About

Susan J. Hemingway is a Professor of Epidemiology and an Adjunct Professor of Pediatrics at the University of Washington. Her primary area of expertise is Fetal Alcohol Spectrum Disorders (FASD). She is the director of the Washington State FAS Diagnostic & Prevention Network (FAS DPN), a network of community-based clinics in Washington State linked by a core clinical, research, and training facility at the Center on Human Development and Disability at the University of Washington. Her work focuses on the primary and secondary prevention of FASD through screening, diagnosis, intervention, training, education, and research. Dr. Hemingway has developed comprehensive diagnostic systems for FASD, including the FASD 4-Digit Diagnostic Code, the FAS Facial Photographic Analysis Software, and the Foster Care FAS Screening Program in King County. She has trained over 150 FASD diagnostic teams worldwide and has contributed significantly to advancing diagnostic and preventive strategies for FASD. Her research interests include the effects of prenatal alcohol exposure on brain development, DNA methylation, histone modifications, and neuropsychological outcomes related to FASD.

Research topics

• Pediatrics
• Medicine
• Psychology
• Psychiatry
• Internal medicine
• Environmental health
• Clinical psychology
• Pathology
• Biology
• Genetics

Selected publications

• The relationship between intellectual ability and auditory multitalker speech perception in neurodivergent individuals

  PLoS ONE · 2025-09-24 · 1 citations

  articleOpen accessCorresponding

  The ability to selectively attend to one talker in the presence of competing talkers is crucial to communication in noisy, real-world environments. In this study, we investigated the relationship between intellectual ability and speech perception under multitalker conditions. Since neurodivergent individuals show a wide range of intellectual ability, from above average IQ to intellectual disability, intellectual ability may be an important individual characteristic that impacts multitalker speech perception, but this is not currently well understood. We tested individuals with autism, fetal alcohol spectrum disorder, and an age- and sex-matched comparison group, all with typical hearing. We found a strong positive correlation between IQ and multitalker speech perception thresholds. This demonstrates that deficits in intellectual ability, despite intact peripheral encoding of sound, are associated with difficulty listening under complex conditions for individuals with autism and fetal alcohol spectrum disorder. Future research is needed to investigate specific cognitive control mechanisms that contribute to difficulty listening under complex conditions. These findings suggest that audiological services to improve communication in real-world environments for neurodivergent individuals should be considered during clinical evaluations.

  PublisherDOI

• Developmental, sensory and behavioral outcomes among infants and toddlers with prenatal alcohol exposure

  Research in Developmental Disabilities · 2024-01-22 · 4 citations

  articleSenior author
  PublisherDOI

• Washington and Alaska statewide fetal alcohol spectrum disorder diagnostic clinical networks: Comparison of three decades of 4-Digit Code diagnostic outcomes and prenatal alcohol exposure histories.

  PubMed · 2023-01-01

  articleOpen access1st authorCorresponding

  Background: year. Alaska adopted this Washington model in 1999. Both states have also participated in the CDC Pregnancy Risk Assessment Monitoring System and Behavioral Risk Factor Surveillance System since the 1990s. Study objectives were to describe the two statewide FASD diagnostic networks; graphically compare the 4-Digit-Code FASD diagnoses and prenatal alcohol exposure (PAE) over 2-3 decades and illustrate how network data helped guide FASD public health policies and track successful prevention efforts. Methods: Retrospective descriptive study. Results: FASD diagnostic outcomes were similar across 2,532 Washington and 2,469 Alaskan patients. PAE in each State followed similar annual trajectories from 1991-2020. Both States documented significant decreases in FAS and PAE in the 1990s. Clinic data helped guide public health policies. Conclusions: Both States demonstrated the feasibility and value of establishing statewide interdisciplinary FASD diagnostic clinical networks using the FASD 4-Digit-Code. Legislative support, centralized data collection, and use of a single, evidence-based FASD diagnostic system have been key to the long-term, ongoing success of these two diagnostic networks.

