Children with fetal alcohol spectrum disorders:
A descriptive profile of adaptive function
Tracy Jirikowic, Deborah
Kartin, Heather Carmichael Olson. The Canadian Journal of Occupational Therapy.
Ottawa: Oct 2008. Vol. 75, Iss. 4; pg. 238, 11 pgs
Key words * Fetal alcohol
syndrome * Prenatal alcohol exposure * Occupational therapy * Adaptive behavior
* Child development Mots clés * Syndrome d'alcoolisme foetal * Exposition prénatale
à l'alcool * Ergothérapie * Comportement adaptatif * Développement de
l'enfant
Abstract Background.
Children with fetal alcohol spectrum disorders (FASD) demonstrate
neurobehavioral impairments that affect function and participation.
Adaptive behavior deficits have been documented; however, specific
functional profiles are less well described.
Purpose.
This study compared caregiver-reported adaptive and maladaptive behaviors
between a clinic-referred sample of 25 five- through eight-year-old children
with FASD and a sample of 23 children with typical development.
Findings. Children
with FASD were rated significantly lower on the Scales of Independent
Behavior-Revised in social interaction and communication, personal-living
skills, and community-living skills and significantly higher on maladaptive
behavior scales. Exploratory contrasts revealed strengths and needs within
specific functional domains, along with the need for more support and
supervision than peers with typical development to perform day-to-day adaptive
skills and manage behavior.
Implications. Children
with FASD and their caregivers need support for daily activities involving
personal and social performance. Awareness
of specific strengths and needs can guide interventions that promote function
and participation.
Children with fetal alcohol syndrome (FAS) and other alcohol-related
diagnoses that fall under the umbrella term of fetal alcohol spectrum disorders
(FASD) have multiple neurobehavioral impairments that affect occupational
performance and participation. These
primary neurobehavioral impairments include deficits in cognition,
communication, learning, sensory-motor abilities, and executive functions that
are associated with the teratogenic impact of prenatal alcohol exposure (Connor
& Streissguth, 1996; Mattson & Riley, 1998; Osborn, Harris, &
Weinberg, 1993; Rasmussen, 2005). Significant
adaptive, social, and behavioral problems also are described that indicate the
challenges children with FASD face in their daily functioning in the home,
school, and community (Olson, Morse, & Huffine, 1998; Roebuck, Mattson,
& Riley, 1999; Thomas, Kelly, Mattson, & Riley, 1998; Whaley, O'Connor,
& Gunderson, 2001). High rates
of secondary disabilities later in life, such as failure in school, decreased
independent living, substance abuse, and employment problems further reveal the
persistent and lifelong functional challenges that individuals affected by
prenatal alcohol exposure experience (Streissguth et al., 2004).
Promoting function and participation across all domains over the
lifespan are important priorities among occupational therapists and others who
support individuals with disabilities (American Occupational Therapy
Association, 2002; Law, Baum, & Baptiste, 2002; World Health Organization,
2004). The early identification of
functional deficits (and strengths) among children with FASD could presumably
guide clinical assessment and subsequent interventions that aim to improve safe
and successful participation in daily activities as early as possible.
However, despite evidence that individuals with FASD demonstrate
functional deficits across multiple domains, more specific information about the
quality and type of performance challenges faced by those with FASD,
particularly young children, is still needed.
Adaptive skill deficits are clearly a primary clinical concern for this
population. Among individuals with
FASD, adaptive skills are reported to be significantly lower than expected for
age and intellectual level (Streissguth et al., 2004).
Also, childhood deficits in adaptive skills are reported to increase with
age, even compared to other clinic-referred groups (Whaley et al., 2001).
Social performance deficits have been among the more prominent findings
in the FASD literature, with interpersonal relationships and the use of play and
leisure time identified as specific aspects of problematic social performance
(Thomas et al., 1998). Other
potentially problematic areas of adaptive function such as activities of daily
living (ADL), however, are not well described.
