CLINICAL CORRELATES OF FETAL ALCOHOL SPECTRUM DISORDER AMONG DIAGNOSED INDIVIDUALS IN A RURAL DIAGNOSTIC CLINIC
Main Article Content
Keywords
Fetal alcohol spectrum disorder, diagnostic clinic, mental disorder
Abstract
Background
Diagnosis of fetal alcohol spectrum disorder (FASD) is relevant for the reduction of long term adverse sequalae. However, the diagnostic guidelines require a multidisciplinary approach which may hinder access to diagnostic and management services. Most diagnostic clinics are located in urban areas. There is less emphasis on the operations, capacities, and outcomes from rural diagnostic clinics.
Methods
Over a ten and half years of clinic operations to diagnose children and subsequently adults, all consenting adults provided answers to interviews, participated in measurements and other diagnostic procedures. Information was collected on their contact with mental health services. Comparison of the findings with those from other established clinics included variables relevant to outcome measures.
Results
375 individuals were referred, assessed and diagnosed according to the existing guidelines for FASD diagnosis. Alcohol-related neurodevelopmental disorder (ARND), which was closely associated with age, was the most prevalent FASD diagnosis. One third of those diagnosed had IQ above the average range and ADHD was the most relevant clinical correlate. The diagnostic clinic was able to complete diagnosis on potentially 37.5% of likely affected individuals.
Conclusion
FASD can be diagnosed in children and adults in a rural setting. ADHD and other mental disorders should be a focus for treatment in affected individuals especially adults. It is important to consider the impact of age on the outcome of FASD. To increase diagnostic capacity, clinic operations could be modelled similarly.
References
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9. Mutch R, Peadon EM, Elliott EJ, Bower C. Need to establish a national diagnostic capacity for foetal alcohol spectrum disorders. J Paediatr Child Health 2009;45(3):79-81. Epub 2009/03/26.
10. Mattson SN, Foroud T, Sowell ER, Jones KL, Coles CD, Fagerlund A, et al. Collaborative initiative on fetal alcohol spectrum disorders: methodology of clinical projects. Alcohol 2009; 44(7-8): 635-41. Epub 2009/12/29.
11. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172(5 Suppl):S1-S21. Epub 2005/03/02.
12. Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. 3rd ed. Seattle, WA: University of Washington Publication Services; 2004.
13. Burd L, Martsolf JT, Klug MG, Kerbeshian J. Diagnosis of FAS: a comparison of the fetal alcohol syndrome diagnostic checklist and the Institute of Medicine Criteria for fetal alcohol syndrome. Neurotoxicology and Teratology 2003;25(6):719-24.
14. Astley SJ. Comparison of the 4-Digit diagnostic code and the Hoyme Diagnostic Guidelines for fetal alcohol spectrum disorders. Pediatrics 2006;118(4):1532-45.
15. McFarlane A. Fetal alcohol spectrum disorder in adults: diagnosis and assessment by a multidisciplinary team in a rural area. Canadian Journal of Rural Medicine 2011;16(1):6.
16. Chudley AE, Kilgour AR, Cranston M, Edwards M. Challenges of diagnosis in fetal alcohol syndrome and fetal alcohol spectrum disorder in the adult. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 2007;145C(3):261-72.
17. Clarren SK, Lutke J. Building clinical capacity for fetal alcohol spectrum disorder diagnoses in western and northern Canada. Can J Clin Pharmacol 2008;15(2):e223-37.
18. Warren KR, Hewitt BG, Thomas JD. Fetal alcohol spectrum disorders: research challenges and opportunities. Alcohol Research & Health 2011;24(1):11.
19. Stade B, Beyene J, Buller K, Ross S, Patterson K, Stevens B, et al. Feeling different: the experience of living with fetal alcohol spectrum disorder. J Popul Ther Clin Pharmacol 2011;18(3):e475-85. Epub 2011/11/02.
20. Burd L, Klug MG, Li Q, Kerbeshian J, Martsolf JT. Diagnosis of fetal alcohol spectrum disorders: a validity study of the fetal alcohol syndrome checklist. Alcohol 2010;44(7-8):605-14. Epub 2010/01/08.
