2018 Webinar Series
Multiple diagnostic systems and the alphabet soup that is used to label children affected by prenatal alcohol exposure make it difficult to decide where a child belongs in the spectrum and, most importantly, to communicate this to others. When looking through the scientific literature, you find that many articles fail to clearly define what exact group within the fetal alcohol spectrum they are investigating.
Key questions: What are the competing systems and how do they affect access to clinical services? Is there any agreement between the competing diagnostic systems? Does the diagnosis affect potential for insurance or Medicaid coverage? Do diagnostic criteria vary between countries? How do we ensure that we communicate clinical findings clearly and correctly? The original term for FASD is plural; i.e., Fetal Alcohol Spectrum Disorders. However, it has now morphed to common usage in the singular: Fetal Alcohol Spectrum Disorder. Does this matter?
Neonatal abstinence syndrome (NAS) is narrowly defined as a syndrome due to prenatal opiate exposure. But many infants exposed to non-opiate substances are given the diagnosis.
Key questions: What is true neonatal abstinence and how does it differ from neurobehavioral difficulties? What factors affect diagnostic labeling? Is it in fact important to differentiate the two? Does the diagnosis affect treatment? Does it impact long-term outcome?
There is a big difference between co-occurring mental health disorders, which are etiologically related to a specific syndrome, and multi-occurring mental health disorders, which occur alongside the primary syndrome. The implications for prevention are embedded in this difference and affect our attitudes toward intervention for this population of children and youth affected by prenatal alcohol exposure.
Key questions: What is the difference between co-occurring and multi-occurring mental health disorders? Through considering this difference, can you differentiate the biological impact of prenatal alcohol exposure from environmental factors that affect long-term mental health outcome? Is early intervention a form of prevention? What can research tell us about the role the child welfare system plays in the balance between nature and nurture?
There are emerging treatment strategies that have been shown to positively enhance outcome for children and youth with FASD. In fact, a recent study documents changes in brain functioning in children treated with approaches that emphasize self-regulation. But, the great majority of children diagnosed within the fetal alcohol spectrum are not receiving appropriate interventions or treatment.
Key questions: How do we decide what level of treatment and what type of treatment is needed for a specific child affected by prenatal alcohol exposure?
Most states require reporting of newborns affected by prenatal exposure to illicit drugs to the child welfare system. But there is a great deal of variability as to what constitutes evidence of prenatal exposure, much less great variation within states and even within hospital systems. The Federal Child Abuse Prevention and Treatment Act complicates these issues further, and recent studies have shown that CAPTA is having little impact on promoting the welfare of children.
Key questions: What rights do parents have as to how they wish to raise their child, vs. what responsibility does the State have in protecting children? What role does toxicology testing have in decision-making? How do inherent personal biases regarding race and social class affect placement decisions? How do clinicians’ attitudes toward and the reputation of child welfare systems affect our actions? Can Federal legislation such as CAPTA really make a difference?
There is clear evidence that early recognition and intervention for children with FASD is essential to promoting the children’s long-term outcome. However, the diagnoses within the fetal alcohol spectrum often are missed, and attempts at screening with commonly used standardized tools such as the ASQ-III miss children affected by prenatal alcohol exposure.
Key questions: Is there such a thing as “screening” for FASD, and if so, what should we look for at various stages of development? How do we balance sensitivity with specificity? How do we ensure the earliest possible access to services for infants and children with FASD?