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Fetal Alcohol Spectrum Disorder: An Overview of Deficits

Fetal Alcohol Spectrum Disorder: An Overview of Deficits
Tatyana Elleseff, M.A., CCC-SLP
April 25, 2013

 This text-based course is a transcript of the live seminar, "Fetal Alcohol Spectrum Disorder: An Overview of Deficits”, presented by Tatyana Eleseff, M.A., CCC-SLP. >> Tatyana Elleseff:  I would like to discuss one of my favorite topics today.  I work with a number of children diagnosed with fetal alcohol spectrum disorders on my caseload.  I would like to go over some associated terms with FASD.  I would like to explain some FASD-related diagnostic challenges.  I want to talk about how prenatal alcohol abuse can change the structure and function of the developing brain, and I also want to talk about symptoms of alcohol-related speech and language deficits in children of various ages.   FASD Overview To begin, the term FASD is not a clinical diagnostic term.  You will not or should not see a medical professional diagnose a child with the term FASD.  Rather, it is an umbrella term which talks about a range of effects which can occur due to maternal alcohol consumption during pregnancy.  These effects could be physical.  They could be cognitive.  They could be behavioral or they could be pertaining to language and learning.  For example, one of the common diagnoses you may see is FAS, or fetal alcohol syndrome.   List of Current FASD Terms That specific diagnosis is made based on specific criteria.  A child has to show some growth deficiency.  His/her height and weight have to be under the 10th percentile.  They have to exhibit specific pattern of facial abnormalities such as small eye openings, smooth philtrum which is the space right above your upper lip, a thin upper lip, as well as on some additional manifestations which I did not include here.  Very shortly you will find out why I am a little bit more casual with my description of facial anomalies.  The child is thought to manifest very clear central nervous system damage, which has to be in several different domains: structural neurological and functional.  This diagnosis is fairly difficult to make and as a result some pediatricians or some medical professionals who are on fetal alcohol teams may give a child some other diagnoses which include Partial FAS, where you have most of the features but not all of the features and you are missing some aspect.  Something may not be clearly defined or something may not be as clear.  A child can also be diagnosed, and these are fairly popular diagnoses, with Alcohol Related Neurodevelopmental Disorders.  This is when a child displays a central nervous system damage as well as prenatal alcohol exposure.  Notice I am holding off on talking a lot about prenatal alcohol exposure.  Again I will explain shortly as I go over these terms fairly rapidly.   Some of the present terms or terminology related to FASD is constantly changing.  There used to be a term called “FAE” - fetal alcohol effect.  It is no longer used by the medical community; instead the new terminology called static encephalopathy as well as neurobehavioral disorder have been introduced as well to talk about these children.  This terminology was retrieved from the Department of Washington State (http://depts.washington.edu/fasdpn/htmls/fasd-fas.htm).  Much of this research is based on the works of Dr. Susan Astley.  She is a very prominent physician who has done a tremendous amount of work and studies in this field, and makes an absolutely fascinating read with respect to fetal alcohol spectrum disorders.   CNS DamageTo continue slightly further, before I sum up everything, when I talk about central nervous system damage pertaining to fetal alcohol spectrum disorders, you can have structural damage.  When you have structural damage, it has to be something which is easily observable.  For example, a child will have a very small head known as microcephaly.  You might also observe on pertinent testing, such as MRI, specific brain abnormalities.  An example would be agenesis of the corpus callosum.  During specific testing such as MRI, you might be observing brain structure, which looks different from a normally developing brain.  Certain things might look similar.  Certain things might be absent and so on.   When I am talking about neurological damage or neurological deficits, you can have hard neurological signs, which are typically seizures or presence of different types of seizures, or you can have some soft signs.  Soft neurological signs are less perceptible.  They could be some mild motor signs.  They could be some sensory signs.  These are not as easily diagnosable by a physician, and yet they might be easily noticeable to related professionals such as an occupational therapist who might be seeing some issues with respect to the child's motor and sensory functioning.   When we are talking about specific functional deficits, these are deficits that would be easily recognizable to such professionals as us, speech language pathologists.  We are talking about learning disabilities, language deficits, and cognitive deficits.  Since a number of children diagnosed with alcohol-related disorders have low average or below average IQ, if we are talking about executive function impairment - and this is again in reference to frontal lobe or in the prefrontal cortex which is where executive functions are situated - we are talking about significant difficulties with social communication. We will speak more about that later.  We are talking about a number of difficulties with adaptive behavior and how difficult is it for these children to function in daily environments, whether at home or in school.   FASD Related Statistics- U.S. When it comes to fetal alcohol spectrum disorders and related statistics, this is when we run into a very significant problem.  I am going to backtrack and talk about certain diagnostic factors which are directly related to why we have such poor and unreliable statistics on this specific disorder.  The truth of the matter is that a lot of studies and much of the data are very unreliable and completely out of date.  One of the biggest problems that we are having is the reporting of the data and the data collection.  The figures mentioned by the CDC, or Centers for Disease Control, are significantly out of date.  They...

tatyana elleseff

Tatyana Elleseff, M.A., CCC-SLP

Tatyana Elleseff MA CCC-SLP is a bilingual speech language pathologist who specializes in working with multicultural, internationally and domestically adopted as well as at-risk children with complex communication disorders. She received her MA from NYU, her Bilingual Extension Certification from Columbia University as well as several ACE awards for continuing education from ASHA. She is a member of NY and NJ, Fetal Alcohol Spectrum Disorder (FASD) multidisciplinary teams, the aim of which is to provide specialized services including speech language assessment and intervention to children identified or presenting with features of FASD.  Tatyana’s articles have been published in several magazines including Adoption Today, Adoption Australia, and Advance for Speech Language Pathologists and Audiologists. In addition to previously presenting on Speechpathology.com, Tatyana has presented for a number of medical, academic and non-profit organizations including New York University, New Jersey Speech Language and Hearing Convention, American Academy of Pediatrics: Council on Foster Care, Adoption and Kinship , New Jersey Taskforce on Child Abuse and Neglect as well as North American Council on Adoptable Children (NACAC). 

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