Effects of Fetal Alcohol Syndrome on Neuropsychological Function

Prenatal alcohol exposure (PAE) can have severe and permanent adverse effects on children. The most severe outcome is fetal alcohol syndrome (FAS). FAS can affect the neuroanatomical and neurophysiological make-up of the brain as well as specific neuropsychological function. This paper reviews some of the literature with regard to the neuroanatomical, neurophysiological, and neurobehavioral effects of PAE on individuals. In particular, studies show that there are neuroanatomical changes in the brain due to PAE or FAS, and illustrate specific vulnerability in the hippocampus, corpus callosum, basal ganglia, and the cerebellum. Neurophysiological studies have identified delays in the brain’s electrical response to specific sensory stimuli in children with FAS. Furthermore, neuropsychological studies have identified impairment in overall intellectual functioning, fine and gross motor performance, and adaptive functioning.     

Fetal Alcohol Spectrum Disorders: Implications for Primary Care Nurse Practitioners

Fetal alcohol spectrum disorders (FASDs) encompass a myriad of biological, psychological, and physiological variants. In primary care, FASDs are not routinely screened for, while prevalence rates remain high at 5% to 9%. Alcohol screening and brief intervention is an evidence-based practice that identifies those who may be consuming alcohol at risky levels and provides a brief motivation-enhancing intervention. FASDs are completely preventable when women do not consume alcohol during the prenatal period, and nurse practitioners who provide patient-centered primary care to women are ideally positioned to help in the prevention FASDs     

Assessment and Treatment of Fetal Alcohol Syndrome in Children and Adolescents

This paper describes characteristics of fetal alcohol syndrome (FAS) from infancy through adolescence. This paper also provides information regarding comorbidity of FAS with other psychological syndromes. The literature regarding assessment of FAS across childhood and adolescence is detailed; recommendations toward accurate assessment are included. Finally, this paper discusses treatment of FAS symptoms in children and adolescents.     

Evaluation of a Successful Fetal Alcohol Spectrum Disorder Coalition in Ontario,Canada

ABSTRACT Leading a successful coalition that benefits both the members and the community is a difficult task. Coalitions are complex and require a great deal of skill to initiate, lead, and evaluate. This article examines a successful coalition, developed to build community capacity to address fetal alcohol spectrum disorder (FASD). FASD is a complex, multidimensional health issue common in many communities. Coalitions can be effective in tackling these types of issues and fit with community capacity‐building approaches to health promotion. The Internal Coalition Outcome Hierarchy (ICOH) model ( Cramer, Atwood, & Stoner, 2006a, 2006b ) is used to retrospectively examine the internal constructs of the FASD Action Network and provide useful lessons learned for other coalition leaders and public health nurses. This hierarchical model demonstrates that sound internal processes lead to more successful outcomes and ultimately an increased impact on community issues. The usefulness of ICOH as a tool in evaluating the FASD Action Network and its application to other health‐promotion situations with community capacity goals is described in this article.     

The Relation of Communication and Challenging Behaviors in Infants and Toddlers with Autism Spectrum Disorders

This study analyzes the relationship between communication, expressive and receptive, and challenging behaviors among 168 toddlers with autism spectrum disorder. Communication level was evaluated using the Battelle Developmental Inventory, 2nd Edition and challenging behaviors were assessed using Baby and Infant Screen for Children with aUtIsm Traits, Part 3. Results indicate that lower levels of expressive and receptive communication are significantly correlated with lower levels of aggressive/disruptive behavior and self injurious behavior. However, lower receptive communication alone significantly correlates with higher levels of stereotypies, self-injurious behavior, and to a lesser extent aggressive/disruptive behavior. Implications of the results and how they integrate into the current knowledge base are discussed.     

Imaging of Frequent Emergency Department Users with Alcohol Use Disorders

Background

Patients with altered level of consciousness secondary to alcohol use disorders (AUDs) often undergo imaging in the emergency department (ED), although the frequency and yield of this practice over time are unknown.

Study Objectives

We describe the use of imaging, the associated ionizing radiation exposure, cumulative costs, and identified acute and chronic injuries and abnormalities among frequent users of the ED with AUDs.

Methods

This is a retrospective case series of individuals identified through an administrative database having 10 or more annual ED visits in 2 consecutive years who were prospectively followed for a third year. International Classification of Diseases, 9^th Revision, Clinical Modification and Current Procedural Terminology codes were used to select individuals with alcohol-related diagnoses, track imaging procedures, and calculate cost. Diagnoses, imaging results, and radiation exposure per computed tomography (CT) study were abstracted from the medical record.

Results

Fifty-one individuals met inclusion criteria and had a total of 1648 imaging studies over the 3-year period. Subjects had a median of 5 (interquartile range [IQR] 2–10) CT scans, 20 (IQR 10–33) radiographs, 28.3 mSv (IQR 8.97–61.71) ionizing radiation, 0.2% (IQR 0.07–0.4) attributable risk of cancer, and $2979 (IQR 1560–5440) in charges using a national rate. The incidence of acute fracture or intracranial head injury was 55%, and 39% of the cohort had a history of moderate or severe traumatic brain injury.

Conclusion

The remarkable use of imaging and occurrence of injury among these highly vulnerable and frequently encountered individuals compels further study to refine clinical practices through the development of evidence-based, effective interventions.     

国外孤独症人士职业康复研究现状

随着孤独症患病率的不断提高,越来越多的孤独症人士从儿童期进入青少年和成年期,他们面临的主要发展问题是就业。职业康复不论是对孤独症就业,还是对孤独症的全面发展,都有重要意义。本文主要从孤独症人士就业状况、职业康复现状和职业康复策略技巧三个方面,探讨了国外孤独症人士职业康复研究现状,分析国外孤独症职业康复研究趋势,以期为我国今后建立孤独症职业康复模式提供理论支撑和实践依据。     

Stereotypy in Adults with Autism Spectrum Disorders: Relationship and Diagnostic Fidelity

Autism Spectrum Disorders (ASD), are characterized by severe and debilitating symptoms including stereotypic behaviors. Stereotypies constitute core features of ASD and markedly impede attempts to remediate the disorder. Little previous research has examined characteristics of stereotypies in adults with ASD, or differentiated these behaviors as they present in ASD, from persons with intellectual disability (ID) only. In the present study 336 adults, those with ASD and ID versus ID alone were evaluated with respect to the nature and extent of their stereotypied behavior. A comparison of autistic to PDD-NOS participants was also conducted to offer a more fine-grained analysis specific to the ASD population. The nature and implications of these data for differential diagnosis in adults with ASD are discussed.     

血清NMO-IgG阳性视神经脊髓炎谱系疾病患者的 临床分析

目的:探讨血清视神经脊髓炎-免疫球蛋白G(NMO-IgG)阳性的视神经脊髓炎谱系疾病(NMOSDs)患者的临床和影像特点。方法:纳入34例NMO-IgG阳性NMOSDs患者,回顾性分析其临床表现、实验室指标和影像学结果。结果:34例NMOSDs患者中,男女比例为1∶16,首发年龄为(44.65±5.27)岁。首发症状为感觉异常(52.94%),肢体无力(44.12%),视力下降(29.41%),低热、嗜睡(8.82%),顽固性呃逆呕吐(8.82%),复视(2.94%),行走不稳(2.94%)。临床综合征为脊髓炎(82.35%),视神经炎(50.00%),最后区综合征(14.70%),间脑综合征(8.82%),大脑综合征伴有NMOSD特征性大脑病变(17.65%),其他脑干综合征(14.70%)。临床发作次数1~8次,平均(2.41±0.63)次,24例(70.59%)为复发-缓解病程,10例(29.41%)为单相病程。MRI表现:脑内病灶的发生率依次为脑干35.29%、大脑半球17.65%、间脑8.82%、视交叉8.82%。脊髓病灶以颈胸髓(50.00%)同时累及最为常见,其次为胸髓(17.65%)、颈髓(14.70%)。长节段脊髓受累(≥3个节段)24例(70.59%),其中11例(32.35%)≥10个椎体节段。免疫指标:血清NMO-IgG阳性率100%,脑脊液NMO-IgG阳性率29.41%;抗核抗体阳性率38.24%;甲状腺过氧化物酶抗体增高率32.35%;甲状腺球蛋白增高率17.65%。结论:NMO-IgG阳性NMOSDs患者以中年女性多见,首发症状以感觉异常、肢体无力及视力下降为多,脊髓炎和神经炎是最常见的临床综合征,多表现为复发-缓解病程;MRI病灶以颈胸髓同时受累最为常见,且多≥3个脊柱节段;常合并多种免疫指标异常。     

A Two Time Point Study of Imitative Abilities in Children with Autism Spectrum Disorders

Background Researchers have used various paradigms to explore the universality and specificity of imitation deficits in children with autism spectrum disorders (ASDs). However, some issues still need to be investigated, especially for children with ASDs under the age of 4. Method Two studies were conducted to examine the imitative abilities of children with autism spectrum disorders. Study 1 examined immediate and deferred imitation abilities in 18 children with ASDs, 18 children with developmental delay (DD), and 19 typically developing children (mean ages of all groups were below 4 years). Four tasks were used to evaluate immediate imitation abilities: meaningful actions on objects, non‐meaningful actions on objects, manual movements, and oral‐facial movements. Eighteen months after study 1 was completed, study 2 examined advanced imitative abilities in 11 children with ASDs and 11 children with DD from study 1. Results The results of study 1 indicated that, compared to the two control groups, children with ASDs experienced significant difficulty in imitating non‐meaningful actions only. The findings of study 2 suggested that children with ASDs were still significantly impaired on the imitation of single non‐meaningful actions compared to children with DD. Conclusions The relationships between specific imitation deficits, executive functioning, and shared intentionality in children with ASDs are further discussed.     

