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Objective Individuals with fetal alcohol spectrum disorder (FASD) experience a range of complex neurodevelopmental, psychological, and socioenvironmental vulnerabilities. There is growing evidence that suicidal ideation, attempts, and death by suicide are significant concerns within this population. In this study, we (1) determined the rate of suicidal ideation/attempts in a large group of individuals with prenatal alcohol exposure (PAE) who were assessed for FASD in Canada and (2) investigated the associations between suicidal ideation/attempts and select demographic and biopsychosocial factors in this group. Method A secondary analysis of data from Canada's National FASD Database, a national repository of clinical information gathered through FASD assessment and diagnostic clinics across the country, was conducted. Descriptive analyses, chi-square/Fisher's exact tests, and binary logistic regression were used to examine demographic and biopsychosocial variables and their associations with suicidality. Results In our sample of 796 participants ( Mage = 17.7 years, range = 6–59; 57.6% male) assessed for FASD, 25.9% were reported to experience suicidal ideation/attempts. Numerous demographic and biopsychosocial factors were found to be significantly associated with suicidal ideation/attempts. The strongest associations with suicidal ideation/attempts were substance use, history of trauma/abuse, and impaired affect regulation. Conclusions With this study, we contribute to the emerging evidence of elevated risk of suicidality among individuals with PAE/FASD and improve our understanding of factors that may exacerbate this risk. Findings have relevance for improving screening, prevention, and proactive treatment approaches for individuals with PAE and FASD, their families, and wider support systems.

Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.

Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.

Background: Infants, children, and youth in foster care have frequently experienced prenatal substance exposure (PSE), neglect, and maltreatment as well as disruptions in their relationships with f...

AIM To describe the birth prevalence and characteristics of congenital heart defects in a geographically defined Australian population. METHODS This descriptive, population-based study examined congenital heart defects in live births, stillbirths and pregnancy terminations ascertained by the Western Australian Register of Developmental Anomalies, 1990-2016. Birth prevalence (per 1000 births) was stratified by severity, known cause, maternal and birth characteristics, and primary diagnosis; and prevalence ratios were calculated for Aboriginal versus non-Aboriginal births. Temporal trends in prevalence, diagnosis age and infant mortality were examined. RESULTS For births 1990-2010 (allowing 6 years for complete case ascertainment by 2016), 6419 cases were identified; prevalence was 11.5 per 1000 births (95% confidence interval (CI), 11.2-11.8). Severe defects were ascertained in 2.5 per 1000 births (95% CI 2.4-2.7). Most cases were liveborn (5842, 91.0%), and 28.9% had other birth defects. Prevalence was slightly higher in Aboriginal births (prevalence ratio 1.1; 95% CI 1.0-1.2); and the infant mortality rate more than doubled (13.4% vs. 5.8%, P

People with fetal alcohol spectrum disorder (FASD) and women who drink alcohol while pregnant can experience stigma, possibly exacerbated by stereotyped media portrayals. To understand experiences ...

Background Young people with Fetal Alcohol Spectrum Disorder (FASD) can face significant challenges in their lives, including overrepresentation in the justice system from a young age. Police questioning and court proceedings can be difficult for these young people to navigate. Practice and policy responses are necessary to identify these individuals, provide appropriate support/rehabilitation, and upskill the justice workforce. The aim of this research was to determine the unmet workforce development needs of a regional workforce providing care and support to youth involved with the justice system. Interviews were conducted with 29 participants from 14 organisations to understand the support provided to youth, existence and uptake of referral pathways, and unmet needs. Results Results revealed a workforce that wants to see improvements to outcomes for young people with FASD and other neurodevelopmental disabilities who enter the youth justice system. However more support is required through training, ongoing funding, and assistance to develop FASD informed work practices. Conclusions The workforce supporting youth to navigate the justice system requires practical interventions to achieve best practice so that young people with FASD and other neurodevelopmental disabilities receive the support that they need. Following the interviews a model of care tool was developed and piloted in the sector. The tool includes current pathways through the justice system and provides resources to assist staff in achieving best practice care for young people with FASD and other neurodevelopmental disabilities.

Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)—the most common neurodevelopmental condition—are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.

Objective: Children with fetal alcohol spectrum disorder (FASD) are overrepresented in early intervention programs, foster care, special education, juvenile corrections, and mental health services. In this study, we examine relationships between FASD and non-FASD controls for adverse childhood experiences (ACEs), and neurodevelopmental disorders. Methods: A chart review was conducted among patients seen at our clinic from 2010-2017 with data on FASD, ACEs, neurodevelopmental diagnoses, and foster or residential care placement available. Results: Relative risk for FASD was increased in patients with increased ACE scores (RR = 5.08), increased numbers of neurodevelopmental diagnoses (RR = 2.36), and patients who have been in foster or residential care (RR = 9.53). FASD risk increased as ACE scores or the number of neurodevelopmental diagnoses increased. Patients with any ACEs were 3.96 times more likely to have FASD, and those with eight or more ACEs were 6.31 times more likely to have FASD than those with no ACEs. Patients with three or more neurodevelopmental diagnoses were 6.55 times more likely to have FASD than those with two or fewer diagnoses. Nine or more diagnoses increased the risk for FASD ten-fold (RR = 10.91). Conversely, patients diagnosed with FASD were more likely to have at least three ACEs (RR = 3.71), at least five neurodevelopmental diagnoses (RR = 1.61), and high rates of previous foster or residential care placement (RR = 5.39). Conclusion: This study demonstrates that all children being considered for placement in foster care or residential should be screened for FASD.

The paper aims at reviewing data on the executive functioning in children and adolescents with fetal alcohol spectrum disorder (FASD) in the context of Suchy’s model of executive functioning. Suchy hypothesized that individuals with FASD would present with features of dysexecutive, disinhibited, apathetic and inappropriate, but not disorganized, syndromes. Eight papers satisfied the inclusion criteria for the review. In most respects, the performance of children with FASD was found to be lower than in the control group. According to Suchy’s model of executive functioning, children with FASD demonstrate features of dysexecutive syndrome (with deficits of executive cognitive functions) and of apathetic (deficit in initiation and maintenance) and disinhibited syndromes (deficit in response selection) as well as impaired social cognition that could correspond to socially inappropriate syndromes. None of the reviewed studies included measures of multi-tasking that would address features of disorganized syndrome. The results suggest a mixed pattern of executive deficits in FASD. Difficulties in delineating the executive functioning profile in children and adolescents with FASD may be related to heterogeneous patient populations (different clinical criteria, variable overall intellectual functioning and different living conditions) and also the complex nature of most of the executive measures that rarely tap one aspect of the executive functioning and typically engage a variety of cognitive processes.

Individuals with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder caused by prenatal exposure to alcohol, are overrepresented in criminal justice settings and have complex, for...

Prenatal alcohol exposure can result in a wide range of adverse health outcomes, including in some cases fetal alcohol spectrum disorder (FASD), a lifelong neurodevelopmental disorder. Thus, there is pressing need for effective interventions to prevent alcohol-exposed pregnancies (AEPs). A systematic review was undertaken to provide an up-to-date analysis of the current prevention literature. Pubmed, Embase, CINAHL and PsycINFO were searched for relevant English-language articles published from 1970 onwards. Studies were eligible for the current systematic review if the interventions included pregnant and postpartum women and/or their support networks to prevent AEPs and FASD. Outcomes of interest included alcohol consumption behaviour, knowledge, contraceptive use, neonatal outcomes, family wellbeing or functioning, economics and healthcare utilization outcomes. 34 peer-reviewed studies met the inclusion criteria. Fifteen studies employed brief intervention methods, 6 used long term/intensive strategies, and 5 were educational interventions. A further 3 studies assessed counselling approaches, 2 evaluated multicomponent interventions and 3 assessed nutritional supplementation interventions. The current review identified variable results from available interventions to prevent alcohol use among pregnant and postpartum women. Preliminary evidence demonstrated that brief interventions may be effective among subgroups of pregnant women with higher initial alcohol consumption, those with partner involvement, and those who used alcohol and other substances concurrently. Some preliminary evidence relating to long-term interventions with pregnant women with poly-substance use emerged, specifically case management that not only focused on reduction of substance use, but also on addressing the complex interplay of health and social well-being of families. Overall, additional research is required to improve the effectiveness of preventative approaches during pregnancy and the post-partum period.

Evidence based strategies are needed to enhance the ability of the Alcohol and Other Drugs (AOD) sector to prevent prenatal alcohol exposure (PAE) and harms including Fetal Alcohol Spectrum Disorde...

Purpose Fetal alcohol spectrum disorder (FASD) is a complex lifelong disorder impacting the brain and body. Individuals with FASD may require lifelong supports and are at a higher risk of experiencing adverse outcomes, including incarceration. Individuals with FASD face stigma related to FASD that impacts disclosure of the diagnosis and access to supports. The prevalence of FASD exceeds that of other developmental disabilities, yet it remains less visible and stigmatized. Design/methodology/approach Interviews conducted with health-care and justice professionals in a Canadian province explore their experiences attending to FASD and challenges of stigma. Findings While difficult to access, diagnosis provides a pathway to supports and is crucial in the criminal justice process. Visibility and invisibility in health and justice systems highlight the lack of understanding of FASD and surrounding stigma. When unaddressed, individuals with FASD face additional challenges stemming from a lack of information and strategies by professionals involved in their lives. Originality/value Stigma represents a significant and complex issue intertwined in understandings of FASD. This research explores this relationship and the mechanisms through which FASD stigma has impacts in health-care and justice settings.

Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD) is known to improve outcomes in children. It is less clear if diagnosis in adulthood also conveys benefits. This study investigated long-te...

Impairments in visuomotor integration (VMI) may contribute to anomalous development of motor, as well as social-communicative, skills in children with autism spectrum disorder (ASD). However, it is relatively unknown whether VMI impairments are specific to children with ASD versus children with other neurodevelopmental disorders. As such, this study addressed the hypothesis that children with ASD, but not those in other clinical control groups, would show greater deficits in high-VMI dynamic grip-force tracking versus low-VMI static presentation. Seventy-nine children, aged 7-17 years, participated: 22 children with ASD, 17 children with fetal alcohol spectrum disorder (FASD), 18 children with Attention-Deficit Hyperactivity Disorder (ADHD), and 22 typically developing (TD) children. Two grip-force tracking conditions were examined: (1) a low-VMI condition (static visual target) and (2) a high-VMI condition (dynamic visual target). Low-frequency force oscillations

There is limited evidence to inform effective screening practices for identifying fetal alcohol spectrum disorder (FASD) in forensic mental health settings. This study sought to explore the potenti...

