Abstract
Purpose
This article is a retrospective examination of environmental risk, language performance, and narrative discourse data from a clinical database of school-age children with fetal alcohol spectrum disorder (FASD).
Method
A case-defined diagnostic approach for measuring and reporting the full spectrum of disabilities in children with prenatal alcohol exposure is presented. Demographic, environmental, language, and social communication (as reflected by narrative discourse) data are reported for a large cohort of children with FASD between the ages of 6;0 (years;months) and 12;0.
Results
Children with FASD are a heterogeneous group with varying levels of compromise. The data demonstrate a substantial comorbidity between the effects of prenatal alcohol exposure and adverse caregiving environments. The data further reveal that school-age children with FASD often exhibit clinically meaningful deficits in language and social communication.
Clinical Implication
Children with FASD may be particularly vulnerable to language and social communication deficits as a result of prenatal alcohol exposure and atypical or adverse social interactive experiences. Comprehensive assessment is recommended. Dynamic and functional assessment paradigms may document the language and social communicative deficits in children with FASD and other clinical populations with complex neurodevelopmental profiles.
REFERENCES
-
Abkarian, G. (1992). Communication effects of prenatal alcohol exposure.Journal of Communication Disorders, 25, 221–240. -
Anderson, D. (2002). Mosby’s medical nursing and allied health dictionary (6th ed.). St. Louis, MO: Mosby. - American Speech-Language-Hearing Association. (2000). Guidelines for the roles and responsibilities of school-based speech-language pathologists. Rockville, MD: Author.
-
Astley, S. (2004). Diagnostic guide for fetal alcohol spectrum disorders (3rd ed.). Seattle: University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network. -
Astley, S., & Clarren, S. (2000). Diagnosing the full spectrum of fetal alcohol exposed individuals: Introducing the 4-digit diagnostic code.Alcohol & Alcoholism, 35, 400–410. -
Astley, S., & Clarren, S. (2001). Measuring the facial phenotype of individuals with prenatal alcohol exposure: Correlations with brain dysfunction.Alcohol & Alcoholism, 36, 147–159. -
Baron-Cohen, S. (2000). Theory of mind and autism: A fifteen year review.InS. Baron-Cohen, H. Tager-Flusberg, & D. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (pp. 3–20). New York: Oxford University Press. -
Becker, M., Warr-Leeper, G., & Leeper, H. (1990). Fetal alcohol syndrome: A description of oral motor, articulatory, short term memory, grammatical, and semantic abilities.Journal of Communication Disorders, 23, 97–124. -
Botting, N. (2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments.Child Language and Teaching Therapy, 18(1)1–21. -
Bundy, A., Lane, S., & Murray, E. (2002). Sensory integration: Theory and practice. Philadelphia: F.A. Davis. -
Caldwell, S. (1993). Nurturing the delicate rose.InJ. Kleinfeld, & S. Wescott (Eds.), Fantastic Antone succeeds! Experiences in educating children with fetal alcohol syndrome (pp. 97–129). Anchorage: University of Alaska Press. -
Carmichael Olson, H., Feldman, J. J., Streissguth, A. P., Sampson, P. D., & Bookstein, F. L. (1998). Neuropsychological deficits in adolescents with fetal alcohol syndrome: Clinical findings.Alcoholism: Clinical and Experimental Research, 20, 1998–2012. -
Carney, L., & Chermak, G. (1991). Performance of American Indian children with fetal alcohol syndrome on the Test of Language Development.Journal of Communication Disorders, 24, 123–134. -
