Toward Earlier Identification and Strengths-Based Intervention for Infants and Toddlers with Prenatal Alcohol Exposure: Evidence from the Washington State Fetal Alcohol Syndrome Diagnostic & Prevention Network Clinical Database

Abstract

The purpose of this two-article dissertation was to describe the early developmental outcomes of infants/toddlers with prenatal alcohol exposure (PAE) based on results from 10 years of retrospective clinical data, toward the goal of earlier identification. Although there is extensive research on school-age children and youth, there is a limited body of research describing the developmental delays, sensory processing differences and challenging behaviors among infants/toddlers with PAE. In addition, little research has focused on the positive attributes and strengths of young children with PAE, which can provide direction for a strengths-based approach to assessment and intervention. The first article in the dissertation, “Developmental, Sensory and Behavioral Outcomes Among Infants and Toddlers with Prenatal Alcohol Exposure” was a retrospective analysis of diagnostic clinical data from the University of Washington Fetal Alcohol Syndrome Diagnostic and Prevention Network (FASDPN). Descriptive statistics were used to document the proportion of infants/toddlers classified with typical, at-risk, or delayed development on three measures used in the FASD diagnostic evaluation. Empirical analyses were conducted to examine relationships between outcomes, PAE and/or other postnatal risk factors. Results showed that a majority of infants/toddlers presented with clinically significant delays in development, sensory processing and/or behavioral functioning. Adverse developmental outcomes were significantly correlated with PAE and/or postnatal risk factors. Present findings, considered with similar studies reported in the literature, suggest that several domains of child functioning may be vulnerable to the teratogenic impact of PAE, and that these delays are evident in the first years of life. The second article in the dissertation, “Concerns and Strengths: Caregiver Perceptions of Their Infant/Toddler with Prenatal Alcohol Exposure”, described caregiver-reported concerns and strengths in the same clinical sample of infants/toddlers. Using a directed approach to content analysis, caregivers’ written responses to open-ended questions on two parent-report questionnaires were coded and analyzed. Results indicate the caregivers’ most frequently reported concerns were related to aggressive behavior, language/communication, and sensory processing. Frequently reported strengths included happiness, sociability, and love. These findings demonstrate the value of eliciting and understanding caregiver perspectives as an aid to identifying the needs of infants/toddlers with PAE within the context of their families, and for informing a strengths-based approach to assessment and intervention.