CanFASD Research Network has released an issue paper to draw attention to the gap in research focused on FASD diagnosis in preschool aged children and to highlight the benefits of early diagnosis.

The issue paper, authored by a team from the Department of Pediatrics & Child Health at the University of Manitoba and the Manitoba FASD Centre/MB FASD Network and led by Ana Hanlon-Dearman, MD, M.Sc. highlights two key points:

·      Infants and preschoolers prenatally exposed to alcohol and other substances benefit from specialized multidisciplinary assessments.

·      Assessments by an experienced team supports positive development and facilitates early intervention.

The paper notes that “assessment of preschoolers has its own unique set of challenges” and makes the following recommendations:

·      Diagnostic assessment of preschoolers should focus on both comprehensive physical exam as well as developmental assessment by a clinical team experienced in preschool assessment. The physical exam should include measurement of growth parameters (head circumference, height, and weight) and assessment of facial dysmorphic features (ie. Facial differences, specifically in FASD including short palpebral fissures, smooth philtrum and thin upper lip). Facial features are most sensitively assessed when children are young, ideally in the preschool period.

·      Preschool developmental assessment of brain domains should be undertaken by a clinical team experienced in preschool assessment. These domains should include language, motor function, executive function, adaptive functioning, with additional assessment of sensory processing differences. Researchers have shown early motor and sensory differences in preschooler with PAE that later have an impact on the child’s performance (e.g. cognitive and motor skills). The paper notes the particular importance of this range of domains in assessing preschoolers with PAE who do “are non-dysmorphic (i.e., who do not have physical or facial features) and normocephalic (i.e., have a head size within the normal range for their age)”.

In a discussion of the benefits of early diagnosis, the authors note: “Early intervention is important in reducing the impact of risk factors like PAE on neurobehavioural outcomes of children while at the same time supporting and enriching protective factors. As the severity of delays and impairments can become more pronounced with age, it is critical that appropriate supports are put in place as soon as possible. With the implementation of proper supports, later life challenges often associated with FASD can be prevented, and opportunities for success across environments can be promoted throughout the lifespan.”

The paper makes the following recommendations for research and practice.

Future Research:

·      Multisite, longitudinal studies with preschool aged children and their families is needed, as well as further research on the ways in which interventions can impact their lives.

·      Further studies of appropriate assessment protocols and tools for preschool aged children undergoing FASD assessment are also required.

Multidisciplinary Assessment: Preschool aged children need to be assessed by clinicians experienced in preschool behaviour and development.

·      Preschool assessment should be:

o   Multifaceted: using a variety of measures and approaches

o   Ecological: considering the child in multiple context, such as in the home, preschools, and communities

o   Comprehensive

o   Strengths-based

o   Informative for early intervention strategies and referrals

·      In keeping with the current Canadian Guidelines, FASD assessment should include a multidisciplinary team experienced in the developmental and medical assessment of preschoolers including:

o   Coordinator

o   Social worker

o   Developmental pediatrician or psychologist experienced in preschool assessment

o   Geneticist

o   Speech-language pathologies

o   Occupational therapist

o   Physiotherapist

·      The team must be able to carefully and comprehensively consider differential diagnosis, cumulative risk, and protective influences.