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• Comparing narrative storytelling ability in individuals with autism and fetal alcohol spectrum disorders

  International Journal of Language & Communication Disorders · 2023-10-18 · 5 citations

  articleOpen access

  BACKGROUND: Narrative discourse, or storytelling, is used in daily conversation and requires higher-level language and social communication skills that are not always captured by standardised assessments of language. Many autistic individuals and individuals with fetal alcohol spectrum disorders (FASD) have difficulties with both social communication and language skills, and narrative discourse analysis offers an ecologically relevant approach to assessing those challenges. AIMS: This study investigated narrative discourse in individuals with autism and FASD, as well as an age- and sex-matched comparison group. METHODS AND PROCEDURES: Narratives from 45 adolescents and adults, 11 with autism, 11 with FASD and 23 age- and sex-matched comparison participants were elicited using a wordless storybook. They were then transcribed orthographically, formatted to the Systematic Analyses of Language Transcript (SALT) convention and scored based on the SALT Narrative Scoring Scheme (NSS), a standardised language analysis protocol. In addition to the NSS total score, which assesses the overall structure and cohesion of the narratives produced, local and global measures of language ability were also employed. The local language measures included the number of mental state and temporal relation terms produced, while the global language measures included mean length of utterance, total different words, total words, total utterances, rate of speech, the number of mazes (e.g., repetitions, 'um', 'uh' or self-corrections) per total word and the NSS total score. OUTCOMES AND RESULTS: Using the SALT Language Sample Analysis tool, our results revealed that on global language measures, group differences were found on rate of speech, number of mazes per total words and the description of conflict/resolution in the narratives produced. The autism group produced significantly more mazes per total word and scored higher on the NSS conflict/resolution category score compared to the FASD and comparison groups. Both the autism and FASD groups spoke at a lower rate than the comparison group. On local language measures of narrative production, all groups were comparable, on average. CONCLUSIONS AND IMPLICATIONS: While many aspects of narrative discourse in the autism and FASD groups were similar to each other and to the comparison group, we observed group differences on global measures of narrative production and significant individual variability within groups, suggesting that narrative abilities considered at an individual level may provide important clinical information for intervention planning. Future research should also consider additional variables that influence narrative discourse, such as motivation, distractibility or decision-making of individual participants. WHAT THIS PAPER ADDS: What is already known on the subject Narrative discourse, or storytelling, is used in daily conversational interactions and reveals higher-level language skills that may not be well captured by standardised assessments of language. Many autistic individuals and individuals with fetal alcohol spectrum disorders (FASD) show difficulty with pragmatic and expressive language skills. What this paper adds to existing knowledge We found that many aspects of the narratives produced by the adolescents/young adults in the autism and FASD groups were comparable to each other and to the neurotypical group. However, the groups differed on three global measures of narrative production: rate of speech, number of mazes per total words and the description of conflict/resolution in the narratives produced. Also, significant variability was observed within groups, suggesting that narrative abilities should be considered at an individual level as opposed to their clinical groups. What are the potential or actual clinical implications of this work? This study showed that narrative discourse is an appropriate task that can be added to routine clinical assessments of language abilities in autistic adolescents/young adults as well as those with FASD or typical development and has the potential to reveal higher-level, real-world language skills. An important clinical implication of this study is that narrative language abilities should be considered at an individual level and individual-tailored interventions based on ability level due to the variability observed across individuals.

  PublisherOA PDFDOI

• The impact of cognitive ability on multitalker speech perception in neurodivergent individuals

  medRxiv · 2022-09-20 · 3 citations

  preprintOpen access

  Abstract The ability to selectively attend to one talker in the presence of competing talkers is crucial to communication. Here we investigate whether cognitive deficits in the absences of hearing loss can impair speech perception. We tested typical hearing, neurodivergent adolescents/adults with autism spectrum disorder, fetal alcohol spectrum disorder, and an age- and sex-matched neurotypical group. We found a strong correlation between IQ and speech perception, with individuals with lower IQ scores having worse speech thresholds. These results demonstrate that deficits in cognitive ability, despite intact peripheral encoding, can impair listening under complex conditions. These findings have important implications for conceptual models of speech perception and for audiological services to improve communication in real-world environments for neurodivergent individuals.