The first study to investigate the prevalence of fetal alcohol spectrum disorder (FASD) within an Australian juvenile detention centre has identified the highest known prevalence of FASD among a justice-involved population worldwide. However, there has been limited investigation into the capacity of the custodial workforce to identify and manage young people in Australian detention centres with FASD or other neurodevelopmental impairment (NDI), and no published interventions aiming to develop environments appropriate for those with FASD in justice settings. Using the Template for Intervention Description and Replication checklist, this study describes the conception, implementation and evaluation of a training intervention aiming to upskill the custodial workforce in the management of youth with FASD and NDI; 117 staff participated in the intervention, and 109 completed pre- and post-intervention surveys. Improvements were seen across almost all knowledge and attitude items, and the intervention was considered highly necessary, appropriate and valuable by the workforce.

Fetal alcohol spectrum disorder (FASD) is a diagnostic term used to describe an array of structural, neurocognitive, and behavioral effects that result from prenatal alcohol exposure. While ongoing efforts have been made to increase the capacity of communities to provide early FASD diagnosis, there continues to be on-going challenges, particularly for remote and rural communities. Telehealth is the use of technology to connect communities at a distance and has been effectively used in medicine for several decades. This literature review describes the use of telehealth in FASD and other developmental disabilities and makes recommendations for how telehealth can be used to facilitate the assessment and diagnosis of FASD in rural and remote communities.

Fetal alcohol syndrome is regarded as a spectrum. Fetal alcohol spectrum disorder (FASD) might be surprisingly common, especially in vulnerable populations. Mental health problems, substance abuse, inappropriate sexual behavior, school and legal problems and unemployment might cooccur with FASD. Treatment of comorbidities might be helpful, however effects of stimulants in FASD are controversial. Women who drink during pregnancy might suffer from nutritional deficiencies, therefore try of compensation might be helpful for both mother and child. Moreover, nutrient of children with FASD might play an important role as a potential supportive therapy. In addition, physical exercise therapy might be beneficial for both mother and children because of neurogenesis induction potential. There is no established therapy for FASD, therefore further studies should focus on formulating one. (JNNN 2020;9(3):119–122)

Background Fetal alcohol spectrum disorder (FASD) is a leading cause of neurodevelopmental disorders. Children in foster care or domestically adopted are at greater risk for FASD. The aim of this study was to determine the prevalence or risk for FASD in a selected population of foster and adopted children. Methods Children between 2 and 12 years who were candidates for adoption in foster care were evaluated for clinical manifestations and historical features of fetal alcohol spectrum disorder based on established criteria for FASD. Results Of the 89 children evaluated, 18 had mothers with a confirmed history of alcohol consumption during pregnancy. Two children had fetal alcohol syndrome and one had partial fetal alcohol syndrome. In addition, five had alcohol-related neurodevelopmental disorder, one had alcohol-related birth defects, and a single child had manifestations of both. Of the 71 children in which fetal alcohol exposure could not be confirmed, many had manifestations that would have established a diagnosis of FASD were a history of maternal alcohol consumption obtained. Conclusions In a population of high-risk children seen in an adoption clinic, many had manifestations associated with FASD especially where prenatal alcohol exposure was established. The reported prevalence in this study is higher than that reported in our previous study of younger children. This is most likely due to the higher number of children diagnosed with alcohol-related neurodevelopmental disorders that typically manifest at an older age.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention. Electronic supplementary material The online version of this article (10.1007/s10803-020-04545-w) contains supplementary material, which is available to authorized users.

Background There is increasing interest in the development of newborn screening tests to identify children at risk of fetal alcohol spectrum disorder (FASD) in order to provide these children with early intervention. Phosphatidylethanol (PEth) has emerged as a potential universal newborn screening candidate. Methods The aim of this report was to present the results of a study designed to compare PEth levels in 1,140 postpartum women and their newborn infants in Montevideo, Uruguay, and Sao Paulo, Brazil. Self-report alcohol use during pregnancy data was collected, along with both maternal and newborn dried blood spot samples for PEth analysis. Results The average age and parity of the women in the sample were 26 years of age and 2.3 pregnancies. For the Uruguay sample (n = 611), 45.8% of postpartum women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 43.6 ng/ml. In contrast, 86.8% of the newborns had PEth levels ≥ 8 ng/ml, with a mean positive PEth of 77.4 ng/ml. For the Brazil sample (n = 529), 33.2% of women had PEth levels ≥ 8 ng/ml with a mean positive PEth of 31 ng/ml. In contrast, 76.9% of the Brazil newborns had PEth levels ≥ 8 ng/ml and 43.9% with a mean positive PEth of 61.1 ng/ml. PEth levels were significantly higher in newborns compared with their postpartum mothers in both the Uruguay and Brazil samples. Self-reported third-trimester alcohol was 6% in the Uruguay sample and 9.1% in the Brazil sample compared with positive maternal PEth levels in 45.8% and 33.2%, respectively. Conclusions Clinicians may want to consider newborn PEth screening in high-risk populations where prenatal alcohol use is common. The mechanism underlying significantly higher PEth levels in newborns compared with their mothers is not known.

