Neurodevelopmental Functioning in Children With FAS, pFAS, and ARND

Chasnoff, Ira J.; Wells, Anne M.; Telford, Erin; Schmidt, Christine; Messer, Gwendolyn

doi:10.1097/dbp.0b013e3181d5a4e2

Cited by 65 publications

(54 citation statements)

References 18 publications

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“…2,17,18 Recent studies have documented that use of third percentile for growth assessment neurodevelopmentally differentiates children within the fetal alcohol spectrum. 10,15 Also, growth criteria below third percentile align more closely with the original definition of FAS. 1 • Facial dysmorphology: abnormal measurements of the upper lip (rank 4 or 5) and the philtrum (rank 4 or 5) and shortened palpebral fissures based on direct measurement or, after 2003, according to analysis of facial features utilizing the Lip-Philtrum Guide and digital facial photograph based on the criteria of Astley and Clarren.…”

Section: Diagnostic Assignmentmentioning

confidence: 88%

“…Previous studies have demonstrated that anywhere from 40% to 75% of children with FASD are diagnosed with ADHD. 15,26,27 However, there are qualitative differences in the types of attention problems seen in children with FASD as compared with children with ADHD. [28][29][30] Children with ADHD and FASD have been shown to have greater deficits in verbal comprehension and perceptual reasoning than children having ADHD without prenatal alcohol exposure.…”

Section: Discussionmentioning

confidence: 99%

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Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

2015

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OBJECTIVE: The purpose of this article is to assess the rate of misdiagnosis and missed diagnoses of fetal alcohol spectrum disorders (FASD) among a population of foster and adopted youth referred to a children's mental health center.METHODS: Data were collected from a sample of 547 children who underwent a comprehensive multidisciplinary diagnostic evaluation. Utilizing current diagnostic criteria, children were diagnosed, as appropriate, with fetal alcohol syndrome, partial fetal alcohol syndrome, alcoholrelated neurodevelopmental disorder, or alcohol-related birth defects. Changes in rates of alcohol exposure-related diagnoses and cooccurring mental health disorders pre-and postassessment were analyzed by using McNemar's test for dependent proportions.RESULTS: Among 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum, 125 had never been diagnosed as affected by prenatal alcohol exposure, a missed diagnosis rate of 80.1%. Of the 31 who had been recognized before referral as affected by prenatal alcohol exposure, 10 children's FASD diagnoses were changed within the spectrum, representing a misdiagnosis rate of 6.4%. The remaining 21 (13.5%) children's diagnoses stayed the same. There also were significant changes in the rate of mental health diagnosis, and learning disorders, communication disorders, and intellectual disability, objective signs of neurocognitive damage, were not recognized in a significant number of children with FASD.CONCLUSIONS: Within this clinical sample, 86.5% of youth with FASD had never been previously diagnosed or had been misdiagnosed. These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services. WHAT'S KNOWN ON THIS SUBJECT:Researchers speculate that children with fetal alcohol spectrum disorders often are not recognized or diagnosed correctly. WHAT THIS STUDY ADDS:This is the first study to assess the rate of missed diagnoses and misdiagnosis in foster and adopted children with fetal alcohol spectrum disorders.

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Section: Diagnostic Assignmentmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

2015

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“…The most severe and common impairments in intellectual functioning (IQ<70) are seen for FAS (Pulsifer 1996); those with FAS tend to have lower IQ compared to those with pFAS or ARND (Chasnoff et al 2010). IQ is arguably the characteristic most strongly associated with EF in FASD populations (Pulsifer 1996;Steinhausen and Spohr 1998).…”

Section: Factors That Influence the Association Between Fasd And Efmentioning

confidence: 97%

Executive Functioning in Children and Adolescents Prenatally Exposed to Alcohol: A Meta-Analytic Review

