Behavioral phenotype helps diagnose FASD in children.

BALTIMORE -- Defining behaviors associated with fetal alcohol syndrome help clinicians identify the condition in children, a developmental and disability expert said.

This behavioral phenotype will help distinguish them from a significant number of children who have developmental problems linked to maternal alcoholism but don't have full-blown fetal alcohol syndrome disorders (FASD), said Piyadasa W. Kodituwakku, Ph.D., of the Center for Development and Disability at the University of New Mexico, Albuquerque.

"The whole brain is not equally affected in FASD; there are more abnormalities in some areas than in others," he explained. Studies comparing alcohol-exposed children with control children have shown evidence of abnormalities in the corpus callosum, and in the proportions of gray matter to white matter in the temporal and parietal lobes of the alcohol-exposed children.

The abnormal brain development associated with FASD appears to have an observable impact on logical memory, but less impact on spatial memory, based on studies that compared children with FASD to healthy children, Dr. Kodituwakku said at a meeting on developmental disabilities sponsored by Johns Hopkins University.

On average the FASD children have reduced intellectual function, with average IQs in the borderline range of 65-75, he said. This reduced intellectual function, compared with healthy children, tends to remain stable with age. In addition, infants with FASD tend to process information slowly, compared with healthy children, and this difference persists at least to school age. These biologic deficits translate into a tendency toward certain behaviors that teachers and parents may be able to identify.

Dr. Kodituwakku described results from a study that he conducted in a community sample of Italian children: 22 children with FASD were compared with 60 control children. The FASD children scored lower than the controls on tests of nonverbal reasoning and language comprehension. And on tests of disruptive behaviors, the FASD children had more problems with inattention, hyperactivity, and impulsivity. The inattentive symptoms were associated with poor school performance, and inattentiveness is consistent with the slow processing of information that is characteristic of children with FASD, he noted (Alcohol Clin. Exp. Res. 2006;30:1551-61).

He also cited a study in which the Child Behavior Checklist was administered to parents and caregivers of 30 children with FASD, 30 children with attention-deficit/hyperactivity disorder (ADHD), and 30 healthy children. Overall, the FASD children showed significant differences from controls on items reflecting hyperactivity, inattention, disobedience, lying and cheating, and lack of guilt about misbehavior. Behaviors that separated children with FASD from ADHD children included cruelty, a lack of guilt after misbehaving, and acting young for their ages (Arch. Womens Ment. Health 2006;9:181-6).

On the basis on the results from these and other studies, Dr. Kodituwakku proposed a behavioral phenotype for children with FASD that includes dysexecutive syndrome, increased inattentiveness, compared with controls, and possible signs of hyperactivity, mood disorders, and conduct disorder.

The data on behavioral phenotypes of children with FASD suggest some clinical interventions, he said. Use concrete examples, present information slowly, and repeat the information several times. Also, visual aids and illustrations can help these children learn, as can hands-on techniques such as calculators and subject-specific teaching keyboards.

Dr. Kodituwakku said he had no financial conflicts of interest to disclose.

BY HEIDI SPLETE

Senior Writer