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Neurobehavioral outcomes associated with prenatal alcohol exposure range from severe intellectual deficiency to subtle attention and motor deficits. Diagnosis of individuals with fetal alcohol spectrum disorders (FASD) can be challenging especially when physical markers are absent or prenatal histories are unavailable. In addition, due to neurobehavioral similarities, individuals with FASD and those with attention-deficit/hyperactivity disorder (ADHD) can be confused clinically, making differential diagnosis difficult. Research has recommended that identification of FASD be based on a neurobehavioral profile. However, some neurocognitive domains, including decision-making, have received little attention. Emotion-based decision-making involves strategic adaptation of behavior based on uncertain information and is essential for everyday function. Deficits in decision-making in individuals with FASD are suggested by neuroanatomical abnormalities and difficulty with everyday function. The Iowa Gambling Task (IGT) is a widely used measure of decision-making, simulating unpredictable reward and loss contingencies of complex decision-making. The IGT, which has not been used in alcohol-exposed populations, was administered to children with FASD (n = 21), ADHD (n = 22), and typically developing controls (n = 21). Further, because working memory, the process of temporarily storing and manipulating information, may be related to decision-making, a measure of working memory was included in the test battery. A mixed-model ANOVA demonstrated that children with FASD chose significantly fewer advantageous cards than control children. In contrast, children with ADHD were distinguished from controls based on processing frequency of rewards/losses on the IGT. Group decision-making performance was not accounted for by working memory performance in either the FASD or ADHD group. Collectively, these results suggest that children with FASD and ADHD have aberrant decision-making processes, although their dysfunction may be due to distinguishable mechanisms. While children with FASD were deficient in making decisions based on learning from exposure to past contingencies, children with ADHD differed from controls in their ability to tolerate unpredictable reinforcement schedules. Decision-making was found to be independent of intellectual function and other high order cognitive abilities, including working memory, and therefore should be a consideration in further research and clinical assessment of children with FASD and ADHD.
Diagonal In A Parallel World Navigating through this Journey of Fetal Alcohol Spectrum Disorder has with intensity made a profound imprint on my own self awareness. The level of honesty and transparency that was essential to accepting and overcoming my own fears, truths and ownerships was the hardest hurdles. In achieving the required inner balance through acceptance, I was given the clarity needed to see how easily a life can significantly transform simply by choice, and association. The magnitude of transformations and emotional upheavals by description were ?the best of times and the worst of times and literally had the power to transpire in a split second. The truths of Fetal Alcohol Spectrum Disorder are without question one of the most perplexing set of societal dilemmas. Preventing this Brain based disability from reoccurring could in fact be just one societal based decision from a profound permanent positive change. However the lifelong adverse repercussion for those already impacted by FASD will never disappear; the quality of life or the standard to which they function can only change through implemented interventions and supports. It does not just take a community to raise a child with special needs it literally involves universal change and commitment! ?The Truth is Powerful? This book is a reflection of truths that will hopefully be what is required to bring forth positive changes. Theresa L. Johnson
Prenatal alcohol exposure is the leading non-genetic, biological cause of birth defects and other anomalies. Perhaps as many as 1 in 100 children born in the United States each year have been exposed to alcohol during prenatal development and meet the criteria for a Fetal Alcohol Spectrum Disorder (FASD) diagnosis (May & Gossage, 2001; Schonfeld et al., 2006; Wattendorf & Muenke, 2005). There is abundant evidence of deficits in social functioning as a result of prenatal alcohol exposure (Coggins et al., 2003; Kodituwakku, May et al., 2001; McGee et al., 2009; Thomas et al., 1998). Many other atypically developing populations with demonstrated social deficits also have emotion-specific impairments in facial recognition that are more pronounced than would be expected based on the overall cognitive functioning of these individuals (i.e. emotion specificity hypothesis; Rojahn et al., 1995). The documented social impairment in children with prenatal alcohol exposure indicates these individuals also have emotion- specific facial recognition impairments. This study tested the emotion specificity hypothesis in a group of children with FASD and compared the facial emotion processing abilities of these children with reports of their adaptive social behavior. Twenty-five children with a FASD diagnosis, 14 children with Down syndrome, and 23 typically developing children matched on mental age participated in this study. Four facial processing tasks (2 emotion processing and 2 control tasks) were administered to all participants. Both labeling and matching formats were included in the emotion and control tasks. Although not expected, the children with FASD had similar performance to the typically developing children on all facial processing tasks, which failed to support the emotion specificity hypothesis in this population. As predicted, the children with Down syndrome showed poorer performance than the children with FASD and the typically developing children across all facial processing tasks. These tasks failed to reveal performance differences between children with FASD and typically developing children; however, facial emotion processing deficits may still exist within the FASD population. Future studies should consider modifying task demands to more accurately reflect natural face processing situations and include children with a FASD diagnosis from less enriched environments and with documented intellectual delays.
