New FASD Research: December 2020

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Here is a brief summary of some of the latest research published on Fetal Alcohol Spectrum Disorder (FASD).
Prevention
Differential Effects of Maternal Diets on Birth Outcomes and Metabolic Parameters in Rats After Ethanol Consumption during Pregnancy Maternal nutrition plays an important role in the development of FASD, but researchers have a limited understanding of how exactly this occurs. The researchers in this study looked at birth outcomes from four different groups of pregnant rats: those with standard diets; those with standard diets and alcohol exposure; those with high energy diets; and those with high energy diets and alcohol exposure. They found that:
  • Offspring of rats with standard diets who were exposed to alcohol had decreased birth weights and the mothers had fewer offspring.
  • High-energy diets in pregnant rats reduced the incidence of alcohol-induced weight loss in mothers, increased body and liver weights in offspring, and increased negative metabolic outcomes in both mothers and offspring compared to standard diets.
  • In pregnant rats fed high energy diets, ethanol consumption did not significantly affect litter size compared to pregnant rats on high energy diets without alcohol exposure.
Take home message: More research is needed to understand the full impact of maternal diets on humans with prenatal alcohol exposure, but researchers of this study suggest that interventions targeting maternal nutrition could potentially mitigate some of the effects of FASD. Wang, Y., Feltham, B., Eskin, M., & Suh, M. (2020). Differential Effects of Maternal Diets on Birth Outcomes and Metabolic Parameters in Rats After Ethanol Consumption during Pregnancy. British Journal of Nutrition, 1-25. doi:10.1017/S0007114520005152

More Prevention Research:

Prenatal Care Outcomes in Women with Substance Use Disorders: A Retrospective Cohort Study Commentary: Pregnancy, partners, and alcohol warning labels (open-access)
Diagnosis
Use of Telemedicine for the Physical Examination of Children with Fetal Alcohol Spectrum Disorders (FASD) In most FASD assessment clinics, an FASD diagnosis typically requires that an individual’s physical features, neurobehavioral functioning, and history of prenatal alcohol exposure are assessed by a team of experts. However, there are limited numbers of FASD diagnostic experts in the United States. In this study, researchers explored the use of telemedicine as a means of assessing physical features for FASD. They conducted examinations of 61 individuals using two digital technologies and compared these results to those of face-to-face examinations. They found that:
  • Agreements in the findings between face-to-face evaluations and evaluations via telemedicine for most physical features of FASD were in the “almost perfect” range with some exceptions in the “substantial” range.
  • Imprecision in measurement and subjectivity underlie lower agreement for some features in both face-to-face and telemedicine examinations.
  • External conditions such as lighting, distance, and angles from the camera could be optimized to ensure the reliability of telemedicine examinations.
Take home message: Telemedicine can be a valid and reliable method of examining the physical features of FASD and may allow for greater FASD diagnostic capacity, particularly in regions where diagnostic expertise is limited. Del Campo, M., Beach, D., Wells, A. & Jones, K. L. (2020). Use of Telemedicine for the Physical Examination of Children with Fetal Alcohol Spectrum Disorders (FASD). Alcohol Clin Exp Res., Online ahead of print. doi: 10.1111/acer.14533.

More Diagnosis Research

Fatty acid ethyl esters in meconium and substance use in adolescence Evolution of the Physical Phenotype of Fetal Alcohol Spectrum Disorders from Childhood through Adolescence
Intervention
Health, social and legal outcomes of individuals with diagnosed or at risk for fetal alcohol spectrum disorder: Canadian example (Open Access) Individuals with FASD experience high rates of adverse outcomes. It is important to understand the factors influencing these outcomes in order to create targeted solutions. Researchers in this study looked at the characteristics and challenges of a cohort of individuals with or at-risk for FASD in British Columbia. They found that:
  • Participants had high levels of developmental disabilities (78%); involvement in child welfare (75%); substance use (50%); physical health comorbidities (38%); and involvement in the criminal justice system (30%).
  • Individuals over 20 years had higher rates of any past substance use (60.9%); alcohol use (39.1%); and stimulant use (30.4%) compared to individuals aged 10-19 years (41.3 %; 12.0 %; 14.1 %, respectively).
  • Involvement in the child welfare system was associated with higher risk of experiencing anxiety.
  • Involvement in the criminal justice system was associated with higher rates of past substance
Take home message: Comprehensive services, including mental health and substance use programming, are needed to support positive outcomes for individuals diagnosed with or at-risk for FASD. Targeted efforts may be especially important for those involved with the child welfare and criminal justice systems. Popova, S., Temple, V., Dozet, D., O’Hanlon, G., Toews, C., & Rehm, J. (2020). Health, social and legal outcomes of individuals with diagnosed or at risk for fetal alcohol spectrum disorder: Canadian example. Drug and Alcohol Dependence. Online ahead of print. DOI: https://doi.org/10.1016/j.drugalcdep.2020.108487

