Hearing, Language, Speech, Vestibular, and Dentofacial Disorders in Fetal Alcohol Syndrome

Abstract

Fetal alcohol syndrome (FAS) is characterized by congenital anomalies traditionally associated with hearing disorders. The present study sought to (a) evaluate possible central hearing loss; (b) verify and extend previous observations on sensorineural and conductive hearing losses; (c) evaluate possible vestibular disorders; (d) examine the relationships between hearing, speech, language, vestibular, and dentofacial disorders in FAS patients; and (e) evaluate the influence of patient age, race, and gender on the expression of these morbidities. A biracial group of 22 FAS patients (aged 3 to 26 years) were evaluated by standard hearing, speech, language, and vestibular tests. Dentofacial and other malformations were also assessed. Of the 22 FAS patients, 17 (77%) had intermittent conductive hearing loss due to recurrent serous otitis media that persisted from early childhood into adulthood, whereas 6 (27%) had sensorineural hearing loss in addition to the conductive hearing loss. Among the 12 patients tested for central hearing function, all (100%) were significantly impaired. Among the patients tested for speech and language ability, 18 of 20 (90%) had speech pathology, 16 of 21 (76%) had expressive language deficits, and 18 of 22 (82%) had receptive language deficits. Hearing, speech, and language deficits were not influenced by age, race, or gender. On the vestibular tests, all performed within normal limits with the possible exception of one child (n = 6). High incidences of dentofacial, temporomandibular joint, ocular, cardiac, and skeletal disorders were observed. Race and gender tended to influence dental malocclusion class. Two subjects exhibited autistic tendencies. In conclusion, new and important findings included a high prevalence of sensorineural, conductive, and central hearing deficits, the persistence of otitis proneness into adulthood, the existence of temporomandibular joint disorders, and the possible influence of gender or race on dental malocclusions. Such disorders can contribute to the learning, behavioral, and emotional difficulties seen in FAS patients and warrant early, aggressive intervention.

Cost of speech-language interventions for children and youth with foetal alcohol spectrum disorder in Canada

“…People with FASD often suffer from SLD due to brain damage caused by the teratogenic effects of pre-natal alcohol exposure (Church et al, 1997). Pre-natal alcohol exposure can disrupt both an individual’s development and their use of language (Mattson & Riley, 1998; Streissguth, Barr, Kogan, & Bookstein, 1996).…”

“…Individuals with FASD may also be vulnerable to developing SLD as a result of their greater propensity for atypical or adverse social interactions (Coggins, Timler, & Olswang, 2007). Among such SLD are poor receptive and expressive language skills, phonological deficits, fluency and articulation difficulties, and associated neurocognitive abnormalities that can adversely impact speech-language development (Church et al, 1997). In addition, individuals with FASD often have other mental disorders, a well-established dimension of FASD that is also likely to affect language acquisition that may subsequently lead to difficulties with speech and articulation (Church et al, 1997).…”

“…Several studies have reported a high occurrence of SLD among individuals with FASD (Church et al, 1997; Egeland et al, 1998; Elliott et al, 2008; Kvigne et al, 2004; Pensiero, Manna, Michieletto, & Perissutti, 2007). Specifically, unspecified SLD have been reported to occur in 40% (CDC, 1995) to 90% (Church et al, 1997) of individuals with FAS, and 37% (Spohr et al, 1994) to 60% (Elliott et al, 2008) of individuals with FASD.…”

“…Specifically, unspecified SLD have been reported to occur in 40% (CDC, 1995) to 90% (Church et al, 1997) of individuals with FAS, and 37% (Spohr et al, 1994) to 60% (Elliott et al, 2008) of individuals with FASD. Furthermore, Mills, McLennan, and Caza (2006) found, based on self-reports obtained from caregivers, that ˜ 79% of children with FASD under the age of 7 years have visited a speech-language pathologist, and 57% of them received speech and language therapy in Alberta, Canada.…”

Atypical Hemispheric Asymmetry in Fetal Alcohol Spectrum Disorders: A Review of the Effects of Prenatal Alcohol Exposure on Language Lateralization.

“…Thus, given the anatomical atypicalities noted, it is not surprising that the majority of people with FASD present with language problems consistent with the left hemisphere regions affected. Such deficits include speech impairments (e.g., Church et al, 1997), expressive and receptive grammar deficits (e.g., Carney, & Chermak, 1991), impairments in category and letter fluency (e.g., Kodituwakku et al, 2006), and impaired verbal learning (e.g., Sowell et al, 2007). Tasks that rely on the left tempo-parietal region are particularly affected, with children prenatally exposed to alcohol performing significantly worse than typically developing controls on measures of both word comprehension (Peabody Picture Vocabulary Test-Revised) and naming ability (Boston Naming Test; .…”