Despite the anecdotal evidence of social difficulties in children with Fetal Alcohol Spectrum Disorders (FASD), and the risk for secondary disabilities as a result of these social difficulties, very little research has examined social-emotional functioning in children with FASD. The majority of the research conducted thus far has relied on parent and teacher reports to document social impairments. These parent and teacher reports provide a broad measure of social functioning but are unable to elucidate the specific aspects of social functioning that this group of children might find difficult. As a result, it has been very difficult to develop effective social interventions for children with FASD because it is unclear what aspects of social functioning should be targeted. The current study aimed to examine emotion recognition abilities in children with FASD, as recognition of emotions is an important precursor for appropriate social interaction. The study included 22 participants with diagnosed FASD (ages 8-14), with age- and gender- matched typically developing controls. Participants were assessed using computerized measures of emotion recognition from three nonlinguistic modalities: facial expressions (static and dynamic, child and adult faces), emotional tone of voice (child and adult voices), and body positioning and movement (postures and point-light walkers). In addition, participants completed a task assessing emotion recognition in real-life scenarios. Finally, caregivers completed measures of behavioural functioning, adaptive functioning, FASD symptomatology, and a demographics questionnaire. Overall, findings suggest that children with FASD do have more difficulties than age-matched typically developing peers in aspects of emotion recognition, with particular difficulties in recognizing emotions from adult facial expressions and adult emotional prosody. In addition, children with FASD had more difficulty perceiving differences in facial expressions. When t.
This book is intended for medical and mental health clinicians faced with the challenge of evaluating adolescents and adults in the legal context who may have a fetal alcohol spectrum disorder (FASD). Luminaries in their respective fields, the contributors to this book offer a range of expertise and perspectives regarding the forensic investigation of FASD: medical, psychological, psychiatric, criminal defense, prosecution, and the judiciary. The primary goal of the book is to provide medical and mental health clinicians with practical procedures that can be used in a variety of forensic and clinical settings. It includes protocols that have been used successfully in legal matters ranging from rights waiver and competency to capital murder and sexual offending. It not only provides detailed guidelines for interviewing birth mothers about the delicate topic of substance use during pregnancy but also introduces a methodology that can be used in the absence of exposure confirmation to arrive at a sound diagnostic conclusion through the process of differential diagnosis. Taken as a whole, the methodological procedures described by the contributors to the book serve as ‘best practices’ for comprehensive forensic mental health evaluation of potential FASD in juveniles and adult defendants as well as in victims.
It sounds simple: Women who drink while pregnant may give birth to children with defects, so women should not drink during pregnancy. Yet in the 20 years since it was first described in the medical literature, fetal alcohol syndrome (FAS) has proved to be a stubborn problem, with consequences as serious as those of the more widely publicized "crack babies." This volume discusses FAS and other possibly alcohol-related effects from two broad perspectives: diagnosis and surveillance, and prevention and treatment. In addition, it includes several real-life vignettes of FAS children. The committee examines fundamental concepts for setting diagnostic criteria in general, reviews and updates the diagnostic criteria for FAS and related conditions, and explores current research findings and problems associated with FAS epidemiology and surveillance. In addition, the book describes an integrated multidisciplinary approach to research on the prevention and treatment of FAS. The committee: Discusses levels of preventive intervention. Reviews available data about women and alcohol abuse and treatment among pregnant women. Explores the psychological and behavioral consequences of FAS at different ages. Examines the current state of knowledge about medical and therapeutic interventions, education efforts, and family support programs. This volume will be of special interest to physicians, nurses, mental health practitioners, school and public health officials, policymakers, researchers, educators, and anyone else involved in serving families and children, especially in high risk populations.
