Fetal Alcohol Spectrum Disorders

(FASD)

What is FASD?

2

Facts about FASD

3

FASD affects 1 in 100 live births

In Minnesota, more than 8,500 babies are born each year with prenatal exposure to alcohol (Cite: CDC, 2011/SAMHSA, 2006)

Nationally 1 in 13 pregnant women report alcohol use (CDC Morbidity and Mortality Weekly Report, July 20, 2012)

FASD occurs in all racial, ethnic and socioeconomic groups

FASD in comparison

Three major known causes of intellectual disability •Down Syndrome •Fetal Alcohol Spectrum Disorders (FASD) •Fragile X Syndrome

Alcohol use during pregnancy is the leading known preventable cause of intellectual disabilities and birth defects in the United States.

Source: National Institute on Alcohol Abuse and Alcoholism

4

What are Fetal Alcohol Spectrum Disorders

(FASD)? • A set of physical, behavioral, and cognitive

disorders seen in individuals exposed to alcohol prenatally

• Lifetime disability with brain injury that never goes away

• Broad range (spectrum) of characteristics that vary from person to person

5

6

The FASD UmbrellaFetal Alcohol Spectrum Disorders

Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol

Syndrome (pFAS)

Fetal Alcohol Effects (FAE) replaced by ARBD & ARND in 2006

Alcohol-Related Birth Defects

(ARBD)

Alcohol-Related Neurodevelopmental Disorder (ARND)

Areas of Diagnostic Evaluation

1. Facial Dysmorphia

2. Growth Problems

3. Central Nervous System Abnormalities

4. History of Maternal Alcohol Exposure

7

FASD is NOT a diagnosis

• FAS Fetal Alcohol Syndrome

• PFAS Partial Fetal Alcohol Syndrome

• ARND Alcohol Related Neurodevelopmental

Disorder

• ARBD Alcohol-Related Birth Defects

• FAE Fetal Alcohol Effects (Outdated term)

8

Alcohol is alcohol

9

Teratogen

• Alcohol is a teratogen—a substance that the fetus is exposed to that impedes growth and disrupts normal development.

Spring 2013 MN Organization on Fetal Alcohol Syndrome 10

“No amount of alcohol consumption can be considered safe during pregnancy.”

Surgeon General’s Advisory on Alcohol Use in Pregnancy - U.S. Surgeon General Richard H. Carmona, February 21, 2005.

11

Factors that affect each pregnancy

Risks with Known Prenatal Alcohol Exposure: • Not always going to result in an FASD • Manifestations are unique in each individual

Factors that affect each pregnancy: • Blood alcohol concentration of the mother • Binge drinking is especially harmful • Timing of the exposure • Resiliency of the fetus • Metabolism and diet of the mother Source: Davies & Bledsoe, 2005

12

MN Organization on Fetal Alcohol Syndrome 13

National Organization on Fetal Alcohol Syndrome (NOFAS), 2004; Adapted from Moore, 1993.

Feb 2013

Areas of the brain most affected

15

Prenatal exposure to alcohol causes permanent

brain injury that never goes away.

Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

16

FAS Facial Characteristics

Thin upper lipPalpebral fissures

Smooth, long philtrumCDC 2004Might also have: Low set ears, flat mid-face, up-turned nose, small chin, and epicanthal folds.

FAS Facial Characteristics – Image courtesy of FASTAR..

Ethnicities and Characteristic FAS Facial

Features

17

18

FASD is an invisible disability

• Attention deficits • Hyperactivity • Memory deficits • Difficulty with abstract

concepts • Inability to manage

money

19

Invisible Disability

Difficulty with the passage of time Difficulty learning from consequences Immature social behavior Inappropriately friendly to strangers Lack of control over emotions Poor impulse control Poor judgment

20

Sensory Challenges• Sensory processing disorders

– Brain “misreads” information from senses, which affects learning and behaviors

• Other challenges– Sensory seeking– Sensory avoiding

21

Behavior Challenges• Hyperactivity/impulsiveness – ADHD

common• Stubborness – perseveration issues• Passivity• High-risk behaviors• Sleep disorders• Hypersensivity• Depression• Anxiety

22

Prenatal Alcohol Exposure and Information Processing

MN Organization on Fetal Alcohol Syndrome 23

• input (taking information in from the senses)

• integration (interpreting information, making sense of it)

• memory (storing information for later use, connecting with previous experiences)

• output (response, behavior)

Feb 2013

Look at the chart and say the color not the word

YELLOW BLUE ORANGE BLACK RED GREENPURPLE YELLOW REDORANGE GREEN BLACK BLUE RED PURPLE

LEFT-RIGHT CONFLICTYour right brain tried to say the color but your

left brain insists on reading the word.

MN Organization on Fetal Alcohol Syndrome 24Feb 2013

Modify Expectations• Individuals with an FASD may break rules

repeatedly because they forget them or cannot apply them

• Accept that the individual may have unique learning challenges

• The emotional and social age of adults with an FASD is often lower than their chronological age

25

Strategies for Success• Environmental modifications• Social reminders• Self-awareness• Proactive, not reactive

26

Strategies for Success• Timers• Picture schedules• Songs• Routines

27

Recognize strengths• Highly verbal• Artistic, musical• Athletic• Long-term visual

memory• Willing• Helpful • Loyal•

• Generous• Hard working,

energetic• Forgiving• Spontaneous• Friendly, outgoing• Want to succeed

28

Don’t Try Harder Try Differently

If you’ve told a child a thousand times and he still does not understand, then it is not the child who is the slow learner. - Walter Barbee

MN Organization on Fetal Alcohol Syndrome 29Feb 2013

Resources

Online Resources• General Information on FASD

– Center for Disease Control and Prevention, FAS site

• http://www.cdc.gov/ncbddd/fas

– FASD Unit @ the Univ of Washington School of Medicine

• http://depts.washington.edu/fadu/

– MOFAS Resource Directory – • http://www.mofas.org

MN Organization on Fetal Alcohol Syndrome 31

MN Organization on Fetal Alcohol Syndrome

31Feb 2013

Contact Information:MOFASPhone: 651-917-2370www.mofas.org