Fetal Alcohol Syndrome

1. Fetal Alcohol Syndrome Monique Burns Tabitha Capps Elizabeth Cash Angela Burney Patrick Bullock

2. What is Fetal Alcohol Syndrome? • FAS is a lifelong yet completely preventable set of physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy. Some babies with alcohol-related birth defects, including smaller body size, lower birth weight, and other impairments, do not have all of the classic FAS symptoms. These symptoms are sometimes referred to as Fetal Alcohol Effects (FAE). Researchers do not all agree on the precise distinctions between FAS and FAE cases. (1994-2004, para. 1) • Cause of the Problem: Alcohol in a pregnant woman's bloodstream circulates to the fetus by crossing the placenta. There, the alcohol interferes with the ability of the fetus to receive sufficient oxygen and nourishment for normal cell development in the brain and other body organs. • FAS is the leading known cause of mental retardation and birth defects. (1994-2004, para. 2)

3. Effects of Fetal Alcohol Syndrome Birth Defects: • Leading cause of mental retardation • Multiple Organ Dysfunction • Intra- and postnatal grow defects • Lower Intelligence • Dysfunction in central nervous system which can lead to learning disability • Cranial and Facial Dysmorphology (Eustace et. al., 2003)

4. Common Cognitive and Behavioral Problems • Attention Deficit Hyperactivity Disorder • Inability to foresee consequences • Inability to learn from previous experience • Inappropriate Behavior • Lack of Organization • Leaning Difficulties • Poor Abstract Thinking • Poor Adaptability • Poor Impulse Control • Poor Judgment • Speech Problems (Koren et al., 2003)

5. Secondary Disabilities and percent of cases • Mental Health Problems 90% • Dependent Living 80% • Employment Problems 80% • Disruptive School Experience 60% • Trouble with the Law 60% • Confinement 50% • Inappropriate Sexual Behavior 50% • Alcohol or Drug Problems 30% (Koren et al., 2003)

6. FAS Diagnosis----brief definitions • Microcephaly: small size of the head in relation to the rest of the body • Philtrum: the vertical groove in the median portion of the upper • Palpebral: eyelid • Hypoplasia: incomplete development of an organ or tissue • Microphthalmia: abnormal smallness of the eyeball (Abel, 1984)

7. FAS Diagnosis A Patient must meet 3 criteria to be diagnosed with FAS: • Prenatal or postnatal growth retardation (below 10th percentile for body weight, length, or head circumference) • Characteristic facial anomalies (at least 2 or 3)             a. Microcephaly (below 3rd percentile)            b. Microphthalmia or short palpebral fissures           c. Underdeveloped philtrum, thin upper lip, and maxillary hypoplasia • Central nervous system dysfunction (neurological abnormality, mental deficiency, developmental delay. (Abel 1984)

8. Abnormalities in FAS Children Abnormal Facial Features • Eyes Small, slant downward, drooping eyelid, wide-set • Ears large, low set (below eyes), posterior rotation (toward back of head), poorly formed concha (hollow of external ear) • Nose upturned, shortened, hypoplasia of nasal bridge • Mouth wide, thin upper lip, cleft palate, cleft lip, poorly formed teeth, indistinct philtrum (Abel, 1984)

9. Facial Features Associated with FAS The illustration Below is from Vol. 18, No. 1, 1994 of the Journal Alcohol Health & Research Worldwww.niaaa.nih.gov/gallery/ fetal/faskid.htm

10. Abnormal Organ Development People diagnosed with FAS may have abnormal organ development in the…. • Heart, kidneys, genitals, respiratory system, liver, limb/joint and muscular abnormalities  (Abel, 1984)

11. Central Nervous System Abnormalities • abnormal brain structures • hydrocephalus (excessive fluid in brain) • anencephaly (absence of brain) (Abel, 1984)

12. Brain of Child with FAS http://www.come-over.to/FAS/FASbrain.htm

13. Central Nervous System abnormalities can cause an array of problems such as… • *Mental retardation • *Hyperactivity • *Poor hand-eye coordination • *Learning disability (in absence of mental retardation) • *Cerebral palsy • *Seizure disorders • *Sleep problems • *Neonatal irritability • *Neonatal alcohol withdrawal • *Low APGAR scores (Abel, 1984)

14. FAS Children and School Program/Curriculum needs should address a balance of: --child/teacher directed activities --hands-on learning --small class size --flexibility of scheduling --few transitions --consistent adults --integrated teaching --realistic expectations --multi-sensory learning --focus on sensory and ego development --functional social and life skills rather than academics (1999, para. 4)

15. FAS & School cont… Individual assessments are necessary in establishing a child’s strengths and deficits. Evaluations include: --Speech/Language --Occupational Therapy --Cognitive Functioning --Psychiatric --Neurological --Physical Therapy (1999, para. 2)

