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

• Published in: Alcohol (Fayetteville, N.Y.) Vol. 67; pp. 37 - 43
• Main Authors: Bakhireva, Ludmila N., Garrison, Laura, Shrestha, Shikhar, Sharkis, Janet, Miranda, Rajesh, Rogers, Karen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018; Elsevier Limited
• Subjects: Adopted children; Age; Alcohol use; Alcoholism; Alcohols; Children; Children & youth; Diagnosis; Disease control; Encephalopathy; Exposure; Fetal alcohol spectrum disorders; Fetal alcohol syndrome; Foster care; Foster children; Genotype & phenotype; Guardians; Intervention; Literature reviews; Maternal & child health; Medical diagnosis; Minority & ethnic groups; Pediatrics; Population; Prenatal alcohol exposure; Prenatal experience; Psychologists; Rehabilitation; School districts; Systematic review; United States > US; Texas; Fetal alcohol spectrum disorders; Foster children; Diagnosis; Adopted children; Prenatal alcohol exposure
• ISSN: 0741-8329; 1873-6823
• DOI: 10.1016/j.alcohol.2017.05.004

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. •FASD profiles of 681 children were evaluated in a pediatric developmental center in Texas.•The role of unknown prenatal alcohol exposure in FASD diagnostic outcomes was evaluated.•74% of foster/adopted children had unknown prenatal alcohol exposure (PAE).•41% of children living with a biological parent or relative had unknown PAE.•Lack of PAE information in foster/adopted children is a barrier to FASD diagnosis.