Carrow-Woolfolk, E. (1985). Test of Auditory Comprehension of Language–R. Austin, TX: Pro-Ed. -
Carrow-Woolfolk, E. (1999). Test of Auditory Comprehension of Language–3. Austin, TX: Pro-Ed. -
Chudley, A., Conry, J., Cook, J., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis.Canadian Medical Association Journal, 172(Suppl. 5), 1–21. -
Church, M., Eldis, F., Blakley, B., & Bawle, E. (1997). Hearing, language, speech, vestibular, and dentofacial disorders in fetal alcohol syndrome.Alcoholism: Clinical and Experimental Research, 2, 227–237. -
Church, M., & Kaltenbach, J. (1997). Hearing, speech, language, and vestibular disorders in the fetal alcohol syndrome: A literature review.Alcoholism: Clinical and Experimental Research, 21, 495–512. -
Cicchetti, D. (2004). An odyssey of discovery: Lessons learned through three decades of research on child maltreatment.American Psychologist, 58, 731–741. -
Cicchetti, D., & Rizley, R. (1981). Developmental perspectives on the etiology, intergenerational transmission, and sequelae of child maltreatment.New Directions for Child Development, 11, 32–59. -
Cicchetti, D., Rogosch, F., Maughan, A., Toth, S., & Bruce, J. (2003). False-belief understanding in maltreated children.Developmental and Psychopathology, 15, 1067–1091. -
Clarren, S., Carmichael Olson, H., Clarren, S., & Astley, S. (2000). A child with fetal alcohol syndrome.InM. Guralnick (Ed.), Interdisciplinary clinical assessment of young children with developmental disabilities (pp. 307–326). Baltimore: Paul H. Brookes. -
Coggins, T. (1997, July). Assessment of language and social communication in FAS. Paper presented at the Prevention and Management of Fetal Alcohol Syndrome and Prenatal Substance Abuse Conference, Breckenridge, CO. -
Coggins, T., Friet, T., & Morgan, T. (1998). Analyzing narrative productions in older school-age children and adolescents with fetal alcohol syndrome: An experimental tool for clinical applications.Clinical Linguistics & Phonetics, 12, 221–236. -
Coggins, T., Olswang, L., Carmichael Olson, H., & Timler, G. (2003). On becoming socially competent communicators: The challenge for children with fetal alcohol exposure.International Review of Research in Mental Retardation, 27, 121–150. -
Coster, W., Gersten, M., Beeghly, M., & Cicchetti, D. (1989). Communicative functioning in maltreated toddlers.Developmental Psychopathology, 25, 1020–1029. -
Curenton, S., & Justice, L. (2004). African American and Caucasian preschoolers' use of decontextualized language: Literate language features in oral narratives.Language, Speech, and Hearing Services in Schools, 35, 240–253. -
Eigsti, I., & Cicchetti, D. (2004). The impact of child maltreatment on expressive syntax at 60 months.Developmental Science, 7, 88–102. -
Fletcher, P., & Miller, J. (2005). Developmental theory and language disorders. Amsterdam: John Benjamins. -
Gentry, B., Griffith, L., & Dancer, J. (1998). Prenatal alcohol exposure and communication, behavior and nonverbal intelligence of 3 school-age children.Perceptual and Motor Skills, 86, 1089–1090. -
Guralnick, M. (1999). Family and child influences on the peer-related social competence of young children with developmental delays.Mental Retardation and Developmental Disabilities, 5, 21–29. -
Hamilton, M. (1981). Linguistic abilities of children with fetal alcohol syndrome. Unpublished doctoral dissertation. University of Washington, Seattle. - Health Resources and Services Administration. (2005). Women’s health USA 2005. Rockville, MD: U.S. Department of Heath and Human Services.