Documentation regarding the support and resources needed to help children
with FASD improve or maintain daily function is also lacking.
Such resources are particularly important considering the remarkably high
levels of stress, parenting challenges, and unmet needs reported among
caregivers raising children with FASD (Olson, Brooks, Davis, & Astley, 2004;
Ryan & Ferguson, 2006).
Adaptive behavior is broadly defined as the performance of daily
activities required for personal and social sufficiency (Sparrow, Cicchetti,
& Balla, 2006). Standardized
assessments of adaptive behavior provide one means for understanding function
and participation in childhood occupations that include ADL, social
participation, and work/school performance.
Adaptive behavior scales, such as the Scales of Independent
Behavior-Revised (SIB-R) (Bruininks, Woodcock, Weatherman, & Hill, 1996),
make it possible to examine age-related adaptive skills in specific contexts
based on the standards or expectations of others (e.g., parent).
The purpose of this study was to compare the adaptive function of a
clinical sample of young school-aged children with clearly diagnosed FASD to a
group of children with typical development (TD) using a standardized caregiver
report of both adaptive and maladaptive behaviors. The first objective was to determine whether children with
FASD would indeed demonstrate lower mean standard scores across the SIB-R
adaptive clusters of motor, social interaction and communication, personal
living, and community-living skills and higher maladaptive behavior ratings than
the comparison group of children with TD. The
second objective was to identify specific areas of strength and need among
children with FASD by describing function within each of the SIB-R adaptive
cluster subscales and problem behavior indexes.
The final objective was to estimate the intensity of support and
resources needed for those with FASD to participate in personal and social
activities by describing the SIB-R support scores, a unique composite score
derived from both adaptive skill performance and problem behaviors.
Methods
Participants All procedures met research standards set and approved by
the university's institutional review board.
The current analysis included data from 25 children with FASD and 23
children with TD (ages
5-0 to 8-6 years) whose caregivers completed the SIB-R.
The SIB-R, a caregiver report of adaptive and maladaptive behavior, was
one measure administered within a larger study that examined sensory motor
abilities, school function, and behavior in which all of the children in the
current analysis were enrolled (Jirikowic, 2003).
The children with FASD were selected through a clinical registry
database that at the time included over 1,500 children and adults systematically
diagnosed with FASD from a diagnostic specialty clinic at a major urban
university. FASD diagnoses were
derived by an interdisciplinary team (Clarren, Carmichael Olson, Clarren, &
Astley, 2000) using the 4-Digit Diagnostic Code (Astley & Clarren, 2000).
Children with FASD were eligible for the study if they (a) were 5
through 8 years of age; (b) lived within a 125-mile radius of the diagnostic
specialty clinic; and (c) had a 4-Digit Diagnostic Code of fetal alcohol
syndrome (FAS) or other diagnosis that met the Institute of Medicine (Stratton,
Howe, & Battaglia, 1996) criteria for falling on the broader fetal alcohol
spectrum. The 4-Digit Diagnostic
Codes (Astley, 2004) included neurobehavioral disorder (alcohol exposed), static
encephalopathy (alcohol exposed), partial FAS (alcohol exposed), or the full FAS
(with or without confirmed alcohol exposure). To decrease the possible confounding effects of a new or
unstable caregiving environment on behavior, children with FASD were excluded if
they had resided in their current home or foster placement for less than one
year. Children with a severe
physical or neurological disability (e.g., cerebral palsy) or intellectual
disability (e.g., IQ standard score <60 or descriptive evidence of severe
mental retardation) were excluded to reduce the confounding effects of severe
motor and/or intellectual impairments on performance.
From the diagnostic specialty clinic's database population of 1,500
individuals, 73 children with FASD were eligible and invited to participate.
Of the 73 invited, 25 children (34%) were enrolled.
These 25 children were representative of the larger target population on
key sociodemographic variables (e.g., gender, race/ethnicity, diagnosis).
