The Toronto experience: DISCUSSION(7)

For children who remain in the care of a substance-abusing caregiver, there is the potential for environmental factors to adversely affect cognitive and socioemotional development, by exacerbating the pre-existing effects of prenatal exposure or by creating different problems altogether. Future studies may attempt to decipher which neu-rodevelopmental effects are associated more with the alcohol toxicity in utero and which are associated with having an alcoholic parent at some point during childhood. This might be accomplished by comparing sample populations of children who have been taken into care from birth (and placed into relatively stable homes) with children who have remained in the care of their biological parent(s). buy asthma inhaler

Despite its original approach and unique findings, the present study suffers some notable limitations. First, because the current sample was clinic referred, the ARND-diagnosed children may represent the extreme end of the spectrum and may have more severe problems on average than other children prenatally exposed to alcohol who were not referred. We must not forget that not all children exposed to alcohol prenatally are negatively affected by the exposure per se and that not all children identified with ARND will present either in type or severity with all of the problems associated with the disorder. Second, our assignment of deficits and strengths relied on clinical judgment. Even though there was high agreement between the two reporters, the system is not transparent and requires testers with high clinical sensitivity. Third, a small proportion of the children were admitted on the basis of a lower number of deficits because of the severity of deficits exhibited. This suggests the need to develop a severity rating system and not to list all deficits equally. Fourth, assets were not assets per se but rather required judgment on the part of the examiner as to the child’s personal strength. While an attempt was made to assign traits as assets based on numerical values, most traits were judged qualitatively.

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