Fetal Alcohol Spectrum Disorders: Survey of Healthcare Providers after Continuing Education
Pages 133-143
Shirley F. Evans, Leigh E. Tenkku, Tay Kennedy, Roger Zoorob and P. Kevin Rudeen

DOI: http://dx.doi.org/10.6000/2292-2598.2014.02.02.7

Published: 26 September 2014

Abstract: Fetal alcohol spectrum disorders (FASD) occur as a result of prenatal alcohol exposure and are commonly associated with intellectual disability. Maternal alcohol consumption affects fetal development resulting in numerous lifelong physical, mental, and neurobehavioral abnormalities. To promote prevention of prenatal alcohol exposure and intervention to mitigate alcohol’s postnatal effects, the Centers for Disease Control and Prevention (CDC) provides continuing education to healthcare providers through their FASD Regional Training Centers (RTCs). An online survey evaluated healthcare providers’ perceived competency after training. Cover letters with the survey link were electronically mailed to healthcare providers, who received training between 2002 and 2009 from the Midwest and Southeast RTCs. Eighty-two providers who treated women or children responded to the survey (7.5% response rate). Approximately 86% of providers who treated women have identified women ‘at risk’ for alcohol abuse with 90% indicating they would refer to Substance Abuse or Mental Health Services. However, over 25% perceived lack of training and limited time as barriers in treating women of childbearing age for at-risk drinking. Over 90% of providers who treated children reported feeling competent in recognizing FAS and other alcohol-related effects. Yet, only 23% of providers for children reported using FASD diagnostic schema and were more apt to use growth charts (70%) rather than lip philtrum guides (58%) or palpebral fissure length measurements (50%), tools typically used in FAS determination. These results suggest a need for training to focus on methodology that assists providers to easily incorporate screening, diagnostic, and treatment procedures into their daily practice.

Preterm Infants’ Follow-Up Program at a Public Hospital in Buenos Aires: Two-Decade Study
Pages 144-154
N. Aspres, I. Schapira, A. Benitez, A. Galindo, M. Brundi, L. Kasten, V. Feld, G. Granovsky, G. Allignani, A. Fiorentino, M. Cuneo-Libarona, S. Vivas, G. Gerometta, M.A. Gonzalez and A.B. Álvarez Gardiol

DOI: http://dx.doi.org/10.6000/2292-2598.2014.02.02.8

Published: 26 September 2014

Abstract: Objectives: To analyze temporal trends of mortality, morbidity, growth and neurodevelopment until 2 years of corrected age (CA) of very low birth weight infants (VLBWI) born between 1986- 2005 in Ramon Sardá Maternal Infant Hospital (RSMIH).

Methods: Descriptive temporal trend study divided in 5 quinquenniums.1255 VLBWI were born at RSMIH between 1986-2005; 46 were excluded (genetic syndromes, major congenital malformations, confirmed intrauterine infections), 84 were referred out and 1125 were studied. Birth weight (BW), gestational age (GA); morbidity; growth; neurodevelopment at 1 and 2 years of CA; neurological and sensorial disorders, antenatal steroids use, breastfeeding; rehospitalizations; mothers´ age and years of schooling and Unsatisfied Basic Needs Index (UBNI) were recorded.

Results: Survival rates increased during the last two periods, especially in <1000g BW infants despite the decrease in GA and BW. Children receiving surfactant (Sf), parenteral nutrition (PN) and antenatal steroids (AS) in the last quinquennium obtained better results in growth (40 weeks GA and 1 CA). The use of these therapies increased greatly in the last decade. Also breastfeeding at 40 weeks GA and 4 months tended to be better. Bronchopulmonary dysplasia (BPD) increased. Rehospitalizations (majorly attributable to lower tract infections) and UBNI stayed equal all along. Mothers’ years of schooling increased a little in the last two quinquenniums.

Conclusion: In the last quinquennium children tended to be smaller in GA and BW due to an increase in the survival rate as a result of higher technology and appropriate interventions such as AS, PN, Sf, etc.