Results of a Nurse‐Led Workshop Designed to Prevent Fetal Alcohol Spectrum Disorder

ABSTRACT Preventing the negative consequences of prenatal exposure to alcohol remains an unmet challenge. This paper presents the results of a workshop, designed to increase the implementation of fetal alcohol spectrum disorders (FASD) prevention interventions in 8 counties of New York. The workshop was based on constructivist learning theory and used the Population‐Based Public Health Nursing Intervention Model as the structure for discussing potential interventions. The number and type of FASD interventions implemented were determined by surveys sent out postworkshop to 167 participants. At 4 months postworkshop, 37 participants reported implementing 226 primary, secondary, and tertiary interventions in 74 different worksites. The results indicate that incorporation of constructivist learning theory shows promise for future public health and continuing education programs aimed at changing or enhancing practice.     

视神经脊髓炎谱系疾病临床特点分析及治疗进展

目的:研究视神经脊髓炎谱系疾病(NMOSD)的临床特点,探讨治疗进展。方法:回顾性分析13例NMOSD患者的临床表现、辅助检查结果、治疗及预后,并进行分析。结果:13例NMOSD患者中男女比例1∶3.3,平均(45±14)岁。急性脊髓炎11例,视神经炎9例,延髓最后区综合征2例,伴发皮肤瘙痒2例,肢体痉挛性疼痛3例。9例患者血和/或脑脊液AQP4-Ig G阳性,3例抗体阴性患者中1例MOG-Ig G阳性。11例MRI表现为脊髓长节段脱髓鞘信号伴强化,1例延髓背侧异常信号,1例视神经异常信号伴强化。大部分患者急性期给予大剂量激素冲击或免疫球蛋白或血浆置换治疗,部分患者给予硫唑嘌呤预防复发。11例患者(84.6%)好转,1例患者(7.7%)无好转,1例患者(7.7%)自行缓解。8例(61.5%)呈复发病程,5例(38.5%)为单相病程。结论:NMOSD临床表现多种多样,除了典型的核心症状以外,还有很多非典型症状。大剂量激素冲击、血浆置换和免疫球蛋白治疗仍是目前急性期首选治疗方案,硫唑嘌呤、吗替麦考酚酯和利妥昔单抗是预防发作的一线用药。     

A brief assessment for selecting communication modalities for individuals with Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASD) have impairments in their ability to communicate with others. Estimates indicate that about 25–50% of children with ASD are nonvocal. To address these deficits, a number of augmentative and alternative communication strategies have emerged. Commonly used communication responses have included vocal speech, picture exchange, and manual signs. While these communication strategies have all been shown to be effective in specific clinical instances, the selection of communication topography has generally been based on philosophical preference, rather than on empirical analyses. Relatively little research has evaluated procedures to determine which modality represents a “best fit” with individual learning styles. The purpose of the current investigation was to design a brief assessment model to evaluate the rate of acquisition and preference for different communication modalities for three individuals with ASD. The results show that participants acquired different modalities of communication at different rates and displayed clear preferences for different styles of communication. These findings suggest that this procedure may help to empirically determine which communication system represents a best fit for individual learners.     

胎儿肾动脉和大脑中动脉阻力指标比值联合Tei指数预测妊娠期高血压疾病胎儿缺氧

目的 探讨胎儿肾动脉(RA)和大脑中动脉(MCA)阻力指标比值联合Tei指数预测妊娠期高血压疾病胎儿宫内缺氧的临床价值.方法 运用脉冲多普勒技术检测所有胎儿RA和MCA阻力指数(RI)、搏动指数(PI)及S/D值,计算RA和MCA阻力指标比值,同时运用组织多普勒成像技术测量所有胎儿左、右心室等容收缩时间(ICT)、等容舒张时间(IRT)及射血时间(ET),获得左、右心室Tei指数.结果 妊娠期高血压疾病组胎儿RA和MCA阻力指标比值均高于对照组(P＜0.05);左、右心室Tei指数均高于对照组(P＜0.05);疾病组胎儿RA和MCA阻力指标比值与左、右心室Tei指数均呈正相关.结论 胎儿肾动脉和大脑中动脉阻力指标比值联合Tei指数可帮助预测妊娠期高血压疾病胎儿宫内缺氧情况.     

The Family Empowerment Network: a service model to address the needs of children and families affected by Fetal Alcohol Spectrum Disorders

Fetal Alcohol Spectrum Disorders (FASD) represent a leading cause of mental retardation and learning disabilities in children seen in pediatric offices today. This article provides an overview of FASD and describes a model program, the Family Empowerment Network (FEN). FEN is an information, referral, and support network for children and families affected by Fetal Alcohol Spectrum Disorders (FASD) and the professionals who serve them. FEN's mission includes: (a) increasing awareness about FASD by providing education, training and resources to families, providers, and the general public; (b) providing support and referrals to families affected; and (c) increasing opportunities for diagnosis and intervention. We hope to increase awareness of the resources available to nurses and their patients and provide a template that can be replicated in other service delivery systems. Pediatric nurses are in a unique position not only to assist in the recognition of children at risk of FASD, to link families to appropriate diagnostic and intervention services, but also to work to develop additional local and regional resources with other providers.