Alcohol’s teratogenic effect on the developing fetal brain is devastating, resulting in, for inst... more Alcohol’s teratogenic effect on the developing fetal brain is devastating, resulting in, for instance, structural abnormalities as well as behavioral and neuropsychological impairments in the child. The umbrella term Fetal Alcohol Spectrum Disorders (FASD) is used to describe the range of effects, from neuropsychological dysfunctions to complete Fetal Alcohol Syndrome (FAS). The disabilities associated with FASD have a major impact on life for children, and perhaps even in adulthood. However, only a few studies have addressed the long-term outcome in adults prenatally exposed to alcohol, especially with a diagnosis of FAS, from a psychological perspective. The main aim of this thesis was to investigate the psychological, psychosocial and neuropsychological consequences of FAS in adulthood. Participants in the studies in this thesis consisted of 79 adults (mean age: 32 years) with an FAS diagnosis. In Study I, data on the adults with FAS and a gender- and age-matched comparison group...
Methods: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women w... more Methods: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009-2015. Additional data were obtained from local child healthcare services (CHS), which provide routine paediatric care. Results: More than three-quarters (76%) of the children had prenatal exposure to alcohol and drugs and 17% were born with withdrawal symptoms. The mothers had a high rate of psychiatric diagnoses (38%) and were more likely to smoke after delivery and less likely to breastfeed than the general population. However, adherence to the CHS programme was generally high. Additional visits to the nurse, referrals to specialists, collaboration meetings and reports of concerns to social services decreased when the children began attending ordinary CHS centres. Conclusion: Children born to women with addictions during pregnancy faced a high risk of developmental problems and should be offered additional CHS resources to minimise negative long-term consequences.
Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditio... more Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists. Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their conditionfor instance, in terms of wellbeingis not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.
First European Conference on Fetal Alcohol Syndrome Kerkrade the Netherlands, 2010
Few studies focus on psychosocial functioning in adults with fetal alcohol syndrome (FAS). A prev... more Few studies focus on psychosocial functioning in adults with fetal alcohol syndrome (FAS). A previous follow-up study of Swedish children with FAS showed that they had severe problems with social relationships and education, problems that remained throughout childhood. The aim of this register study is to further investigate the past and present social and psychosocial demographics of these children who now are adults (n = 79, mean age 29 [18-49 years], 37 % women and 63 % men). A swedish longitudinal integrated database for health insurance and labour market studies (LISA by Swedish acronym) is used for this purpose. Examples of data that will be utilized from the database LISA are employment, income (e.g. parental leave, unemployment, labour market activity, rehabilitation, early retirement, social assistance), place of residence (county, municipality, parish and property) and highest level of education. Obtained data will be compared to a gender and age matched comparison group, also retreived from the database LISA. Preliminary results show that almost 30 % of the adults with FAS had been subjected to the Swedish enforcement authority and the Social services. Moreover, about 70 % of the individuals had been regularly in contact with the Swedish public employment services. The results indicate that FAS have a major impact on the adult daily life, especially on social and psychosocial demographics.
Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure The prevalence o... more Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure The prevalence of fetal alcohol syndrome and fetal alcohol spectrum disorders in larger communities in USA is now updated to 0.4 % and 4.8 % respectively. Affected individuals bear witness to disease symptoms from many organ systems in addition to the brain and behavioural dysfunctions. In the light of modern epigenetic research, early alcohol exposure appears to play a hidden role in fetal reprogramming. The underlying mechanisms explain the »developmental origin of health and disease«, which has an impact on complex interactions between genome, environment and epigenetics.
Aims: To investigate self-reported physical and psychiatric problems, use of alcohol and illicit ... more Aims: To investigate self-reported physical and psychiatric problems, use of alcohol and illicit drugs, as well as conviction, and being a victim, of crime in adults with foetal alcohol syndrome (FAS). Methods: Interviews with 20 adults, aged 30+8 years with FAS diagnosis (65% female) and an age-and-gender-matched comparison group. Measures used were the Addiction Severity Index interview, the Beck Depression Inventory Scale and the Beck Anxiety Inventory Scale. Results and conclusions: Adults with FAS need healthcare for depression and suicidal ideation, which occurred commonly, but problems with use of alcohol and illicit drugs were not more common in the FAS group. Although self-reported physical health problems were not more common in the FAS group, their number of days with sickness leave indicated that they are often in too poor a physical condition to work. A majority of the FAS group had been victims of crime, which makes this an important topic for further research. The groups did not differ in crime conviction rates. Everyone in the study group had been diagnosed with FAS; a diagnosis may give access to social
Background: Even in adulthood, the disabilities associated with fetal alcohol spectrum disorders ... more Background: Even in adulthood, the disabilities associated with fetal alcohol spectrum disorders (FASD) may have a major impact on life, but different environmental circumstances during childhood may also be influential. This study aimed to investigate placements in out-of-home care, and number of early separations from caregivers, related to psychosocial outcomes in adults with fetal alcohol syndrome (FAS). Additional analyses were then done on a subgroup's cognitive development and mental health. Methods: Data on education and living with biological parents or in out-of-home care were obtained from childhood medical records on 51 adults (43% women), mean age 32, all diagnosed with FAS. Adult psychosocial outcomes (e.g. highest completed education, economic status, care due to alcohol or illicit drug abuse, mental health and conviction for crime) were obtained from national registers. Results: No significant within-group differences related to the adult psychosocial outcomes were found. Psychiatric disorders, psychotropic drug prescriptions and crime convictions were equally common, regardless of whether placement in care was early or late, or whether the participants had experienced few or many early separations. Conclusions: We suggest that the findings illustrate the heterogeneity among individuals with FASD. Welfare authorities' decisions concerning special education and placement in out-of-home care should be tailored to each individual. Interventions from society are still needed for individuals with FAS over 22 years old.