Comprehensive Multi-Disciplinary Assessment Protocol for Autism Spectrum Disorder
Pages 68-82

Janet L. Dodd, Lauren K. Franke, Jeanette K. Grzesik and Jenna Stoskopf

DOI: http://dx.doi.org/10.6000/2292-2598.2014.02.01.9

Published: 28 May 2014 

Abstract: Legal mandates established under IDEA specify a student must be assessed in all areas of suspected disability. Never is this task more overwhelming than its application to the assessment of a student suspected of a diagnosis of autism. The assessment of an individual suspected of an autism spectrum disorder (ASD) diagnosis is a complex task and is dependent on the integration of information gleaned from assessments conducted by an array of professionals, each with their own distinct area of expertise. The purpose of this article is to introduce the Comprehensive Multidisciplinary Assessment Protocols-Autism Spectrum Disorder, referred to as the CMAPs, as a mechanism for organizing multidisciplinary team assessments. The CMAPs were developed in response to the challenges experienced by school-based assessment teams in developing appropriate and legally defensible assessment plans. The CMAPs provide teams a systematic, organizational, and comprehensive platform to organize the assessment of students across the spectrum of the disorder with the goal of making the task less overwhelming. Each assessment protocol considers the assessment needs of individuals with ASD using their communication skills as a preliminary starting point.

Quality of Life and its Determinants in Preschool Children with Down Syndrome
Pages 12-20

M.E. Weijerman, P.E.M. van Schie, M.J.M. Volman, A.M. van Furth and R.J.B.J. Gemke

DOI: http://dx.doi.org/10.6000/2292-2598.2013.01.02.2

Published: 06 May 2014

Abstract: Objective: Children with Down syndrome (DS) show a delay in cognitive and motor development and have various concomitant health problems. We compared Health-Related Quality of Life (HRQoL) in preschool children with DS with a reference group, and investigated child-related factors (i.e., developmental quotient, adaptive function, health problems, problem behaviour), and maternal level of education on HRQoL.

Method: In a cohort of 55 children with DS, HRQoL was measured with the TNO-AZL preschool children Quality of Life Questionnaire (TAPQoL). Data from a reference group were used for comparison. Developmental Quotient (DQ) was assessed with the Bayley Scales of Infant Development II, adaptive function with the Pediatric Evaluation of Disability Inventory, health problems were derived from the medical file, and behavioural problems were measured with the Child Behaviour Checklist.

Results: Children with DS (N=55; mean age 41.7 months) scored significantly lower on the TAPQoL domains lung and stomach problems, motor function and communication compared to the reference group. DQ had a significant negative correlation with the domains lung problems and liveliness. Children with DS with respiratory or gastro-intestinal problems showed significant lower scores on lung problems and communication. Problem behavior had a significant negative correlation with the domains sleeping, appetite and social function. A low level of maternal education correlated negatively with positive mood. Adaptive function and congenital heart defect (CHD) did not significantly correlate with HRQoL.

Conclusion: Preschool children with DS show a lower HRQoL on particular domains of functioning compared to a normative sample. HRQoL of children with DS is correlated to DQ, respiratory and gastro-intestinal health problems, problem behaviour and maternal education, but not to CHD and adaptive function.

Quantified Observations of Sensory Processing (QOSP): Resource Tool for Screening Sensory Processing Difficulties in Preschoolers
Pages 1-11

Moushami S. Kadkol

DOI: http://dx.doi.org/10.6000/2292-2598.2013.01.02.1

Published: 06 May 2014

Abstract: Sensory Processing (SP) difficulties in children are seen to be increasing in today’s world. Quite a few typically developing children are reported to have difficulties in coping with school, home and play environments. Their difficulties are mostly labeled abnormal behaviors and with superficial assessments these children often receive traditional treatments that marginally decrease their problems without giving long term functional gains. Hence their SP dysfunctions make them adopt pathological behaviors as they grow, making them incompetent as compared to their peers.

One of the factors behind these children getting unnoticed at an early age is lack of awareness about SP difficulties among the parents, teachers and medical fraternity in India. The other important factors include unavailability of contributory study in this area done on the Indian population and the use of non-normated, generalized evaluation tools done for evaluation of these difficulties. Further less information on what is age related typical SP makes it trickier to differentiate between a typical behavior and SP difficulty. The present study is the first study that would make an effort to understand the age related SP in Indian preschoolers aged 3-7 years.

The QOSP includes observations based on literature and theoretical constructs of SP which are graded and made quantitative for ease of administration and interpretation. This study intends to establish the age appropriate expected response and estimate the children posing risk to develop SP dysfunctions. The study further attempts to understand correlations between the different parameters of QOSP and tries to identify those parameters that can be considered red flags for SP difficulties.

The results of the study suggest about 3% of children in the typically developing group to be at the risk of having SP difficulties. About 20% are estimated to be having difficulties in at least one of the SP areas when compared with behaviors rated on Sensory Processing Measure. Apart from typically developing children the tool was also used in co-morbid conditions and was found to be useful in understanding the underlying Sensory Processing difficulties. Thus the QOSP can be considered a good measure not only in screening children with suspected sensory processing difficulties but also to gear the intervention program to be streamlined and goal oriented.