Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database

Abstract

Aims Individuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses. Methods Data from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared. Results Individuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder. Conclusion AR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.

A Systematic Review of Interventions to Improve Mental Health and Substance Use Outcomes for Individuals with Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder

“…Moreover, there are no established best practices for individuals with FASD in the midst of a mental health crisis. Although not directly incorporating the traditional therapeutic approach, the skill‐building interventions reviewed here are promising, considering that some of the negative outcomes associated with FASD (e.g., high‐risk behavior, suicidality) may be rooted in the neurocognitive deficits associated with PAE (e.g., poor emotion regulation, impaired decision making, impulsivity; Rasmussen and Wyper, 2007; Temple et al, 2019). Again, targeted approaches to mitigating the functional consequences of these impairments are important and may help to prevent or minimize the later development of mental health or substance use problems.…”

“…Elevated rates of both internalizing and externalizing problems have been reported among people with FASD (Khoury et al, 2018), and common comorbid diagnoses include attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, and psychotic disorders (Fryer et al, 2007;Lange et al, 2018;Pagnin et al, 2019;Patel et al, 2020;Popova et al, 2016;Rasmussen et al, 2010;Weyrauch et al, 2017). Individuals with FASD also experience high rates of suicidality (Landgren et al, 2019;O'Connor et al 2019;Streissguth et al, 1996), which has been linked to comorbid mental health and substance use problems, impaired emotion regulation, history of trauma, financial stress, and a lack of stable social support (Dirks et al, 2019;Huggins et al, 2008;Temple et al, 2019). PAE is also associated with the development and high rates of substance use problems later in life (Dodge et al, 2019;Goldschmidt et al, 2019;McLachlan et al, 2020;Streissguth et al, 1996Streissguth et al, , 2004Yates et al, 1998).…”

Zebrafish Shoaling, Its Behavioral and Neurobiological Mechanisms, and Its Alteration by Embryonic Alcohol Exposure: A Review

“…Stress-inducing situations, such as a new environment or the approach of a predator, often result in tighter shoal cohesion, which eventually loosens as the fish habituate to the environment (Hoare et al, 2004 ; Miller and Gerlai, 2011 ). The effect of stress and anxiety on shoaling behavior is an important observation from the perspective of FASD research because embryonic alcohol exposure has been suspected to alter stress and anxiety in humans (e.g., Temple et al, 2019 ) and zebrafish alike (Baiamonte et al, 2015 ), a question we will return later.…”

Prenatal Alcohol Exposure as a Case of Involuntary Early Onset of Alcohol Use: Consequences and Proposed Mechanisms From Animal Studies

“…At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), which may occur with prolonged consumption of relatively high amounts of alcohol . Prenatal exposure to alcohol may also produce either partial FAS (some of the diagnostic features occur) or may result in Alcohol-Related Birth Defects, or Alcohol-Related Neurodevelopmental Disorders (Stratton et al, 1996;Johnson et al, 2018) Interestingly, whilst the level of alcohol exposure may determine the severity of the observed effects, other cognitive, neuropsychological, and behavioral deficits have consistently been observed (Streissguth, 1986;Astley et al, 2009;Guerri et al, 2009;Kable et al, 2016;Temple et al, 2019).…”