Physical and Neurodevelopmental Evaluation of Children Adopted from Eastern Europe
Can J Clin Pharmacol Vol 16 (3) Fall 2009:e432-e440; October 29, 2009
Original Research
Monique Robert, Ana Carceller, Valerie Domken, Felix Ramos, Otilia Dobrescu, Marie-Noelle Simard, Julie Gosselin

Presented in part at The Canadian Pediatric Society 83rd Meeting in June 2006; St. John's, Newfoundland

Background
Children adopted from Eastern Europe are at risk of prenatal alcohol exposure, consequently at risk of Fetal Alcohol Spectrum Disorders (FASD). To our knowledge, a systematic complete assessment of these disabilities among adoptees from Eastern Europe has not yet been reported.

Objective
To assess physical and neurodevelopmental status to identify FASD in children adopted from Eastern Europe.

Method
Cross sectional study at International Adoption Clinic of a paediatric academic hospital. This evaluation was realized according to the 4-Digit Diagnostic Code (4-DDC).

Results
Twenty-nine children were evaluated. Five years after adoption, 7% (N=2) still presented growth delay and 24% (N=7) microcephaly. Facial evaluation demonstrated moderate Fetal Alcohol Syndrome (FAS) features in 7% (N=2) of children. Amiel-Tison Neurological Assessment was non optimal in 46% (N=13/28) of children. Visual-motor perception skills were mainly normal, but 14% (N=4) showed distal somatopraxic problems. Cognition, executive functioning, abstract reasoning and memory were normal. Full scale IQ was 105.5 ± 13.3; verbal IQ < performance IQ (p<0.005), work memory < short memory (p<0.0001), receptive <expressive language (p<0.0001). Attention-deficit hyperactive disorder was presented in 31% (N=9). Concerning adaptive behaviour, social skills and social communication, 29% (N=8) performed <-2 SD and 33% (N=5/15) needed school assistance. According to 4-DDC, 7% (N=2) of children were normal, 21% (N=6) of children were known exposed to alcohol, one of these was classified as Partial FAS and five others presented neurological damage, or neurobehavioral disorders with or without sentinel physical findings. Three percent (N=1) were classified FAS although alcohol exposure was unknown. Sixty-nine percent (N=20) of children presented physical findings alone or neurological anomalies with or without physical findings.

Conclusion
In our cohort, the 4-DDC was useful. Systematic and multidisciplinary neurodevelopmental assessment is needed in these adopted children, for an early intervention to prevent secondary disabilities and therefore optimize children’s outcome.

Keywords: fetal alcohol spectrum disorder; fetal alcohol syndrome; international adoption; Eastern Europe; 4-Digit Diagnostic Code; 4-DDC
 

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