Enhancing Fetal Alcohol Spectrum Disorders Diagnosis

This article aimed to provide clinical guidelines that denote the fetal alcohol spectrum disorders (FASD), and which should be observed during the fetal alcohol syndrome diagnostic process. These guidelines are an update to the practical guidelines they published in 2005 in order to operationalize the four distinct FASD categories identified by the Institute of Medicine (IOM) in 1996- which include: fetal alcohol syndrome (FAS, which is the most severe of all FASD forms), partial fetal alcohol syndrome (PFAS), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND).

Evaluation of the Article

The article provides an overview and scope of the FASD problem, where it highlights its prevalenFce in the United States as well as globally, and the immense burden associated with FASD. FASD’s high prevalence produces rather immense burdens to society in financial terms, untold human suffering and unrealized productivity. The annual cost estimates in the United States range from $74.6 million in 1984 to $4.0 billion in 1998. Larry Burd of the University of North Dakota School of Medicine and Health Sciences, Grand Fork, estimates that while there is variance in the type of costs for children versus adults, on average, FASD carries costs of more than $23,000 per person annually (Greenmyer et al. 2018). In Canada, the estimated costs in 2007 were CAD $5.3 billion. It further provides an explanation of how the guidelines should be applied in FASD diagnosis by highlighting the complex diagnostic process in terms of who and the steps it involves), as well as the characteristics that distinguish the four distinct FASD categories and which prompt FASD consideration or diagnosis. This article is therefore highly important given that the updated FASD clinical guidelines significantly contribute to the standardization of the FASD diagnoses and diagnostic process in clinical settings.

Article’s Contribution to Poster

This article will be essential to my poster given that it details the FASD diagnostic process which are based on an extensive review of literature and the combined expertise of the author. It also outlines the key FAS diagnosis criteria that highlight the conditions or characteristics of the key FASD manifestations- neurobehavioral disabilities, facial dysmorphology, growth retardation and central nervous system dysfunction- whose presence are required for the diagnosis of FASD. These guidelines provide an improved clarity and distinctiveness that guide clinicians and therefore contribute to the accuracy of their FASD diagnosis. The heightened clarity and specificity provides clinicians with guidance on accurate diagnosis of infants and those children who are exposed to alcohol prenatally, leading to general improved outcomes for children and infants.

The aim of this study was to investigate fetal alcohol syndrome and fetal alcohol spectrum disorders which arise from prenatal (intrauterine) exposure to alcohol and which are associated with the development of a variety of nonheritable intellectual disorders. The study also examined data by the Centres for Disease Control and Prevention (CDC) on alcohol consumption among pregnant women, and why the trend is an issue of concern given the place of alcohol as the most common teratogen. The study further provides a review of FASD diagnosis, key diagnostic criteria and differential diagnosis for FASD. This study highlights the problem of commonly missing or misdiagnosing FAS, which in effect prevents children from timely receiving the needed services. The article further recognizes FASD as a broader diagnosis encompassing FAS among others affected by prenatal alcohol exposure but who do not meet FAS criteria.

The study evaluates FAS and FASD in relation to their prevalence by drawing on the data provided by the CDC that illustrates the growing trend of drinking and binge drinking by women during pregnancy. Additionally, it outlines the main manifestations of FASD that a child who was prenatally exposed to alcohol would present with, including central nervous system dysfunction, growth deficiency, neurobehavioral disabilities or facial dysmorphology, and the characteristics associated with each of these manifestations. The study demonstrates the prenatal alcohol assessment, which is the first step in the FASD diagnosis process, and how it should be undertaken. It also demonstrates the key diagnostic criteria by highlighting the characteristics that should be looked out for in order to determine a diagnosis of FASD.

Article’s Contribution to Poster

The study makes a vital contribution to my poster following its clear detailing of the FASD diagnosis and the key diagnosis criteria that is used to prove or rule out the existence of FASD. It therefore enables me to develop my knowledge and understanding of the FASD diagnostic process and key criteria, which is also critical to health care professionals involved in FASD diagnosis by contributing to the accuracy of their diagnoses.

