Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect therapeutic progress

Abstract

Grant, T., Novick Brown, N., Graham, J., Whitney, N., Dubovsky, D. , & Nelson, L. (2013). Screening in treatment programs for Fetal Alcohol Spectrum Disorders that could affect therapeutic progress. The International Journal Of Alcohol And Drug Research, 2(3), 37-49. doi:10.7895/ijadr.v2i3.116 (http://dx.doi.org/10.7895/ijadr.v2i3.116)Aims: While structured intake interviews are the standard of care in substance abuse treatment programs, these interviews often do not screen for cognitive impairments, such as those found in fetal alcohol spectrum disorders (FASD) and other brain-based developmental disorders. The research reported here supports a brief interview protocol, the Life History Screen (LHS), that screens clients unobtrusively for adverse life-course outcomes typically found in FASD, so as to guide follow-up assessments and treatment planning.Design: Two-group observational study.Setting: A three-year case management intervention program in Washington State for high-risk women who abuse alcohol and/or drugs during pregnancy.Participants: Group 1: No prenatal alcohol exposure (N = 463); Group 2: Diagnosed with FASD (Fetal Alcohol Syndrome, Alcohol Related Neurodevelopmental Disorder, fetal alcohol effects, or static encephalopathy) by a qualified physician (N = 25), or suspected of having FASD (reported prenatal alcohol exposure and displayed behaviors consistent with a clinical diagnosis of FASD) (N = 61).Measures: The Addiction Severity Index (ASI) was administered to participants at intake. We analyzed eleven ASI items that corresponded to questions on the LHS in order to assess the potential of the LHS for identifying adults with possible FASD. The Life History Screen itself was not administered.Findings: Analysis of group differences between the diagnosed FASD and suspected FASD groups supported our decision to collapse the two groups for the main analysis. The Life History Screen shows promise as an efficient pre-treatment screen, in that core items are significantly associated with FASD group membership on factors involving childhood history, maternal drinking, education, substance use, employment, and psychiatric symptomatology.Conclusions: The Life History Screen may have utility as a self-report measure that can be used at the outset of treatment to identify clients with cognitive impairments and learning disabilities due to prenatal alcohol exposure.

Fetal Alcohol Spectrum Disorders: What Pediatric Providers Need to Know

“…These factors can lead to the development of secondary disabilities in adolescence and adulthood, including educational disruption, legal trouble, difficulty securing or keeping a job, confinement in psychiatric institutions or jail, inappropriate sexual behavior, and substance use disorders (Blaschke et al, 2009). Another troubling finding is that affected females have a higher risk of having an alcohol-or substance-exposed pregnancy themselves (Grant et al, 2013). Most individuals with FASDs need ongoing social support and mental health services.…”

A culturally-tailored behavioral intervention trial for alcohol use disorders in three American Indian communities: Rationale, design, and methods

“…Given the high comorbidity of Post-Traumatic Stress Disorder in adults with AUDs, we will assess for the presence of this condition using the MINI [40]. We will also assess for potential Fetal Alcohol Spectrum Disorder using the Life History Screen [54], a brief measure that unobtrusively screens participants for adverse life-course outcomes typically found in FASD. Medical comorbidity will be measured using a modified version of the Charleson Deyo Scale [55], a simple self-report questionnaire assessing the presence of chronic medical conditions.…”

Evaluation of the German biographic screening interview for fetal alcohol spectrum disorder (BSI-FASD)

“…If the subjects did not understand a question, we used the "B-note" (a predetermined paraphrase) for each question. Overall, previous studies reported that the interview is an easy and quick diagnostic tool 17,24 . The interviews were conducted by well-trained physicians and doctoral students.…”

“…The BSI-FASD. The German BSI-FASD version was initially developed by Schwerg and colleagues on the basis of the English LHS 17 . The development of the BSI-FASD was a five step process.…”

“…The Life History Screen (LHS), which assesses nine domains (see below) that are often conspicuous among FASD patients, showed a sensitivity of 0.81 and a specificity of 0.66 17 . It was recently translated into German by Schwerg and colleagues, who developed the Biographical Screening Interview (BSI-FASD) after adapting it to the German context.…”