Academic journal article Alcohol Research

Behavioral Interventions for Children and Adolescents with Fetal Alcohol Spectrum Disorders

Academic journal article Alcohol Research

Behavioral Interventions for Children and Adolescents with Fetal Alcohol Spectrum Disorders

Article excerpt

More than 35 years ago, fetal alcohol syndrome (FAS) was first identified in the United States as a major birth defect resulting from prenatal alcohol exposure (Jones and Smith 1973; Jones et al. 1973). FAS is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system dysfunction. Evidence from both animal and human studies, however, suggests that there is considerable variability in the manifestations of in utero alcohol exposure across individuals. Such variability depends on numerous factors, including dosage, timing of exposure, pattern of exposure, maternal age and body mass index and genetics, as well as postnatal variables such as nutrition, socioeconomic conditions, and environmental enrichment (Bonthius and West 1990; Day and Richardson 2004; Downing et al. 2009; Hannigan et al. 2007; Jacobson et al. 2006; Jones 2006; May et al. 2008, see also May and Gossage, pp. 15-26, in this issue). In light of this variability, the umbrella term, fetal alcohol spectrum disorders (FASD) (Warren et al. 2004) has come into usage to reflect the entire continuum of effects associated with in utero alcohol exposure. In addition to FAS, this term encompasses the conditions of partial FAS, alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBDs, as described by the Institute of Medicine [Stratton et al. 1996]).

Over the past three decades, extensive research has documented the teratogenic effects of alcohol in both animal and human studies, and such research has highlighted a range of cognitive, behavioral, and physical impairments associated with prenatal alcohol exposure. Intellectual and learning disabilities, executive dysfunction, speech and language delays, behavioral and emotional difficulties, poor social skills, and motor deficits have all been reported among people with FASD (Burd et al. 2003; Green et al. 2009; Guerri et al. 2009; Kalberg et al. 2006; Kodituwakku 2007, 2009; O'Connor and Paley 2009; Paley and O'Connor 2007; Rasmussen 2005; Rasmussen and Bisanz 2009; Riley and McGee 2005; Roebuck et al. 1998; Streissguth 2007; Streissguth et al. 2004; Walthall et al. 2008; Willoughby et al. 2008).

Notably, much of the FASD research has focused on people receiving treatment, often at clinics specializing in FASD diagnosis and treatment. Therefore, less is known about how people exposed to alcohol prenatally might present in more generalized mental health or medical settings, where their impairments may be less readily identified as resulting (at least partly) from in utero exposure to alcohol. More population-based studies are needed to identify alcohol-exposed individuals who exhibit significant impairments but cannot access medical or mental health services, as well as those who exhibit milder (or more subtle) effects of such exposure. Recent studies focusing on school-based samples in the United States, Europe, and South Africa have found that children with FASD perform significantly worse on measures of cognitive and adaptive functioning when compared with children without FASD (Adnams et al. 2001; Aragon et al. 2008; Kodituwakku et al. 2006a, b; May et al. 2009). Such findings offer preliminary evidence that the impairments seen in children with FASD are not limited to those seen in clinical settings, but additional epidemiological studies would help clarify the full range of outcomes for individuals with a history of in utero alcohol exposure.

From economic, societal, and family perspectives, FASD represent a major public health issue. Prevalence estimates vary depending on the method of ascertainment and the populations sampled. A recent review by May and colleagues (2009) estimates the prevalence of FAS in the United States to be at least 2 to 7 per 1,000 in typical, mixed-race populations of mixed socioeconomic status. Prevalence estimates for the entire continuum of FASD range from 1 to 5 percent (May et al. …

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