Mansfield Mela - Prenatal Alcohol Exposure: A Clinicians Guide

by

Mansfield Mela, MBBS, M.Sc.Psych.

Director, Centre for Forensic Behavioral Science and Justice Studies
Professor, Department of Psychiatry, University of Saskatchewan
Diagnostic Research Lead, Canada FASD Research Network
Forensic Psychiatrist, Regional Psychiatric Centre
Saskatoon, Canada

Note: The author has worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.

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First Edition

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Library of Congress Cataloging-in-Publication Data

Names: Mela, Mansfield, author. | American Psychiatric Association Publishing, publisher.

Title: Prenatal alcohol exposure : a clinicians guide / by Mansfield Mela.

Description: First edition. | Washington, DC : American Psychiatric Association Publishing, [2021] | Includes bibliographical references and index.

Identifiers: LCCN 2020048844 (print) | LCCN 2020048845 (ebook) | ISBN 9781615372393 (paperback ; alk. paper) | ISBN 9781615373697 (ebook)

Subjects: MESH: Fetal Alcohol Spectrum Disorderspsychology | Prenatal Exposure Delayed Effects | Mental Disordersdiagnosis | Mental Disorderstherapy

Classification: LCC RG629.F45 (print) | LCC RG629.F45 (ebook) | NLM WQ 211 | DDC 618.3/26861dc23

LC record available at https://lccn.loc.gov/2020048844

LC ebook record available at https://lccn.loc.gov/2020048845

British Library Cataloguing in Publication Data
A CIP record is available from the British Library.

1. PART I
   History and Epidemiology
2. PART II
   Etiology
3. PART III
   Presentation
4. PART IV
   Assessment and Diagnosis
5. PART V
   Treatment
6. PART VI
   Special Populations
7. PART VII
   Systems of Care

This book provides clinically relevant information for mental health experts, but it goes beyond that to provide sufficient content to improve clinicians level of comfort with information to which they have not hitherto been exposed. Clinicians in this context include professionals in the medical, mental, educational, vocational, legal and correctional, child welfare, and others in the health and social services sectors who encounter individuals with a hidden disability. The scope and course content of curricula needed to equip professionals are usually informed by the requisite skills and experience for optimum clinical care. Professionals require essential training to appropriately support patients who navigate the mental health system because of the consequences of prenatal alcohol exposure (PAE). Because curricula have only recently begun to incorporate this material, a text providing basic as well as advanced information is necessary. This book is significant because its content is useful for professional training across many mental health disciplines. It covers information missing from curricula about the long-term effects of PAE (fetal alcohol spectrum disorder [FASD 101]) and includes clinical information on the mental disorders relevant to FASD. Given the burgeoning research and knowledge in this area, the text also updates, synthesizes, and consolidates current information into one source. Even seasoned mental health professionals well versed in the research data can use this information to become better educated and informed on the intersecting mental health consequences of PAE.

Because a large number of individuals with neurobehavioral disorder associated with PAE/FASD also manifest overlapping features of mental disorders or have additional mental disorder diagnoses, advocating for a separate system that addresses their specific needs has lasting implications and benefits. Acknowledging the realities of life, educating and training mental health professionals to adapt their practices to recognize these needs is the next best thing. That is my hope for this text, with the future goal of stimulating innovation in the field.

The themes covered in this book outline a close and intricately complex relationship between PAE and mental disorder. The boundary between the two is open to various interpretations that potentially affect care and prognosis. The interface (discussed in several chapters of the book) refers to the overlapping and enmeshed relationship between the recognized effects of PAE and the additional mental health problems that can manifest.

Over the five decades that the complications of prenatal alcohol exposure (PAE) have been recognized in the scientific literature, terms used to describe these entities have changed. It is helpful for the reader to understand the acronyms referred to in this textbook. FASD is universally accepted as standing for fetal alcohol spectrum disorder, the recognized term used in this text to encompass the representative diagnostic formsfetal alcohol syndrome [FAS], fetal alcohol effects (FAE), partial FAS (pFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol and related birth defects (ARBD)of conditions caused by PAE. FASD was elevated to a diagnostic term in 2016 by the Canadian Diagnostic Guidelines (). Most studies prior to 2013 (when ND-PAE was introduced in the literature) used FASD in reference to patients with PAE who were diagnosed medically. In this text, using the term FASD and its diagnostic forms applies to evidence, research findings, and discussions derived from subjects differentiated as having FASD before the option of ND-PAE was available. Hence, using FASD sequesters research and clinical and policy outcomes to the preND-PAE period.

By now, mental health clinicians and professionals have become acquainted with the term neurobehavioral disorder associated with PAE. In its strict usage, ND-PAE refers to the 2013 criteria found in Section III of DSM-5 (Conditions for Further Study). This term can be easily confused with neurodevelopmental disorder associated with PAE, which has raised a number of criticisms, responses, and reactions. Research articles, conference presentations, policy briefs, and clinical case series have used these terms interchangeably. Available to clinicians and researchers, DSM-5 allows conditions associated with PAE to be clinically diagnosed under the formal rubric of other neurodevelopmental disorders (other specified and unspecified categories).