Fetal Alcohol Spectrum Disorders

Fetal Alcohol Syndrome

Fetal Alcohol Effects

Alcohol-Related Neurodevelopmental Disorder

Alcohol-Related Birth Defects

Fetal Alcohol Spectrum Disorders

“ (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.”National Organization on Fetal Alcohol Syndrome terminology, 2004

FASD History

Thoughts and concerns regarding alcohol consumption’s effects on procreation or pregnancy are not new (centuries old), though reportedly different1,2

First ‘official’ documentation in 1899 Breakthrough in 1960’s and 1970’s:

In 1968 Dr. Paul Lemoine studied 127 children with features and symptoms related to prenatal alcohol exposure

In 1970’s further study in Seattle termed the condition “fetal alcohol syndrome”

1Source: Clarren, Sterling K. Recognition of Fetal Alcohol Syndrome. JAMA. 1981;245(23):2436-2439. doi: 10.1001/jama.1981.033104800520332Abel, Ernest L.. "Was the Fetal Alcohol Syndrome Recognized by the Greeks and Romans?." Alcohol and Alcoholism 34.6 (1999): 868-872. Was the Fetal

Alcohol Syndrome Recognized by the Greeks and Romans?. Web. 20 Feb. 2014.

FASD Prevalence

Approximated Among United States births:

< 10 in 100,000 born with HIV 1.5 in 1000 born with Down Syndrome 6 in 1000 born with Fetal Alcohol Spectrum

Disorder

Morgan Fawcett (YouTube, 0-1:55)Source: Centers for Disease Control

Fetal Alcohol Syndrome (FAS)

Affects .2-1.5 babies per 1000 (CDC) FAS is the leading cause of intellectual delay FAS is the leading cause of birth defects Caused by a mother’s heavy drinking during pregnancy

Central nervous system (brain, spinal cord) damage Untreated, this primary disability can lead to secondary disabilities

Environmental issues complicate the condition Many FAS-affected children in foster care

Prevalence: 60 out of 1000*

FAS is irreversible*

Lange, Shannon, Kevin Shield, Jurgen Rehm, and Svetlana Popova. "Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Meta-analysis." Pediatrics 142.4 (2013): e980-e995. Pediatrics.org. Web. 7 Nov. 2013.

Four Fetal Alcohol Syndrome Criteria Growth problems Specific facial features Central nervous system damage or dysfunction Prenatal alcohol exposure 4-Digit Diagnostic Code (WA State Diagnostic &

Prevention Network)

Growth Problems

Growth retardation Bone growth - prenatally and postnatally Height Weight Head circumference Heart malformations

Low Birth WeightSource: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#4

Low Birth Weight (example only; not due to FASD)Source: Beginbeforebirth.org

FAS Physical Characteristics

Facial characteristics Small head Small eyes Large cheeks Thin upper lip Flat nose Clinical presentation (AAFP, 2005)

Vision IssuesSource: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#2

Fetal Alcohol Syndrome (FAS) Cognitive Characteristics

Learning differences Visual-spatial learning

Objects on table (remembered, not placed correctly) Slower reaction times (eye movements - geometric patterns) Difficulty planning, organizing

Difficulty letting go of problem-solving strategies, even when they do not work Memory deficits

Early stages, rather than recall (different from Down’s Syndrome) • Attention deficits

May be misdiagnosed ADHD May focus and maintain attention well, but shift attention poorly

Source: NIAAA, Alcohol Alert, December 2000

Brain SizeSource: The Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#1

Fetal Alcohol Syndrome

Vignettes(Fetal Alcohol Syndrome, National Academies Press:1996. Page 54)

http://books.nap.edu/books/0309052920/html/54.html#pagetop

Fetal Alcohol Effects (FAE)

Those affected with prenatal alcohol exposure Those without all the symptoms of FAS

Growth deficiencies Behavior problems Substance abuse Cognitive deficits Some facial features

FAE now known as two diagnoses: Alcohol-Related Neurodevelopmental Disorder, Alcohol-Related Birth Defects

Alcohol-Related Neurodevelopmental Disorder Issues related to nervous system:

Communication problems Memory problems Learning differences Visual & spatial skill problems Problems with motor skills

Alcohol-Related Birth Defects

Defects in major organ systems: Abnormal development Underdevelopment

Heart Kidneys Eyes, ears Skeleton

Is Any Amount of Alcohol Considered Safe? There is no “safe” amount of alcohol consumption (Chart: MN

Department of Health) Most physicians will recommend pregnant women abstain from

alcohol consumption According to American Pregnancy Association:

2-4 drinks, frequently, can lead to FAE 5-6 drinks, frequently, can lead to FAS

According to Fetal Alcohol Syndrome (Institute of Medicine; National Academies Press: 1996, p. 68) Effects of mild alcohol intake are controversial Existing research suggests alcohol bingeing related to FAS

Experiment in Alaska bars (NBC, 2014)

Protective Factors

Early diagnosis Special education Social services Nurturing environment Absence of violence(National Center on Birth Defects and

Developmental Disabilities)

Early Intervention

Common Issues Among FAS Babies

Sleep disturbances Poor sucking response Crying Underdevelopment Toilet training challenges Distractibility, difficulty following directions DisobedienceSource: Teresa Kellerman, Coordinator, FAS Resource Center

Screening

In September 2012, American Academy of Pediatrics recommended all children be screened for Fetal Alcohol Syndrome

At Emory University, Experts Try New Approach to Treating Fetal Alcohol Syndrome (CBS Atlanta, September 2012)

Affected Individuals

Randy (ARND) Matt (FAS) Stefanie (FAS) Sinja (FAS; English child living in Germany) The Story of Iyal (YouTube, 3:49)

FAS: Real People

Fetal Alcohol Syndrome: A Biological Basis (Youtube.com)

Resources

Fetal Alcohol Syndrome Diagnostic and Prevention Network (UW), 206-598-0555

National Organization on Fetal Alcohol Syndrome Washington State (Mill Creek), 206-940-2832

Fetal Alcohol Drug Unit (UW), 206-543-7155