of children and adolescents growing up with FASD were significantly compromised compared to both typically-developing peers and IQ-matched children with SLD. Clearly different adaptive profiles were revealed where the FASD group performed worse than the SLD group, who in turn performed worse than the CON1 group. Importantly, the SLD group outperformed the FASD group on adaptive behavior in spite of comparable cognitive levels. This is the first study to compare adaptive abilities in a group of children and adolescents with FASD relative to both a contrast group of IQ-matched children with SLD and to a group of typically-developing peers. Finally, in Study 5, through magnetic resonance spectroscopic imaging (MRS) evidence of longstanding neurochemical alterations were observed in adolescents and young adults with FASD related to alcohol exposure in utero 14-20 years earlier. Neurochemical alterations were seen in several brain areas: in frontal and parietal cortices, corpus callosum, thalamus and frontal white matter areas as well as in the cerebellar dentate nucleus. The findings are compatible with neuropsychological findings in FASD. Glial cells seemed to be more affected than neurons. In conclusion, more societal efforts and resources should be focused on recognizing and diagnosing FASD, and supporting subgroups with elevated risk of poor outcome. Without adequate intervention children and adolescents with FASD run a great risk of marginalization and social maladjustment, costly not only to society but also to the lives of the many young people with FASD.

Effets de l’alcoolisme fœtal sur le développement du corps genouillé latéral du singe

L’exposition du fœtus à l’éthanol est reconnue comme étant la principale cause de maladies évitables lors du développement. Une forte exposition à l’alcool durant la gestation peut occasionner des dysmorphies cranio-faciales et des retards mentaux, ainsi que des troubles d’apprentissages et du comportement. Le développement du système visuel est également perturbé chez une grande majorité d’enfants qui ont été exposés à l’alcool. Lorsque les doses prises sont élevées, le système visuel peut présenter une panoplie de symptômes comme une augmentation de la tortuosité des vaisseaux rétiniens, de la myopie, de l’hypermétropie, du strabisme et une hypoplasie du nerf optique. Cependant, très peu d’études se sont penchées sur les effets de plus faibles doses sur le développement du système visuel du primate. Le singe est un excellent modèle pour étudier le système visuel car il possède plusieurs similitudes avec l’humain tant au niveau développemental qu’au niveau structurel. De plus, le singe utilisé, le Chlrocebus aethiops sabeus, possède l’avantage que des individus de cette espèce ont une consommation naturelle et volontaire à l’alcool. Une étude (Clarren et al., 1990) a suggéré qu’une faible exposition à l’alcool du fœtus du primate non humain occasionnait une diminution du nombre de cellules ganglionnaires de la rétine (CGRs). Étant donné que le corps genouillé latéral dorsal (CGLd) reçoit la plupart de ses intrants de la rétine, il est raisonnable d’assumer que les couches rétino-récipientes du CGLd devraient être aussi affectées. Nous avons alors émis l’hypothèse que le CGLd devrait également subir une diminution du nombre de neurones. Pour la première fois, nous avons utilisé une méthode stéréologique pour quantifier le nombre de cellules dans les couches parvo- (P) et magnocellulaires (M) du CGLd. Contrairement à notre hypothèse de départ, nous n’avons pas observé de diminution dans le nombre global de neurones dans le CGLd des animaux exposés à l’alcool par rapport à des sujets contrôles, ni une diminution de son volume. Nous avons toutefois observé une diminution de la taille du corps cellulaire seulement dans la population M du CGLd. Ces résultats suggèrent que le système visuel est affecté par une faible exposition à l’alcool durant son développement qui devrait se traduire sur le comportement par des déficits dans les fonctions de la voie M.

Aspectos da fluência na narrativa oral de indivíduos com Transtorno do Espectro Alcoólico Fetal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Comportamentos de escolares com o espectro do álcool

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Caracterização da narrativa oral de história de indivíduos com transtorno do espectro alcoólico fetal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-analysis

BACKGROUND AND OBJECTIVES: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or moderate to heavy maternal alcohol intake.METHODS: A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to <= 18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS: The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.CONCLUSIONS: The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.