21. Astley SJ, Aylward EH, Olson HC, Kerns K, Brooks A, Coggins TE, et al. Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2009;33(10):1671-89. Epub 2009/07/04.
22. Astley SJ. Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network. Can J Clin Pharmacol 2010;17(1):e132-64. Epub 2010/03/26.
23. Astley SJ, Olson HC, Kerns K, Brooks A, Aylward EH, Coggins TE, et al. Neuropyschological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Can J Clin Pharmacol 2009;16(1):e178-201. Epub 2009/03/31.
24. Mushtaq MU, Shahid U, Abdullah HM, Saeed A, Omer F, Shad MA, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan's Punjab province. International Journal for Equity in Health 2011;10(1):8.
25. van der Hoeven M, Kruger A, Greeff M. Differences in health care seeking behaviour between rural and urban communities in South Africa. International Journal for Equity in Health 2012;11(1):31.
26. Habbick BF, Nanson JL, Snyder RE, Casey RE, Schulman AL. Foetal alcohol syndrome in Saskatchewan: unchanged incidence in a 20-year period. Can J Public Health 1996;87(3):204-7. Epub 1996/05/01.
27. May PA, Gossage JP, Brooke LE, Snell CL, Marais AS, Hendricks LS, et al. Maternal risk factors for fetal alcohol syndrome in the Western cape province of South Africa: a population-based study. Am J Public Health 2005;95(7):1190-9. Epub 2005/06/04.
28. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Journal of Developmental & Behavioral Pediatrics 2004;25(4):228-38.
29. McFarlane A, Rajani H. Rural FASD diagnostic services model: Lakeland Centre for fetal alcohol spectrum disorder. Can J Clin Pharmacol 2007;14(3):e301-6. Epub 2007/11/21.
30. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal alcohol syndrome: neuropsychiatric phenomics. Neurotoxicology and Teratology 2003;25(6):697-705.
31. Egeland GM, Perham-Hester KA, Gessner BD, Ingle D, Berner JE, Middaugh JP. Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative prevalence derived from multiple data sources. Am J Public Health 1998;88(5):781-6. Epub 1998/05/20.
32. Viljoen DL, Gossage JP, Brooke L, Adnams CM, Jones KL, Robinson LK, et al. Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area. J Stud Alcohol 2005;66(5):593-604. Epub 2005/12/08.
33. Tough SC, Ediger K, Hicks M, Clarke M. Rural-urban differences in provider practice related to preconception counselling and fetal alcohol spectrum disorders. Can J Rural Med 2008;13(4):180-8. Epub 2008/10/11.
34. Jacobson SW. Specificity of neurobehavioral outcomes associated with prenatal alcohol exposure. Alcohol Clin Exp Res 1998;22(2):313-20. Epub 1998/05/15.
35. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22(2):279-94. Epub 1998/05/15.
36. Kodituwakku PW, Kalberg W, May PA. The effects of prenatal alcohol exposure on executive functioning. Alcohol Res Health 2001;25(3):192-8. Epub 2002/01/29.
37. Mattson SN, Riley EP, Gramling L, Delis DC, Jones KL. Neuropsychological comparison of alcohol-exposed children with or without physical features of fetal alcohol syndrome. Neuropsychology 1998;12(1):146-53. Epub 1998/02/14.
38. Streissguth AP, Barr HM, Sampson PD. Moderate prenatal alcohol exposure: effects on child IQ and learning problems at age 7 1/2 years. Alcohol Clin Exp Res 1990;14(5):662-9. Epub 1990/10/01.
39. Mattson SN, Riley EP, Gramling L, Delis DC, Jones KL. Heavy prenatal alcohol exposure with or without physical features of fetal alcohol syndrome leads to IQ deficits. J Pediatr 1997; 131(5): 718-21. Epub 1997/12/24.
40. Loock C, Conry J, Cook JL, Chudley AE, Rosales T. Identifying fetal alcohol spectrum disorder in primary care. CMAJ 2005;172(5):628-30. Epub 2005/03/02.
41. Santhanam P, Coles CD, Li Z, Li L, Lynch ME, Hu X. Default mode network dysfunction in adults with prenatal alcohol exposure. Psychiatry Res 2011;194(3):354-62. Epub 2011/11/15.
