Here is a brief summary of some of the latest research published on Fetal Alcohol Spectrum Disorder (FASD).
Prevention
Effective interventions are needed to support women and girls to have healthy pregnancies. The researchers of this study conducted a systematic review of the literature on the prevention of alcohol-exposed pregnancies. They reviewed studies from 1970 onward and found that of the 34 peer-reviewed studies that met the search criteria:
- 15 used brief interventions
- 6 explored long-term/intensive strategies
- 5 looked at educational interventions
- 3 assessed counseling approaches
- 2 evaluated multi-component strategies; and
- 3 assessed nutritional supplementation interventions
Take home message: Approaches for reducing alcohol consumption among pregnant and postpartum women are varied. There is growing evidence for the positive impacts of brief interventions, however, more research is needed overall to understand the effectiveness of prevention approaches in pregnancy and postpartum periods.
Erng, M.N., Simrnov, A., and Reid, N., (2020). Prevention of Alcohol-Exposed Pregnancies and Fetal Alcohol Spectrum Disorder Among Pregnant and Postpartum omen: A Systematic Review. Alcoholism: Clinical & Experimental Research. DOI: https://doi.org/10.1111/acer.14489
More Prevention Research:
Social Stigma and Perinatal Substance Use Services: Recognizing the Power of the Good Mother Ideal
Diagnosis
Genetic testing in patients with possible foetal alcohol spectrum disorder
Some of the symptoms of FASD in children can resemble a number of genetic disorders. Therefore, children may be referred to a specialist to rule out any genetic disorders before making a diagnosis of FASD. The authors of this study examined data from 110 patients referred from January 2013 to December 2017 to a clinical genetics service in the United Kingdom. They found that:
- 93% of referrals were made by pediatricians, and the average age of participants was 7.6 years (range 6 months – 26 years)
- 130 genetic investigations were conducted, and most (66%) of these were array comparative genomic hybridisation (aCGH) as a first-line test
- Genetic abnormalities were identified in 25 participants, but in only 4 cases, these abnormalities were deemed to be contribute to the child’s symptoms
- Therefore, the overall genetic diagnostic rate was only 3.6% (4 in 110)
Take home message: Not all children with FASD will require referral for clinical genetics. Pediatric teams should consider routinely performing an aCGH as a first-line test for children suspected of having a developmental disability prior to referral for clinical genetics testing. For children suspected of having FASD, aCGH results should be considered in the context of the full FASD diagnostic criteria before a genetics referral is made.
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More Diagnosis Research:
Ethanol-mediated alterations in oligodendrocyte differentiation in the developing brain (open-access)
Intervention
Researchers have previously shown that, in general, exercise can improve cognitive functioning. This study was a systematic review from October 2018 to January 2019 of all research articles on exercise-related interventions for executive functioning in children with Autism Spectrum Disorder (ASD), FASD, and Attention Deficit Hyperactivity Disorder (ADHD). They found:
- 28 studies from on the relationship between exercise interventions and improvement in executive functioning in youth and adolescents (0-18) with ASD, ADHD, and FASD
- Only five studies were identified that looked at exercise interventions for children with ASD and FASD. In this study, the results for ASD and FASD were combined because of the limited data.
- Of the 1,281 research participants total across studies, 30 had FASD
- For children with FASD, exercise interventions were associated with improvements in working memory and response inhibition
Take home message: Exercise may be a cost-effective and easy way to implement interventions to improve some aspects of executive functioning in individuals with FASD and other neurodevelopmental disorders.
Varigonda, A.L., Edgcomb, J.B., and Zima, B.T. (2020) The impact of exercise in improving executive function impairment among children and adolescents with ADHD, autism spectrum disorder, and fetal alcohol spectrum disorder: a systematic review and meta-analysis. Arch Clin Psychiatry, 47(5): 146-156. DOI: 10.1590/0101-60830000000251
More Intervention Research
The oral health status and treatment needs of children with fetal alcohol spectrum disorder
Child Welfare
CREATING NORMALCY: FOSTER CARE FOR CHILDREN AND YOUTH WITH DISABILITIES AND MEDICAL FRAGILITY IN GERMANY(open access)
In Germany, there is very little research on best practices for children and youth with disabilities and medical conditions living in the foster care system. Foster parents often find themselves caring for children with disabilities, but their knowledge levels vary. In this study, the researcher interviewed 19 foster parents from 15 families in Germany to understand their experiences in fostering children with special needs. The author found that:
- Caregivers used one of three strategies to overcome challenges (i.e., action-, resource-, or reflection-oriented strategy)
- Action-oriented families may need more assistance and become frustrated without access to supports
- Resource-oriented families may need less hands-on supports but may seek effective resources
- Reflection-oriented families may prefer to make their own decisions related to what supports they need and may become frustrated if too much support was forced on them. They may appreciate small amounts of encouragement at times.
- Neither the type nor severity of disability impacted the type of strategy that caregivers used
Take home message: Foster families in Germany use different strategies to care for children with disabilities. Understanding caregivers’ preferred strategy can help service providers to find the best supports for each family.
Föltz, F. (2020). Creating Normalcy: Foster care for children and youth with disabilities and medical fragility in Germany. International Journal of Child, Youth and Family Studies, 11(4.1): 132-151. DOI: 10.18357/ijcyfs114202019942
Justice
An invisible problem: stigma and FASD diagnosis in the health and justice professions
People with FASD face stigma, which can impact their disclosure of a diagnosis and their access to supports. Researchers in this study conducted interviews with professionals in the healthcare and justice fields in Montreal, Canada to understand how stigma impacted their professional interactions with people with FASD. The author found that:
- There was a lack of understanding of FASD and related stigma in health care and justice settings
- FASD diagnosis can be difficult to access but was perceived as an important step in accessing supports
- People with FASD can face additional challenges when stigma and lack of understanding of FASD goes unaddressed in these systems
Take home message: It is critically important to improve FASD knowledge and understanding in health and justice settings or to address the complex stigma experienced by individuals with FASD in these contexts.
Dunbar Winsor, K. (2020), “An invisible problem: stigma and FASD diagnosis in the health and justice professions”, Advances in Dual Diagnosis, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/ADD-07-2020-0014
This blog is intended to provide a summary of some of the recent literature on FASD. For a more complete and nuanced understanding of these findings, please read the full research papers. Please note that this is not a comprehensive list of all research published on FASD in November 2020, but rather a snapshot of some of the articles most relevant to the CanFASD priority areas.