title: Physical and neurodevelopmental evaluation of children adopted from Eastern Europe.
abstract: BACKGROUND
  Children adopted from Eastern Europe are at risk of prenatal alcohol exposure, consequently at risk of Fetal Alcohol Spectrum Disorders (FASD). To our knowledge, a systematic complete assessment of these disabilities among adoptees from Eastern Europe has not yet been reported.
  
  
  OBJECTIVE
  To assess physical and neurodevelopmental status to identify FASD in children adopted from Eastern Europe.
  
  
  METHODS
  Cross sectional study at International Adoption Clinic of a paediatric academic hospital. This evaluation was realized according to the 4-Digit Diagnostic Code (4-DDC).
  
  
  RESULTS
  Twenty-nine children were evaluated. Five years after adoption, 7% (N=2) still presented growth delay and 24% (N=7) microcephaly. Facial evaluation demonstrated moderate Fetal Alcohol Syndrome (FAS) features in 7% (N=2) of children. Amiel-Tison Neurological Assessment was non optimal in 46% (N=13/28) of children. Visual-motor perception skills were mainly normal, but 14% (N=4) showed distal somatopraxic problems. Cognition, executive functioning, abstract reasoning and memory were normal. Full scale IQ was 105.5 +/- 13.3; verbal IQ < performance IQ (p<0.005), work memory < short memory (p<0.0001), receptive <expressive language (p<0.0001). Attention-deficit hyperactive disorder was presented in 31% (N=9). Concerning adaptive behaviour, social skills and social communication, 29% (N=8) performed <-2 SD and 33% (N=5/15) needed school assistance. According to 4-DDC, 7% (N=2) of children were normal, 21% (N=6) of children were known exposed to alcohol, one of these was classified as Partial FAS and five others presented neurological damage, or neurobehavioral disorders with or without sentinel physical findings. Three percent (N=1) were classified FAS although alcohol exposure was unknown. Sixty-nine percent (N=20) of children presented physical findings alone or neurological anomalies with or without physical findings.
  
  
  CONCLUSIONS
  In our cohort, the 4-DDC was useful. Systematic and multidisciplinary neurodevelopmental assessment is needed in these adopted children, for an early intervention to prevent secondary disabilities and therefore optimize children's outcome.
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Canada.
authors.forename: Monique
authors.initials: M
authors.lastname: Robert
authors.forename: Ana
authors.initials: A
authors.lastname: Carceller
authors.forename: Valérie
authors.initials: V
authors.lastname: Domken
authors.forename: Félix
authors.initials: F
authors.lastname: Ramos
authors.forename: Otilia
authors.initials: O
authors.lastname: Dobrescu
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Simard
authors.forename: Julie
authors.initials: J
authors.lastname: Gosselin
mesh_terms: D000300:Adoption; D000428:Alcohol Drinking / Q000009:adverse effects; D000437:Alcoholism / Q000150:complications; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000209:etiology* / Q000523:psychology; D005061:Europe, Eastern; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis* / Q000523:psychology; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007360:Intelligence; D007391:International Cooperation; D008297:Male; D009483:Neuropsychological Tests; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects