The Toronto experience: DISCUSSION(6)

The Toronto experience: DISCUSSION(6)

Very recently, researchers at the Hospital For Sick Children have developed a method to test meconium, as well as neonatal and maternal hair samples, for information about type and duration of prenatal substance exposure. This advance offers great potential for overcoming the aforementioned problem about confirmation of exposure history among ARND sample populations. However, because children with ARND do not present with the obvious physical signs of prenatal alcohol exposure that are apparent in the full-blown syndrome, physicians may be less inclined to identify the need to use this test with neonates with suspected or known prenatal alcohol exposure. This raises an important issue with respect to awareness: comprehensive training of medical practitioners, especially obstetricians and pediatricians, in the area of prenatal exposure and its devastating consequences may be the first step in increasing the likelihood that a substance abuse problem will be recognized and responded to early on, either before or during pregnancy, or shortly thereafter.

Another factor that has been largely overlooked in the extant literature pertains to the likely occurrence of comorbidity with respect to a mother’s (or father’s) substance abuse and cognitive, behavioural and socioemotional problems. Many children born to substance-abusing parents may also be genetically predisposed to develop problems quite separately from those considered to be secondary to the effects of prenatal alcohol exposure. In our current sample, biological parents of children in the ARND group had significantly lower full scale and verbal IQ than parents in the comparison group (although in both groups the scores were within the average range). Similarly, in the study of Korkman et al , mothers of children in the alcohol-exposed group were found to have lower levels of education than controls. The fact that a majority of alcohol-exposed children do not remain in the care of their biological parents makes detailed information of this kind very difficult to obtain. Nonetheless, the paucity of information in this regard seems to constitute another major confounding factor within the existing literature.

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