Fetal Alcohol Spectrum Disorders

1. Fetal Alcohol Spectrum Disorders Fetal Alcohol Syndrome Fetal Alcohol Effects Alcohol-Related Neurodevelopmental Disorder Alcohol-Related Birth Defects

2. 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

3. 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” \Source: Clarren, Sterling K. Recognition of Fetal Alcohol Syndrome. JAMA. 1981;245(23):2436-2439. doi: 10.1001/jama.1981.03310480052033 2Abel, 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.

4. FASD Prevalence • Approximated • Among United States births: • < 1 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

5. Fetal Alcohol Syndrome (FAS) • Affects ~2 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.

6. 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)

7. Growth Problems • Growth retardation • Bone growth - prenatally and postnatally • Height • Weight • Head circumference • Heart malformations

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

9. FAS Physical Characteristics • Facial characteristics • Small head • Small eyes • Large cheeks • Thin upper lip • Flat nose • Clinical presentation (AAFP, 2005)

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

11. 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

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

13. Fetal Alcohol Syndrome Vignettes(Fetal Alcohol Syndrome, National Academies Press:1996. Page 54) http://books.nap.edu/books/0309052920/html/54.html#pagetop

14. 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

15. Alcohol-Related Neurodevelopmental Disorder • Issues related to nervous system: • Communication problems • Memory problems • Learning differences • Visual & spatial skill problems • Problems with motor skills

16. Alcohol-Related Birth Defects • Defects in major organ systems: • Abnormal development • Underdevelopment • Heart • Kidneys • Eyes, ears • Skeleton

17. 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

18. Protective Factors • Early diagnosis • Special education • Social services • Nurturing environment • Absence of violence (National Center on Birth Defects and Developmental Disabilities)

19. Early Intervention

20. Common Issues Among FAS Babies • Sleep disturbances • Poor sucking response • Crying • Underdevelopment • Toilet training challenges • Distractibility, difficulty following directions • Disobedience Source: Teresa Kellerman, Coordinator, FAS Resource Center

21. 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)

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

23. FAS: Real People Fetal Alcohol Syndrome: A Biological Basis (Youtube.com)

24. 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