  PublisherOA PDFDOI

• Comparing Narrative Storytelling Ability in Individuals with Autism Spectrum Disorder and Fetal Alcohol Spectrum Disorder

  medRxiv · 2022-09-20 · 1 citations

  preprintOpen access

  Abstract Purpose Narrative discourse, or storytelling, is used in daily conversational interaction and reveals higher level language skills that may not be well captured by standardized assessments of language. Many individuals with autism spectrum disorder (ASD) and fetal alcohol spectrum disorder (FASD) show difficulty with pragmatic language skills and narrative production offers one method of assessing expressive and pragmatic language skills in an ecologically relevant manner. This study investigated narrative abilities on both local and global levels of adolescent/young adults with ASD and FASD, and their age- and sex-matched comparison group. Method Narratives from forty-five adolescents/young adults, 11 with ASD, 11 with FASD, 23 age- and sex-matched neurotypical comparison group, were elicited using a wordless storybook. They were then transcribed orthographically, formatted to the Systematic Analyses of Language Transcript (SALT) convention, and scored based on the narrative scoring scheme (NSS). Additional analyses investigated local language measures such as the number of mental state and temporal relation terms produced, as well as global language measures including the mean length of utterance, total number of different words, total number of words, total number of utterances, rate of speech, and the narrative scoring scheme total score. Results On local language measures, no significant group differences were found. On global language measures, many aspects of narrative production in the ASD and FASD groups were comparable to each other and to the comparison group, although important differences were observed for the total number of words produced and rate of speech. Conclusions Given significant variability observed within groups, these findings suggest that language abilities should be assessed at an individual level. Future research should also consider additional variables that influence narrative production such as motivation, distractibility, or decision-making of individual subjects.

  PublisherOA PDFDOI

• High facial specificity and positive predictive value are required to diagnose fetal alcohol syndrome when prenatal alcohol exposure is unknown.

  PubMed · 2020 · 4 citations

  1st authorCorresponding
  • Medicine
  • Internal medicine
  • Pediatrics

  BACKGROUND: Facial criteria with high specificity and positive predictive value (PPV) to prenatal alcohol exposure (PAE) are required to diagnose fetal alcohol syndrome (FAS) when documentation of PAE is unavailable. Not all fetal alcohol spectrum disorder (FASD) diagnostic guidelines appear to meet these criteria. METHODS: A dataset generated from a 10-year FAS screening of 1,602 children in fostercare conducted by the University of Washington FAS Diagnostic & Prevention Network was used to determine how well the FAS facial phenotype, microcephaly and growth deficiency (individually and in combination at varying levels of magnitude) predicted PAE. RESULTS: percentile) did not increase PPV beyond chance (52%). CONCLUSIONS: FASD diagnostic guidelines that use relaxed criteria for the FAS facial phenotype risk misdiagnosing and over-diagnosing FAS and partial FAS when PAE is unknown.

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• Prevalence and patterns of sensory processing behaviors in a large clinical sample of children with prenatal alcohol exposure

  Research in Developmental Disabilities · 2020 · 35 citations

  Senior authorCorresponding
  • Psychology
  • Medicine
  • Pediatrics
  PublisherDOI

• What proportion of the brain structural and functional abnormalities observed among children with fetal alcohol spectrum disorder is explained by their prenatal alcohol exposure and their other prenatal and postnatal risks?