BACKGROUND Fetal alcohol spectrum disorder (FASD) is a diagnosis relating to neurocognitive impairments associated with prenatal alcohol exposure. A key aspect of improving FASD diagnostic processes and management is understanding the demographic and neurocognitive profile of those living with FASD. The aim of this study was to describe the demographic and neurocognitive profile of the first 199 individuals diagnosed with FASD in PATCHES Paediatrics clinics. METHODS A retrospective cross-sectional descriptive study design was conducted with individuals diagnosed with FASD between 2013 and 2018 through a multidisciplinary team according to the Australian FASD Diagnostic Guidelines. RESULTS Participants were primarily male 133 (66.8%) and Aboriginal Australian 147 (73.9%), aged 2 to 31 (mean 10.5), with 94 (47.3%) from remote or very remote parts of Western Australia. Participants came from low 119 (59.8%), medium 48 (24.1%), and high 32 (16.1%) socioeconomic (SE) backgrounds. Low SE background was found to be a predictor of number of sentinel facial features (Wald χ2 (1) = 4.03, p

The purpose of this research was to examine the utilization of enhanced practice standards for children in care with Fetal Alcohol Spectrum Disorder (FASD). Children in care with FASD represent a vulnerable population and require multiple supports from a cross-disciplinary perspective. Children removed from the care of their parents were identified as having needs beyond standard care provided within Children’s Services in Alberta. To address this concern a project was initiated in 2002 and completed in 2005 which identified positive benefit from an increase in caseload hours for workers responsible for children with FASD in the Aboriginal Unit including more contact with children and additional supports for foster parents. Standards regarding family visitation are also highlighted. An additional casework position was developed in order to decrease caseloads and meet the standards. Changing the way child welfare and foster care services are delivered for children with FASD is an important phenomenon to study and this research may guide future interventions.

BACKGROUND AND PURPOSE: In the medicolegal literature, notching of the corpus callosum has been reported to be associated with fetal alcohol spectrum disorders. Our purpose was to analyze the prevalence of notching of the corpus callosum in a fetal alcohol spectrum disorders group and a healthy population to determine whether notching occurs with increased frequency in the fetal alcohol spectrum disorders population. MATERIALS AND METHODS: We performed a multicenter search for cases of fetal alcohol spectrum disorders and included all patients who had a sagittal T1-weighted brain MR imaging. Patients with concomitant intracranial pathology were excluded. The corpus callosum was examined for notches using previously published methods. A χ2 test was used to compare the fetal alcohol spectrum disorders and healthy groups. RESULTS: Thirty-three of 59 patients with fetal alcohol spectrum disorders (0–44 years of age) identified across all centers had corpus callosum notching. Of these, 8 had an anterior corpus callosum notch (prevalence, 13.6%), 23 had a posterior corpus callosum notch (prevalence, 39%), and 2 patients demonstrated undulated morphology (prevalence, 3.4%). In the healthy population, the anterior notch prevalence was 139/875 (15.8%), posterior notch prevalence was 378/875 (43.2%), and undulating prevalence was 37/875 (4.2%). There was no significant difference among the anterior (P = .635), posterior (P = .526), and undulating (P = .755) notch prevalence in the fetal alcohol spectrum disorders and healthy groups. CONCLUSIONS: There was no significant difference in notching of the corpus callosum between patients with fetal alcohol spectrum disorders and the healthy population. Although reported to be a marker of fetal alcohol spectrum disorders, notching of the corpus callosum should not be viewed as a specific finding associated with fetal alcohol spectrum disorders.

PURPOSE OF REVIEW To highlight research, publications, and medical advancements in fetal alcohol spectrum disorder (FASD) over the past 18 months. RECENT FINDINGS Prevalence numbers have been updated, allowing for a more accurate account of the societal impact. Further work on diagnostic techniques and the underlying mechanisms will allow us to better understand the pathophysiology of FASD and could translate into treatments for the condition. Continued research on new treatments and interventions is needed to improve the affected individual's health care and quality of life. Measurable outcomes allow us to tangibly measure improvements for individuals and families affected by FASD. SUMMARY The current review highlights recent publications from January 2018 to August 2019 showing continued medical advancement in improving the care for children and families affected by FASD.

Primary Subject area Developmental Paediatrics Background The incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of developmental and cognitive disabilities among Ontario’s children. No study has conducted a comparison of the costs associated with FASD among Indigenous children, and Non-Indigenous children. Objectives To calculate and compare an estimate of direct and indirect costs associated with FASD at the patient level among Indigenous children and Non-Indigenous children living in Ontario. Design/Methods A cross-sectional study design was used. Eight-hundred and thirty (830) participants completed the study tool. Participants included caregivers of children aged 3 months to 17.5 years, living in urban and rural communities throughout Ontario. Four-hundred and twelve (412) participants were Indigenous Ontarians, and 418 participants were Non-Indigenous Ontarians. Participants completed the Health Services Utilization Inventory (HSUI). Key cost components were elicited: direct costs (medical, education, social services, out-of-pocket costs); and indirect costs (productivity losses). Total average costs per child with FASD were calculated by summing the costs for each, in each cost component, and dividing by the sample size. Costs were extrapolated to one year. A t-test was used to compare costs associated with FASD in the two groups. A stepwise multiple regression analysis was used to identify significant determinants of costs. Results Total adjusted annual costs associated with FASD at the individual level was $51,543 (95% CI $46,825; $56,642) among Indigenous children compared to $36,435 (95% CI $31,935; $42,245), among Non-Indigenous children (p Conclusion Study results demonstrated the cost associated with FASD in Ontario was significantly greater among Indigenous children compared to Non-Indigenous children. Implications for practice, policy, and research are discussed.

