fetal alcohol syndrome psychopathology 1 master of clinical psychology program 1
TRANSCRIPT
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Fetal Alcohol Syndrome
Psychopathology 1Master of Clinical Psychology
Program
http://pernod-ricard.com/724/csr/responsible-drinking/pregnant-women
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What is Fetal Alcohol Syndrome?• Pattern of anomalies that have resulted due to
prenatal exposure to alcohol– Facial anomalies– Growth retardation– Central nervous system dysfunction
• Recognised as being at the higher end on a continuum of disorders which can be attributed to prenatal alcohol exposure.
http://news.discovery.com
4http://www.webjam.com/fas_supportjax
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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, behavioural, and/or learning
disabilities with possible lifelong implications. The
term FASD is not intended for use as a clinical
diagnosis. (Bertrand et al., 2004, pp. 4)
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• Small size for age (especially as an infant)• Facial abnormalities such as small eye openings• Poor coordination• Poor suck and sleep disturbances in infancy• Hyperactive behaviour• Learning disabilities• Developmental disabilities (e.g. speech and
language delays)
How would someone with FASD present?
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Characteristics of FASD Con’t…
• Mental retardation or low IQ
• Poor reasoning and judgment skills
• Inconsistent or spotty memory
• Poor abstract thinking
• Impulsive and difficulty learning from mistakes
• Temper tantrum and difficulty with self control (not
appropriate for age)
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How is a diagnosis of FAS reached?
Patient
General Practitioner
Paediatrician
Psychologist
Social Worker
Psychiatrist
Neurologist
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Framework for FAS Diagnosis and Services
Child presents for office visit – Triggers Emerge
Complete initial evaluation to gather data
related to FAS
FAS Criteria NOT met – Continue to monitor
changes in health over time.
FAS Criteria Met - Refer to Specialist for further
assessment
FAS Diagnosis confirmed.Intervention plan is
developed
Intervention Plan is communicated to frontline providers
Source: Bertrand. J., Floyd, R.L., Weber, M.K., O'Connor, M., Riley, E.P., Johnson, K.A., Cohen, D.E., National Task Force on FAS/FAE. Fetal alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention; 2004, p.8.
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Diagnostic Schemas
• 4-digit code / University of Washington
• National Task Force / The Centre for Disease Control and Prevention (CDC)
• Canadian Guidelines
• Revised Institute of Medicine (IOM)
• All four schemas look to the three distinct areas
– Prenatal and/or postnatal growth deficiency– Central nervous system dysfunction– Characteristic pattern of facial anomalies (differ on
how many need to be present)
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http://www.aafp.org/afp/2005/0715/p279.html
www.come-over.to/FAS/FASbrain.htmPhoto by Sterling Clarren, MD
http://news.discovery.com
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Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic
Code (2004)• Allows for a full assessment to be undertaken by a multi-disciplinary team
of professionals• The 4-Digit code of 4444 indicates a diagnosis of FAS, at the most extreme
end of the FASD.• Code of 1111 would indicate:
– normal development, – no signs of facial deformities, – no CNS concerns and – no prenatal exposure to alcohol.
• This therefore allows for 256 Diagnostic Codes which can be logically grouped in 22 Diagnostic Categories
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• Physician– Sections pertaining to growth, structural &
neurological measures of the CNS, facial features and other physical findings.
• Occupational Therapist, Psychologist, speech language pathologist and/or other team members complete sections pertaining to psychometric measures of CNS function.
• All members participate in the derivation of the 4-Digit Code and intervention plan.
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Lets start at the beginning…
http://rffada.org/resources/research - Russell Family Fetal Alcohol Disorders Association
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Presenting symptoms of FAS
• Documentation of all three facial abnormalities – Smooth philtrum– Thin vermillion – Small palpebral fissures
• Documentation of growth deficits • Documentation of Central Nervous System (CNS)
abnormality
http://www.aafp.org/afp/2005/0715/p279.html - Photograph
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Facial Dysmorphia
• Based on racial norms• Must exhibit all three characteristic facial
features
http://www.come-over.to/FAS/WhoseBabyIsThis.htm
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• Smooth philtrum • Thin vermillion border(University of Washington Lip-Philtrum Guide rank 4 or 5)
http://depts.washington.edu/fasdpn/htmls/lip-philtrum-guides.htm
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Photo reprinted with permission from Susan Astley, University of Washington: www.fasdpn.org
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Small palpebral fissures – at or below 10th percentile
Photo reprinted with permission from Susan Astley, University of Washington: www.fasdpn.org.
20http://m.medlineplus.gov/ency/imagepages/19842.htm
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GrowthDocumentation of growth deficits:• Confirmed prenatal or postnatal height or weight, or both, at or below
the 10th percentile, documented at any one point in time (adjusted for age, sex, gestational age, and race or ethnicity).
Australasian Paediatric Endocrine Group
• Australian and New Zealand Growth Charts• US Growth Charts (Centre for Disease Control)• The WHO Child Growth Standards
http://www.apeg.org.au/clinicalresourceslinks/growthgrowthcharts/tabid/101/default.aspx
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Central Nervous System• Structural
– Head circumference at or below the 10th percentile adjusted for age and sex
– Clinically significant brain abnormalities observable through imaging.
