Fetal Alcohol Spectrum Disorder (FASD)

Reducing alcohol-related harm through a nonjudgmental approach

Dr. Samuel Harper

Nadia V.

Nadia V., 20 years old

First baby

Has been drinking alcohol since she was 12 years old

Smokes pot to fall asleep

Mother had drinking problems, she received foster care multiple times

Spouse drinks and smokes pot in an occasional, “social” manner

Screening for problematic drinking

Must be systematic

Open questions

Nonjudgmental attitude

T-ACE

Is my baby going to be okay?

Doctor, can you tell her to stop drinking?

Epidemiology of FASD

The prevalence of FAS in the United States: 1 to 3/1000 live births

FASD: 9.1 for 1000 live births

In Canada, there are no national statistics. It is estimated that nine children out of one thousand have FASD.

FASD, what is it?

It stands for Fetal Alcohol Spectrum Disorder (FASD). This is a generic term rather than a clinical diagnosis. FASD includes:

• FAS• Partial FAS• Alcohol-Related Birth Defects (ARBD)• Alcohol-Related Neurodevelopmental Disorder

(ARND)

What is FAS?

A. A mother’s confirmed exposure to alcohol

B. Presence of characteristic impairments in the facial features such as short palpebral fissures and anomalies in the premaxillary region

C. Prenatal or postnatal delayed growth

(cont’d)D. Neurodevelopmental anomalies of the central

nervous system

• Small head circumference at birth • Structural brain anomalies• Mild to severe neurological disorders

E.g.: impaired fine motor skills, neurosensory hearing loss, poor tandem gait and poor hand-eye coordination

Dysmorphic features

Dysmorphic features

- Smooth philtrum

- Thin upper lip

Dysmorphic features

- Short palpebral fissures

What is partial FAS?

A. Mother’s confirmed exposure to alcohol

B. Presence of certain characteristic facial features

Presence of C, D or E

C. Presence of prenatal or postnatal delayed growth

D. Neurodevelopmental anomalies of the central nervous system

E. The presence of a complex series of behavioural or cognitive anomalies that are incompatible with the level of development and which cannot be fully explained by family history or the environment

Alcohol-related birth defects (ARBD)

List of systems affected by birth defects, including malformations and dysplasias:

• Cardiac• Skeletal• Renal• Ocular• Auditory

Alcohol-Related Neurodevelopmental

Disorder (ARND)

A. Neurodevelopmental anomalies of the central nervous system

• Small head circumference at birth• Structural brain anomalies• Mild or severe neurological disorders

E.g.: impaired fine motor skills, neurosensory hearing loss, poor tandem gait and poor hand-eye coordination

Presence of A or B or both

(cont’d)

B. The presence of a complex series of behavioural or cognitive anomalies that are incompatible with the level of development and which cannot be fully explained by family history or the environment.

Causes of FASD

Alcohol consumption during pregnancy is the only cause of FASD

Genetics and nutrition have an impact on the risk

The consequences of a same exposure can vary greatly from one person to another and from one fetus to another

FASD can be 100% avoided

Alcohol causes malformations and we have no idea if there is a safe amount of alcohol that a pregnant woman can drink

The danger exists throughout pregnancy

The father’s consumption is NOT a cause of FASD

• All alcoholic beverages are harmful

• "Binge drinking" is particularly damaging

• The risk increases with maternal age

• No amount of alcohol during pregnancy is proven safe

Primary disabilitiesIntelligence (IQ)

Hyperactivity

Inattention

Executive functioning and abstract reasoning

Expressive and receptive communication

Adaptive behaviour, social skills and communication

Learning and memory difficulties

Secondary disabilities• Mental health problems

• Interrupted education

• Legal problems

• Deviant sexual behaviour

• Incarceration or treatment centre stays

• Problems related to drug and alcohol use

• Dependency related to the activities of daily living

• Employment difficulties

Risk factors

IQ exceeding 70Individuals with a dx other than FAS are often more at risk

Exposure to violence (physical and/or sexual abuse)

Occurs in 72% of individuals with FASD

Protection factors

Early diagnosis

Stability in place of residence

Not having witnessed or been a victim of violence

Nadia V.

I am unable to stop drinking…

I feel really guilty…

Harm reduction

Reducing the negative consequences of drinking and using drugs

Establishing a trusting relationship

Increasing self-esteem

Taking baby steps

Building on successes

Harm reduction

Believing in herself

Relapse is normal

Working on the causes of drug and alcohol use

Nadia V.

Had managed to reduce her consumption of alcohol and then quit drinking altogether

Had stopped smoking cannabis because she wanted to breastfeed

Gave birth to Océane