The study sought to investigate the child traits and maternal factors that increased the risk of developing FASD in a Southern-eastern United States country. The study used a simple random sampling method to obtain a sample size of 231 children in the first grade, all of whom were examined in terms of growth and dysmorphology, and a further 84 tested and ranked on neurobehavior. Regarding maternal risk factors, the study interviewed 72 mothers. Significant differences were found between the FASD children and entire sample’s physical attributes (height, weight, body mass index) and the three dysphormology features linked to FAS (palpebral fissure length, narrow vermilion and smooth philtrum). However, intellectual function and inhibition differences were not as significant, although the two groups demonstrated significant differences in terms of their spatial/visual measures, while the FASD group demonstrated significantly worse behavioral traits. The study also identified postpartum depression, alcohol intake frequency and recovery from drinking addiction as the major maternal risk factors linked to FASD. The study made a conclusion that careful and detailed clinical evaluation of children drawn from small random samples was necessary during the estimation of FASD traits within communities.

This is a study that involved first-grade children in public schools in order to evaluate the differences that exist and/or can be observed between children diagnosed with FASD and the typically developing children in terms of their physical, intellectual and behavioral traits, which were measured in accordance with the revised IOM diagnostic guidelines for FASD developed by Hoyme et al. (2005). The study’s findings, which are consistent with those of all other previous ones, add to the existing evidence on how FASD children and those without FASD differ in terms of their physical traits.

This study is vital to my poster as it illustrates that FASD, children who tend to be significantly smaller and less-developed intellectually compared to their counterparts without FASD, may also demonstrate aggressive or deviant behavioral traits. This knowledge would be of significance as it would enable teachers understand the diminished intellectual abilities and aggressive behavioral traits demonstrated by FASD children and how to best deal with them.

In recognition of FASD as a global problem, this study highlighted maternal alcohol consumption as an important FASD risk factor. Therefore, the study aimed to identify the alcohol consumption patterns that most strongly predicted FASD. This was a systematic review that involved the search of different databases, among them PubMed, PsychINFO, PsycARTICLES, ERIC, EMBASE, and MEDLINE. All the studies that provided a measure of maternal alcohol drinking behaviors and FASD reported retrospective data on maternal drinking patterns, and employed both categorical and continuous measures, and additionally exhibited relatively substantial heterogeneity in alcohol consumption measures. The alcohol consumption measures included; timing of exposure, definition of a standard drink, and quantification of alcohol measure. An observation was made that the quality of studies improved over time and appeared higher for those studies that were based on active ascertainment of cases, especially those that were carried out in schools, and when interviews were used for assessment of behavior.

The study used a rather comprehensive search strategy for purposes of covering the published literature. This study, however, fell short because it did not consult grey literature. Grey literature sources are able to provide increasingly richer details as compared to scientific studies. That is because these grey sources are not tied to any such conventional structures, and could be longer and possibly provide even more detail. Also, with grey literature, it is possible to write search results in styles that are increasingly accessible and useful for practitioners, as compared to scientific papers, making them worthwhile sources.

This study is useful because it identifies the specific maternal drinking behaviors that are related to FASD, helping avert irreversible lifelong consequences for unborn children.

The study described an integrated three-phase approach for the identification of FASD and also psychiatric comorbidity for children and youth in care, comprising of; completion of a standardized neurobehavioral screening tool by a child protection worker (CPW), pediatrician assessment inclusive of facial measurements, and integration of findings in a psychiatric assessment. The study recognized that there were several challenges in existence during the diagnosis of FASD and the identification of co-morbid psychiatric illness, and particularly for children and youth under child welfare services. Most of the participants whom the CPW and pediatrician suspected of having FASD through the use of the screening tool were determined to fulfil the criteria. For all the cases were there was a history of prenatal exposure, a diagnosis was done and it was revealed that most of the youth had FASD sentinel facial features. The study supported the utility of an integrated community approach in the diagnosis and treatment of comorbid psychiatric disorders in FASD through the employment of existing child protection and physician services within community settings. On the basis of these findings, the study encouraged the screening of youths with access to formal systems of care, by their CPW and their additional provision with appropriate psychiatric and pediatric assessment for purposes of clarifying the diagnosis, while at the same time identifying comorbid psychiatric illness to enable the targeting of appropriate interventions.

The study utilized a rather small sample size which limited statistical comparison between the group of children who had been diagnosed with FASD and those who were not diagnosed. While there is the possibility of age being related to type or number of comorbidities, the small sample size restricted the making of definitive conclusions.

Despite its illustration of potentially good methodological quality, this study will not be used for the poster given that it does not entirely meet the inclusion criteria given that it is more than 5 years old, having been published in 2014.

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