Background: Fetal alcohol spectrum disorder (FASD) has been recently estimated to afflict up to 5% of American children. Most of these children exhibit different degrees of symptomatology of disruptive behaviors. Yet, there has been very little research on the efficacy and safety of pharmacological modalities, limited mostly to stimulants for attention deficit hyperactive disorder or second generation atypical antipsychotics for aggression. Recently, the use of cannabinoids has been described for symptoms related to autistic spectrum disorder with apparent favorable effects, as well as for other disruptive behaviors. The objective of our study was to follow up in a retrospective case series the effect of cannabis in children and young adults diagnosed with FASD. Methods: In two children and three FASD young adults with severe disruptive behavior, changes in behavior after cannabis use were measured by the parent version of the Nisonger Child Behavior Rating Form. Results: In all five cases, there was a highly statistical decrease in the disruptive behavior score from 18±1.0 before cannabis use to 6±2.1 after introduction of cannabis (p=0.0002). Discussion: In children and young adults with FASD, cannabis, mostly cannabidiol (CBD), has been associated with a marked and statistically significant improvement in serious disruptive behavior. These cases suggest that the efficacy and safety of CBD should be tested in well-controlled studies.

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders (FASDs) are caused by prenatal alcohol exposure (PAE). They cause epigenetic changes, permanent neurodevelopmental deficits, and anomalies in growth and facial structure. This article enforces the need for health and social care professionals to have a greater understanding and awareness of how FAS and FASD may impact on the individual, the family and the community, to enable them to provide the most effective preventive and supportive care possible.

Background: Alcohol is a teratogen and prenatal exposure may adversely impact the developing fetus, increasing risk for negative outcomes, including Fetal Alcohol Spectrum Disorder (FASD). Global trends of increasing alcohol use among women of childbearing age due to economic development, changing gender roles, increased availability of alcohol, peer pressure and social acceptability of women’s alcohol use may put an increasing number of pregnancies at risk for prenatal alcohol exposure (PAE). This risk has been exacerbated by the ongoing COVID-19 pandemic in some countries. Method: This literature review presents an overview on the epidemiology of alcohol use among childbearing age and pregnant women and FASD by World Health Organization regions; impact of PAE on fetal health, including FASD; associated comorbidities; and social outcomes. Results/Conclusion: The impact of alcohol on fetal health and social outcomes later in life is enormous, placing a huge economic burden on countries. Prevention of prenatal alcohol exposure and early identification of affected individuals should be a global public health priority.

Background Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic medication. However, to date there are no FASD specific guidelines for prescribing medication. Recently, Mela and colleagues described four behavioural symptom clusters commonly seen in FASD with suggested pharmacologic treatment for each cluster within an algorithm. The primary objective was to compare the proposed treatment algorithm retrospectively to actual treatment in a real-world FASD pediatric practice. The secondary objective was to refine the description of symptom clusters which will be targeted with treatment. Methods We collected the diagnostic and medication history from all patient visits of a Regina Developmental Pediatrician who specializes in FASD diagnosis and medication treatment. Three hundred fifty-four FASD patients were identified between 2005 to 2020. The medications that would be predicted from the algorithm were compared to the real-world historical data. A positive case was defined as all algorithm-predicted medications matching the historical data; a negative case had one or more medications failing to match. Results Of the 354 patients, 36 were removed for insufficient information. Of the remaining 318 cases, 172 (54.1%) were positive compared to 146 (45.9%) negatives. In single prescription cases (n=147), the incidence of positives was 67.3%; in multi-prescriptions (n=72) it was 27.8%; and in cases where no prescription was needed (n=99), the positive incidence was 53.5%. Conclusions The prescription algorithm is promising but requires further refinement to accommodate the range of presentations in children with FASD. With respect to unclassified symptoms, we propose the following: sleep onset difficulty as hyperarousal; gender dysphoria and obsessive compulsive disorder as cognitive inflexibility; grief as emotional regulation; and autism spectrum disorder as hyperactive/neurocognitive.

Fetal alcohol spectrum disorder (FASD) is one outcome from prenatal alcohol exposure. Social workers are likely to encounter children with the condition, due to the greater likelihood of prenatal alcohol exposure among children in social services settings. This study explores the experiences of social workers in working with children suspected of having FASD and the support offered to social workers, the children and their families. Semi-structured interviews followed by qualitative framework analysis were conducted with seven child and family social workers along with one child protection solicitor who had experience of handling FASD cases. The two main themes that emerged from the data were a lack of knowledge about FASD and the paucity of diagnosis. Lack of knowledge among the social workers was linked to difficulty in managing children suspected to have the condition, feelings of frustration and normalisation of challenging behaviours. The paucity of diagnosis led to an under-emphasis of FASD in assessments, a dearth of specialist services and confusion about its specific effects in contexts of multiple substance misuse and harmful socio-environmental factors. The need for increased FASD awareness within social services and the development of FASD-targeted support for children and families is highlighted. Social workers would benefit from the inclusion of FASD-focused training in their curricula and professional development plans. Improving the diagnostic capacities of health institutions would address the paucity of diagnosis and raise the profile of FASD, especially in the social services setting.

