Masotti, P., George, M. A., Szala-Meneok, K., Morton, A. M., Loock, C., Van Bibber, M., Ranford, J., Fleming, M., & MacLeod, S. (2006). Preventing fetal alcohol spectrum disorder in aboriginal communities: A methods development project. PLoS Medicine, 3(1), 24-29.
May, P. A., Miller, J. H., Goodhart, K. A., Maestas, O. R., Buckley, D., Trujillo, P. M., & Gossage, J. P. (2008). Enhanced case management to prevent fetal alcohol spectrum disorders in northern plains communities. Maternal and Child Health Journal, 12(6), 747-759.
Women proven to be extremely high risk for drinking during pregnancy were provided case management (CM) enhanced with strategies derived from motivational interviewing (MI) as a part of a comprehensive Fetal Alcohol Syndrome (FAS) epidemiology and prevention program in four American Indian communities in Northern Plains states. Data on the first women enrolled (n = 131) revealed that they have extreme issues with alcohol abuse to overcome. Sixty-five percent of these women have experienced extensive alcohol use within their immediate family. At intake, 24% of CM clients reported binge drinking one or more days in the preceding week. Heavy drinking resulted in estimated blood alcohol concentrations (BAC) as high as .576 using the BACCUS methodology. Project staff has attempted to actively engage each of these women in CM. Clients have been in CM an average of 17.2 months (SD = 16.6). The mean number of significant contacts (face-to-face or telephone MI sessions) was 19. Thirty-one percent of the women entered some type of formal alcohol or drug treatment while in CM. Data were collected at 6 month intervals from 6 to 72 months after enrollment. Consumption of alcohol, as measured by both quantity and frequency measures, was reduced at 6 months. Thirty-eight percent of enrolled women reported complete abstinence from alcohol use at 6 months, and the number of binges while drinking in CM declined significantly from 15 at baseline to 4.3 at 6 months. However, mean peak BACs for the heavy drinking sessions were still problematic for those who continued to drink. They ranged from .234 to .275 from baseline to 12 month follow-up, but the total number of binges was reduced substantially at 12 months as well. Furthermore, the most important outcomes are the status of the children born while in CM. One hundred and forty nine pregnancies have occurred among these women, and 76% of those pregnancies have resulted in normal deliveries, and only two children born in CM are suspected of having some form of severe FASD. At 6, 12, 18, and 24 month follow-up milestones, 70% of the women who were not currently pregnant were protected from having a child with FAS by not drinking, using birth control, or both. Other measures of CM success include enrolling in school, regaining custody of children, completing substance abuse treatment, probation from the criminal justice system, substantial periods of abstinence, enrolling in programs to improve life skills, and employment. © Springer Science+Business Media, LLC 2007.
Merrick, J., & Kandel, I. (2007). Fetal alcohol syndrome and suicide. A review. International Journal on Disability and Human Development, 6(3), 237-239.
French and American research groups have made us aware in modern time of the fetal alcohol syndrome and the damaging effects on the fetus. In recent years, research has shown its life long consequences on physical development, intellectual development, behavior, social development, occupation, independence, sexuality or sexual behavior, and increased risk of suicidality. In this review, we found a higher incidence of mental health problems in this population. The only study conducted on suicidal behavior found that fetal alcohol syndrome population had a ten times higher lifetime rate of suicide attempt than the general population. Primary prevention is the obvious intervention, but public health efforts have not been effective, therefore it is important that professionals working with this population also become aware of the risk for suicidal behavior. Copyright © Freund Publishing House Limited.
Morantz, C. A. (2006). CDC releases guidelines on identifying and referring persons with fetal alcohol syndrome. American Family Physician, 73(5), 916-919.
Moore, E. S., Ward, R. E., Wetherill, L. F., Rogers, J. L., Autti-Rämö, I., Fagerlund, Å., Jacobson, S. W., Robinson, L. K., Hoyme, H. E., Mattson, S. N., Foroud, T., & The CIFASD. (2007). Unique facial features distinguish fetal alcohol syndrome patients and controls in diverse ethnic populations. Alcoholism: Clinical and Experimental Research, 31(10), 1707-1713. doi:10.1111/j.1530-0277.2007.00472.x
Background: Effective management of fetal alcohol spectrum disorders (FASD) is dependent on the timely and reliable diagnosis of affected individuals. There are significant diagnostic difficulties because of the reduced prominence of facial features as children age to adulthood as well as potential population or ethnic differences in the most characteristic alcohol-related facial features. Methods: A total of 276 subjects were recruited from 4 sites (Cape Town, South Africa; Helsinki, Finland; Buffalo, New York; and San Diego, California) and completed a detailed dysmorphology evaluation to classify subjects as either fetal alcohol syndrome (FAS; 43%) or control (57%). Computerized anthropometry was employed to identify facial features that could distinguish FAS patients from controls across a wide age range and across ethnically disparate study populations. Results: Subjects were placed into 1 of 4 populations based on their ancestry (Cape Coloured, Finnish Caucasian, African American, or North American Caucasian). Analyses performed in each of the 4 study populations were able to identify a unique set of variables which provided excellent discrimination between the 2 groups (FAS, control). In each study group, at least one ocular-related measurement, shortened palpebral fissure, reduced outer canthal width, or reduced inner canthal width, was included in the final classification model. Conclusions: We found measurements that reflected reduced size of the eye orbit to be a consistent feature discriminating FAS and controls across each study population. However, each population had a unique, though often overlapping, set of variables which discriminated the 2 groups, suggesting important ethnic differences in the presentation of FAS. It is possible that these differences were accentuated by the wide age distribution of the study subjects. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)
Murthy, P., Kudlur, S., George, S., & Mathew, G. (2009). A clinical overview of fetal alcohol syndrome. Addictive Disorders & their Treatment, 8(1), 1-12. doi:10.1097/ADT.0b013e318163b062
Fetal alcohol syndrome is the leading cause of mental retardation worldwide and is also the foremost preventable cause of neurobehavioral and developmental abnormalities. In this paper, we discuss those aspects of fetal alcohol syndrome relevant to the clinician: its clinical characteristics, assessment, diagnosis, and prevention. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract)
Mutch, R., Peadon, E. M., Elliott, E. J., & Bower, C. (2009). Need to establish a national diagnostic capacity for foetal alcohol spectrum disorders. Journal of Paediatrics and Child Health, 45(3), 79-81.
