From her work in community health, forensic psychiatry, and private practice, Dr.
Other diagnoses along the spectrum, such as FAS or pFAS, focus on structural and neurophysiological central nervous system abnormalities eg, microcephaly or neurologic soft signs. Physical features such as facial dysmorphia or growth restrictions either prenatal or postnatal are required for FAS and pFAS.
For example, even with repeated experience and an IQ within normal limits, the memory and learning impairments of a child with ND-PAE may mean that he or she has difficulty with previously learned skills, such as finding his or her locker at school on a routine basis despite repeated instructions and practice 4849 or forgetting how to tie his or her shoes, despite previous mastery, and having to relearn that skill entirely.
This is different from regression of emerging skills seen in some children with autism. In contrast, individuals with ND-PAE tend to have specific difficulty with nonverbal aspects of cognition such as visual—motor skills, learning and memory for recently learned skills, and executive functioning, resulting in behavioral problems.
Behaviorally, children with FASDs have higher rates of social behavioral problems resulting from difficulties in social cognition and emotional processing.
Because of overlap between these other behavioral disorders and ND-PAE, at a general level especially for the self-regulation component it is important for a clinician to consider these as both differential and comorbid diagnoses. Until additional data are available about the validity and reliability of all childhood behavior disorders, including ND-PAE, this will continue to be a tricky diagnostic issue.
Furthermore, for some children a history of early trauma, abuse, neglect, or parental loss will be the only presenting problem because children with prenatal exposure to alcohol are at higher risk for these negative events.
Therefore, it is particularly important to obtain prenatal exposure history in these situations. Such information can inform assessments and evaluation at older ages. Finally, although prenatal alcohol exposure does occur in various contexts and varying levels, the presence of ongoing alcohol or substance abuse in the home confers additional risk.
Families with substance abuse problems are more likely to suffer from multiple forms of trauma, antisocial behavior, financial instability, and poverty.
Ongoing care is the major role of the pediatric medical home. Even if this finding encompasses some amount of ascertainment bias because it is a clinical sample, the number of individuals with FASDs who do not achieve independent living is striking and cause for concern.
This protective effect of early diagnosis has been demonstrated in a number of studies. Medications The evidence base for pharmacologic treatment in this population is limited, 536970 with no medications indicated specifically for ND-PAE.
Studies on human and animal models are inconclusive at this time, and more data are needed for proper guidance. However, findings from small pilot studies suggest that ADHD stimulant medication can improve hyperactive symptoms but not attention and impulsivity.
Such medication failure also might be an indicator to consider a diagnosis under the umbrella of FASDs.
Behavioral, Mental Health, and Academic Referrals By definition ND-PAE is a behavioral or mental health diagnosis, and therefore such patients will benefit from referral to specialties that can address these needs.
An overview of interventions developed specifically for these children found that effective interventions include explicit teaching techniques, repetitive presentation, and caregiver instructions about specific strengths and weaknesses associated with prenatal alcohol exposure.
It is important to remember that all aspects of the ND-PAE diagnosis ie, neurocognition, self-regulation, and adaptive behavior are developmental processes, and the type of specialty needed might change across development.
For younger children, allied health referrals, such as physical or occupational therapies, might be most appropriate. Early intervention might focus on general developmental skills for the infant or preschooler. Occupational therapy is often recommended for fine motor impairments, sensory integration problems, and emerging self-regulation problems.
Several of these interventions are described in the online Supplemental Information. Older children with ND-PAE might need more traditional mental health services and can begin to benefit from modified insight-based therapies. Referral for substance abuse evaluation or treatment also might be warranted.
Of special note for this population is that many affected children and adolescents do not qualify for special education under standard criteria, yet they still need services. Psychoeducational testing by school personnel or private psychologists might be required for diagnostic confirmation and treatment planning.
Creative solutions and closely engaging with the family, school, and community by the pediatric medical home can facilitate meaningful results see the AAP FASD Toolkit at www.
It is important that clinicians ask the difficult questions to screen for prenatal alcohol exposure when they suspect a child might have been prenatally exposed to alcohol. Furthermore, such instruction provides reassurance and support.
Summary and Pediatric Medical Home Practice Suggestions The value of the medical home starts at the identification and diagnostic stage and continues through treatment planning and ongoing care. The brain damage that is caused by prenatal alcohol exposure is permanent and irreversible, resulting in impaired neurocognitive functioning regardless of IQ; however, interventions can improve function.
Although additional taxometric research on ND-PAE is needed, an extensive scientific literature already provides support for its constellation of symptoms and criteria. Several efforts are under way to obtain appropriate taxometric data, with results forthcoming J.
Kable, PhD, personal communication, ; our understanding may require modification once tested in a sizable cohort of children with developmental disabilities. Children and adolescents with ND-PAE can reach their full potential with proper identification, diagnosis, and treatment if clinicians and families work as a team, especially toward early identification, treatment, and family support.The regions of the brain that are most seriously affected by prenatal alcohol exposure in terms of ability to function are: Frontal Lobes - this area controls impulses and judgment.
The most noteworthy damage to the brain probably occurs in the prefrontal cortex, which controls what are called the Executive Functions. A detailed review of the current research on the developmental effects of prenatal alcohol exposure reveals some inconsistencies.
For example, although arithmetic skill is frequently more impaired than verbal skills, some of the most severely affected patients perform poorly in both domains.
Any drinking during pregnancy increases the odds of fetal alcohol syndrome, but the risk to the fetus is highest if a pregnant woman drinks during the second half of . Prenatal alcohol exposure can also affect the brain, causing developmental delays and behavioral problems. Delays may express themselves as learning disabilities, attention deficit/hyperactivity disorder, problems with language and memory, or mental retardation.
Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. Fetal alcohol syndrome causes brain damage and growth problems. The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are not reversible.
Fetal alcohol exposure occurs when a woman drinks while pregnant. No amount of alcohol is safe for pregnant women to drink.
Nevertheless, data from prenatal clinics and postnatal studies suggest that 20 to 30 percent of women do drink at some time during pregnancy.