Spożywanie alkoholu w trakcie ciąży jest zjawiskiem wysoce niepożądanym, często powodującym poronienia lub wiele nieprawidłowości rozwojowych dziecka. Spektrum Płodowych Zaburzeń Alkoholowych, tzw. FASD (ang. Fetal Alcohol Spectrum Disorder) określa zaburzenia fizyczne i psychiczne wynikające z wpływu alkoholu na zdrowie oraz zaburzenia behawioralne dziecka, które zazwyczaj są wtórne do zmian zachodzących w ośrodkowym układzie nerwowym, wywołanych alkoholowym zatruciem płodu w trakcie ciąży. Zmiany te są zazwyczaj nieodwracalne i uwidaczniają się w trakcie całego życia dziecka dotkniętego FASD, ale dzięki odpowiednim terapiom istnieje możliwość zminimalizowania objawów tych zaburzeń. Ich charakter i ciężkość zależą od kilku czynników, między innymi od czasu ekspozycji na alkohol oraz stanu zdrowia kobiety ciężarnej. Wśród klinicznych cech FASD wyróżnia się anomalie w obrębie twarzoczaszki, zaburzenia ośrodkowego układu nerwowego oraz opóźnienie wzrostu. Zmiany strukturalne indukowane alkoholem obejmują anomalie w układzie sercowo-naczyniowym, szkieletowym, nerkowo-moczowodowym, a także w narządach wzroku i słuchu. Ważną rolę odgrywa czas postawienia wstępnej diagnozy, bowiem umożliwia on wprowadzenie odpowiedniej terapii dla dziecka z FASD oraz wprowadzenie odpowiedniej edukacji rodziców i rodziny chorego dziecka. Istnieje możliwość zminimalizowania objawów i zaburzeń wynikających ze Spektrum Płodowych Zaburzeń Alkoholowych, do stopnia umożliwiającego prawidłowe funkcjonowanie dziecka i jego rodziny.

Fetal alcohol spectrum disorder (FASD) is caused by prenatal exposure to ethanol and has been linked to neurodevelopmental impairments. Alcohol has the potential to alter some of the epigenetic components that play a critical role during development. Previous studies have provided evidence that prenatal exposure to ethanol results in abnormal epigenetic patterns (i.e., hypomethylation) of the genome. The aim of this study was to determine how prenatal exposure to ethanol in rats affects the hippocampal levels of expression of two important brain epigenetic transcriptional regulators involved in synaptic plasticity and memory consolidation: methyl CpG-binding protein 2 (MeCP2) and histone variant H2A.Z. Unexpectedly, under the conditions used in this work we were not able to detect any changes in MeCP2. Interestingly, however, we observed a significant decrease in H2A.Z, accompanied by its chromatin redistribution in both female and male FASD rat pups. Moreover, the data from reverse-transcription qPCR later confirmed that this decrease in H2A.Z is mainly due to down-regulation of its H2A.Z-2 isoform gene expression. Altogether, these data provide strong evidence that prenatal exposure to ethanol alters histone variant H2A.Z during neurogenesis of rat hippocampus.

Summary Although prenatal alcohol exposure causes craniofacial anomalies, growth retardation, neurological abnormalities, cognitive impairment, and birth defects, fetal alcohol spectrum disorder is underdiagnosed. Global prevalence of fetal alcohol spectrum disorder is 0·77%, with a higher prevalence of 2–5% in Europe and North America, highlighting the need for increased diagnosis and treatment. However, diagnosis remains challenging because of the poor reliability of self-reported maternal drinking histories, an absence of sensitive biomarkers, and the infrequency of diagnostic dysmorphic facial features among individuals with fetal alcohol spectrum disorder. Different diagnostic systems and disagreements over criteria have slowed progress in the diagnosis and management of the disorder. Neuroimaging shows abnormalities in brain structure, cortical development, white matter microstructure, and functional connectivity in individuals with fetal alcohol spectrum disorder. These abnormalities modify developmental trajectories and are associated with deficits in cognition, executive function, memory, vision, hearing, motor skills, behaviour, and social adaptation. Promising trials of nutritional interventions and cognitive rehabilitation therapies are underway, with the aim of treating cognitive deficits in fetal alcohol spectrum disorders.

It has been known for over 4 decades that prenatal alcohol exposure (PAE) can adversely affect neurodevelopment and behavior (NDB). Yet, early detection of altered NDB due to PAE continues to present a major clinical challenge. Identification of altered NDB in the first 2years of life, before higher-order cognitive processes develop, invites early interventions for affected children to improve long-term outcomes. Studies published in English from January of 1980 to July of 2018 were identified in PubMed/MEDLINE. The review focused on prospective birth cohort studies which used standardized NDB assessments in children up to 2years of age, wherein PAE was the main exposure and NDB was the main outcome. NDB was categorized into the domains of neurocognitive, adaptive, and self-regulation based on the 2016 Updated Clinical Guidelines for Diagnosing fetal alcohol spectrum disorder. An initial search resulted in 1,867 articles for which we reviewed abstracts; 114 were selected for full-text review; and 3 additional abstracts were identified through review of references in eligible publications. Thirty-one publications met criteria and were included: of these, 24 reported neurocognitive outcomes, 24 reported adaptive behavior outcomes, and 12 reported outcomes in the domain of self-regulation. Although self-regulation was assessed in the fewest number of studies, 8/12 (75%) reported PAE-associated deficits. In contrast, results were mixed for the other 2 domains: 13/24 (54%) of the selected studies that included neurocognitive outcomes showed poorer performance following PAE, and 8/24 (33%) studies that assessed adaptive functioning found significant differences between PAE and comparison infants. There is considerable evidence to support the value of early-life assessments of infant NDB when PAE is known or suspected. More studies focusing on infant self-regulation, in particular, are needed to determine the utility of early evaluation of this critical developmental domain in infants with PAE.

