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Workshop Held on Early Childhood Neurobehavioral Assessment

The interagency coordinating committee on Fetal Alcohol Syndrome recently sponsored a workshop that brought together experts from several areas of birth defects research and neuro-development to exchange information about state-of-the-art research and assessment tools. The purpose was to work toward a better understanding and diagnosis of a condition known as alcohol-related neurodevelopmental disorder (ARND). This disorder, which results from significant prenatal alcohol exposure, is difficult to diagnose because affected children lack the characteristic facial traits and growth deficiency of fetal alcohol syndrome (FAS), but still have alcohol-induced mental impairments. These impairments include problems with learning, memory, attention, and higher order and integrative thinking processes called executive functions.

Because there is not yet a precise definition of ARND, this label tends to be applied to any developmental problem when there is reasonable evidence that the child was exposed to alcohol in utero. "This diagnostic category would be more meaningful clinically if it could be limited to a specific pattern of neurobehavioral deficit," said Dr. Faye Calhoun, NIAAA's associate director for collaborative research. Exposure during development to a number of agents besides alcohol can also cause neurobehavioral problems. Called behavioral teratogens, these agents include lead, methylmercury and polychlorinated biphenyls. In addition, neurobehavioral deficits may arise from conditions such as iron deficiency, from genetic factors as in William's syndrome, or from disorders for which the exact cause is not known such as attention deficit hyperactivity disorder and autism.

Because they lack a specific identifier or biological marker, these disorders are currently diagnosed by signs or symptoms measured over time, with affected individuals scoring above a designated threshold. However, "in principle, each disorder might be expected to operate through a somewhat different neuronal pathway and present with a somewhat different pattern of neurobehavioral deficit," said Dr. Kenneth R. Warren, director of NIAAA's Office of Scientific Affairs. "Until this workshop, there has been little systematic effort to determine the distinctive patterns of deficits among these disorders."

The workshop, entitled "Early Childhood Neurobehavioral Assessment for the Differential Diagnosis of Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorder," was sponsored by an interagency committee consisting of staff from NIAAA, NICHD, NIEHS and NINDS and coordinated by Dr. Megan Adamson of NIAAA's Office of Collaborative Research. Among the topics discussed were the effects of prenatal exposure to alcohol, lead, cocaine, polychlorinated biphenyls and methylmercury on neurodevelopment; recent studies on conditions including iron deficiency in infancy, ADHD and autism; and assessment tools and techniques including event-related potentials, eye-blink conditioning, imaging and behavioral and cognitive approaches. In addition, the mother of two adopted children with FAS spoke of the experiences she and other parents have had in raising FAS children and of the difficulties in obtaining information, advice and treatment for these children.

During the final sessions, participants began work on the product that will emerge from the workshop — a set of profiles for the differential diagnosis of ARND and the other neurobehavioral disorders. Proceedings of this workshop will be available in the fall; for more information, contact Adamson at 443-4354.

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