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>Q & A with Dr. Julia Conkel Ziebell on FASD in International Adoption

May 5, 2011

>Not all children prenatally exposed to alcohol will develop FASD. Many will not. But because diagnosis before the age of six is associated with the best outcomes, families need to what to do with the knowledge that their child was prenatally exposed.

Dr. Julia Conkel Ziebell, a psychiatrist specializing in Fetal Alcohol Exposure at HSI in Ramsey County, Minnesota, who performed Hope’s evaluation, kindly agreed to answer a few questions publicly for other parents.

Q: Should all children with known exposure be screened for FASD? Or only if/when parents are concerned?
A: The CDC recommends that all children with known prenatal exposure to alcohol should be screened by health and/or education professionals. This can be done through a well child check-up, a developmental assessment conducted at an international adoption clinic, or an ECSE evaluation. The purpose of such screening is to identify red flags, or conditions known to be related to FASDs. If enough red flags or “triggers” are present, then a referral for a diagnostic assessment is the next step. If parents or caregivers have specific concerns about growth, development, or behavioral issues, they may want to schedule an appointment with their pediatrician to inquire about a referral for an FASD diagnostic evaluation. Additionally, the National Organization on Fetal Alcohol Syndrome has a state resource directory that lists referral sources for parents interested in seeking an evaluation.
Q: Are newly adopted toddlers with reported exposure too young to be evaluated for FASD? 
A: Developmental tests for toddlers are normally not affected by attachment to the new family; however, it is useful clinical information that should be gathered through an interview with the parents. Most tests do presume some level of receptive and expressive English; however, there are tests that minimize verbal instructions/responses and can provide a more accurate picture of the child’s current level of functioning without the “filter” that language provides. These tests include the Kaufman Assessment Battery for Children, Second Edition (KABC-II; ages 3+) and the Comprehensive Test of Nonverbal Intelligence-Second Edition (CTONI-2; ages 6+).
Tests for younger children (including the Stanford Binet-5, the Mullen Scales of Early Learning, and the Bayley Scales of Infant Development-II) can be administered to non-English speaking toddlers; however, language acquisition factors will likely artificially deflate a number of the scales. Once a toddler can follow basic commands in English (e.g., “Where are your ears?” or “Give me the shoe”), which are called Basic Interpersonal Communicative Skills (BICS), the test results are likely to be more accurate. For internationally adopted children, a good evaluation will always consider test results in light of the child’s BICS and for older, school-aged children, Cognitive-Academic Language Proficiency (CALP), which is the “language of learning” children must use in order to solve problems, employ imagination, and utilize analytic/reasoning skills.

I’d like to add a word of practical advice. Make sure that PAE (Prental Alcohol Exposure) is recorded in your child’s chart at your primary care doctor’s office. Hope did not have a chart at the time I discussed her referral with our pediatrician so it was never written down. Between that fact and my own ignorance, Hope’s primary doctor never raised the possibility that her challenges could be related to exposure and I did not know enough to ask. 

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