Successful teacher and speech-language pathologist interventions with traumatized children with prenatal alcohol exposure demand a paradigm shift that requires the development of new perspectives and ongoing training.

Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.

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Children entering the child welfare system have experienced some form of maltreatment, with the impact on behavior and development not always recognized. Complicating the impact is the number of maltreatment types and how many of each a child may have experienced. This study analyzes the relationship between the number of maltreatment events with behavior problems and developmental delays in a clinical sample of children involved with the child welfare system. Results indicate that challenging behaviors are the norm for these children, but do not vary with increased types of maltreatment events. The majority of these children have moderate to major developmental delays, with delays increasing with the number of events experienced. Implications are explored and applied to professional practice. Keywords child maltreatment, child welfare, trauma, neurodevelopment, child behavior During the last two decades, researchers have attempted to understand the impact of childhood adversity on children's behavior and development. Childhood adversity includes adversity within the community setting (natural disasters, war, neighborhood violence), victimization from nonfamilial perpetrators (peer and adult violence toward a child), and maltreatment within the familial system. Within the category of familial maltreatment, there are several factors that potentially influence behavior and development. These include the duration and severity of the maltreatment, the age of onset, and the different types of maltreatment events. A complex interactional effect between these factors either mitigates or exacerbates the impact on children's behaviors and development. The current study looks at one of the factors of maltreatment-the number of types of maltreatment that children experience-and the subsequent behavioral and neurodevelopmental impacts. When familial maltreatment reaches a level of "substantial risk of harm," children are often removed from the maltreating caregivers and harmful environment and placed with foster parents or relatives. Removal from an adverse environment and provision of safe placement is accompanied by the expectation of positive emotional, behavioral, and academic response from the child. When aberrant child responses continue in spite of best efforts, adult

SUMMARY This manuscript describes the key components for establishing collaborative partnerships in the delivery of services to children who have been traumatized by abuse, neglect, and prenatal exposure to alcohol. Specifically, the manuscript addresses: the national need for such collaborative partnerships; the effects of abuse, neglect, and prenatal exposure to alcohol on developmental and educational outcomes; the process used to develop the children's trauma assessment center (CTAC) including discussion on the family centered and transdisciplinary nature of the center; and the accomplishment and future goals of CTAC. The members of the CTAC team currently include the disciplines of counseling, occupational therapy, pediatric medicine, social work, and speech-language pathology. Future goals include expanding the core team to include the nursing and educational psychology disciplines.