Canadian Children and Youth in Care: The Cost of Fetal Alcohol Spectrum Disorder

BACKGROUND: A high prevalence of prenatal alcohol exposure has been reported among children in care and thus, the risk of fetal alcohol spectrum disorder (FASD) in this population is high. OBJECTIVE: The purpose of the current study was to estimate the number of children (0–18 years) in care with FASD and to determine the associated cost by age group, gender, and province/territory in Canada in 2011. METHODS: The prevalence of children in care by province/territory was obtained from the Canadian Child Welfare Research Portal, and the number of children in care with FASD for each province/territory was estimated from available epidemiological studies. In order to calculate the total cost per province/territory, the cost per individual per day, by age group, was applied to the respective number of children in care with FASD. RESULTS: The estimated number of children in care with FASD ranged from 2,225 to 7,620, with an annual cost of care ranging from $57.9 to$198.3 million Canadian dollars (CND). The highest overall cost ($29.5 to$101.1 million CND) was for 11–15 year-olds. CONCLUSION: The study findings can be used to demonstrate the substantial economic burden that FASD places on the child welfare system. Attention towards the needs of this population and prevention efforts to reduce FASD incidence in Canada, and other countries are urgently needed

Cost attributable to Fetal Alcohol Spectrum Disorder in the Canadian correctional system

AbstractPrenatal alcohol exposure is the leading identifiable cause of intellectual disability in the Western world and may result in Fetal Alcohol Spectrum Disorder (FASD). Individuals with FASD have a higher risk of being involved in the legal system, either as offenders or as victims. Therefore, the aim of the current study was to estimate the direct cost for youths (12–17years old) and adults (18+ years old) with FASD to the Canadian correctional system in 2011/2012. The prevalence of FASD in the Canadian correctional system, obtained from the current epidemiological literature, was applied to the average number of youths and adults in the correctional system in 2011/2012. The average daily cost for corrections was then applied to the estimated number of youths and adults with FASD in custody. The cost of corrections among youths with FASD in Canada in 2011/2012 was calculated to be approximately $17.5M Canadian dollars (CND;$13.6M CND for males and $3.8M CND for females) and among adults with FASD was estimated to be about$356.2M CND ($140M CND for provincial and territorial custody and$216.2M CND for federal custody). The study findings emphasize the need to raise awareness regarding the prevalence of FASD in the correctional system. It is crucial to incorporate FASD screening and intervention strategies as early as possible in the criminal justice process

Common developmental trajectories and clinical identification of children with fetal alcohol spectrum disorders: A synthesis of the literature

At an estimated prevalence of up to five percent in the general population, fetal alcohol spectrum disorders (FASD) are the most common neurodevelopmental disorder, at least if not more prevalent than autism (2.3%). Despite this prevalence in the general population, pediatricians and other developmental specialists have thus far failed to diagnose this disability, leaving most children and adults without the supports provided for most other disabilities. This paper will provide a review of clinically relevant literature that describes the developmental challenges of children with fetal alcohol spectrum disorders and addresses similarities to and differences of FASD from other neurodevelopmental disorders such as autism and attention deficit hyperactivity disorder. A subsequent discussion will describe how a diagnosis of an FASD can establish a basis for understanding the developmental and behavioral challenges of children with an FASD, and how specific interventions can help support child development and maximize adult independence

Screening for fetal alcohol spectrum disorder in infants and young children

Introduction: With an estimated prevalence of up to five percent in the general population, fetal alcohol spectrum disorders (FASD) are the most common neurodevelopmental disorder and more prevalent than autism. Early identification and subsequent early intervention have the potential to improve developmental trajectory of children with FASD. In addition, new research suggests supplementation with choline may ameliorate the developmental impairments associated with prenatal alcohol exposure. Availability of a screening tool with acceptable epidemiologic performance criteria may be clinical useful in identification of young children at increased risk for FASD. In this paper we describe the Early Fetal Alcohol Spectrum Disorder Screening Test (E-FAST) to identify young children at increased risk for an FASD.Methods: We developed the E-FAST dataset from previously published studies, comprised of 281 children under 5 years of age, 180 (64.1%) were diagnosed with FASD and 101 (35.9%) were non-FASD.Analysis: The analysis identified seven useful variables (prenatal alcohol exposure, ADHD (Attention Deficit Hyperactivity Disorder), foster care or adopted, small OFC (occipital frontal circumference), communication impairments, impaired social skills, and cognitive deficits. All variables were categorized as yes/no for ease of use in a screening tool. Risk ratios for each of the seven indicators were estimated using two-way table analyses. Weights for each variable were estimated based on the relative strength of their odds ratios.Results: The average age was 2.7 years of age (S.D. 1.29) and ranged from infant (6.4%) to 4 years old (35.9%). Maternal alcohol use alone had a sensitivity of 0.97, specificity 0.65, and accuracy 0.86. For the combined seven variables, sensitivity was 0.94, specificity 0.74, and accuracy 0.87. Thus, the seven-item E-FAST screen had acceptable epidemiologic screening characteristics.Discussion: In the United States, up to 547 infants with FASD are born each day which far exceeds the capacity of multidisciplinary diagnostic clinics. During routine clinical management of infants and young children the use of an evidence-based screening tool provides a time efficient means to exclude large numbers of young children from further follow-up for FASD. Conversely, a positive screen identifies a smaller number of children at increased risk for FASD requiring more intensive evaluation and follow-up

Fetal Alcohol Spectrum Disorders: Fixing Our Aim to Aim for the Fix

We, as editors of this special issue on Fetal Alcohol Spectrum Disorders (FASD), are proud to present eleven papers [...

Is anorexia nervosa a neuropsychiatric developmental disorder? An illustrative case report

We propose the concept that anorexia nervosa is a neuropsychiatric developmental disorder. In support of the concept we present a case report of a 12-year-old girl with high functioning autistic disorder who developed Tourette syndrome and obsessive-compulsive disorder. She subsequently experienced a distinct onset of partial anorexia nervosa characterized by fear of gaining weight, body image distortions, food preference idiosyncrasies including avoidance of fat, dietary restriction, a pursuit of thinness, episodic self-induced vomiting, the missing of her menstrual cycles, and a 10% decrement in expected weight for height. She fell short of the required 15% decrement in expected weight for height to qualify for the full syndrome. Our case presentation emphasizes the longitudinal commonalities and symptomatic overlap of her multiple comorbidities. We discuss treatment approaches typically used with individuals with neuropsychiatric developmental disorders which might benefit higher functioning individuals with eating disorders. We conclude with examples of a neuropsychiatric developmental approach to generate a research agenda for anorexia nervosa