Five (20%) children had FAS and 20 had other alcoholrelated diagnoses on
the fetal alcohol spectrum, specifically 3 (12%) had static encephalopathy
(alcohol exposed), and 17 (68%) had neurobehavioral disorder (alcohol exposed) (Astley,
2004). Caregivers of all 25
children with FASD completed the SIB-R; thus data for 25 participants were
included in this analysis.
Children in the comparison group were recruited by sending invitation
letters to 300 caregivers of children with presumed typical development.
These were children in grades kindergarten through two, attending local
urban and suburban public schools and community after-school programs that
agreed to participate in study recruitment.
Inclusion/exclusion criteria were used to help achieve a TD group
comparable in age, gender, and racial/ethnic background to the FASD group.
All children in the TD group were enrolled in regular education programs
and received no special education services.
Comparison group participants were not formally screened for prenatal
alcohol exposure because of confidentiality restrictions imposed by the
educational institutions that agreed to participate.
It was assumed there would be a low risk of adverse outcomes from
prenatal alcohol exposure in this comparison sample because only children
without special education or related services were eligible to enroll.
Among the 300 children with TD invited to participate, 26 (9%) enrolled
in the peer comparison group. Caregivers
of 23 children with TD completed the SIB-R; three parents did not return the
SIB-R form. Data from 23 children
with TD were included in the current analysis.
Data collection
Each child's primary caregiver completed the Scales of Independent
Behavior-Revised (SIB-R) (full scale checklist version) (Bruininks et al.,
1996). The SIB-R is a comprehensive
measure of adaptive behavior and problem behavior for birth through adulthood
across home, school, work, and community settings. It is comprised of 14 subscales organized into four adaptive
behavior clusters: (a) Motor Skills; (b) Social Interaction and Communication
Skills; (c) Personal Living Skills; and (d) Community Living Skills.
Each item is scored on a 4-point rating scale from 0 to 3.
A "0" indicates the child cannot do the task even if asked. A "3" indicates that the child almost always does
the task independently and does it very well.
The Motor Skills subscales examine gross motor (e.g., rides bicycle,
pours liquid from glass/pitcher) and fine motor abilities (e.g., prints first
name, fastens clothing). The Social
Interaction and Communication Skills subscales examine social interaction (e.g.,
waits for turn in group activity, takes part in games or activities), language
comprehension (e.g., follows two-part directions, responds to common signs and
symbols), and language expression (e.g., says last name when asked, uses complex
sentences). The Personal Living
Skills subscales examine eating and meal preparation (e.g., takes appropriate
portions, prepares simple snacks), toileting (e.g., controls bowel and bladder,
demonstrates appropriate hygiene), dressing (e.g., ties shoes, selects
appropriate clothing), personal self-care (e.g., brushes teeth, dries after
bathing), and basic domestic skills (e.g., clears table, puts belongings in
proper place). The Home/Community
Orientation subscales examine higher level skills involving time and punctuality
(e.g., looks at a clock when it is "time" to do something, locates day
and month on a calendar), understanding of money and value (e.g., counts,
discriminates coins), basic work skills (e.g., indicates when a chore/task is
finished, requests materials when needed), and home and community orientation
skills (e.g., finds toys/objects in the home, stays in yard without wandering,
crosses nearby streets alone).
The SIB-R also includes a problem behavior scale, which contains a
summary of eight problem behavior areas organized into four Maladaptive Behavior
Indexes (Internalized, Asocial, Externalized, and General).
A support score can also be rendered that estimates the amount of support
and supervision needed by an individual in personal and social activities,
taking into account both adaptive and problem behaviors.
The SIB-R is a technically sound measure of adaptive and problem
behaviors (Bruininks et al.,
1996). Cluster and scale
intercorrelations range from .91 to .99 and provide evidence of construct
validity. The SIB-R correlates
strongly with other measures of adaptive behavior and problem behavior, and
evidence of discriminant validity among individuals with different types and
severity of disabilities is reported. Test-retest
reliability coefficients for the Broad Independence score and four cluster
scores are reported above .95. Parent
inter-rater reliabilities range from .88 to .95, and internal consistency
reliabilities are greater than .84. For
the Maladaptive Behavior Indexes, test-retest reliability coefficients range
from .80 to .83, and parent inter-rater reliabilities range from .78 to .86.
