1. Fetal Alcohol Spectrum Disorders (FASD)
Washington D.C.

2. Causes of Mental Retardation in the U.S.
Prenatal Alcohol Syndrome
Downs Syndrome
Fragile X Syndrome

3. FASD in Washington D.C.
Born each year
FAS
ARND
Total

4. Cost of FASD in Washington D.C.
Daily cost $32,177
Annual cost $14,520,068
Special Education
and Juvenile Justice $2,775,360
Five year cost $58.7 million

5. FASD RATES IN NORTH DAKOTA
Location Population FASD Rates
_________________________________________________________________
North Dakota Live Births 1.1%
Site 1 Prenatal care 1/17 = 6%
Child tracking
Site 2 Kindergarten students FAS = 1/98 students
FASD = 17.6 – 22 per ,000 children
North Dakota Statewide EPSDT 28/2,809 = 1%
One year 2001

6. Cost of Care for FASD Paying Upfront
On the day before the child with FASD is born, a state needs to deposit over $540,000 in the bank to cover the lifetime cost of care.

7. THE MOMS Age 27.4 Education 10.6 Unmarried 63% Smoker 82% Alcoholic
10+ years
Heavy Drinker
> 10 day +
Treatment
> 3 (45%)
Minority
53%
Poor +
Poor Diet
Parity 3
Prenatal (1st) 1
Prenatal visits
<3
Maternal Deaths
2.8%

8. THE DADS Age 30.8 Education 10.9 Unmarried 63% Alcoholic 12 + years
Heavy Drinker +
Treatment
> 3
Minority
60%
Poor

9. THE CHILDREN Age Diagnosis 7.1 years Older Sibs 2 Younger
Birth Defects
15%
Cerebral Palsy 6%
Mental Retardation
25%
ADHD
75%
Out of Home
85%
Head Injury
FASD Deaths
Dead Sibling
2.4%
4.5%

10. Severity Effect on Subsequent Births

11. FASD – Familial and GenerationalX X
SIDS
FAS - Red
PFAS - Yellow
ARND - Green

13. MATERNAL RISK SCORE SCORE
____Age Over 25 years ____Unmarried, Divorced, Widow, Living with Partner Check any one,
____On AFDC, WIC, Social Security or Income < $16,000 Per Year Add 5 ____Did not Graduate From High School ____Poor Diet ____Smokes More Than ½ Pack per Day ____Drinks less than 2 days/week & less than Check here, drinks /drinking day Add 20 ____Age First Drunk Less Than 15 years ____In Treatment Over Three Times ____In Treatment in Last 12 Months Check any one, ____Previous Child With FASD, Add or Developmental Disability ____Previous Child Died
____Children Out of Home (Foster Care or Adopted) Check any one, ____Heavy Drinker (3 or more days per week or over 3 drinks Add per drinking day) ____Uses Inhalants, Sniffs or Illegal Drugs Score Risk Category Recommendations None Standard Prenatal Care Low Standard Prenatal Care Moderate Standard Prenatal Care and Patient Education on FAS High High Risk pregnancy, Alcohol-Drug Abuse Treatment Very High High Risk Pregnancy, Inpatient Treatment Total Score
Prenatal
Copyright 2000

14. Exposure Assessment

15. When was your last drink?

20. A.A. Nava-Ocampo et al./Reproductive Toxicology 18 (2004) 613-617
Time-course of maternal blood ethanol concentrations. Symbols represent the observed ethanol concentrations and lines resent the predicted values. The different shapes were used to represent the six patients; however, no specific order was used.

23. Diagnosis

25. FASD: Screening and Early Identification
Sibling with FASD
Mother in substance abuse treatment
Foster care placement
WIC clinics
Juvenile Justice Programs
Specialty Care Clinics

26. Phenotype Detectability
Criteria are Age Dependent
High
Phenotype
Detectability
Low
Birth 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
FASD Diagnostic Age in Years

27. Percent of Children who Moved Up in
Height Percentile Category from Birth to Diagnosis
N=232 %

28. Ikonomidou C, et al. Science 287:1056-1060, 2000.

29. FASD Related Impairments
Memory
Attention
Adaptive behavior
Use of social rules
Sleep
Behavior regulation

30. Reprinted with permission: Wattendorf, Daniel J
Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72

31. Fetal Alcohol Screening
Small head circumference
Low nasal bridge
Epicanthic folds
Short palpebral fissures obscure the canthus (the inner corner of the eye)
a normal feature in certain species of the Mongolian race
Short nose
Short midface
Indistinct philtrum
(an underdeveloped groove in the center of the upper lip between the nose and lip edge)
Thin reddish upper lip

32. Reprinted with permission: Wattendorf, Daniel J
Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72

33. Reprinted with permission: Wattendorf, Daniel J
Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72

34. Reprinted with permission: Wattendorf, Daniel J
Reprinted with permission: Wattendorf, Daniel J. American Family Physician, Vol. 72

39. Adverse Outcomes High Low Fetal Stillbirth Infant FASD-ARND
Exposure
Low
Fetal Stillbirth Infant FASD-ARND
Death Mortality

41. FASD: Does a diagnosis make a difference?

42. FASD Diagnosis Related Risks
Cardiac defects > 30 fold
ADHD > 25 fold
Foster care placement > 50 fold
Substance abuse risk > 20 fold
Mental illness > 15 fold
Corrections placement > 10 fold

43. Does a diagnosis of FASD change intervention?

44. FASD: Diagnosis Specific Management Issues
Mortality rate increased 3-7 fold
Substance abuse treatment for mother
Evaluate all siblings
Increased risk of substance abuse
Recurrence rate in younger siblings 75%
Long term planning
Prevention of secondary disabilities

45. Treatment of FAS Start early-Avoid Abuse Avoid multiple foster homes
Treat in community
Make a place in the community
Avoid problem peers
Use legal system
Long term treatment-more than 10 years

46. Common Recommendations
Annual Evaluation
Positive Behavior Management Program
Respite Care
IEP
Monitor Peers
Schedule
Plan Ahead
Evaluate All Siblings
Find the Mom

47. Prevention of FASD Prevent recurrence
Prevent subsequent exposed pregnancies

48. FASD Recurrence in Washington D.C.
Annual birth cohort: 7,893
New FASD cases: 78
Recurrent cases: 20
5 will recur in families with multiple affected children.
Start Prevention Here

49. Washington D.C. had 3,157 women using alcohol during pregnancy in 2006
How many are identified?
Heavy uses who drink all 40 weeks of pregnancy = 158.

50. Can your program prevent one case of FASD this year?
In Washington D.C. on this date next year, there will be 78 more people with FASD
Can your program prevent one case of FASD this year?