Getting a Diagnosis for Prenatal Alcohol or Drug Exposure

Do you think your child was exposed to alcohol or drugs during pregnancy? If so, a diagnosis can help your child access services and support. Check out this show with Dr. Yasmin Senturias, a developmental-behavioral pediatric specialist with 28 years of experience in developmental pediatrics and prenatal substance exposure. She worked with the American Academy of Pediatrics on developing their FASD Toolkit.

In this episode, we cover:

Prenatal Drug Exposure

Background:

Prenatal drug exposure includes the use in pregnancy of legal and illegal drugs and includes such drugs as opioids, methamphetamines, cocaine/crack, marijuana, and nicotine (smoked or vaped). It also includes drugs used to treat substance abuse disorders, including methadone and buprenorphine (brand name Suboxone).

Do the impacts differ depending on what drug the child was exposed to?
What’s the difference between Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS).
Short-term impacts?
Is the impact less severe for legal drugs, such as nicotine and marijuana?
Is the impact less severe for legal medications used to treat substance abuse disorders in pregnant women?

Diagnosis:

What are the medical disorders in the Diagnostic and Statistical Manual (DSM) or International Classification of Diseases (ICD) for prenatal drug exposure?
Do these diagnoses have to be made at birth?
What diagnosis is available if the child was exposed to drugs in utero but was not born dependent and didn’t go through withdrawal, and therefore did not have a diagnosis of NAS or NOWS in their medical record?
Do these diagnoses help the child and youth receive more services?
What type of doctor can make this diagnosis?

FASD:

Background:

Fetal Alcohol Spectrum Disorder is an umbrella term describing a broad range of adverse developmental symptoms that can occur in an individual with prenatal exposure to alcohol.

It is estimated that 1% to 5% of children in the United States may have an FASD.
How common is drinking in pregnancy? (Centers for Disease Control and Prevention data indicate that approximately 12% of pregnancies may have alcohol exposure.)

FASD is a spectrum disorder. A child, adolescent, or adult with an FASD may have a combination of physical, neurodevelopmental, learning, and behavioral problems, with each manifesting a range of severity.

Is the severity of the impact on the child, youth, or adult directly correlated to the amount of alcohol the mother consumed when pregnant?
What are the actual diagnoses that exist on this spectrum of FASDs?
- Fetal Alcohol Syndrome (FAS),
- Partial FAS (pFAS),
- Alcohol-related neurodevelopmental disorder (ARND),
- Alcohol-related birth defects (ARBD)
- Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).
Explain the differences in these disorders.
Is one diagnosis better than another in terms of getting services and support for the child in childhood, adolescence, and adulthood?
Are these different disorders linear on the spectrum from lesser to greater life impacts?

Diagnosis:

Why is it important to get a diagnosis?
- An FASD diagnosis a framework for understanding an individual’s behavior, and this understanding can help mitigate secondary impacts that result from being raised in an environment that does not understand you.
- Diagnosis can lead to services and support which can improve outcomes for patients and families.
- Maybe medications that can help?
Is it possible to get a diagnosis without mom admitting to using alcohol or drugs during her pregnancy? What to do if the child’s record doesn’t reflect that the mom drank during pregnancy?
If you suspect or know that your child or youth was exposed to alcohol in utero, how can you get a diagnosis?
What are some common misdiagnoses that kids and adolescents with prenatal alcohol exposure may get?
What type of doctor can diagnose?
Do you need a referral from your pediatrician to get an appointment with a specialist?

Dual Exposure to Alcohol and Drugs

How common is the dual use of alcohol and drugs?
How can drugs and alcohol together affect the child both in infancy and throughout life?

Impact of Trauma:

In addition to prenatal alcohol and drug exposure, many of our kids have experienced traumatic events in their young lives. How does trauma interplay with prenatal substance exposure?

Resources:

American Academy of Pediatric Fetal Alcohol Spectrum Disorders
- The American Academy of Pediatrics FASD Toolkit was developed in coordination with the CDC to raise awareness, promote surveillance and screening, and ensure that all children who possibly have FASDs receive appropriate and timely interventions. Focused primarily on providers, it features basic information on FASD, diagnostic tools for use in children suspected of being affected, evidence-based interventions, and guidelines for case management/care coordination. The site also contains FAQ and a list of resources for families and school professionals who care for children with FASD.