Alcohol exposure in pregnancy can induce a broad range of physical and developmental defects in the child, collectively known as foetal alcohol spectrum disorders (FASD). In Australia, there are proven gaps in our knowledge and practice for recognising and diagnosing FASD. The challenge for the Australian health professional is agreeing on a model for diagnosing and treating FASD. The diagnostic method must be evidence based, sensitive and specific, and account for other exposures during pregnancy and early life events. Training in application of the diagnostic method needs to be readily available in metropolitan and regional Australia. The University of Washington FASD 4-digit diagnostic code fulfils all of these best practice criteria, recommending itself as the method of choice. © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
O’Connor, M. J., & Whaley, S. E. (2007). Brief intervention for alcohol use by pregnant women. American Journal of Public Health, 97(2), 252-258.
Objectives. We examined the efficacy of brief intervention as a technique to help pregnant women achieve abstinence from alcohol. A second aim was to assess newborn outcomes as a function of brief intervention. Methods. Two hundred fifty-five pregnant women who were participants in the Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children and who reported drinking alcohol were assigned to an assessment-only or a brief intervention condition and followed to their third trimester of pregnancy. Brief intervention consisted of 10- to 15-minute sessions of counseling by a nutritionist, who used a scripted manual to guide the intervention. Newborn outcomes of gestation, birthweight, birth length, and viability were assessed. Results. Women in the brief intervention condition were 5 times more likely to report abstinence after intervention compared with women in the assessment-only condition. Newborns whose mothers received brief intervention had higher birthweights and birth lengths, and fetal mortality rates were 3 times lower (0.9%) compared with newborns in the assessment-only (2.9%) condition. Conclusions. The success of brief intervention conducted in a community setting by nonmedical professionals has significant implications for national public health policies.
Olson, H. C., Jirikowic, T., Kartin, D., & Astley, S. (2007). Responding to the challenge of early intervention for fetal alcohol spectrum disorders. Infants and Young Children, 20(2), 172-189.
Prenatal alcohol exposure can lead to significant neurodevelopmental disabilities, now recognized as fetal alcohol spectrum disorders (FASD). This includes both fetal alcohol syndrome, a lifelong birth defect, and a wider range of enduring learning and behavior deficits often called alcohol-related neurodevelopmental disorder (ARND). Diagnostic classification systems have been developed to identify children with FASD, and early interventionists from multiple disciplines can be central in identification and referral for diagnosis, and in providing the known protective influence of intervention early in life. With the recent federal mandates to better address needs of children born prenatally affected by substances, or those impacted by abuse and/or neglect, by referring them for screening and possible early intervention services, there is heightened need for providers to understand FASD. There is a growing body of research data describing the teratogenic effects of alcohol on central nervous system function and physical development, the diversity of children with prenatal alcohol exposure and their families, and the developmental and behavioral characteristics of this clinical population. This article reviews the latest research evidence, bearing in mind what is important to early intervention. This article also gives practical guidance on FASD prevention, methods for early screening, and referral of young children for diagnosis of FASD (and referral for needed services once diagnosed), and how to provide education, support, advocacy assistance, and anticipatory guidance for families raising children with FASD. Copyright © 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Olson, H. C., Oti, R., Gelo, J., & Beck, S. (2009). “Family matters:” fetal alcohol spectrum disorders and the family. Developmental Disabilities Research Reviews, 15(3), 235-249.
Information about “family matters” is vital to developing targeted interventions, reducing placement disruption, and enhancing outcome in fetal alcohol spectrum disorders (FASD). The quality of the caregiving environment and family function are associated with long-term outcome in natural history study of individuals with FASD. This article integrates multiple information sources to better understand the role of family factors in the outcome of individuals with FASD, and how the family is affected by raising a child with this lifelong condition. A brief description of the useful informal literature is brought together with a review of the surprisingly limited body of systematic research findings on FASD and caregiver/family function, and new data describing children with FASD and characteristics of their caregivers. Directions for future data-gathering and intervention development emerge from combining what is already known with an exploration of what can be learned from a highly targeted review of family-related data in the wide-ranging, general literature on developmental disabilities, and use of a proposed conceptual framework that joins a developmental systems perspective with a family systems approach. © 2009 Wiley-Liss, Inc.