Pediatricians' Knowledge, Training, and Experience in the Care of Children With Fetal Alcohol Syndrome

Gahagan, Sheila; Sharpe, Tanya Telfair; Brimacombe, Michael; Fry-Johnson, Yvonne; Levine, Robert J.; Mengel, Mark B.; O’Connor, Mary J.; Paley, Blair; Adubato, Susan; Brenneman, George

doi:10.1542/peds.2005-0516

Cited by 71 publications

(65 citation statements)

References 26 publications

(25 reference statements)

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“…24 Further, children's health providers do not routinely consider prenatal alcohol exposure in the differential diagnosis of behavioral and learning problems. 25 In the current study, ADHD was the most common referral diagnosis for children who ultimately were diagnosed with FASD. Previous studies have demonstrated that anywhere from 40% to 75% of children with FASD are diagnosed with ADHD.…”

Section: Discussionmentioning

confidence: 74%

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: Discussionmentioning

confidence: 74%

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

2015

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“…To facilitate diagnosis and treatment of FASDs, it is imperative that professionals working in health care, education, social services, and the criminal justice system are properly trained in how to recognize individuals with PAE and educated regarding appropriate interventions for this population [Gahagan et al, 2006;FASD Regional Training Centers Consortium, 2007;Wedding et al, 2007;Mutch et al, 2009;Paley et al, 2009]. In some cases, it may also be important to change the attitudes of professionals who come in contact with and provide services to alcohol-exposed individuals and their families.…”

Section: Recommendations and Future Directionsmentioning

confidence: 99%

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

Paley¹,

O’Connor²

2009

Dev Disabil Res Revs

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Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidencebased interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs. ' 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 200915:258-267.

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“…however, these data depend on cultural and social factors within each population regarding alcohol use by women, so that the actual rates may be at least tenfold increased in high risk populations. In addition, FAsd incidence rate may be extremely underestimated due to health workers' lack of knowledge [6][7][8] . It has been reported that at least 50% of Canadian and American women drink socially, and as half of all pregnancies are not planned, approximately 25% of newborns may have been exposed to alcohol in utero [9][10] .…”

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confidence: 99%

Proton magnetic resonance spectroscopy in children with fetal alcohol spectrum disorders

Gonçalves

Vasconcelos

Faleiros

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To analyze the metabolic constitution of brain areas through proton magnetic resonance spectroscopy in children affected with fetal alcohol spectrum disorder compared with normal children. Method: The sample of this case-control study included eight boys with epidemiologic history of in utero exposure to alcohol (median age 13.6±3.8 years) who were diagnosed with fetal alcohol spectrum disorder, and eight controls (median age 12.1±3,4 years). An 8 cm 3 single voxel approach was used, with echo time 30 ms, repetition time 1500 ms, and 128 acquisitions in a 1.5T scanner, and four brain areas were analyzed: anterior cingulate, left frontal lobe, left striatum, and left cerebellar hemisphere. Peaks and ratios of metabolites N-acetylaspartate, choline, creatine, and myo-inositol were measured. Results: Children with fetal alcohol spectrum disorder showed a decrease in choline/creatine ratio (p=0.020) in left striatum and an increase in myo-inositol/creatine ratio (p=0.048) in left cerebellum compared with controls. There was no statistically significant difference in all peaks and ratios from the anterior cingulate and frontal lobe between the two groups. Conclusion: This study found evidence that the left striatum and left cerebellum are affected by intrauterine exposure to alcohol. Additional studies with larger samples are necessary to expand our knowledge of the effects of fetal exposure to alcohol.Key words: fetal alcohol syndrome, alcohol-induced disorders of the nervous system, ethanol, fetal development, magnetic resonance spectroscopy. espectroscopia por ressonância magnética de prótons em crianças com transtornos do espectro alcoólico fetal resumo -Objetivo: Analisar a composição metabólica de áreas encefálicas através da espectroscopia de prótons por ressonância magnética em crianças com transtornos do espectro alcoólico fetal e crianças normais. Método: A amostra deste estudo de casos-controles incluiu 8 meninos com história epidemiológica de exposição fetal ao álcool (idade mediana 13,6±3,8 anos), diagnosticados com transtorno do espectro alcoólico fetal, e 8 controles (idade mediana 12,1±3,4 anos). Utilizou-se voxel único de 8 cm³, tempo de eco 30 ms, tempo de repetição 1.500 ms, 128 aquisições, em scanner de 1,5T para as seguintes áreas: cíngulo anterior, lobo frontal esquerdo, estriado esquerdo e hemisfério cerebelar esquerdo. estudaram-se os picos e as razões dos metabólitos N-acetilaspartato, colina, creatina e o mio-inositol. Resultados: As crianças acometidas apresentaram diminuição da razão colina/creatina (p=0,020) no estriado esquerdo, e aumento da razão mio-inositol/creatina (p=0,048) no cerebelo esquerdo. Não houve diferença estatisticamente significativa nos valores encontrados no cíngulo anterior e lobo frontal entre os dois grupos. Conclusão: este estudo encontrou evidências de que o estriado e o cerebelo esquerdos são acometidos pela exposição intra-uterina ao álcool. estudos adicionais com amostras maiores são essenciais para expandir nosso conhecimento dos efeitos d...

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Pediatricians' Knowledge, Training, and Experience in the Care of Children With Fetal Alcohol Syndrome

Cited by 71 publications

References 26 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

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

Proton magnetic resonance spectroscopy in children with fetal alcohol spectrum disorders

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