2015

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Prenatal alcohol exposure is associated with a constellation of adverse physical, neurocognitive and behavior outcomes, which comprise a continuum of disorders labeled Fetal Alcohol Spectrum Disorders (FASD). Extant research has consistently identified executive functions (EF) as a central impairment associated with FASD. Despite this, heterogeneity exists regarding the strength of the association between FASD and different EF, and this association has not yet been quantitatively synthesized. The current meta-analysis reviews 46 studies that compare children and adolescents with FASD to participants without FASD, on a variety of EF measures. In accordance with Miyake et al. Cognitive Psychology, 41, 49-100 (2000) three-factor model of EF, findings for the primary EF domains of working memory, inhibition, and set shifting are reviewed. Results indicate that children and adolescents with FASD demonstrate significant deficits across these EF, although the magnitude of effects diverged between EF, with working memory and inhibition yielding medium effects and set shifting yielding large effects. These results were moderated by sample characteristics, type of FASD diagnosis, and EF methodology. This quantitative synthesis offers novel future research directions.

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“…In the largest profile study conducted to date Astley (2010) found a linear trend of functioning, such that those diagnosed with neurodevelopmental disorder/alcoholexposed (ND/AE) showed the best performance, followed by the static encephalopathy/alcohol-exposed (SE/AE) group, with the most pronounced deficits observed in the FAS/pFAS group. Chasnoff et al (2010) also found that children with FAS were significantly more impaired on measures of intelligence, executive functioning, and memory compared with those with pFAS and ARND. Similarly, Nash et al (2013) found that children with FASD were more impaired on tasks evaluating verbal reasoning, memory, language, and mathematics relative to children with PAE who did not receive an FASD diagnosis.…”

Section: Carmen Rasmussenmentioning

confidence: 77%

“…Alternatively, Astley's (2010) large scale cohort in Washington found a linear trend differentiating cognitive functioning among individuals with ND/AE, SE/AE, and FAS/pFAS, and Chasnoff et al (2010) similarly found differences in functioning between children with FAS compared with those with pFAS and ARND. Different diagnostic approaches and classifications may impact Table 3 under main effects for group b Mean difference scores vary for within FASD group comparisons as the mean for QC includes only the same number of participants who completed both QC and the subtest against which QC is being compared (not all participants completed all subtests of each measure) c Meets Benjamini-Hochberg (1995 false discovery rate criterion the interpretation of within-FASD comparisons in cognitive functioning, underscoring the need for further research in this area across methodologies and diagnostic classification systems.…”

Section: Discussionmentioning

confidence: 99%

Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths

McLachlan

Paolozza

Kully-Martens

et al. 2017

Adv Neurodev Disord

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Children and adolescents with fetal alcohol spectrum disorder (FASD) experience significant impairments in cognitive functioning, though substantial within-group heterogeneity is often observed. The purpose of this study was to characterize the cognitive profile of children and adolescents with FASD with a special focus on examining moderators of functioning and cognitive strengths. Children and adolescents with FASD (n = 87) and controls (n = 110), ages 5 to 18 years completed a cognitive test battery. MANOVAwas used to evaluate betweengroup cognitive differences, as well as the role of age and gender as potential moderators. Relative strengths were evaluated using both within-subject and between-group methods. Participants with FASD were found to show significant impairment on all cognitive tasks relative to controls, with substantial deficits evident on a measure of mathematical skill. Though neither age nor gender emerged as moderators, significant three-way interactions between age, gender, and group were evident on measures of executive functioning (inhibition), verbal memory, and word identification. Tasks measuring higherorder complex attention and visuospatial processing emerged as possible relative strengths in the FASD group. Children and adolescents with FASD had significant cognitive impairment across multiple domains confirming high need for interventions. Differences in the cognitive functioning for boys and girls with FASD at different developmental periods, along with relative strengths, may serve to inform interventions and future longitudinal research.

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Neurodevelopmental Functioning in Children With FAS, pFAS, and ARND

Abstract: The children who met tightly defined physical criteria for a diagnosis of FAS demonstrated significantly poorer neurodevelopmental functioning than children with pFAS and ARND. Children in these latter 2 groups were similar in all neurodevelopmental domains that were tested.

Cited by 65 publications

References 18 publications

Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

Executive Functioning in Children and Adolescents Prenatally Exposed to Alcohol: A Meta-Analytic Review

Unpacking the Heterogeneity of Cognitive Functioning in Children and Adolescents with Fetal Alcohol Spectrum Disorder: Determining the Role of Moderators and Strengths

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