Journal of Investigative Psychology and Offender Profiling, 2014
Investigators often have to deal with small groups of suspects, and this is true both for crimina... more Investigators often have to deal with small groups of suspects, and this is true both for criminal cases and for suspected terrorist cases. There is, however, very little research examining the effectiveness of different interview techniques when facing cells of suspects. In order to remedy this shortcoming, we examined the extent to which three interviewing techniques elicited cues to deception from small groups of suspects. In one technique, the evidence was disclosed early in the interview (early evidence); in another, the evidence was disclosed late using the Strategic use of evidence technique (SUE-basic); and in the third technique, the evidence was disclosed late and with an increased strength and precision (SUE-incremental). We used a mock-theft scenario with 126 participants randomly allocated to one of six conditions: guilty or innocent suspects interrogated with one of the three disclosure tactics. The SUE-incremental proved to be the most effective technique, resulting in significant differences between guilty and innocent suspects for all three cues examined: statementevidence inconsistency, within-statement inconsistency, and within-group inconsistency. Based on the findings, we argue that the SUE technique is effective also for eliciting cues to deception when used for small groups of suspects.
executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrom... more executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrome. Nord J Psychiatry 2015;Early Online:1 -7.
BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a m... more BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS.
Alcohol’s teratogenic effect on the developing fetal brain is devastating, resulting in, for inst... more Alcohol’s teratogenic effect on the developing fetal brain is devastating, resulting in, for instance, structural abnormalities as well as behavioral and neuropsychological impairments in the child. The umbrella term Fetal Alcohol Spectrum Disorders (FASD) is used to describe the range of effects, from neuropsychological dysfunctions to complete Fetal Alcohol Syndrome (FAS). The disabilities associated with FASD have a major impact on life for children, and perhaps even in adulthood. However, only a few studies have addressed the long-term outcome in adults prenatally exposed to alcohol, especially with a diagnosis of FAS, from a psychological perspective. The main aim of this thesis was to investigate the psychological, psychosocial and neuropsychological consequences of FAS in adulthood. Participants in the studies in this thesis consisted of 79 adults (mean age: 32 years) with an FAS diagnosis. In Study I, data on the adults with FAS and a gender- and age-matched comparison group...
Methods: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women w... more Methods: Swedish midwives routinely screen pregnant women for drugs and alcohol and refer women with addictions to the Maternity and Child Healthcare Resource Team. We investigated the medical records of 127 children (51% girls) whose mothers were referred to the Resource Team from 2009-2015. Additional data were obtained from local child healthcare services (CHS), which provide routine paediatric care. Results: More than three-quarters (76%) of the children had prenatal exposure to alcohol and drugs and 17% were born with withdrawal symptoms. The mothers had a high rate of psychiatric diagnoses (38%) and were more likely to smoke after delivery and less likely to breastfeed than the general population. However, adherence to the CHS programme was generally high. Additional visits to the nurse, referrals to specialists, collaboration meetings and reports of concerns to social services decreased when the children began attending ordinary CHS centres. Conclusion: Children born to women with addictions during pregnancy faced a high risk of developmental problems and should be offered additional CHS resources to minimise negative long-term consequences.
Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditio... more Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists. Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their conditionfor instance, in terms of wellbeingis not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.
First European Conference on Fetal Alcohol Syndrome Kerkrade the Netherlands, 2010
Few studies focus on psychosocial functioning in adults with fetal alcohol syndrome (FAS). A prev... more Few studies focus on psychosocial functioning in adults with fetal alcohol syndrome (FAS). A previous follow-up study of Swedish children with FAS showed that they had severe problems with social relationships and education, problems that remained throughout childhood. The aim of this register study is to further investigate the past and present social and psychosocial demographics of these children who now are adults (n = 79, mean age 29 [18-49 years], 37 % women and 63 % men). A swedish longitudinal integrated database for health insurance and labour market studies (LISA by Swedish acronym) is used for this purpose. Examples of data that will be utilized from the database LISA are employment, income (e.g. parental leave, unemployment, labour market activity, rehabilitation, early retirement, social assistance), place of residence (county, municipality, parish and property) and highest level of education. Obtained data will be compared to a gender and age matched comparison group, also retreived from the database LISA. Preliminary results show that almost 30 % of the adults with FAS had been subjected to the Swedish enforcement authority and the Social services. Moreover, about 70 % of the individuals had been regularly in contact with the Swedish public employment services. The results indicate that FAS have a major impact on the adult daily life, especially on social and psychosocial demographics.
Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure The prevalence o... more Fetal alcohol syndrome is not the only consequence of prenatal alcohol exposure The prevalence of fetal alcohol syndrome and fetal alcohol spectrum disorders in larger communities in USA is now updated to 0.4 % and 4.8 % respectively. Affected individuals bear witness to disease symptoms from many organ systems in addition to the brain and behavioural dysfunctions. In the light of modern epigenetic research, early alcohol exposure appears to play a hidden role in fetal reprogramming. The underlying mechanisms explain the »developmental origin of health and disease«, which has an impact on complex interactions between genome, environment and epigenetics.
Aims: To investigate self-reported physical and psychiatric problems, use of alcohol and illicit ... more Aims: To investigate self-reported physical and psychiatric problems, use of alcohol and illicit drugs, as well as conviction, and being a victim, of crime in adults with foetal alcohol syndrome (FAS). Methods: Interviews with 20 adults, aged 30+8 years with FAS diagnosis (65% female) and an age-and-gender-matched comparison group. Measures used were the Addiction Severity Index interview, the Beck Depression Inventory Scale and the Beck Anxiety Inventory Scale. Results and conclusions: Adults with FAS need healthcare for depression and suicidal ideation, which occurred commonly, but problems with use of alcohol and illicit drugs were not more common in the FAS group. Although self-reported physical health problems were not more common in the FAS group, their number of days with sickness leave indicated that they are often in too poor a physical condition to work. A majority of the FAS group had been victims of crime, which makes this an important topic for further research. The groups did not differ in crime conviction rates. Everyone in the study group had been diagnosed with FAS; a diagnosis may give access to social
Background: Even in adulthood, the disabilities associated with fetal alcohol spectrum disorders ... more Background: Even in adulthood, the disabilities associated with fetal alcohol spectrum disorders (FASD) may have a major impact on life, but different environmental circumstances during childhood may also be influential. This study aimed to investigate placements in out-of-home care, and number of early separations from caregivers, related to psychosocial outcomes in adults with fetal alcohol syndrome (FAS). Additional analyses were then done on a subgroup's cognitive development and mental health. Methods: Data on education and living with biological parents or in out-of-home care were obtained from childhood medical records on 51 adults (43% women), mean age 32, all diagnosed with FAS. Adult psychosocial outcomes (e.g. highest completed education, economic status, care due to alcohol or illicit drug abuse, mental health and conviction for crime) were obtained from national registers. Results: No significant within-group differences related to the adult psychosocial outcomes were found. Psychiatric disorders, psychotropic drug prescriptions and crime convictions were equally common, regardless of whether placement in care was early or late, or whether the participants had experienced few or many early separations. Conclusions: We suggest that the findings illustrate the heterogeneity among individuals with FASD. Welfare authorities' decisions concerning special education and placement in out-of-home care should be tailored to each individual. Interventions from society are still needed for individuals with FAS over 22 years old.
Journal of Investigative Psychology and Offender Profiling, 2014
Investigators often have to deal with small groups of suspects, and this is true both for crimina... more Investigators often have to deal with small groups of suspects, and this is true both for criminal cases and for suspected terrorist cases. There is, however, very little research examining the effectiveness of different interview techniques when facing cells of suspects. In order to remedy this shortcoming, we examined the extent to which three interviewing techniques elicited cues to deception from small groups of suspects. In one technique, the evidence was disclosed early in the interview (early evidence); in another, the evidence was disclosed late using the Strategic use of evidence technique (SUE-basic); and in the third technique, the evidence was disclosed late and with an increased strength and precision (SUE-incremental). We used a mock-theft scenario with 126 participants randomly allocated to one of six conditions: guilty or innocent suspects interrogated with one of the three disclosure tactics. The SUE-incremental proved to be the most effective technique, resulting in significant differences between guilty and innocent suspects for all three cues examined: statementevidence inconsistency, within-statement inconsistency, and within-group inconsistency. Based on the findings, we argue that the SUE technique is effective also for eliciting cues to deception when used for small groups of suspects.
executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrom... more executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrome. Nord J Psychiatry 2015;Early Online:1 -7.
BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a m... more BACKGROUND AND OBJECTIVE: Primary disabilities in children prenatally exposed to alcohol have a major impact on their daily life. It is suggested that these issues persist into adulthood, but few studies have addressed the outcome in adults with prenatal exposure, especially those with fetal alcohol syndrome (FAS). The aim of this follow-up study was to investigate outcome variables, such as education, employment, health, and criminal acts, in 79 adults diagnosed with FAS.
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