• Neurological– Neurological problems not due to a postnatal insult or fever, or
other soft neurological signs outside normal limits.• Functional
• Global cognitive or intellectual deficits representing multiple domains of deficit (or significant developmental delay in younger children) – performance below the 3rd percentile
• Functional deficits below the 16th percentile (in at least three domains)• See below for a table to assist with identifying Functional CNS deficits.Source: Adapted from Bertrand,J., Floyd, R. L., Weber, M. K., O'Connor, M., Riley, E. P.,Johnson, K. A., Cohen, D. E., & National Task Force on FAS/FAE. Fetal alcohol syndrome: Guideiines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention;2004.
http://en.wikipedia.org/wiki/Human_brain
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What does a healthy brain do?
http://alcoholpregnancy.childhealthresearch.org.au/about/fetal-alcohol-spectrum-disorders-(fasd).aspx
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Comorbidity• To increase the difficulty in achieving a correct
diagnosis, a number of disorders are often comorbid with FAS.
• Autism• Conduct Disorder (CD)• Oppositional Defiant Disorder (ODD)• Anxiety Disorders• Adjustment Disorders• Sleep Disorders• Depression
http://allthingsd.com
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FASD ADHD
Set Shifting
Complex Motor Skills
Static Balance
Social Skills
Communication Skills
Parent reports of behaviour
Basic Motor Control
Focused Attention
Sustained Attention
RetrievalFace &
Emotion Processing
Daily Living Skills
Verbal Encoding
Shifting Attention
IQ
Verbal Fluency
Problem Solving
Mattson, Crocker & Nguyen, 2011
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Fetal Alcohol Syndrome Summary
• 100% Preventable• 0% Curable BUT with early
diagnosis and appropriate intervention individuals with FAS do have the potential to do well.
• Major Public Health Concern –vs- Moral Panic?
• 0.2 to 1.5 cases of FAS occur every 1,000 live births in USA.
• If FAS and ARND were added together – 9.1 cases for every 1,000 live births in USA. That would be nearly 1 in 100.
http://www.come-over.to/FAS/WhoseBabyIsThis.htm
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Summary Con’t….
• There is no biomarker for the diagnosis of Fetal Alcohol Syndrome. • The effects of FAS may include physical, behavioural and/or
learning difficulties.• Comorbidity with a number of other disorders can complicate
diagnosis.• To ensure accurate diagnosis a Multidisciplinary Team approach is
best.
http://pernod-ricard.com/724/csr/responsible-drinking/pregnant-women
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ReferencesArmstrong, E. M., & Abel, E. L. (2000). Fetal alcohol syndrome: The origins of a moral panic. Alcohol &
Alcoholism, 35(3), pp. 276-282.
Astley, S. J. P. D. (2004). Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The four digit diagnostic code
(Third ed., pp. 123). Seattle, WA: University of Washington.
Bertrand, J., Floyd, R. L., Weber, M. K., O'Connor, M., Riley, E. P., Johnson, K. A., & Cohen, D. E. (2004). Fetal
Alcohol Syndrome: Guidelines for referral and diagnosis. 62. Retrieved from
http://www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf
Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice. (pp.
274). Washington, DC: U.S. Government Printing Office.
Mattson, S. N., Crocker, N., & Nguyen, T. T. (2011). Fetal Alcohol Spectrum Disorders: Neuropsychological and
Behavioural Features. [Review]. Neuropsychology Review, 21, 81-101. doi: 10.1007/s11065-011-9167-9
O'Connor, M. J., & Paley, B. (2009). Psychiatric conditions associated with prenatal alcohol exposure.
Developmental Disabilities Research Review, 15(3), 10.
Paley, B., & O’Connor, M. J. (2011). Behavioral interventions for children and adolescents with fetal alcohol
spectrum disorders. Alcohol Research & Health, 34(1), 64-75.
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Riley, E. P., Infante, M. A., & Warren, K. R. (2011). Fetal Alcohol Spectrum Disorders: An overview. [Overview].
Neuropsychology Review, 21, 73-80. doi: 10.1007/s11065-011-9166-x
Stratton, K., Howe, C., & Battaglia, F. C. (1996). Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention,
and treatment (pp. 230). Retrieved from http://www.nap.edu/catalog/4991.html
Telethon Institute for Child Health Research. (). Alcohol Pregnancy & FASD. Retrieved from http://
alcoholpregnancy.childhealthresearch.org.au/abou t/fetal-alcohol-spectrum-disorders-(fasd).aspx
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Helpful Linkshttp://dcanoy.wix.com/fas-disorders
• Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code
depts.washington.edu/fasdpn/pdfs/guide2004.pdf
• Brief outline of Diagnostic Criteriawww.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf
• Australasian Paediatric Endocrine Grouphttp://www.apeg.org.au/clinicalresourceslinks/growthgrowthcharts/tabid/101/default.aspx
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