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MRI scans could pinpoint what’s unique about the brains of children with fetal alcohol spectrum disorders, leading to earlier diagnosis and more targeted treatment.
MRI is a powerful tool for understanding the brain and could help in the diagnosis of neurological problems such as fetal alcohol spectrum disorders.
For caretakers of children affected by fetal alcohol spectrum disorders (FASD), each day brings challenges — from coping with violent behaviour to guiding children through the simplest daily tasks, such as taking a shower or getting dressed.
Marianne (not her real name), who lives in Winnipeg, saw those challenges early on with her adopted son, who is now 11 years old. “He used to get horrendous night terrors, six or ten a night. And his temper was very bad.” She has had two surgeries to repair a deviated septum from when her son, then one-and-a-half, smashed her with his head during a temper tantrum.
But it has taken 10 years to get a clear diagnosis of FASD, and Marianne fears that the diagnosis may have come too late. “A lot of the help that could have been there for him is past him,” she says. Younger children are more willing to try new things, she explains, but by the pre-teen years, children become resistant. “You’ve got your peer pressure going — I’m not going to do that, that’s not going to make me cool.”
Did you know?
Exposure to alcohol in the womb is one of the leading causes of developmental disability in Canadian children.
Medical experts estimate that at least one percent of children in Canada suffer from FASD — a catchall term for conditions ranging from mild intellectual and behavioural issues to profound disabilities or even premature death. But the true numbers may be much higher because FASD can be very difficult to diagnose — and, hence, to treat.
“Getting the right diagnosis is important because it would open the door to different and better treatments,” says Dr. Krisztina Malisza, an NRC researcher in Winnipeg. “If you can diagnose a child with FASD, then you know these kids need extra help, and the reason they cannot function well is because of alcohol exposure. It means we can look at training and teaching methods that target those kids specifically.”
Often misdiagnosed as ADHD
The FASD continuum ranges from full-blown fetal alcohol syndrome to milder alcohol-related neurodevelopmental disorders. “Children with fetal alcohol syndrome are those whose mothers drank alcohol at a specific time in pregnancy and in amounts that caused distinctive facial features,” says Dr. Malisza. For example, children with fetal alcohol syndrome often have smaller heads, low-set ears and a smooth “philtrum” — the space between the nose and mouth. In addition, these children have behavioural and neurological problems.
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“At the other end of the spectrum are kids who have behavioural and cognitive problems associated with alcohol exposure, but who lack the facial characteristics of fetal alcohol syndrome, so they’re often misdiagnosed,” says Dr. Malisza. “They can be easily misdiagnosed with attention deficit hyperactivity disorder (ADHD) instead of FASD.”
Dr. Malisza and her colleagues are hot on the trail of an objective diagnostic test, based on functional magnetic resonance imaging (fMRI). In previous research, Dr. Malisza learned that imaging specific brain regions in FASD children may provide clues that help physicians make an accurate diagnosis. In the first study of its kind, she is now comparing the brain scans of children diagnosed with alcohol-related neurodevelopmental disorders to those with ADHD to see if it’s possible to distinguish between the two groups.
The study involves asking children to perform three different tasks while inside an MRI. The tasks involve either pressing or not pressing specific buttons in response to visual cues. “So far, my research shows that the two groups respond in different ways when performing tasks related to attention, working memory and impulse control,” she says.
Dr. Malisza hopes that her study will help pinpoint differences in brain function, structure or chemistry between the two groups of children. “Our ultimate goal is to provide an accurate means of diagnosing FASD that can be translated into more effective treatment.”
Marianne says that an earlier diagnosis would have made a huge difference for her son. “Because then you know what you’re working with, and can get help earlier.” If she had known sooner that he had FASD, Marianne says she would have focused more on teaching him the skills that would help him function as an adult, such as working with money and telling time. Both of these concepts are very difficult for her son to grasp.
“I just want him to do well in today’s society,” she says. “I want him to be able to go out there and work.” 