Women of reproductive age who are drinking alcohol and not using effective contraception are at-risk for an alcohol-exposed pregnancy, which could result in a child with a fetal alcohol spectrum disorder (FASD). Nurses are an important partner in addressing at-risk alcohol use. It is imperative for alcohol education to be incorporated into nursing curricula so that future nurses have the tools to identify at-risk alcohol use. Three universities have worked together to create Fetal Alcohol Spectrum Disorders: A Toolkit. This toolkit was designed for nurses to facilitate the recognition and prevention of FASD and address gaps that exists around alcohol use.

Materials and Methods Participants were recruited through the university research participation website where a link to an online survey was made available to first year undergraduate psychology students. The online questionnaire included questions on contraceptive and alcohol consumption behaviours in the past month, and questions that assessed participants’ knowledge and attitudes. A total of 106 participants were included in the current study. Results The majority of participants reported using contraception when having sex in the past month. The most common form of contraceptive used was male condoms (~60%), followed by the oral contraceptive pill (~46%). There was a significant difference in one of the knowledge scales between the two contraceptive groups: participants who reported Never/Sometimes using contraception had higher knowledge of reproduction compared to those who reported using contraception more often. The proportion of participants who used contraception more frequently reported having more positive attitudes towards contraception compared to those who reported Never or Sometimes using contraception. Conclusion Given the lifelong impacts that can be experienced for individuals with Fetal Alcohol Spectrum Disorder (FASD), prevention of unintended alcohol-exposed pregnancies is an area that requires serious attention. If the high prevalence rates of FASD are to be reduced, prevention needs to take place for people of reproductive age, particularly in Australia where we have high rates of unplanned pregnancies and a binge drinking culture.

Aims: To examine and compare sensory processing in children diagnosed with Fetal Alcohol Spectrum Disorder (FASD) to children designated as "at risk" for neurodevelopmental disorders and FASD, associated with Prenatal Alcohol Exposure (PAE). Method: A retrospective chart review methodology was applied to examine sensory processing in a clinic referred sample of 90 children under the age of 3 with PAE of which 28 children were diagnosed with FASD and 62 were in the "at risk" category. Results: Young children with FASD rated significantly lower on the Infant/Toddler Sensory Profile in auditory processing and low registration and more often in the probable difference range in sensory sensitivity and sensation avoiding. Some children in both groups demonstrated definite differences in low threshold scores. Conclusions: Sensory processing differences in young children with FASD are supported when compared to children with PAE who are "at risk" for future diagnoses. Occupational therapists should consider sensory processing when assessing and providing early intervention services to this population.

Background: Fetal alcohol spectrum disorder (FASD), a complex diagnosis that includes a wide range of neurodevelopmental disabilities, results from exposure to alcohol in the womb. FASD remains poorly understood by Canadians, which could contribute to reported stigma faced by both people with FASD and women who drink alcohol while pregnant. Methods: To better understand how information about FASD is presented in the public sphere, we conducted content analysis of 286 articles from ten major English-language Canadian newspapers (2002-2015). We used inductive coding to derive a coding guide from the data, and then iteratively applied identified codes back onto the sample, checking inter-coder reliability. Results: We identified six major themes related to clinical and scientific media content: 1) prevalence of FASD and of women’s alcohol consumption; 2) research related to FASD; 3) diagnosis of FASD; 4) treatment of FASD and maternal substance abuse; 5)primary disabilities associated with FASD; and 6) effects of alcohol exposure during pregnancy. Discussion: Across these six themes, we discuss three instances of ethically consequential exaggeration and misrepresentation: 1)exaggeration about FASD rates in Indigenous communities; 2)contradiction between articles about the effects of prenatal alcohol exposure; and 3) scientifically accurate information that neglects the social context of alcohol use and abuse by women. Respectively, these representations could lead to harmful stereotyped beliefs about Indigenous peoples, might generate confusion about healthy choices during pregnancy, and may unhelpfully inflame debates about sensitive issues surrounding women’s choices., Contexte: L’ensemble des troubles causés par l’alcoolisation fœtale (ETCAF), un diagnostic complexe qui comprend une vaste gamme de troubles neurodéveloppementaux, résulte de l’exposition à l’alcool dans l’utérus. L’ETCAF demeure mal compris par les Canadiens, ce qui pourrait contribuer à la stigmatisation dont souffrent les personnes atteintes d’ETCAF et les femmes qui consomment de l’alcool pendant leur grossesse. Méthodes: Pour mieux comprendre comment l’information sur l’ETCAF est présentée dans la sphère publique, nous avons analysé le contenu de 286 articles tirés de dix grands journaux canadiens de langue anglaise (2002-2015). Nous avons utilisé le codage inductif pour établir une grille de codage à partir des données, puis nous avons appliqué de façon itérative des codes identifiés sur l’échantillon, en vérifiant la fiabilité intercodeurs. Résultats: Nous avons identifié six grands thèmes liés au contenu cliniques et scientifiques des médias : 1) prévalence de l‘ETCAF et de la consommation d’alcool chez les femmes; 2) recherche en lien avec l’ETCAF; 3) diagnostic d’ETCAF ; 4) traitement de l’ETCAF et de l’abus de substances par les mères; 5) incapacités primaires associés à l’ETCAF; et 6) effets de l’alcool pendant la grossesse. Discussion: Dans le cadre de ces six thèmes, nous examinons trois types d’exagération et de fausse représentation qui ont des conséquences sur le plan éthique: 1) l’exagération des taux d’ETCAF dans les communautés autochtones; 2) la contradiction entre les articles sur les effets de l’exposition prénatale à l’alcool; et 3)l’information scientifiquement exacte qui néglige le contexte social de la consommation et de l’abus d’alcool par les femmes. Respectivement, ces représentations pourraient mener à des croyances stéréotypées préjudiciables au sujet des peuples autochtones, pourraient créer de la confusion quant aux choix sains pendant la grossesse et risqueraient d’enflammer inutilement les débats sur des questions délicates concernant les choix des femmes.