16. General educational issues include: --Hyperactivity --Impulsivity --Distractibility --Poor Social Skills --Poor memory --Poor Ego Development --Sensory Processing Dysfunction --Sensory defensiveness --Scattered cognitive skills --High-levels of anxiety and arousal --Learning Disabilities (1999, para. 2)

17. Examples of Successful Programs Behavioral Regulation Training (BRT) BRT teaches parents ways to modify the child’s environment to reduce excess stimulation, use appropriate social reinforcement, and communicate choices rather than commands. (2004, March 4, para. 3) Parent Child Interaction Therapy (PCIT) Behavioral specialists conduct group sessions with parents to teach them appropriate and effective behaviors and interaction techniques (2004, March 4, para. 5) Parent-Assisted Social Skills Training Children participate in didactic training sessions, behavior rehearsal, and coaching to reduce maladaptive behaviors and promote pro-social interaction skills (2004, March 4, para. 6)

18. Studies on FAS The reported rates of FAS vary widely. These different rates depend on the population studied and the surveillance methods used. CDC studies show FAS rates ranging from 0.2 to 1.5 per 1,000 live births in different areas of the United States. Other prenatal alcohol-related conditions, such as alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) are believed to occur approximately three times as often as FAS. (2004, March 4, para. 3)

19. (Little, 1977) • Effects of more moderate alcohol consumption during pregnancy is unknown • There is an observed connection between moderate alcohol use and lower birth weight • Alcohol use decreased dramatically after conception”

20. (Little, 1977) • “In this sample, daily consumption of one once of absolute alcohol before pregnancy is associated with a decrease in birth weight of 91 grams.” • “One ounce consumed in late pregnancy is associated with a decrease in birth weight of 160 grams.”

21. (Ihlen &Tronnes, 1993) • Did 2 studies 5 years apart at same hospital on women that had just given birth • The 2nd group’s alcohol consumption lowered by more than 50%

22. Cullen & Moriah,1995 • Not known if there is a “‘safe’ amount of alcohol use during pregnancy” • “Surgeon General recommends complete avoidance of alcohol during pregnancy” • 15-20 million Americans are heavy drinkers

23. So Just Remember…. “When a pregnant woman drinks alcohol, so does her unborn baby.  There is no known safe amount of alcohol to drink while pregnant and there also does not appear to be a safe time to drink during pregnancy either.  Therefore, it is recommended that women abstain from drinking alcohol at any time during pregnancy.  Women who are sexually active and do not use effective birth control should also refrain from drinking because they could become pregnant and not know for several weeks or more. “ (2004, March 4, para. 1)

24. REFERENCES Abel, Ernest L. (1984). Fetal alcohol syndrome and fetal alcohol effects. New York & London: Plenum Press. pgs. 73-79. Cullen, T.A. & Moriah, K.A., (1995). Screening for alcohol abuse in pregnancy. American Family Physician, 51. 1666-1670. Eustace, Larry W., Kang, Duck-Hee, & Coombs, David. (March/April 2003). Fetal alcohol syndrome: A growing concern for health care professionals. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(2), 215-221. Ihlen, B.M., Amundsen, A. & Tronnes, L. (1993). Reduced alcohol use in pregnancy and changed attitudes in the population. Addiction, 88. 389-394. Koren, Gideon, Nulman, Irena, Chudley, Albert E. & Looke, Christine. (2003). Fetal alcohol spectrum disorder. Medical Association Journal, 169(11), 1181-1185.

25. References Little, R.E. (1977). Moderate alcohol abuse during pregnancy and decreased infant birth weight. AJPH, 67. 1154-1156. Shea, C., & Winners, S. (1999). Information on Fetal Alcohol Syndrome/Fetal Alcohol Effects. Retrieved April 8, 2004, from Northeast Consultation and Training Center Web site: http://www.taconic.net/seminars/index.html (2004, March 4). The National Center on Birth Defects and Developmental Disabilities. Developing Intervention Strategies for Children. Intervening with Children and/or Adolescents with Fetal Alcohol Syndrome or Alcohol Related Neurodevelopment Disorders. Retrieved April 8, 2004, from Center for Disease Control and Prevention web site: http://www.cdc.gov/ncbddd/fas/intervening.htm

26. References (2004, March 4).. The National Center on Birth Defects and Developmental Disabilities. Developing Intervention Strategies for Children. Intervening with Children and/or Adolescents with Fetal Alcohol Syndrome or Alcohol Related Neurodevelopment Disorders. Retrieved April 8, 2004, from Center for Disease Control and Prevention web site: http://www.cdc.gov/ncbddd/fas/fasask.htm#how (1994-2004). National Organization on Fetal Alcohol Syndrome. Protecting Children and Families by Fighting the Leading Known Cause of Mental Retardation and Birth Defects. Retrieved April 7, 2004. http://www.nofas.org/main/FAS-FASD-ARND-ARBD.htm