42. Astley SJ, Richards T, Aylward EH, Olson HC, Kerns K, Brooks A, et al. Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Magn Reson Imaging 2009;27(6):760-78. Epub 2009/04/04.
43. Driscoll CD, Streissguth AP, Riley EP. Prenatal alcohol exposure: comparability of effects in humans and animal models. Neurotoxicol Teratol 1990;12(3):231-7. Epub 1990/05/01.
44. O'Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry 2002;47(4):349-54. Epub 2002/05/25.
45. Premji S, Benzies K, Serrett K, Hayden KA. Research-based interventions for children and youth with a fetal alcohol spectrum disorder: revealing the gap. Child Care, Health and Development 2007;33(4):389-97.
46. Kooistra L, Ramage B, Crawford S, Cantell M, Wormsbecker S, Gibbard B, et al. Can attention deficit hyperactivity disorder and fetal alcohol spectrum disorder be differentiated by motor and balance deficits? Human Movement Science 2009;28(4):529-42.
47. Connor PD, Sampson PD, Streissguth AP, Bookstein FL, Barr HM. Effects of prenatal alcohol exposure on fine motor coordination and balance: a study of two adult samples. Neuropsychologia 2006;44(5):744-51. Epub 2005/09/13.
48. Nash K, Rovet J, Greenbaum R, Fantus E, Nulman I, Koren G. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Archives of Women's Mental Health 2006;9(4):181-6.
49. Peadon E, Rhys-Jones B, Bower C, Elliott EJ. Systematic review of interventions for children with fetal alcohol spectrum disorders. BMC Pediatr 2009;9:35. Epub 2009/05/26.
2. Kodituwakku PW. Defining the behavioral phenotype in children with fetal alcohol spectrum disorders: a review. Neurosci Biobehav Rev 2007;31(2):192-201. Epub 2006/08/26.
3. Famy C, Streissguth AP, Unis AS. Mental illness in adults with fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry. 1998;155(4):552-4. Epub 1998/04/18.
4. Barr HM, Bookstein FL, O'Malley KD, Connor PD, Huggins JE, Streissguth AP. Binge drinking during pregnancy as a predictor of psychiatric disorders on the Structured Clinical Interview for DSM-IV in young adult offspring. Am J Psychiatry 2006;163(6):1061-5. Epub 2006/06/03.
5. Riley EP, McGee CL. Fetal alcohol spectrum disorders: an overview with emphasis on changes in brain and behavior. Experimental Biology and Medicine 2005;230(6):357-65.
6. Streissguth AP, Barr HM, Kogan J, Bookstein FL. Primary and secondary disabilities. In: Streissguth AP KJ, editor. Fetal Alcohol Syndrome in the Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. Seattle, Washington University of Washington Press, pp25-39; 1997. p. 25-39.
7. Riley EP, Clarren S, Weinberg J, Jonson E. Appendix: FASD Consensus Statement of the Jury. Fetal Alcohol Spectrum Disorder: Wiley-VCH Verlag GmbH & Co. KGaA; 2010. p. 433-50.
8. May PA, Gossage JP, Kalberg WO, Robinson LK, Buckley D, Manning M, et al. Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies. Dev Disabil Res Rev 2009;15(3):176-92. Epub 2009/09/05.
9. Mutch R, Peadon EM, Elliott EJ, Bower C. Need to establish a national diagnostic capacity for foetal alcohol spectrum disorders. J Paediatr Child Health 2009;45(3):79-81. Epub 2009/03/26.
10. Mattson SN, Foroud T, Sowell ER, Jones KL, Coles CD, Fagerlund A, et al. Collaborative initiative on fetal alcohol spectrum disorders: methodology of clinical projects. Alcohol 2009; 44(7-8): 635-41. Epub 2009/12/29.
11. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ 2005;172(5 Suppl):S1-S21. Epub 2005/03/02.
12. Astley SJ. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code. 3rd ed. Seattle, WA: University of Washington Publication Services; 2004.
