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FASD and ADHD Link
The implications of this possible link between FASD and ADHD have some practical consequences for clinical management. Patients often present with early-onset ADHD resulting from prenatal brain damage, and their reactions to medication are unpredictable. Thus, medication may sometimes increase a patient's impulsivity or aggressiveness, and an increase in the dosage may actually worsen the clinical situation, rather than alleviating it. Stimulant medication for children with FASD and ADHD should be considered as part of a multimodal treatment array. Ideally, management will include various treatment modalities, such as sensory integration, language therapy, special schooling, nonverbal play therapy, medication therapy, parent education, and supportive family therapy. Multimodal treatment to manage childhood ADHD has been recommended by the MTA Cooperative Group and the American Academy of Pediatrics. One study has indicated that it is unwise to use stimulants to help children cope with an unsafe environment, because ADHD high arousal-vigilance may have a protective role for the child in this environment. Therefore, removal of the ADHD symptoms may potentially decrease the child's wariness and so increase the risk of abuse.
The clinical presentation of ADHD in children with FASD is commonly seen with such comorbid developmental, psychiatric, and medical conditions. The complex learning disability in children with FASD can include an unrecognized mixed receptive-expressive language disorder that affects their social cognition and social communication. Children with FASD and ADHD are commonly quite talkative, and their lack of cognitive understanding, with inappropriate answers, can frequently be misdiagnosed as an oppositional defiant disorder. Commonly, the child will also show problems in working memory. A mathematics disorder is frequently seen, which may underpin an executive-function deficit in deductive reasoning. Thus, children with FASD often do not link cause and effect or respond to standard behavioural-management techniques. Judgement and self-awareness are also suspect, not just in childhood but throughout the lifespan. Morphological changes in the corpus callosum have been tied to the FASD complex learning disability.
The psychiatric comorbid disorders include; anxiety disorder (with panic attacks), mood disorder or affective instability, conduct disorder, psychotic disorder, and intermittent explosive disorder. Finally, comorbid medical conditions such as cardiac, renal, eye, or skeletal problems are often present and warrant specific interventions. Sometimes as well, there may be a complex partial or absence seizure disorder.
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