Responding to the Challenge of Early Intervention for Fetal Alcohol Spectrum Disorders

Abstract

Prenatal alcohol exposure can lead to significant neurodevelopmental disabilities, now recognized as fetal alcohol spectrum disorders (FASD). This includes both fetal alcohol syndrome, a lifelong birth defect, and a wider range of enduring learning and behavior deficits often called alcoholrelated neurodevelopmental disorder (ARND). Diagnostic classification systems have been developed to identify children with FASD, and early interventionists from multiple disciplines can be central in identification and referral for diagnosis, and in providing the known protective influence of intervention early in life. With the recent federal mandates to better address needs of children born prenatally affected by substances, or those impacted by abuse and/or neglect, by referring them for screening and possible early intervention services, there is heightened need for providers to understand FASD. There is a growing body of research data describing the teratogenic effects of alcohol on central nervous system function and physical development, the diversity of children with prenatal alcohol exposure and their families, and the developmental and behavioral characteristics of this clinical population. This article reviews the latest research evidence, bearing in mind what is important to early intervention. This article also gives practical guidance on FASD prevention, methods for early screening, and referral of young children for diagnosis of FASD (and referral for needed services once diagnosed), and how to provide education, support, advocacy assistance, and anticipatory guidance for families raising children with FASD. Key words: early diagnosis and intervention, fetal alcohol syndrome,

Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management

“…Notably, children with FASDs are often not referred for diagnosis until they are school-aged, suggesting that by the time many of these children are diagnosed, an important window of opportunity for early intervention has been missed. Olson et al [2007] recently reported on data from the Washington State FAS Diagnostic and Prevention Network (FAS DPN), which indicated that the average age of referral for diagnosis was 9.5 years. Thus, increased efforts must be directed towards both identifying children with FASDs at a much earlier age and providing them with developmentally-appropriate interventions.…”

“…A comprehensive approach to intervention entailing coordination across multiple systems of care is strongly advocated in the treatment of FASDs [Streissguth, 1997;Olson et al, 2007]. One recently developed program, ''New Choices,'' designed to address the social and mental health needs of mothers with substance abuse problems and their children has yielded improvements in mothers' reports of social support, depressive symptoms, and empathy for their children, as well as improvements in their children's social development [Niccols and Sword, 2005].…”

“…Such education may have a multitude of benefits. Because FASDs are not always wellunderstood by family members, behavior problems may sometimes be viewed as reflective of poor motivation, an absence of empathy, or as willful defiance rather than as a function of the individual's neurocognitive impairments [Green, 2007;Olson et al, 2007;Scott and Dewane, 2007]. Clarifying for parents or caregivers that such behaviors are often secondary to alcohol-related brain damage may help them respond to their children in a more supportive and patient manner.…”

Randomized, double-blind, placebo-controlled clinical trial of choline supplementation in school-aged children with fetal alcohol spectrum disorders

“…This research extends previous studies and contributes to our understanding of choline's effects across development from infancy through late childhood. Because FASDs are not often identified until children enter school (15), it is critical to examine treatment options for children at older ages.…”

The fatty acid ethyl esters (FAEE) hair test: emerging technology for the diagnosis of fetal alcohol spectrum disorders (FASD)

“…FASD is the most prevalent cause of neurocognitive handicap among children in North America [1,2]. It has been estimated that approximately one percent of the pediatric population is affected [3,4], but the majority of cases remain undiagnosed until school age or later, if diagnosed at all [5,6]. One of the most serious challenges in diagnosing FASD is the need to establish evidence of excessive maternal drinking during pregnancy as one of the major diagnostic criteria [7].…”