-
Hinde, J. (1993). Early intervention for alcohol-affected children.InJ. Kleinfeld, & S. Wescott (Eds.), Fantastic Antone succeeds! Experiences in education children with fetal alcohol syndrome (pp. 131–147). Anchorage: University of Alaska Press. - Institute of Medicine (1996). Division of Biobehavioral Sciences and Mental Disorders, Committee to Study Fetal
Alcohol Syndrome.In
K. Stratton, C. Howe, & F. Battaglia (Eds.), Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment (pp. 82–99). Washington, DC: National Academic Press. -
Jacobson, S., & Jacobson, J. (2000). Teratogenic insult and neurobehavioral function in infancy and childhood.InC. Nelson (Ed.), Minnesota symposia on child psychology (pp. 61–112). Hillsdale, NJ: Erlbaum. -
Janzen, L., Nanson, J., & Block, G. (1995). Neuropsychological evaluation of preschoolers with fetal alcohol syndrome.Neurotoxicology and Teratology, 17, 273–279. -
Kaufman, J., Plotsky, P., Nemeroff, C., & Charney, D. (2000). Effects of early adverse experiences on brain structure and function: Clinical implications.Biological Psychiatry, 48, 778–790. -
Kelly, S., Day, N., & Streissguth, A. (2000). Effects of prenatal alcohol exposure on social behavior in humans and other species.Neurotoxicology and Teratology, 22, 143–149. -
Kerns, J., Don, A., Mateer, C., & Streissguth, A. (1997). Cognitive deficits in nonretarded adults with fetal alcohol syndrome.Journal of Leaning Disabilities, 30, 685–693. -
Kodituwakku, P., Handmaker, N., Cutler, S., Weathersby, E., & Handmaker, S. (1995). Specific impairments in self-regulation in children exposed to alcohol prenatally.Alcoholism: Clinical & Experimental Research, 19, 1558–1564. -
Kodituwakku, P., May, P., Ballinger, L., Harris, M., Aase, J., & Aragon, A. (1997, July). Executive controlling functioning and theory of mind in children prenatally exposed to alcohol. Paper presented at the Prevention and Management of Fetal Alcohol Syndrome and Prenatal Substance Abuse Conference, Breckenridge, CO. -
Kopara-Frye, K., Dehaene, S., & Streissguth, A. (1996). Impairments of number processing induced by prenatal alcohol exposure.Neuropsychologica, 34, 1187–1197. -
Leonard, L. (1998). Children with specific language impairment. Cambridge, MA: MIT Press. -
Lohmann, H., & Tomasello, M. (2003). The role of language in the development of false belief understanding: A training study.Child Development, 74, 1130–1144. -
Mattson, S., & Riley, E. (1998). A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol.Alcoholism: Clinical and Experimental Research, 22, 279–294. -
Mattson, S. N., Goodman, A. M., Caine, C., Delis, D. C., & Riley, E. P. (1999). Executive functioning in children with heavy prenatal alcohol exposure.Alcoholism: Clinical and Experimental Research, 23, 1808–1815. -
Mayer, M. (1969). Frog, where are you?. New York: Dial Books for Children. -
McCauley, E. (2001). Assessment of language disorders in children. Mahwah, NJ: Erlbaum. -
McCauley, E., & Swisher, L. (1984). Psychometric review of language and articulation tests for preschool children.Journal of Speech and Hearing Research, 49, 34–42. -
McFadyen, R., & Kitson, W. (1996). Language comprehension and expression among adolescents who have experienced childhood physical abuse.Journal of Child Psychology, Psychiatry & Allied Disciplines, 37, 551–562. -
Morriset, C., Barnard, K., Greenberg, M., Booth, K., & Spieker, S. (1990). Toddlers' language development: Sex differences within social risk.Developmental Psychology, 31, 851–865. -
Newcomer, P., & Hammill, D. (1988). Test of Language Development–P. Austin, TX: Pro-Ed. -
Newcomer, P., & Hammill, D. (1997). Test of Language Development–P:3. Austin, TX: Pro-Ed. -
Norbury, C., & Bishop, D. (2003). Narrative skills of children with communication impairments.International Journal of Language and Communication Disorders, 38, 287–313. -
Olswang, L., Coggins, T., & Timler, G. (2001). Outcome measures for school-age children with social communication problems.Topics in Language Disorders, 22, 50–73. -
Olswang, L., Svensson, L., Coggins, T., Beilinson, J., & Donaldson, A. (2006). Reliability issues and solutions for coding social communication events in classroom settings.Journal of Speech, Language, and Hearing Research, 49, 1058–1071. -
