Fetal Alcohol Spectrum Disorder
Specialized Assessment of Fetal Alcohol Spectrum Disorders (FASD)
The term Fetal Alcohol Spectrum Disorder (FASD) represents a broad group of physical, neurological, and behavioral disorders that can occur in an individual whose mother consumed alcohol during pregnancy.
Individuals with fetal alcohol spectrum disorder often have learning disabilities, social-emotional disorders, poor mood regulation, ADHD with pronounced impulsivity and/or hyperactivity, problems with memory, and many other brain-based deficits.
Unfortunately, FASDs are routinely underdiagnosed and often misdiagnosed, leading to incorrect or ineffective services for children, adolescents, and adults desperately needing support.
Accurate diagnosis of a fetal alcohol spectrum disorder is an essential first step in moving children and adolescents toward effective services.
The Brenner Assessment Center maintains a working collaboration with the Massachusetts State Taskforce on FASD. Our specialists in psychological and neuropsychological assessment work with specialists in physiology and dysmorphology to provide accurate diagnosis of fetal alcohol spectrum disorder.
If you have a child who exhibits perplexing and difficult behavior, who is underperforming in school, or who exhibits unusual or peculiar social behaviors, and who may have been exposed to alcohol while in-utero, please contact the Brenner Assessment Center for more information about FASDs and FASD diagnosis.
What is FASD and How Does It Affect a Child's Development
Fetal Alcohol Spectrum Disorder (FASD) represents a range of disorders that can occur in an individual whose mother consumed alcohol during pregnancy.
The term “FASD” is an umbrella term generally understood to include the following conditions: Fetal Alcohol Syndrome (FAS), the diagnosis given to the most profoundly affected children; Partial Fetal Alcohol Syndrome (PFAS) for children who display some, but not all, of the physical/neurodevelopmental characteristics of FAS; Alcohol-Related Neurodevelopmental Disorder (ARND)/Specified Other Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE) for children who demonstrate cognitive or behavior impairment without the characteristic physical features; and alcohol-related birth defects (ARBD) for children with a physical malformation linked to maternal drinking without other symptoms.
The effects of prenatal alcohol exposure may include physical, mental, behavioral, or learning disabilities with possible lifelong implications. FASD often co-occurs with substance use and mental illness, and generally requires modifications to traditional treatments for successful outcomes. More than 400 health conditions can co-occur with FASD [1]. Nationally, FASD is under-diagnosed and is often misdiagnosed. A recent study found that 86.5% of youth with behavioral health disorders and FASD had not been previously diagnosed, or had been misdiagnosed [2]. Additionally, issues of stigma surrounding FASD may lead to under-reporting, disguising true prevalence. The Center for Disease Control (CDC) estimates that up to 1 in 20 children in the US have an FASD; Massachusetts estimates range from between 2-5% [3].
The presentation of FASD varies widely from person to person, and generally reflects the timing of exposure during pregnancy, amount of exposure, genetic susceptibility, and a number of other factors. Deficits may span a very wide range of intellectual and social characteristics. For example, a child with FASD may be diagnosed with Intellectual Disability despite having some areas of clear intellectual strength. Alternatively, another child with FASD may be exceptionally bright, yet continually underperform in school. Often, children with FASD exhibit peculiar social and emotional characteristics and may be misunderstood as having autism, or simply as being oppositional, defiant, hyperactive, or impulsive.
Parents and teachers of children with FASD are often perplexed by a child’s unusual learning style, inconsistent social and academic performance, and unpredictable behavior. Children with FASD often do not “fit” well into traditional academic and social support services.
FASD by the Numbers
- 94% of individuals with FASD also have a mental illness [4]
- 50% of adolescents and adults displayed inappropriate sexual behavior [5]
- 60% of people with FASD have a history of trouble with the law [6]
- 50% of individuals with FASD have a history of confinement in a jail, prison, residential drug treatment facility, or psychiatric hospital [7]
- 73-80% of children with full-blown FASD are in foster care or an adoptive placement [8]
- Children in foster care with FASD are often undiagnosed or misdiagnosed [9]
- FASD in North America is 17-19 times more prevalent in foster care and residential placements than in the general population [10]
- 61% of adolescents with FASD experienced significant school disruptions [11]
Brenner Center Diagnosis of FASDs
FASD is not well understood or even reliably identified within the primary care medical community. Fortunately, in 2013, the diagnostic description “Specified Other Neurodevelopmental Disorder—Prenatal Alcohol Exposure (ND-PAE)" was added as a psychiatric diagnosis, finally allowing clinicians to diagnose alcohol-related neurodevelopmental disabilities [12].
The Brenner Assessment Center uses both the ND-PAE criteria as well as the updated (2016) International Organization of Medicine criteria in our FASD diagnosis [13]. Our assessments include comprehensive neuropsychological examination and, if warranted, a referral for a dysmorphology exam by a physician with specialized training in alcohol-related birth defects.
Payment Options
Our specialized neuropsychological evaluations are offered in two ways: on a self-pay basis or through the following insurance plans:
- Blue Cross Blue Shield
- Beacon: Fallon Health, BMC Healthnet, Neighborhood Health Plan
- Tufts Health Together
- Massachusetts Behavioral Health Partnership (MBHP)
Our self-pay fee for a comprehensive evaluation and report (with feedback session for parents) is $3,500. We can provide an itemized invoice documenting your payment for you to submit to your insurance if you wish to seek reimbursement from your insurer; however, if you choose to pay privately, please know that you cannot be reimbursed by a plan that we otherwise accept.
Footnotes
[1] Popover, S.et al. (2016) Comorbidity of fetal alcohol spectrum disorder: a systematic review and meta-analysis. The Lancet, Vol. 387, Np. 10022, p978-987. 5 March 2016.
[2] Chasnoff, I., Wells, A., and King, L. (2015). Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics, 135(2), 264-270. DOI: 10.1542/peds.2014-2171
[3] May PA, et al. (2014). Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. 2014;134:855-66.
[4] Streissguth, A.P.; Bookstein, F.L.; Barr, H.M.; et al. 2004. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Journal of Developmental and Behavioral Pediatrics 25(4):228-238
[5] Ibid.
[6] Ibid.
[7] Ibid.
[8] Burd, 2001; May, Hymbaugh, Aase, and Samet, 1983; Streissguth, Clarren, and Jones, 1985. Studies by May et al., (1983) and Streissguth et al., (1985)
[9] Chasnoff, I., Wells, A., and King, L. (2015). Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure. Pediatrics, 135(2), 264-270. DOI: 10.1542/peds.2014-2171
[10] Lange, S. et al (2013). Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Meta-analysis. Pediatrics.September, 2014.
[11] Streissguth, A.P. et al. 2004. Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Journal of Developmental and Behavioral Pediatrics 25(4):228-238.
[12] Kable, J.A. et al. (2016). Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM Diagnosis. Child Psychiatry Hum Dev. April; 47(2):335-46.
[13] Hoyme, HE et al (2016). Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders. Pediatrics 138