The Test of Non-verbal Intelligence 2nd edition (TONI-2) (Brown,
Sherbenou, & Johnson, 1990) was administered to each child as part of the
comprehensive assessment battery in the larger study.
Intellectual differences between the two study groups were anticipated;
however time and resource constraints did not permit administration of a full IQ
test. The TONI-2 was therefore used
as an IQ estimate. The TONI-2 is a
relatively brief language-free, motor-reduced, and culture-reduced measure of
cognitive ability involving abstract and figural problem solving.
Internal consistency (Cronbach's alpha = .95), test-retest reliability (r
= .86), and test-retest stability over one week (r = .85) are reported.
The TONI-2 correlates significantly (r = .64 to .85) with other
full-scale measures of intelligence such as the Weschler Intelligence Scale for
Children-Revised (Weschler, 1974), indicating high concurrent validity.
Data
analysis
ANCOVA was used to compare the performance between groups on the SIB-R
adaptive cluster standard scores. The
TONI-2 standard score was entered as a covariate because, as expected,
statistically significant group differences on nonverbal IQ were found (See
Table 1) (t [45] = -4.18, p = <.001 [two-tailed]). Chi-square tests for independence or the Fisher Exact Test
were used to compare group contrasts in proportions on demographic and
categorical test variables (See Table 2). To
explore performance on each of the 14 SIBR subscales, a difference score was
calculated by subtracting the child's age-equivalent scores from the child's
actual age in days. To aide
clinical interpretation, the mean group difference score was then divided by
365.25 to transformdays into years. Group
contrasts for the mean difference scores on each of the 14 SIB-R subscales were
examined with t-tests. Significance
levels for all contrasts were set at a two-tailed alpha p = 0.05.
All p values for exploratory contrasts should be interpreted with caution
due to multiple comparisons and the increased risk for Type I error.
Findings
Sociodemographic data for the study participants, 25 children
with FASD and 23 children with TD, are presented in Tables 1 and 2.
The groups were balanced by age, gender, and race/ethnicity.
The groups differed significantly by grade level as several children with
FASD were enrolled in preschool. The
groups also differed significantly by family structure, but not by number of
caregivers in the home. Only two
children with FASD were living in a stable home situation with a biological
parent at the time of the study, while the remaining 23 were in other stable
home placements (e.g., foster, adoptive).
Table
3 presents descriptive statistics and mean contrasts
for the SIB-R Broad Independence score and four adaptive cluster scores adjusted
for IQ. Even with statistical
adjustment for nonverbal IQ, the mean standard score for the SIB-R Broad
Independence score was significantly lower for the group with FASD compared to
the group with TD. Of the children
with FASD, almost half (48%) scored 1.0 SD below the mean on the SIB-R Broad
Independence score, with onethird (32%) of the sample scoringmore than 2.0 SD
below the mean. The mean scores on
three of the four adaptive clusters (Social Interaction and Communication,
Personal Living, and Community Living) were also significantly lower for the
group with FASD. The mean score on
theMotor Skills cluster was also lower, but the group contrast was not
significant following adjustment for nonverbal IQ.
Performance across the 14 SIB-R adaptive subscales is profiled by group
in Figure 1. All contrasts with the
exception of Gross Motor Skills, Domestic Skills, and Home/Community Orientation
were significant between the two groups. Results
indicate that the children with FASD were performing most skills at an age level
well below that of peers with TD; however, relative strengths in the Gross
Motor, Personal Self-care, and Domestic subscales emerged.