Children with Fetal Alcohol Spectrum Disorder (FASD) have impaired sensory processing skills as a result of neurodevelopmental anomalies. The somatosensory barrel field of rodent brain is a readily accessible model for studying the effects of alcohol exposure. Within the barrel field, the posterior medial barrel subfield (PMBSF) receives sensory inputs from the large vibrissae on the contralateral face. This study reports on the consequence of prenatal exposure to alcohol on the somatosensory cortices of mice later in life. Two control groups, a sucrose and a non-treated control, were also examined. At postnatal day (PND) 56 the cerebral hemisphere of mice from each group were processed for cytochrome oxidase reactivity. In contrast to previous studies, there were no significant differences in the mean areas of: (I) the PMBSF enclosure, (II) the PMBSF barrels, (III) the individual PMBSF barrels and (IV) the septal portion of the PMBSF in the alcohol group compared to the controls. However barrel sizes in rows D and E in the alcohol group were significantly reduced, indicating an alcohol-induced damage on the barrel development and which may reduce the amount of the cortex devoted to processing somatosensory input– a common defect seen in children with FASD.

Self-regulation and executive functioning impairments are common in children with fetal alcohol spectrum disorder. Given the high rates of fetal alcohol spectrum disorder identified amongst children living in the remote Fitzroy Valley region of Western Australia, the Alert Program® was identified as a culturally safe intervention for use in local primary schools. Researchers collaborated with Aboriginal Elders, community members, and staff from a Fitzroy Valley primary school to trial the Alert Program®. Teachers were trained to deliver eight Alert Program® lessons to children in class. Self-regulation and executive functioning were measured using teacher and parent/caregiver questionnaires three times. Data were analyzed using repeated-measures ANOVA. Teacher-led delivery of the Alert Program® was feasible in a region with high fetal alcohol spectrum disorder rates. As measured by teacher and parent/caregiver ratings, this curriculum may improve the self-regulation and executive functioning of children for some outcomes and provide sustained effects for some children. This community partnered pilot research, evaluated a school-based program to reduce the behavioral impact of fetal alcohol spectrum disorder, and informed design of a larger trial across eight Aboriginal community schools.

Background The recommended “gold standard” for Fetal Alcohol Spectrum Disorder (FASD) assessment involves a multidisciplinary diagnostic team and comprehensive battery of neuropsychological tests to evaluate functioning across 10 brain domains. The current Canadian Guideline for diagnosis of FASD outlines a list of test measures for assessment; however, very little research exists to explore which specific tools are being used in clinical practice. Objectives The purpose of the current study was to gain a better understanding of the testing measures used by FASD clinicians in Alberta, Canada. Methods A survey was sent to coordinators of 23 Alberta FASD clinics requesting them to distribute the survey to their diagnostic team members, including physicians, psychologists, speech-language pathologists, and occupational therapists. Results A wide range of measures (both direct and indirect; n = 173) to assess brain domains were reported by clinics. Many tests were used to assess function across multiple brain domains. Most of the commonly used tests aligned with those suggested in the Canadian Guideline; however, there were many additional measures being used that were not listed in the Guideline. Conclusions This study revealed important information about the use of testing measures in FASD assessment and sheds light on the commonalities in practice across clinics in Alberta. Results demonstrate strong convergence of direct and indirect measures to assess brain function. Ultimately, identifying a comprehensive, reliable, and usable testing battery of measures for FASD assessment will improve the clarity and accuracy of the diagnostic process and facilitate advancements in the field, as well as enable comparisons across clinics.

Background: Individuals with fetal alcohol spectrum disorder (FASD) experience a range of cognitive, affective, and physical deficits following prenatal alcohol exposure. They are thought to be overrepresented in criminal justice settings. However, limited evidence is available to inform prevalence. We sought to estimate the prevalence of FASD in a Northern Canadian correctional population. Methods: Using an active case ascertainment approach we recruited a representative sample of 80 justice-involved adults (ages 18–40, 85% male) over an 18-month period from 2013 to 2015. Participants completed interdisciplinary clinical assessments comprising medical and psychological evaluations that adhered to the 2005 Canadian FASD Diagnostic Guidelines. Results: We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2% with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment. Conclusions: Findings showed disproportionately high estimated FASD prevalence in this representative sample compared to general population estimates in both Canada and the U.S. (2–5%), underscoring the need for improved FASD screening and diagnosis in correctional settings, and education for clinicians working in the justice context. Strengthened health prevention and intervention efforts to support the needs of individuals with FASD outside the criminal justice context are needed.