Fetal Alcohol Spectrum Disorder: A Preventable Epidemic

Barry S Parsonson PhDExplore & Applied Psychology

International

FASD: Causes• FASD is caused by maternal consumption of

alcohol during pregnancy;• Alcohol affects developing neural and physical

systems differentially according to timing in relation to fetal development stage, amounts consumed and duration of exposure;

• The minimum amount causing some effect is currently not known, hence advice against all alcohol consumption when pregnant;

• FASD is thus entirely preventable!

FASD Diagnosis

• There are four internationally agreed classes of FASD based on assessment of severity using a 4-digit code relating to FAS characteristics;

• FAS, PFAS, ARND, & ARBD:• In each case, confirmed evidence of maternal

prenatal alcohol misuse is required;• DSM-V does not include FASD as a diagnosis

although it is described and identified as a “Condition for further study”!

FASD Diagnosis 1-FAS

• Fetal Alcohol Syndrome (FAS) is the most severe form. It includes:

• Facial Anomalies (small eye slits, thin upper lip, smooth philtrum) and Microcephaly;

• Growth Deficiency (height or weight <10%ile)• CNS Damage with evidence of structural and/or

functional brain abnormality;• Confirmed Prenatal Alcohol Exposure (needed if

cluster of facial anomalies not present).

Facial Anomalies of FAS

FASD Diagnosis 2-PFAS

Partial Fetal Alcohol Syndrome (PFAS) is characterised by:• Growth Deficiency (height or weight <10%ile)• CNS Damage with evidence of structural

and/or functional brain abnormality;• Confirmed Prenatal Alcohol Exposure (Reliable

evidence of maternal alcohol misuse).

FASD Diagnosis 3- ARND

Alcohol Related Neurodevelopmental Disorder (ARND) is characterised by:• CNS Damage: Evidence of structural or

functional brain abnormality;• Confirmed Prenatal Alcohol Exposure (Reliable

evidence of maternal alcohol misuse).

FASD Diagnosis 4-ARBD

Alcohol Related Birth Defects (ARBD) is classified by:• Physical Defects: Heart, Kidney or other

anomalies present at Birth;• Confirmed Prenatal Alcohol Exposure: Reliable

evidence of maternal Alcohol Misuse.

FASD Prevalence

• A Base Rate of 1% of the School Age population is estimated from a number of US, Canadian and European Studies;

• Some communities have rates of up to 8.5%;• Preliminary NZ data lead to guesstimates of at least

3000 school-age children with FASD;• Accurate data are difficult to obtain and probably

underestimate the true situation.• FASD is now the most common cause of ID.

Post-Natal FASD Effects on Cognition & Learning

• Executive functioning (Planning, attention)• Memory (encoding, rote, working & spatial)• Reasoning (verbal, abstract, numerical)• Language (learning, comprehension, meaning)• Sensorimotor (visual/motor integration,

visual-spatial processing)• Attention (short span, distractible, often ADHD

labelled)

Distribution of IQ Scores

FASD Effects on Communication & Sensory Functioning

• Delayed Language Development• Impaired receptive & expressive language• Difficulties in language production &

comprehension affect learning• Poor social communication affects relationship

building• Hearing disorders found common in a small

FAS clinic sample

FASD Behavioural Effects

• Physical Aggression• Lying and Confabulation• Impulsiveness and hyperactivity• Cheating, stealing, bullying & animal cruelty• Lack of remorse• Emotional lability• Substance abuse & self-harming

FASD Lifespan Effects

Collectively, these Cognitive, Learning, Social, Communication and Behavioural deficits have lifetime effects. Data from samples indicate:• Family life (85% of children in foster care FASD)• Educational achievement (60% excluded)• Mental Health (87% 5-13 y.o.; 23% adults suicide)• Criminality (60% of FASD teens, many Prisoners)• Relationship and Employment difficulties are

common.

Discussion Questions

• How do we, as a profession, intervene by way of increasing awareness and promoting prevention?

• Education? Who, when, how?• Increase Political and Public awareness? What

strategies might work?• What about the “Binge Drinking” Culture – Does

it contribute? If so, how to change that?• What can we offer to those on the FASD

spectrum? In Schools, Prisons, the Community?