The mean subscale age-equivalent scores were higher than expected for
this group of children with TD; therefore, a post-hoc analysis contrasted the
mean difference score for each subscale to the expected normative age-equivalent
score of zero for the FASD group. Exploratory
t-tests revealed significant differences in the following subscales: Language
Expression, Eating/Meal Preparation, Toileting, and Dressing (p < .05); and
Language Comprehension, Money/Value, Time/Punctuality, Work Skills, and
Home/Community Orientation (p < .001). Performance
on these subscales, with the exception of Home/Community Orientation, was
significantly lower than both the comparison group and the SIB-R normative
sample.
Table 4 describes
performance on the Maladaptive Behavior Indexes, which indicates the seriousness
of problem behaviors based on the reported frequency and severity.
Children with FASD were classified in significantly more serious behavior
categories than peers with TD across all of the indexes. The
percentage of caregivers reporting each of the eight problem behaviors examined
by the Maladaptive Behavioral Indexes is presented by group in Figure 2.
For children with FASD, "disruptive behaviors" were the most
frequently reported problem behaviors, followed by "uncooperative
behaviors." This was also true of children with TD, though their problem
rates were far lower. Interestingly,
"socially offensive behavior" was reported far more frequently among
children with FASD (65%) relative to same-age peers with TD (9%).
The SIB-R support scores for both groups are presented in Table 5.
The support score is a composite score derived from both adaptive
behavior (SIB-R Broad Independence score) and problem behavior (General
Maladaptive Behavior Index score). Six
support levels describe the overall intensity of the estimated resources,
supports, and supervision required to improve or maintain an individual's
functional independence in school, home, and other community settings.
Most of these young school-aged children with TD (74%) were classified as
needing "intermittent" support or less.
In contrast, the majority of the children with FASD (74%) were perceived
as needing "limited" or "frequent" support and supervision
to manage daily adaptive skills and behavior, with a small percentage (13%)
requiring "extensive" support and supervision.
Discussion
This clinic-referred sample of young children with FASD functioned
significantly more poorly across caregiver-rated clusters of adaptive behavior
involving social, personal living, and community-living skills and showed
significantly more maladaptive behaviors than a comparison group of peers with
TD. Indeed, results replicate
earlier findings that describe compromised adaptive function among children with
FASD; however, findings from the current study expand the literature in two
important ways. First, children
with FASD clearly required greater levels of support and supervision than same
age peers with TD to help them performdaily activities and tomanage challenging
behaviors. This suggests that even
though this group of children had, on average, nonverbal IQ performance within
normal limits, their capacity to successfully function at age level within
several facets of home and community life was substantially limited by a
combination of delayed adaptive skills and more frequent and severe problem
behaviors. Second, although this
group of children with FASD performed well below age expectations in most areas
of function, on average about 1 to 2 years lower than the comparison group of
peers, results provide a broader descriptive profile of the occupational
performance of young children with FASD and reveal more specific areas of
relative strength and need.
Findings underscore the clinical importance of addressing functional
skills among this population. Occupational
therapists are well suited to evaluate and support adaptive function at multiple
levels by considering the impact of alcohol-related neurobehavioral impairments
on component skills and how task demands, caregiver expectations, and other
contextual factors interact to influence performance.
Further, individuals with FASD often face challenges getting needed
supports and services, and adaptive abilities may decline even further as
children with FASD get older (Whaley et al., 2000).
Therefore, advocating for or providing early, targeted interventions
aimed at enhancing function and participation across daily living, social, and
other adaptive domains appear critical and timely for both young children and
their caregivers.
The increased level of support required by children with FASD is an
important finding for both clinical practitioners and service systems.
The SIB-R support score is expected to better predict service intensity
than either the level of adaptive function or maladaptive behavior alone (Bruininks
et al., 1996). This means, for instance, that a higher functioning
individual with severe behavior problemsmay be more difficult to support than a
lower functioning individual without problem behaviors. Children with FASD often present with "borderline"
neurocognitive abilities that do not easily meet the eligibility criteria for
supports and services available to children with other developmental
disabilities (Streissguth, 1997), or they present with behavior problems that do
not respond well to available intervention.