13. Burd L, Martsolf JT, Klug MG, Kerbeshian J. Diagnosis of FAS: a comparison of the fetal alcohol syndrome diagnostic checklist and the Institute of Medicine Criteria for fetal alcohol syndrome. Neurotoxicology and Teratology 2003;25(6):719-24.
14. Astley SJ. Comparison of the 4-Digit diagnostic code and the Hoyme Diagnostic Guidelines for fetal alcohol spectrum disorders. Pediatrics 2006;118(4):1532-45.
15. McFarlane A. Fetal alcohol spectrum disorder in adults: diagnosis and assessment by a multidisciplinary team in a rural area. Canadian Journal of Rural Medicine 2011;16(1):6.
16. Chudley AE, Kilgour AR, Cranston M, Edwards M. Challenges of diagnosis in fetal alcohol syndrome and fetal alcohol spectrum disorder in the adult. American Journal of Medical Genetics Part C: Seminars in Medical Genetics 2007;145C(3):261-72.
17. Clarren SK, Lutke J. Building clinical capacity for fetal alcohol spectrum disorder diagnoses in western and northern Canada. Can J Clin Pharmacol 2008;15(2):e223-37.
18. Warren KR, Hewitt BG, Thomas JD. Fetal alcohol spectrum disorders: research challenges and opportunities. Alcohol Research & Health 2011;24(1):11.
19. Stade B, Beyene J, Buller K, Ross S, Patterson K, Stevens B, et al. Feeling different: the experience of living with fetal alcohol spectrum disorder. J Popul Ther Clin Pharmacol 2011;18(3):e475-85. Epub 2011/11/02.
20. Burd L, Klug MG, Li Q, Kerbeshian J, Martsolf JT. Diagnosis of fetal alcohol spectrum disorders: a validity study of the fetal alcohol syndrome checklist. Alcohol 2010;44(7-8):605-14. Epub 2010/01/08.
21. Astley SJ, Aylward EH, Olson HC, Kerns K, Brooks A, Coggins TE, et al. Magnetic resonance imaging outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Alcohol Clin Exp Res 2009;33(10):1671-89. Epub 2009/07/04.
22. Astley SJ. Profile of the first 1,400 patients receiving diagnostic evaluations for fetal alcohol spectrum disorder at the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network. Can J Clin Pharmacol 2010;17(1):e132-64. Epub 2010/03/26.
23. Astley SJ, Olson HC, Kerns K, Brooks A, Aylward EH, Coggins TE, et al. Neuropyschological and behavioral outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Can J Clin Pharmacol 2009;16(1):e178-201. Epub 2009/03/31.
24. Mushtaq MU, Shahid U, Abdullah HM, Saeed A, Omer F, Shad MA, et al. Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan's Punjab province. International Journal for Equity in Health 2011;10(1):8.
25. van der Hoeven M, Kruger A, Greeff M. Differences in health care seeking behaviour between rural and urban communities in South Africa. International Journal for Equity in Health 2012;11(1):31.
26. Habbick BF, Nanson JL, Snyder RE, Casey RE, Schulman AL. Foetal alcohol syndrome in Saskatchewan: unchanged incidence in a 20-year period. Can J Public Health 1996;87(3):204-7. Epub 1996/05/01.
27. May PA, Gossage JP, Brooke LE, Snell CL, Marais AS, Hendricks LS, et al. Maternal risk factors for fetal alcohol syndrome in the Western cape province of South Africa: a population-based study. Am J Public Health 2005;95(7):1190-9. Epub 2005/06/04.
28. Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Journal of Developmental & Behavioral Pediatrics 2004;25(4):228-38.
29. McFarlane A, Rajani H. Rural FASD diagnostic services model: Lakeland Centre for fetal alcohol spectrum disorder. Can J Clin Pharmacol 2007;14(3):e301-6. Epub 2007/11/21.
30. Burd L, Klug MG, Martsolf JT, Kerbeshian J. Fetal alcohol syndrome: neuropsychiatric phenomics. Neurotoxicology and Teratology 2003;25(6):697-705.
31. Egeland GM, Perham-Hester KA, Gessner BD, Ingle D, Berner JE, Middaugh JP. Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative prevalence derived from multiple data sources. Am J Public Health 1998;88(5):781-6. Epub 1998/05/20.
