identification of fetal alcohol syndrome in children of

Identification of Fetal Alcohol Syndrome in Children of Incarcerated Parents

LeeAnne Denny, MDClinical EducatorBannerUniversity of Arizona College ofMedicine Phoenix

April 23, 2018 2:30 pm

Disclosures

• I have no conflict of interest to disclose.

Learning Objectives

By the end of this session, the learner will be able to1. List the diagnoses within Fetal Alcohol Spectrum Disorders.2. Identify features which should prompt consideration of the

diagnosis of Fetal Alcohol Spectrum Disorders.3. Identify the process for diagnosing Fetal Alcohol Spectrum

Disorders4. Discuss the prognosis for Fetal Alcohol Syndrome. 5. Describe the benefits of recognition and appropriate management

of the Fetal Alcohol Spectrum Disorders.

FASD

• Children of incarcerated parents may be at increased risk for having fetal alcohol syndrome

• Fetal alcohol syndrome is frequently missed or misdiagnosed• Early identification of fetal alcohol spectrum disorders (including fetal

alcohol syndrome) by providers caring for children of incarcerated children can help the affected child get needed therapies and services.

Presenter

Presentation Notes

Diagnosed at an average age of 48.3 months, commonly missed or misdiagnosed.

FASD Prevalence

• Fetal Alcohol Syndrome: 0.3-0.8/1000 children• Fetal Alcohol Spectrum Disorders 33.5/1000 children

Presenter

Presentation Notes

The most common non-heritable cause of intellectual disability Least prevalent in Hispanic children, most prevalent In Native American and Alaska Native children

Alcohol Use

• 10.2% of pregnant women reported alcohol usage in pregnancy• 3.1% of pregnant women reported binge drinking

• 69% of women going into jail meet DSMIV criteria for substance abuse or substance dependence.

Presenter

Presentation Notes

69% (women in jail) KARBERG, J. C., & JAMES, D. J. (2005). Substance dependence, abuse, and treatment of jail inmates, 2002. Washington, DC, U.S. Dept. of Justice, Office of Justice Programs, Bureau of Justice Statistics. http://www.ojp.usdoj.gov/bjs/pub/pdf/sdatji02.pdf. Compared to The lifetime prevalence of alcohol and drug use disorders in women is 19.5% and 7.1%, respectively Obstet Gynecol Clin North Am. 2014 Jun; 41(2): 177–189. doi: 10.1016/j.ogc.2014.02.001 PMCID: PMC4068964 NIHMSID: NIHMS587352 PMID: 24845483 Epidemiology of Substance Use in Reproductive-Age Women R. Kathryn McHugh, Ph.D.,1,2 Sara Wigderson, B.A.,1 and Shelly F. Greenfield, M.D., M.P.H.1,2

When to consider FASD

• Signs and symptoms which should prompt consideration fetal alcohol spectrum disorders

• Growth deficiency • 10%ile or less

• CNS abnormality • Abnormal brain structure or small brain size• Epilepsy

• Neurobehavioral impairments• Intellectual disability• Poor self- regulation

• Facial features

Presenter

Presentation Notes

Early diagnosis and intervention (before 12 yo) have significantly better outcomes (2-4 fold reduction in imprisonment/substance abuse)

Fetal Alcohol Spectrum DisordersFetal Alcohol Spectrum Disorder

Features

Fetal Alcohol Syndrome +/- documented prenatal alcohol exposure+ Facial dysmorphology, growth deficiency, CNS dysfunction, neurobehavioral impairments

Partial Fetal Alcohol Syndrome

+/- documented prenatal alcohol exposure+/- Facial dysmorphology, growth deficiency, CNS dysfunction, neurobehavioral impairments

Alcohol Related Neurodevelopmental Disorder

+/- documented prenatal alcohol exposure- Facial dysmorphology, growth deficiency, CNS dysfunction+ Global impairment/deficit in at least two neurobehavioral domains

Alcohol-related birth defects

+ documented prenatal alcohol exposureDefects of the heart/kidneys/skeleton/hearing/vision- CNS dysfunction, neurobehavioral impairments

FASD Prognosis

• Varies widely• Increased likelihood for

• Special education• Disability• Unemployment

Presenter

Presentation Notes

Early diagnosis and intervention (before 12 yo) have significantly better outcomes (2-4 fold reduction in imprisonment/substance abuse)

FASD Care Plan

• Educational Support• Behavioral Support• Nutritional Support• Family Support• Address Comorbid Conditions

• Hearing/vision

Presenter

Presentation Notes

Care is interprofessional and interdisciplinary

What to do when you identify a child with possible FASD• Refer the child to his or her primary care provider or directly to a

developmental pediatrician

Summary

• Any of the following should prompt consideration for FASD:• Growth deficiency • CNS abnormality • Neurobehavioral impairments• Facial features

• If you have any suspicion for FASD, refer the child to a primary care provider or a developmental pediatrician

• Early identification can change a child’s life

Questions

identification of fetal alcohol syndrome in children of

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