Subsequently, they may not be served, or they may be provided with
services that are not well-tailored to their actual deficits.
These support score findings clearly show that considerable support for
daily function is required for many children with FASD and, as such, begin to
explain the burden of caregiving experienced by parents who report very high
levels of child-related parenting stress (Olson et al., 2004; Paley, O'Connor,
Frankel, & Marquardt, 2006).
The adaptive profiles revealed by examining performance on the SIB-R
subscales generate more clinical insight into the daily function and needs of
younger children with this set of neurodevelopmental disabilities.
Motor skills were revealed as a relative strength among this sample of
young children with FASD. However,
closer analysis revealed that while gross motor abilities may be quite
functional, fine motor skills may actually lag behind the more advanced
abilities of children with TD, as noted in other studies (e.g., Adnams et al.,
2001; Kahlberg et al., 2006).
Social communication has been described as an underrecognized but
crucial area of need among children along the fetal alcohol spectrum (Coggins,
Olswang, Carmichael Olson, & Timler, 2003). Indeed, this sample of children with FASD was struggling to
meet age expectations during social interactions requiring the use of social
conventions and rules to engage with other people (e.g., taking turns, asking
for food to be passed, playing games by the rules), and evenmore so in
understanding and using language effectively on a daily basis in ways that
become increasingly important with age (e.g., following directions, using verbal
and written communication skills). It
is essential to recognize social communication deficits and address them in
order to fully promote the social development and participation of children with
FASD (e.g., when teaching friendship skills).
Children with FASD acquired fewer age-appropriate ADL skills than
children with TD in dressing, mealtime, and toileting domains.
The impact on parents of raising children with problems in these areas is
self-evident. Relative strengths
among these young children were seen in the areas of personal self-care and the
"domestic skills" of helping to maintain a home environment through
such activities as household chores. Personal
living skills have been reported as an area of relative strength among
adolescents and adults affected by prenatal alcohol exposure (Olson, Feldman,
Streissguth, Sampson, & Bookstein, 1998; Streissguth, 1997), but findings
fromthis study suggest it is clearly not a uniform strength in the younger
years. Results point out an
important need to target self-help skill development in young children with FASD
and help parents cope with caregiving needs that may persist over time.
Implementing accommodations (e.g., visual schedules, clothing
adaptations) or reframing developmental expectations may be useful interventions
to support skill performance (Olson et al., 2004).
Higher-level skills tapped within the Community Living Skills cluster
also fell below expected age norms. Certainly,
many of these skills are expected to emerge later in life as "executive
functions" (higher level cognitive abilities) develop.
But, it is notable that the early precursors to more complex skills and
concepts involving time,money, and value (e.g., basic number recognition,
calendar skills, understanding/telling time) were already lagging significantly
behind peers with TD. These
findings are congruent with reported deficits in arithmetic, cognitive
estimation, and related conceptual impairments in older children, adolescents,
and adults with FASD (Coles et al.,1991; Kopera-Frye, Dehaene, &
Streissguth, 1996). Interestingly,
both groups demonstrated lower than expected performance on home and community
orientation activities. This may be
a reflection of more contemporary personal safety trends that demand greater
parental vigilance and supervision for all children within their neighborhoods
and communities.
Because
this was a clinical sample of children with FASD, it was expected that this
group would exhibit more maladaptive behaviors than peers with TD.
Indeed, slightly over three-quarters of the children with FASD were
classified as having marginally serious to serious behavior problems on the
General Maladaptive Behavior Index. Findings
from this study, along with previous descriptions of behavioral and psychosocial
problems (Brown et al., 1991; Mattson & Riley, 2000; Olson et al., 1998;
Roebuck et al., 1999) highlight the importance of addressing problem behaviors
in young children with FASD since they are an overarching concern and one of the
primary reasons that families seek diagnosis or treatment (Spohr &
Steinhausen, 1996). Disruptive
behaviors (e.g., pestering, arguing, interrupting) and uncooperative behaviors
(e.g., refusing to take turns or follow rules, acting defiantly, pouting) were
reported among the majority of the children with FASD.