32. Viljoen DL, Gossage JP, Brooke L, Adnams CM, Jones KL, Robinson LK, et al. Fetal alcohol syndrome epidemiology in a South African community: a second study of a very high prevalence area. J Stud Alcohol 2005;66(5):593-604. Epub 2005/12/08.
33. Tough SC, Ediger K, Hicks M, Clarke M. Rural-urban differences in provider practice related to preconception counselling and fetal alcohol spectrum disorders. Can J Rural Med 2008;13(4):180-8. Epub 2008/10/11.
34. Jacobson SW. Specificity of neurobehavioral outcomes associated with prenatal alcohol exposure. Alcohol Clin Exp Res 1998;22(2):313-20. Epub 1998/05/15.
35. Mattson SN, Riley EP. A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcohol Clin Exp Res 1998;22(2):279-94. Epub 1998/05/15.
36. Kodituwakku PW, Kalberg W, May PA. The effects of prenatal alcohol exposure on executive functioning. Alcohol Res Health 2001;25(3):192-8. Epub 2002/01/29.
37. Mattson SN, Riley EP, Gramling L, Delis DC, Jones KL. Neuropsychological comparison of alcohol-exposed children with or without physical features of fetal alcohol syndrome. Neuropsychology 1998;12(1):146-53. Epub 1998/02/14.
38. Streissguth AP, Barr HM, Sampson PD. Moderate prenatal alcohol exposure: effects on child IQ and learning problems at age 7 1/2 years. Alcohol Clin Exp Res 1990;14(5):662-9. Epub 1990/10/01.
39. Mattson SN, Riley EP, Gramling L, Delis DC, Jones KL. Heavy prenatal alcohol exposure with or without physical features of fetal alcohol syndrome leads to IQ deficits. J Pediatr 1997; 131(5): 718-21. Epub 1997/12/24.
40. Loock C, Conry J, Cook JL, Chudley AE, Rosales T. Identifying fetal alcohol spectrum disorder in primary care. CMAJ 2005;172(5):628-30. Epub 2005/03/02.
41. Santhanam P, Coles CD, Li Z, Li L, Lynch ME, Hu X. Default mode network dysfunction in adults with prenatal alcohol exposure. Psychiatry Res 2011;194(3):354-62. Epub 2011/11/15.
42. Astley SJ, Richards T, Aylward EH, Olson HC, Kerns K, Brooks A, et al. Magnetic resonance spectroscopy outcomes from a comprehensive magnetic resonance study of children with fetal alcohol spectrum disorders. Magn Reson Imaging 2009;27(6):760-78. Epub 2009/04/04.
43. Driscoll CD, Streissguth AP, Riley EP. Prenatal alcohol exposure: comparability of effects in humans and animal models. Neurotoxicol Teratol 1990;12(3):231-7. Epub 1990/05/01.
44. O'Malley KD, Nanson J. Clinical implications of a link between fetal alcohol spectrum disorder and attention-deficit hyperactivity disorder. Can J Psychiatry 2002;47(4):349-54. Epub 2002/05/25.
45. Premji S, Benzies K, Serrett K, Hayden KA. Research-based interventions for children and youth with a fetal alcohol spectrum disorder: revealing the gap. Child Care, Health and Development 2007;33(4):389-97.
46. Kooistra L, Ramage B, Crawford S, Cantell M, Wormsbecker S, Gibbard B, et al. Can attention deficit hyperactivity disorder and fetal alcohol spectrum disorder be differentiated by motor and balance deficits? Human Movement Science 2009;28(4):529-42.
47. Connor PD, Sampson PD, Streissguth AP, Bookstein FL, Barr HM. Effects of prenatal alcohol exposure on fine motor coordination and balance: a study of two adult samples. Neuropsychologia 2006;44(5):744-51. Epub 2005/09/13.
48. Nash K, Rovet J, Greenbaum R, Fantus E, Nulman I, Koren G. Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential. Archives of Women's Mental Health 2006;9(4):181-6.
49. Peadon E, Rhys-Jones B, Bower C, Elliott EJ. Systematic review of interventions for children with fetal alcohol spectrum disorders. BMC Pediatr 2009;9:35. Epub 2009/05/26.