Background Magnetic resonance (MR) technology offers non-invasive methods for in vivo assessment of neuroabnormalities. Methods A comprehensive neuropsychological/psychiatric battery, coupled with MR imaging, (MRI), MR spectroscopy (MRS), and functional MRI (fMRI) assessments, were administered to children with fetal alcohol spectrum disorders (FASD) to determine if global and/or focal abnormalities could be identified, and distinguish diagnostic subclassifications across the spectrum. The four study groups included: 1. FAS/Partial FAS; 2. Static Encephalopathy/Alcohol Exposed (SE/AE); 3. Neurobehavioral Disorder/Alcohol Exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and 4. healthy peers with no prenatal alcohol exposure. Presented here are the MRI assessments used to compare the sizes of brain regions between the four groups. The neuropsychological/behavioral, MRS, and fMRI outcomes are reported separately. Results Progressing across the four study groups from Controls to ND/AE to SE/AE to FAS/PFAS, the mean absolute size of the total brain, frontal lobe, caudate, putamen, hippocampus, cerebellar vermis, and corpus callosum length decreased incrementally and significantly. The FAS/PFAS group (the only group with the 4-Digit FAS facial phenotype) had disproportionately smaller frontal lobes relative to all other groups. The FAS/PFAS and SE/AE groups (the two groups with the most severe CNS dysfunction) had disproportionately smaller caudate regions relative to the ND/AE and Control groups. The prevalence of subjects in the FAS/PFAS, SE/AE, and ND/AE groups that had one or more brain regions, two or more standard deviations below the mean size observed in the Control group was78%, 58%, and 43%, respectively . Significant correlations were observed between size of brain regions and level of prenatal alcohol exposure, magnitude of FAS facial phenotype, and level of CNS dysfunction. Conclusions MRI provided further validation that ND/AE, SE/AE, and FAS/PFAS, as defined by the FASD 4-Digit Code, are three clinically distinct and increasingly more affected diagnostic subclassifications under the umbrella of FASD. Neurostructural abnormalities are present across the spectrum. MRI could importantly augment diagnosis of conditions under the umbrella of FASD, once population-based norms for structural development of the human brain are established.

This study described sensory processing behaviors and sensory-motor abilities in children with fetal alcohol spectrum disorders (FASD) and explored their relationship to home and school function. A clinic-referred sample of 25 children with FASD, ages 5 to 8 years, was compared with 26 children with typical development, balanced for age, gender, and race/ethnicity, on standardized tests examining sensory processing, sensory-motor performance, school performance, and adaptive behavior. Children with FASD scored significantly more poorly on sensory processing, sensory-motor, adaptive, and academic achievement measures, and demonstrated more problem behaviors at home and school. Correlations were significant between measures of sensory processing and sensory-motor performance, adaptive behavior, and some aspects of academic performance. Sensory processing and related foundational sensory-motor impairments should be considered when determining the developmental needs of children with FASD. These impairments may co-occur with and contribute, at least in part, to decreased adaptive and school function.

Results provide evidence that children with FASD demonstrate problem behaviors and sensory-processing impairments as reported by parents and that sensory-processing deficits co-occur with problem behaviors at a high rate in this population. This finding suggests that deficits in sensory processing may affect the ability of children with FASD to respond adaptively to their environments.

Magnetic resonance (MR) technology offers noninvasive methods for in vivo assessment of neuroabnormalities. A comprehensive neuropsychological/behavioral, MR imaging (MRI), MR spectroscopy (MRS) and functional MRI (fMRI) assessment was administered to children with fetal alcohol spectrum disorders (FASD) to determine whether global and/or focal abnormalities could be identified and to distinguish diagnostic subclassifications across the spectrum. The four study groups included (1) FAS/partial FAS; (2) static encephalopathy/alcohol exposed (SE/AE); (3) neurobehavioral disorder/alcohol exposed (ND/AE) as diagnosed with the FASD 4-Digit Code; and (4) healthy peers with no prenatal alcohol exposure. Results are presented in four separate reports: MRS (reported here) and neuropsychological/behavioral, MRI and fMRI outcomes (reported separately). MRS was used to compare neurometabolite concentrations [choline (Cho), n-acetyl-aspartate (NAA) and creatine (Cre)] in a white matter region and a hippocampal region between the four study groups. Choline concentration in the frontal/parietal white matter region, lateral to the midsection of the corpus callosum, was significantly lower in FAS/PFAS relative to all other study groups. Choline decreased significantly with decreasing frontal white matter volume and corpus callosum length. These outcomes suggest low choline concentrations may reflect white matter deficits among FAS/PFAS. Choline also decreased significantly with increasing severity of the 4-Digit FAS facial phenotype, increasing impairment in psychological performance and increasing alcohol exposure. NAA and Cre concentrations did not vary significantly. This study provides further evidence of the vulnerability of the cholinergic system in FASD.

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,