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Alcohol. 2018 Mar;67:37-43. doi: 10.1016/j.alcohol.2017.05.004. Epub 2017 Aug 24.

Challenges of diagnosing fetal alcohol spectrum disorders in foster and adopted children.

Author information

1
Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA; Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA. Electronic address: lbakhireva@salud.unm.edu.
2
Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
3
Texas Office for Prevention of Developmental Disabilities, Texas Health and Human Services Commission, Austin, TX, USA.
4
Department of Neuroscience & Experimental Therapeutics, Texas A&M University, Bryan, TX, USA.
5
PALs Developmental Center, Lubbock, TX, USA; Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Abstract

Fetal Alcohol Spectrum Disorders (FASD) might be 10-15 times more prevalent among foster/adopted children compared to the general population; however, many of these children remain undiagnosed or misdiagnosed. The lack of confirmed prenatal alcohol exposure (PAE) may be a key barrier to diagnosis. Our sample included 681 patients evaluated for FASD, according to the University of Washington 4-Digit Diagnostic Code, at a pediatric specialty clinic. Guardianship status and other patient characteristics were evaluated by multinomial logistic regression as potential predictors of being classified into one of the following FASD groups: 1) full or partial Fetal Alcohol Syndrome (FAS/pFAS; n = 97); 2) Static Encephalopathy/Alcohol-Exposed (SE/AE) or Neurobehavioral Disorder/Alcohol-Exposed (ND/AE) (n = 135); and 3) some features of FASD (equivalent to pFAS, SE/AE or ND/AE phenotypes) but unknown PAE (n = 449). Median age at assessment was 7.0 years, non-Hispanic White constituted the predominant racial/ethnic group (49.5%), and the majority (81.8%) lacked involvement from a biological parent/relative. Many patients (66.0%) had some features of FASD but lacked reliable PAE information. Children classified into the 'some features/unknown PAE' group had higher median age of assessment (8 years) compared to other groups (6 years; p < 0.001). No association was observed between race/ethnicity or child's sex and FASD outcomes (p > 0.05). Adopted/foster children were 2.8 times as likely (95% CI: 1.6; 4.8) to be classified into the 'some features/unknown PAE' group compared to children living with a parent/relative after adjusting for covariates. This study's findings indicate that adopted/foster children are more likely to have unknown PAE and not receive a FASD diagnosis, potentially denying them access to specialized services, treatment, and rehabilitation.

KEYWORDS:

Adopted children; Diagnosis; Fetal alcohol spectrum disorders; Foster children; Prenatal alcohol exposure

PMID:
29316477
DOI:
10.1016/j.alcohol.2017.05.004
[Indexed for MEDLINE]

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