More Intervention Research

An fMRI investigation of neural activation predicting memory formation in children with fetal alcohol spectrum disorders (open access) Executive and Social Functioning Across Development in Children and Adolescents with Prenatal Alcohol Exposure Epigenetic Clock Analysis in Children with Fetal Alcohol Spectrum Disorder. Completed secondary education among youth with prenatal substance exposure: A longitudinal register-based matched cohort study (open access)
Justice
Fetal Alcohol Spectrum Disorder and Neurodevelopmental Disorders: An International Practice Survey of Forensic Mental Health Clinicians Individuals with FASD are overrepresented in the criminal justice system. The researchers of this study surveyed 81 forensic clinicians to understand their experiences in providing services to clients with FASD and other neurodevelopmental disorders (NDD). They found that:
  • The majority of clinicians had experience working with clients with FASD and other NDDs in forensic settings.
  • Clinicians identified that limited training, gaps in readiness for service provisions, and barriers to practice prevented them from working effectively with these populations.
  • Clinicians reported seeing fewer clients with FASD compared to clients with NDDs and felt less prepared to support this population.
  • Most clinicians highlighted the need for additional training and supports to improve their practices. Suggestions for additional supports include the development of screening tools, clinical guidelines, and access to experts or specialists for consultation.
Take home message: Additional research, training, and policy consideration is needed to develop evidence-based FASD practice resources and recommendations for professionals in forensic settings. McLachlan, K., Mullally, K., Ritter, C., Mansfield, M., & Pei, J. (2020). Fetal alcohol spectrum disorder and neurodevelopmental disorders: an international practice survey of forensic mental health clinicians. International Journal of Forensic Mental Health. doi: 10.1080/14999013.2020.1852342

More Justice Research

Parents With Fetal Alcohol Spectrum Disorder Within Canada’s Child Protection Trials
Family Collaboration
Selecting and Using Children’s Books with Authentic Representations of Characters with Developmental Disabilities (Open Access) Providing kids with books that include characters with diverse abilities is a creative and valuable way to challenge societal perceptions of those with disabilities. It is important that these books showcase individuals with disabilities in an authentic, inclusive, and respectful way without contributing to stereotypes and stigma. The researchers of this study explored 47 books featuring characters with developmental disabilities to understand how these characters are portrayed. They found that:
  • Of the 47 books evaluated only 1 book had a character with FASD. In contrast there were 33 books portraying Autism Spectrum Disorder, 5 portraying Down Syndrome, 7 portraying Intellectual Disability and Developmental Disability, and 1 portraying developmental delay.
  • 80% of the characters were portrayed positively with disabilities and 20% were portrayed in a neutral fashion. There were no negative portrayals.
  • Most of the characters (74%) were male.
  • In the book, A Time to Run: Stuart and Sam, which featured a character with FASD, the character was portrayed as realistic, positive, and dynamic. The character experienced positive social interactions, positive relationships with siblings, and positive exemplary practices.
Take home message: Books offer an important opportunity for children to learn about the world. This research provides a great baseline for parents and caregivers to use to expose their children to accurate, positive, and realistic portrayals of individuals with disabilities. Taylor, T., Moss, K., Brundage, K. E., and Prater, M. A. (2020). Selecting and Using Children’s Books with Authentic Representations of Characters with Developmental Disabilities. DADD Online Journal, 7(1), 10-30.

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, read the full research papers. Please note that this is not a comprehensive list of all research published on FASD in December 2020; it is a snapshot of some of the articles most relevant to the CanFASD priority areas.

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