Utilization of psychotropic medications in children with FASD: a retrospective review

Abstract Background Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic m...

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Autores principales:	Michael-Roy R. Durr, Susan Petryk, Mansfield Mela, Andrea DesRoches, Mackenzie Wekerle, Sanjida Newaz
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Fetal Alcohol Spectrum Disorder Prenatal Alcohol Exposure Medication Algorithm Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/7eae29c3625d427f9f42d78ab4c67309
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spelling	oai:doaj.org-article:7eae29c3625d427f9f42d78ab4c673092021-11-21T12:33:19ZUtilization of psychotropic medications in children with FASD: a retrospective review10.1186/s12887-021-02986-51471-2431https://doaj.org/article/7eae29c3625d427f9f42d78ab4c673092021-11-01T00:00:00Zhttps://doi.org/10.1186/s12887-021-02986-5https://doaj.org/toc/1471-2431Abstract Background Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic medication. However, to date there are no FASD specific guidelines for prescribing medication. Recently, Mela and colleagues described four behavioural symptom clusters commonly seen in FASD with suggested pharmacologic treatment for each cluster within an algorithm. The primary objective was to compare the proposed treatment algorithm retrospectively to actual treatment in a real-world FASD pediatric practice. The secondary objective was to refine the description of symptom clusters which will be targeted with treatment. Methods We collected the diagnostic and medication history from all patient visits of a Regina Developmental Pediatrician who specializes in FASD diagnosis and medication treatment. Three hundred fifty-four FASD patients were identified between 2005 to 2020. The medications that would be predicted from the algorithm were compared to the real-world historical data. A positive case was defined as all algorithm-predicted medications matching the historical data; a negative case had one or more medications failing to match. Results Of the 354 patients, 36 were removed for insufficient information. Of the remaining 318 cases, 172 (54.1%) were positive compared to 146 (45.9%) negatives. In single prescription cases (n=147), the incidence of positives was 67.3%; in multi-prescriptions (n=72) it was 27.8%; and in cases where no prescription was needed (n=99), the positive incidence was 53.5%. Conclusions The prescription algorithm is promising but requires further refinement to accommodate the range of presentations in children with FASD. With respect to unclassified symptoms, we propose the following: sleep onset difficulty as hyperarousal; gender dysphoria and obsessive compulsive disorder as cognitive inflexibility; grief as emotional regulation; and autism spectrum disorder as hyperactive/neurocognitive.Michael-Roy R. DurrSusan PetrykMansfield MelaAndrea DesRochesMackenzie WekerleSanjida NewazBMCarticleFetal Alcohol Spectrum DisorderPrenatal Alcohol ExposureMedication AlgorithmPediatricsRJ1-570ENBMC Pediatrics, Vol 21, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Fetal Alcohol Spectrum Disorder Prenatal Alcohol Exposure Medication Algorithm Pediatrics RJ1-570
spellingShingle	Fetal Alcohol Spectrum Disorder Prenatal Alcohol Exposure Medication Algorithm Pediatrics RJ1-570 Michael-Roy R. Durr Susan Petryk Mansfield Mela Andrea DesRoches Mackenzie Wekerle Sanjida Newaz Utilization of psychotropic medications in children with FASD: a retrospective review
description	Abstract Background Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic medication. However, to date there are no FASD specific guidelines for prescribing medication. Recently, Mela and colleagues described four behavioural symptom clusters commonly seen in FASD with suggested pharmacologic treatment for each cluster within an algorithm. The primary objective was to compare the proposed treatment algorithm retrospectively to actual treatment in a real-world FASD pediatric practice. The secondary objective was to refine the description of symptom clusters which will be targeted with treatment. Methods We collected the diagnostic and medication history from all patient visits of a Regina Developmental Pediatrician who specializes in FASD diagnosis and medication treatment. Three hundred fifty-four FASD patients were identified between 2005 to 2020. The medications that would be predicted from the algorithm were compared to the real-world historical data. A positive case was defined as all algorithm-predicted medications matching the historical data; a negative case had one or more medications failing to match. Results Of the 354 patients, 36 were removed for insufficient information. Of the remaining 318 cases, 172 (54.1%) were positive compared to 146 (45.9%) negatives. In single prescription cases (n=147), the incidence of positives was 67.3%; in multi-prescriptions (n=72) it was 27.8%; and in cases where no prescription was needed (n=99), the positive incidence was 53.5%. Conclusions The prescription algorithm is promising but requires further refinement to accommodate the range of presentations in children with FASD. With respect to unclassified symptoms, we propose the following: sleep onset difficulty as hyperarousal; gender dysphoria and obsessive compulsive disorder as cognitive inflexibility; grief as emotional regulation; and autism spectrum disorder as hyperactive/neurocognitive.
format	article
author	Michael-Roy R. Durr Susan Petryk Mansfield Mela Andrea DesRoches Mackenzie Wekerle Sanjida Newaz
author_facet	Michael-Roy R. Durr Susan Petryk Mansfield Mela Andrea DesRoches Mackenzie Wekerle Sanjida Newaz
author_sort	Michael-Roy R. Durr
title	Utilization of psychotropic medications in children with FASD: a retrospective review
title_short	Utilization of psychotropic medications in children with FASD: a retrospective review
title_full	Utilization of psychotropic medications in children with FASD: a retrospective review
title_fullStr	Utilization of psychotropic medications in children with FASD: a retrospective review
title_full_unstemmed	Utilization of psychotropic medications in children with FASD: a retrospective review
title_sort	utilization of psychotropic medications in children with fasd: a retrospective review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/7eae29c3625d427f9f42d78ab4c67309
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Utilization of psychotropic medications in children with FASD: a retrospective review

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