Fetal alcohol spectrum disorders (FASD) represent a range of physical, mental, and behavioral disabilities caused by alcohol use during pregnancy, or prenatal alcohol exposure (PAE). FASDs are considered to be one of the leading causes of developmental disability, with an estimated 2-5% of children being born with FASD each year in the world. Despite its high prevalence, FASD is often misdiagnosed or underdiagnosed, making intervention more challenging. A multidisciplinary team of providers who understand the diagnostic requirements is crucial for an accurate FASD diagnosis. This text provides a comprehensive, state-of-the art review of this field, and serves as a valuable resource for clinicians and researchers with an interest in FASD. The book provides a detailed overview for clinicians of various backgrounds on the diagnostic process, extensive mechanistic and embryologic data, neuropsychologic aspects of the condition, prevention and treatment approaches, and the ethical, legal, and policy perspectives that impact patients and families. The chapters are organized parallel to the journey of individuals who experience alcohol-related conditions, beginning with the prenatal period addressing epidemiology of alcohol exposure, prevention and interventions, continuing through the fetal experience with a focus on embryology. Challenges of children and their families are considered next including the diagnostic process and health effects. Finally, issues related to systems of care for individuals with FASD and the broader community are addressed. The global context of FASD is presented throughout the textbook. Written by experts in the field, Fetal Alcohol Spectrum Disorders provides a concise yet comprehensive summary of the current status of this issue that helps guide prevention efforts, the diagnostic process, school and community interventions, and global policy efforts.
This handbook offers a comprehensive review of intellectual disabilities (ID). It examines historical perspectives and foundational principles in the field. The handbook addresses philosophy of care for individuals with ID, as well as parent and professional issues and organizations, staffing, and working on multidisciplinary teams. Chapters explore issues of client protection, risk factors of ID, basic research issues, and legal concerns. In addition, chapters include information on evidence-based assessments and innovative treatments to address a variety of behaviors associated with ID. The handbook provides an in-depth analysis of comorbid physical disorders, such as cerebral palsy, epilepsy and seizures, and developmental coordination disorders (DCD), in relation to ID. Topics featured in this handbook include: Informed consent and the enablement of persons with ID. The responsible use of restraint and seclusion as a protective measure. Vocational training and job preparation programs that assist individuals with ID. Psychological and educational approaches to the treatment of aggression and tantrums. Emerging technologies that support learning for students with ID. Key sexuality and relationship issues that are faced by individuals with ID. Effective approaches to weight management for individuals with intellectual and developmental disabilities. The Handbook of Intellectual Disabilities is an essential reference for researchers, graduate students, clinicians and related therapists and professionals in clinical child and school psychology, pediatrics, social work, developmental psychology, behavioral therapy/rehabilitation, child and adolescent psychiatry, and special education.
This book discusses and provides insight on the legal and ethical dilemmas of managing those with Fetal Alcohol Spectrum Disorder (FASD). This book provides a clear perspective for those clinicians and legal professionals who are working with those with this disorder, and correspondingly increases their understanding when arranging effective supports for this population. Historically, the primary focus on FASD has been on children. However, this is a lifelong disorder and the implications of this disorder become even more prominent and complex in adulthood. Those with this condition can struggle with impulsiveness, and a host of cognitive difficulties. This correspondingly impacts their independence and employability, and produces an elevated risk for homelessness and other residential issues, involvement in substance use, being exploited, development of behavioural issues, and subsequent legal difficulties. Their cognitive difficulties result in challenges for legal systems around the world to understand their issues, and to design appropriate remedial strategies, recommendations for treatments and supports, and even for understanding the failure of many of these individuals to be able to change their behaviours effectively. This produces various legal and ethical dilemmas, which are discussed in detail in this volume by 28 authors from Europe, New Zealand and North America. These include discussions regarding the rights of the unborn child, the alcohol industry’s duty to warn, whether small amounts of alcohol during pregnancy can be condoned, and even the current use of involuntary hospitalization for addicted mothers. Other chapters discuss the need for training on FASD for front line officers, use of lies during interrogation of those with FASD, medical and legal interventions for offenders with FASD, access to diagnostic services and follow-up supports, and whether FASD can be considered a mitigating factor for sentencing. Furthermore, caregivers also provide their stories regarding the daily dilemmas that are faced in raising those with FASD.
From a 1994 working conference at the National Institutes of Health, Rockville, Maryland, researchers in psychology, neuropsychology, special education, and medicine present theory and research on three central cognitive processes--attention, memory, and executive function--and explain how their findings can help clinicians assess and remediate reading and attention disorders. Annotation copyright by Book News, Inc., Portland, OR