Child Care Settings: Prevalence of Fetal Alcohol Syndromes

Svetlana Popova, M.D., M.P.H., Ph.D. Senior Scientist, Social and Epidemiological Research, Centre for Addiction and Mental Health Assistant Professor, Epidemiology Division Dalla Lana School of Public Health, University of Toronto Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto Graduate Faculty Associate Member, Institute of Medical Science, University of Toronto CAMH, 33 Russell Street, Room # T507 Toronto Ontario, Canada M5S 2S1MedicalResearch.com Interview with:

Svetlana Popova, M.D., M.P.H., Ph.D.
Senior Scientist, Social and Epidemiological Research,
Centre for Addiction and Mental Health
Assistant Professor, Epidemiology Division
Dalla Lana School of Public Health, University of Toronto
Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
Graduate Faculty Associate Member, Institute of Medical Science, University of Toronto
CAMH, 33 Russell Street, Room # T507
Toronto Ontario, Canada M5S 2S1

MedicalResearch.com: What are the main findings of the study?

Dr. Popova: We conducted a systematic literature review and meta-analysis of internationally published and unpublished studies that reported the prevalence of FAS and/or FASD in all types of child care systems (e.g., orphanage, foster care, boarding school, adoption centre, or child welfare system).

The primary objective was to estimate a pooled (combined) prevalence for FAS and FASD in various child care systems using data from existing studies that used an Active Case Ascertainment method (when researchers/clinicians actively seek and diagnose FASD cases). The available data was analyzed by using a standard statistical technique (called meta-analysis).

This study revealed that the vast majority of existing studies report that the prevalence of Fetal Alcohol Spectrum Disorder (FASD) in the various child-care settings in the different countries is extremely high.

Our analysis of these studies demonstrated that the pooled prevalence of FAS in child care settings (6%) was found to be approximately 9-30 times higher than the prevalence of FAS in the general population of North America, which is reported to range from 2 to 7 cases per 1,000 individuals in the USA and 1 per 1,000 in Canada. Thus, children in care represent a high-risk population for FASD.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Popova: There were a couple of extreme findings. For example, the prevalence of FAS in orphanages for children with special needs in Russia ranged from about 43% to 68%. However, there were no cases reported for FASD among children from China, which were adopted by USA parents. However, larger studies are needed before any conclusions can be drawn based on the above findings.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Popova: This study has important international implications. It showed that children housed in the various child-care settings throughout the world can be considered a high-risk population for FASD. We hope that the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure. We hope that routine screening for FASD in this high-risk population will be established in order to facilitate early diagnosis. Screening for FASD among children in care is imperative – this can be done by a child’s pediatrician/family physician during their routine health examination.  Early diagnosis can lead to early participation in developmental interventions, which can in turn, improve the quality of life for children with an FASD and their families. Early interventions may also increase the potential for the prevention of secondary disabilities (e.g., school failure and drop-out, addictions, mental health problems, sexually deviant behavior, dependent living, involvement with the law, and incarceration). These secondary disabilities occur because behaviors can become more extreme when left untreated.

Research has shown that early diagnosis and providing an appropriate environment improves outcomes and decreases the risk for additional impairments by up to four fold.

It was also reported that adopting a child with FASD at a young age could prove to be beneficial since it gives the adoptive parents a greater opportunity to provide the structure, nurture, and the right set of circumstances to promote the growth and development of the child. Providing a positive environment may help the child to overcome difficulties that may arise later on in life. Research shows that children with FASD have the best outcomes when living in a stable, loving and nurturing home and have a highly structured and consistent living environment. Therefore, these children prenatally exposed to alcohol need loving homes even more than others.

We also hope that this study will raise awareness of the severe consequences of prenatal alcohol exposure and, hopefully, prevent further alcohol-exposed pregnancies across the globe. Clinicians should be screening pregnant women and women of child-bearing age for alcohol-use disorders so that early interventions can be put in place.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Popova: More research studies are needed in the field of prenatal alcohol exposure and FASD across the globe. For example, we still do not know the prevalence of FASD in the vast majority of the countries. The first step in understanding the severity and impact of FASD is to determine how many people have these conditions.

We need to know how many people with FASD exist not only in general populations, but also among “special” populations such as heavy drinking women, aboriginal populations, children in care, prison populations, where the risk of prenatal alcohol exposure might be substantially higher.

Once this information is available, policies and programs can be planned to benefit those living with FASD and to prevent more children from being born with these conditions.

Citation:

Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings:
A Meta-analysis
Shannon Lange, Kevin Shield, Jürgen Rehm, and Svetlana Popova

Pediatrics peds.2013-0066; published ahead of print September 9, 2013, doi:10.1542/peds.2013-0066

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