In addition, however, slightly over half of the children with FASD also
showed marginally serious to serious internalizing problems. Although externalizing behaviors may be easier to identify,
these results, along with findings reported by O'Connor and Paley (2006),
suggest that clinicians should also be aware of behavioral signs and risk
factors for internalizing problems such as depression.
Limitations and directions for future research Limitations of this study
include the use of the SIB-R checklist version instead of the caregiver
interview. This may have resulted
in caregiver bias and higher ratings than actual performance levels for both
groups. The small sample size and
use of a clinical sample limit generalizability of findings to the entire
population of children with prenatal alcohol exposure.
The more advanced skills seen in this group of children with TD also may
have spuriously increased the number of significant exploratory contrasts among
the adaptive cluster subscales; therefore, descriptive findings should be
interpreted with particular caution. Given
the significantly higher IQ estimates among the children with TD in this sample,
the use of clinical comparison groups matched on IQ would strengthen future
studies.
Finally, this study raises important questions about the nature of
adaptive behavior deficits among those with FASD. Adaptive function rests on a broad, complex interplay of
personal, environmental, and contextual factors. To learn how to best support occupational performance, future
research into the adaptive skills of children with FASD shouldmove forward from
questionnaire studies of clinical samples to more intensive consideration of how
child and context interact. Possible
research directions include detailed qualitative interviews that focus on
caregiver observations of adaptive function, direct observations of
participation and performance in specific childhood contexts (home, school,
recreational settings), or careful study of "resilient" children with
FASDand the natural ecological factors that support them.
Conclusion
The group of young children with FASD in this study demonstrated
caregiver-reported impairments in function and participation across multiple
domains of occupational performance. Findings
suggest that personal, social, and community-based adaptive skills as well as
problem behaviors should be concurrently addressed when evaluating the
development of young school-aged children with FASD and the needs of their
caregivers. By considering how
child, family, and other contextual factors interact, occupational therapists
have the capacity to implement a wide range of supports, accommodations, and
direct interventions to maximize independence and safety in daily activities and
manage problem behaviors among this clinical population.
Acknowledgments
This work was facilitated, in part, by grant no.
P30 HD02274 from the National Institute of Child Health and Human
Development; contract no. 7923-0 fromtheWashington State Division of Alcohol and
Substance Abuse, Department of Social and Health Services, which supports the
University of Washington FAS Diagnostic & Prevention Network; and the NIDA
Nursing Research Training Grant in Substance Abuse, Grant # 5 T32 DAO7257-14.
Key
messages
* Young children with fetal alcohol spectrum disorders (FASD)
demonstrate significant occupational performance deficits as indicated by
adaptive skill delays and increased behavior problems relative to peers with
typical development.
* Children with FASD need support and supervision beyond
age-level expectations to perform daily activities safely and successfully.
* The deficits identified in this study fall within the scope of
practice of occupational therapists.
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Author.
Author Affiliation
Tracy Jirikowic, Ph.D, OTR/L is
Occupational Therapist with the University of Washington Fetal Alcohol Syndrome
Diagnostic and Prevention Network and Assistant Professor in the Department of
Rehabilitation Medicine, University of Washington, School ofMedicine. Box 356490
Seattle,WA 98195-6490. 206.598.5764; email: tracyj@u.washington.edu.
Deborah Kartin, Ph.D, PT, is
Associate Professor in the Department of Rehabilitation Medicine, Division of
Physical Therapy at the University of Washington, School of Medicine. Box 356490
Seattle,WA 98195-6490.
Heather Carmichael Olson, Ph.D,
is a licensed psychologist in the University of Washington Fetal Alcohol
Syndrome Diagnostic and Prevention Network, and Senior Lecturer in the Division
of Child Psychiatry, Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine. Seattle, WA 98195-6490.