Ten-year experience of fetal alcohol spectrum disorder; diagnostic and resource challenges in Indigenous children
Ten-year experience of fetal alcohol spectrum disorder; diagnostic and resource challenges in Indigenous children
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DOI：
10.1093/pch/pxx052
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发表时间：
2017-06-01
影响因子：
1.9
通讯作者：
Shah, Chandrakant
中科院分区：
文献类型：
--
作者：
Banerji, Anna;Shah, Chandrakant
背景：虽然胎儿酒精谱系障碍(FASD)在一些土著社区有不成比例的影响，但关于其流行病学的文献很少。目的：了解多伦多Anishnawbe Health 10年间确诊为FASD的18岁以下原住民的流行病学特征。方法：纳入2002-2012年间在Anishnawbe Health Toronto接受评估并符合2005年FASD标准的儿童。多学科小组评估了神经发育异常、FASD面部特征和生长参数，并询问了母亲饮酒、目前的监护权和参与刑事司法系统的情况。结果：49名儿童被诊断为FASD。所有受试者均未患完全胎儿酒精综合征(Fas)；12例诊断为部分Fas，37例为酒精相关神经发育障碍(ARND)。其中35例为男性，确诊时的中位年龄为9岁。19个是儿童服务中心的病房，8个是和养父母住在一起的。所有儿童在心理测试中都有异常。其他问题包括：行为问题(80%)；学习障碍(63%)；注意力缺陷多动障碍(43%)；发育迟缓(14%)；参与刑事司法系统(12%)和酗酒(10%)。与部分FASD相比，ARND的发病率和损害几乎在每一项指标上都更高。结论：FASD是土著儿童终身显着发病的可预防原因，儿童需要寄养服务的比例很高，并且在很小的时候就参与了刑事司法系统。虽然ARND很难诊断，但它可能会导致严重的发病率。需要为土著家庭提供对文化敏感的FASD初级预防和早期诊断所需的额外资源。
Background: Although fetal alcohol spectrum disorder (FASD) can have a disproportionate impact in some Indigenous communities, there is a paucity of literature on its epidemiology. Objective: To characterize the epidemiology of Indigenous individuals under the age of 18 years who were diagnosed with FASD at Anishnawbe Health Toronto over a 10-year period.Methods: Children who were assessed at Anishnawbe Health Toronto from 2002 to 2012 and met the 2005 criteria for FASD were included. The multidisciplinary team assessed neurodevelopmental abnormalities, FASD facial features and growth parameters and enquired about maternal alcohol consumption, current custody and involvement with the criminal justice system.Results: Forty-nine children were diagnosed with FASD. None of these had full fetal alcohol syndrome (FAS); 12 were diagnosed as partial FAS and 37 with alcohol-related neurodevelopmental disorder (ARND). Thirty-five were male and the median age at diagnosis was 9 years. Nineteen were wards of children's services, and 8 were living with adoptive parents. All children had abnormalities in psychometric testing. Other issues included: behavioural issues (80%); learning disabilities (63%); attention deficit hyperactivity disorder (43%); developmental delay (14%); involvement with the criminal justice system (12%) and alcohol abuse (10%). The morbidity and impairment for ARND was higher on almost every measurement compared with partial FAS.Conclusions: FASD is a preventable cause of lifelong significant morbidity to Indigenous children with a high proportion of children needing foster-care services and involvement with the criminal justice system at an early age. Although ARND is difficult to diagnose, it can result in significant morbidity. Additional resources for culturally sensitive primary prevention and early diagnosis of FASD for Indigenous families are required.