267-256-2050 jfcsphilly info@jfcsphilly

1. Fetal Alcohol Spectrum Disorders and Impact on Brain DevelopmentSara H. Wenger, M.S.Education and Outreach ServicesJewish Family and Children’s Service 267-256-2050 www.jfcsphilly.org info@jfcsphilly.org

2. WHAT IS FASD? • Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. • May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. • Not a diagnosis

3. FASD Spectrum • Fetal alcohol effects (FAE) • Alcohol-related birth defects (ARBD) • Alcohol-related neurodevelopmental disorder • (ARND) • Partial FAS (pFAS) • Fetal Alcohol Syndrome (FAS)

4. Fetal Alcohol Spectrum Disorder • It is the leading cause of mental retardation in the West. • FASD is preventable.

5. Maternal Alcohol Consumption Each year over 40,000 American children are born with defects because their mother drank alcohol when pregnant.

6. Incidence of FASD • The range of FASD is more common than disorders such as Autism and Down Syndrome. • Generally accepted incidence rates for FASD are 1 in 100 live births.

7. According to the CDC, NIAAA, Surgeon’s General Report: There is no known amount of alcohol that is safe for a woman to drink during pregnancy.

8. Fetal Alcohol Syndrome FAS is a serious combination of birth defects seen in the offspring of women who have been heavy drinkers (usually at a rate of six or more drinks per day) throughout pregnancy.

9. Fetal Alcohol Effects Refers to symptoms of children with a history of prenatal alcohol exposure (mothers drank approximately 14 drinks per week) but not all of the physical or behavioral symptoms of FAS.

10. Alcohol is a Teratogen • A teratogen is any substance that produces birth defects by influencing fetal development. • Alcohol crosses the placenta and enters the fetus, causing the level of alcohol in the fetus to approximate the mother’s alcohol level.

11. Alert! There is ever-increasing recognition that alcohol is the most common chemical teratogen presently causing malformations and mental deficiency in the human offspring.

12. One drink per day throughout pregnancy adds up to 39 baby bottles full of booze.

13. Alcohol Teratogenesis in the Brain • Alcohol has the most detrimental effect on both brain development and function. • The infant is not only born with a smaller brain size, but the teratogenic effect of alcohol both reduces the number of brain neurons as well as alters their distribution. • This results in mental deficiency.

14. How Does Fetal Alcohol Damage Occur? Alcohol is a FOOD, a DRUG and a POISON (toxin). It results in: • Direct toxic effects on tissues • Interference w/ fetal nutrition • Interference w/ fetal oxygen supply • Interference w/ growth-signaling chemicals

15. Risk Factors of Maternal Alcohol Consumption • The alcohol a pregnant woman drinks reaches the fetus within a few minutes. • Alcohol passes through the placenta. This exposure can cause a lifetime of damage. • The central nervous system and the brain grow throughout pregnancy and are affected during any stage of development.

16. The Brain The portion of the central nervous system responsible for: • The interpretation of sensory impulses • The coordination and control of bodily functions • The exercise of emotion and thought.

17. Fetal Brain DevelopmentFetal brain cells are generated at about 250,000 per minute.

18. Alcohol Exposure During Stages of Pregnancy First Trimester Alcohol interferes with the migration and organization of brain cells.

19. Second Trimester Heavy drinking during the second trimester, particularly from the 10th-20th week after conception, seems to cause more clinical features of FAS than at other times during pregnancy.

20. Third Trimester • During the 3rd trimester, the hippocampus is greatly affected, leading to problems with encoding visual and auditory information. • The hippocampus plays a fundamental role in memory.

21. Signs and Symptoms of FAS • A baby may be born drunk and addicted to alcohol. • Baby will have low birth weight and short length. • Baby will have a small head, flattened nose, thin upper lip, small eyes. • Baby has permanent damage to the brain and central nervous system.

22. The Baby with FAS • “Failure to thrive”: they lose weight, have poor sucking reflexes, no desire to eat. • Baby may have trouble sleeping; does not develop a regular schedule; irritable, squirmy, difficult to soothe. • Baby may be slow to talk, learning language is a lifelong problem; slow to walk and to be toilet-trained.

23. Maternal Alcohol Use and Fetal Development The most common characteristics of children born with FAS are as follows: Growth deficiency Craniofacial abnormalities Musculoskeletal defects Cardiac disease Nervous system abnormalities Neuro-developmental delay Mental deficiency

24. Dysmorphic Features

25. Children with FAS • Friendly and outgoing, sometimes to their disadvantage. • Impulsive; poor judgment. • Hyperactive; cannot sit still. • Falls behind peers socially and academically. • Easily manipulated by others.

26. The Child with FAS • Average IQ is 65. • Physically smaller. • Learning disabilities: • Difficulty matching words and behaviors • Difficulty mastering new skills or remembering something recently learned (tying shoelaces) • Spotty memory • Inflexibility of thought • Difficulty predicting outcomes • Difficulty distinguishing fact from fantasy • Difficulty distinguishing friends from strangers.

27. Fetal Alcohol Effects in Infants • Lighter weight babies • Jittery and tremulous • Difficulties with habituation • Disrupted sleep patterns • Abnormal reflexes • Weaker sucking reflex

28. Fetal Alcohol Effects in Children Learning and Behavioral Problems • Difficulty sustaining attention • Difficulty retaining information • Difficulty comprehending words • Difficulty with word recall/organizational skills • Impulsive behaviors • Distractible and Inflexible

29. Overall Difficulties for Persons with an FASD • Taking in information • Storing information • Recalling information when necessary • Using information appropriately in a specific situation.

30. Sensory Integration Issues • Overly sensitive to sensory input • Upset by bright lights or loud noises • Annoyed by tags in shirts or seams in socks • Bothered by certain textures of food • Have problems sensing where their body is in space.

31. Information Processing • Do not complete tasks or chores and may appear to be oppositional • Have trouble determining what to do in a given situation • Do not ask questions because they want to fit in • Have trouble with changes in tasks and routine

32. Information Processing • Have trouble following multiple directions • Say they understand when they do not • Cannot operationalize what they’ve memorized • Misinterpret others’ words, actions, or body movements • Literal in their thinking and interpretation

33. Some Typical Difficulties: Executive Function and Decision-Making • Repeatedly break the rules • Tend not to learn from mistakes or natural consequences • Frequently do not respond to reward systems • Difficulty entertaining themselves • Give in to peer pressure • Naïve, gullible • Difficulty with abstract concepts

34. Self-Esteem and Personal Issues • Often feel “stupid” or like a failure • Seen as lazy, uncooperative and unmotivated • Have hygiene problems • Aware they’re ‘different’ from others • Often grow up in multiple homes and experience multiple losses.

35. Impact of FAS on Society • FAE believed to occur at a rate of approx. 3-5 per 1,000 live births in the U.S. • FAS present in approx. 1-3 per 1,000 • Nation spends approximately $4 billion in caring for families affected by FAS • Estimates of lifetime costs: range $1.4 million in 1988 to $2 million in 2008.

36. Impact on Families and Communities • Emotional • Legal • Financial • Criminal • Social • Physical • Psychological

37. Prevention • Grade appropriate education • Health Professional education • Required warning labels on alcoholic beverages • Public health information campaign • Chemical dependence treatment programs • Community support systems • Improved screening and referral systems