  PubMed · 2020 · 31 citations

  1st authorCorresponding
  • Medicine
  • Pediatrics
  • Psychology

  BACKGROUND: Individuals with prenatal alcohol exposure (PAE) often present with a myriad of other prenatal (e.g. exposure to tobacco and other illicit drugs, poor prenatal care) and postnatal risk factors (e.g. multiple home placements, physical/sexual abuse, low socio-economic status)-all of which are likely contributing to their adverse outcomes. METHODS: A comprehensive neuropsychological battery, coupled with magnetic resonance imaging, was administered to children with fetal alcohol spectrum disorders (FASD) in 2009. Study participants diagnosed with FASD by the University of Washington using the FASD 4-Digit Code were compared to typically-developing peers with no PAE. Data from this MRI study were used to explore the proportion of variance in brain structural and functional abnormalities explained by PAE and 14 other prenatal and postnatal risk factors. RESULTS: PAE was the dominant risk factor explaining the largest proportion of variance in regional brain size (total brain, frontal lobe, caudate, hippocampus and corpus callosum) and brain function (intellect, achievement, memory, language, executive-function, motor, adaptation, behavior-attention and mental health symptoms). Other prenatal and postnatal risk factors were 3 to 7-fold more prevalent than in the general population. Individually, each risk factor explained a statistically significant, but smaller proportion of variance in brain outcome compared to PAE. In combination, the proportion of variance explained by the presence of multiple prenatal and postnatal risks rivaled that of PAE. CONCLUSION: A better understanding of the impact other prenatal and postnatal risk factors have on the neurodevelopmental outcomes of individuals with FASD can inform more effective prevention and intervention strategies.

  PublisherOA PDF

• Listening Difficulties in Children With Fetal Alcohol Spectrum Disorders: More Than a Problem of Audibility

  Journal of Speech Language and Hearing Research · 2019-04-30 · 18 citations

  articleOpen accessSenior author

  Purpose Data from standardized caregiver questionnaires indicate that children with fetal alcohol spectrum disorders (FASDs) frequently exhibit atypical auditory behaviors, including reduced responsivity to spoken stimuli. Another body of evidence suggests that prenatal alcohol exposure may result in auditory dysfunction involving loss of audibility (i.e., hearing loss) and/or impaired processing of clearly audible, “suprathreshold” sounds necessary for sound-in-noise listening. Yet, the nexus between atypical auditory behavior and underlying auditory dysfunction in children with FASDs remains largely unexplored. Method To investigate atypical auditory behaviors in FASDs and explore their potential physiological bases, we examined clinical data from 325 children diagnosed with FASDs at the University of Washington using the FASD 4-Digit Diagnostic Code. Atypical behaviors reported on the “auditory filtering” domain of the Short Sensory Profile were assessed to document their prevalence across FASD diagnoses and explore their relationship to reported hearing loss and/or central nervous system measures of cognition, attention, and language function that may indicate suprathreshold processing deficits. Results Atypical auditory behavior was reported among 80% of children with FASDs, a prevalence that did not vary by FASD diagnostic severity or hearing status but was positively correlated with attention-deficit/hyperactivity disorder. In contrast, hearing loss was documented in the clinical records of 40% of children with fetal alcohol syndrome (FAS; a diagnosis on the fetal alcohol spectrum characterized by central nervous system dysfunction, facial dysmorphia, and growth deficiency), 16-fold more prevalent than for those with less severe FASDs (2.4%). Reported hearing loss was significantly associated with physical features characteristic of FAS. Conclusion Children with FAS but not other FASDs may be at a particular risk for hearing loss. However, listening difficulties in the absence of hearing loss—presumably related to suprathreshold processing deficits—are prevalent across the entire fetal alcohol spectrum. The nature and impact of both listening difficulties and hearing loss in FASDs warrant further investigation.

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Frequent coauthors

• Tracy Jirikowic

  University of Washington

  9 shared

• John C. Thorne

  Alabama Power (United States)

  9 shared

• Erin M. Olson

  University of Washington

  6 shared

• Julian K Davies

  University of Washington

  6 shared

• Annette Estes

  University of Washington

  6 shared

• Adrian K. C. Lee

  Institute for Learning Innovation

  6 shared

• Julia M Bledsoe

  University of Washington

  5 shared

• Allison Brooks

  5 shared

Labs

• Department of EpidemiologyPI