Owens, R. (1999). Language disorders: A functional approach to assessment and intervention (3rd ed.). Boston: Allyn & Bacon. -
Paul, R. (1995). Language disorders from infancy through adolescence: Assessment and intervention. St. Louis, MO: Mosby Yearbook. -
Perner, J. (1991). Understanding the representational mind. Cambridge, MA: MIT Press. -
Plumridge, D., Bennett, R., Dinno, N., & Branson, C. (1993). The student with a genetic disorder: Educational implications for special education teachers and for physical therapists, occupational therapists and speech pathologists. Springfield, IL: Charles C. Thomas. -
Reilly, J., Losh, M., Bellugi, U., & Wulfeck, B. (2004). “Frog, where are you?” Narratives in children with specific language impairment, early focal brain injury, and Williams syndrome.Brain and Language, 88(2)163–257. -
Renfrew, C. (1991). The bus story (2nd ed.). Oxford, England: Author. -
Semel, E., Wiig, E., & Secord, W. (1987). Clinical Evaluation of Language Fundamentals–R. San Antonio, TX: The Psychological Corporation. -
Semel, E., Wiig, E., & Secord, W. (1995). Clinical Evaluation of Language Fundamentals–3. San Antonio, TX: The Psychological Corporation. -
Silliman, E., Diehl, S., Bahr, R., Hnath-Chisolm, T., Zenko, C., & Friedman, S. (2003). A new look at performance on theory-of-mind tasks by adolescents with autism spectrum disorder.Language, Speech, and Hearing Services in Schools, 34, 236–252. -
Singer, B., & Bashir, A. (1999). What are executive functions and self-regulation and what do they have to do with language-learning disorders?.Language, Speech, and Hearing Services in Schools, 30, 265–273. -
Streissguth, A. (1997). Fetal alcohol syndrome: A guideline for families and communities. Baltimore: Paul H. Brookes. -
Streissguth, A., Barr, H., Kogan, J., & Bookstein, F. (1996). Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE): Final report to the Centers for Disease Control and Prevention on Grant No. R04/CCR008515 (Tech. Report No. 96060). Seattle: University of Washington Fetal Alcohol and Drug Unit. -
Streissguth, A., & Kanter, J. (1997). The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle: University of Washington Press. -
Tager-Flusberg, H. (1993). What language reveals about the understanding of minds in children with autism.InS. Baron-Cohen, H. Tager-Flusberg, & D. Cohen (Eds.), Understanding other minds: Perspectives from children with autism (pp. 138–157). Oxford, England: Oxford University Press. -
Thomas, S., Kelly, S., Mattson, S., & Riley, E. (1998). Comparison of social abilities of children with fetal alcohol syndrome to those of children with similar IQ scores and normal controls.Alcoholism: Clinical and Experimental Research, 22, 528–533. -
Thorne, J., Coggins, T., Carmichael Olson, H., & Astley, S. (in press). Exploring the utility of narrative analysis in diagnostic decision-making: Elaboration, reference strategy, and fetal alcohol spectrum disorder.Journal of Speech, Language, and Hearing Research. -
Timler, G., & Olswang, L. (2001). Variable structure/variable performance: Caregiver and teacher perspectives of a school-age child with fetal alcohol syndrome.Journal of Positive Behavior Intervention, 3, 48–56. -
Timler, G., Olswang, L., & Coggins, T. (2005). “Do I know what I need to do?”: A social communication intervention for children with complex clinical profiles.Language, Speech, and Hearing Services in Schools, 36, 73–84. -
Trabasso, T., & Rodkin, P. (1994). Knowledge of goal/plans: A conceptual basis for narrating Frog, where are you?.R. Berman, & D. Slobin (Eds.), Relating events in narrative: A cross-linguistic developmental study (pp. 85–108). Hillsdale, NJ: Erlbaum. -
Wellman, H. (1990). The child’s theory of mind. Cambridge, MA: MIT Press. -
Weinberg, N. (1997). Cognitive and behavioral deficits associated with prenatal alcohol use.Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1177–1186. -
Wiig, E., & Secord, W. (1989). Test of Language Competence. San Antonio, TX: The Psychological Corporation. -
Wiig, E., & Secord, W. (1992). Test of Word Knowledge. San Antonio, TX: The Psychological Corporation. -
Willis, D., & Silovsky, J. (1998). Prevention of violence at the societal level.InP. Trickett, & C. Schellenach (Eds.), Violence against children in the family and the community (pp. 401–416). Washington, DC: American Psychological Association.