Article Summary #11: Mental Health and Affect Regulation in FASD

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This Article Summary is part of our CanFASD Connect Top Articles Summary Series. Over the next several months, we will be bringing you summaries of all the recent research papers from our list of the Top FASD Articles of 2019. This is an overview of a recent research paper called Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database.

Background:
Affect regulation (AR) is the ability to control emotional arousal. AR helps us to optimally interact with our environment and ensures an appropriate emotional response to different situations. Individuals with FASD or prenatal alcohol exposure (PAE) often have challenges with AR. They also experience high rates of comorbid mental health disorders. Based on the Canadian diagnostic guideline, individuals have an AR impairment when they are diagnosed with one (or more) of several specified mood or anxiety disorders or are experiencing a pattern of dysregulation across a significant period of time. People who are reacting to temporary challenges in their environment (i.e. a new foster home or failure at school) are not considered to have significant AR impairment. Although there is a lot of evidence about the presence of AR impairment among individuals with FASD, there are few studies that look at how AR impairment presents and intersects in individuals with FASD. The aim of the current study was to examine the relationship between AR impairment in FASD and mental health comorbidities using data from CanFASD’s National FASD Database.
Main findings:
  • Among individuals assessed for FASD at a subset of diagnostic clinics in Canada, 41% of those with FASD or ‘at risk’ for FASD had AR impairments.
  • Individuals with FASD with AR impairments were significantly older at the time of diagnosis compared to individuals without (19.1 years vs. 12.5 years).
  • Individuals with FASD with AR impairment also experienced significantly higher levels of overall neurodevelopmental impairment (on average 5.37 other domains of neurodevelopmental impairment) compared to those without (on average 4.17 other domains of neurodevelopmental impairment).
  • Individuals with AR impairment were at a higher risk of having an attachment disorder, conduct disorder, history of suicidal intentions, or PTSD.
Recommendations:
  • AR impairments should be recognized early in children with PAE to identify and implement effective coping strategies and supports to decrease the risk of negative outcomes.
  • Future research is needed to refine what disorders and challenges should be considered within the domain of AR and to understand how this domain intersects with other diagnostic criteria for PAE.
  • Future research is also needed to investigate the relationship between other prenatal exposures (i.e., cannabis) and AR and to compare AR deficits in FASD with other neurodevelopmental disorders (i.e., autism). 
Take-home message: Individuals with FASD and AR impairments are at higher risk for later diagnoses, higher levels of neurodevelopmental impairment, and additional mental health challenges. Early recognition of AR impairments may reduce the risk of negative outcomes. More research is needed to better understand the intersection of AR impairments and prenatal substance exposure.

Authors: Valerie K. Temple, Jocelynn L. Cook, Kathy Unsworth, Hasu Rajani, and Mansfield Mela Journal: Alcohol and Alcoholism Date: June 19, 2019 Read the full article (not available open access)

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