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Fetal Alcohol Syndrome

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Presentation on theme: "Fetal Alcohol Syndrome"— Presentation transcript:

1 Fetal Alcohol Syndrome
Fetal Alcohol Syndrome Psychopathology 1 Master of Clinical Psychology Program

2 Email –
Doreen Canoy

3 What is Fetal Alcohol Syndrome?
Pattern of anomalies that have resulted due to prenatal exposure to alcohol Facial anomalies Growth retardation Central nervous system dysfunction Recognised as being at the higher end on a continuum of disorders which can be attributed to prenatal alcohol exposure.


5 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, behavioural, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. (Bertrand et al., 2004, pp. 4)

6 How would someone with FASD present?
Small size for age (especially as an infant) Facial abnormalities such as small eye openings Poor coordination Poor suck and sleep disturbances in infancy Hyperactive behaviour Learning disabilities Developmental disabilities (e.g. speech and language delays)

7 Characteristics of FASD Con’t…
Mental retardation or low IQ Poor reasoning and judgment skills Inconsistent or spotty memory Poor abstract thinking Impulsive and difficulty learning from mistakes Temper tantrum and difficulty with self control (not appropriate for age)

8 How is a diagnosis of FAS reached?
Patient General Practitioner Paediatrician Psychologist Social Worker Psychiatrist Neurologist Multidisciplinary Team Approach

9 Framework for FAS Diagnosis and Services
Child presents for office visit – Triggers Emerge Complete initial evaluation to gather data related to FAS FAS Criteria NOT met – Continue to monitor changes in health over time. FAS Criteria Met - Refer to Specialist for further assessment Intervention plan is developed FAS Diagnosis confirmed. Intervention Plan is communicated to frontline providers Source: Bertrand. J., Floyd, R.L., Weber, M.K., O'Connor, M., Riley, E.P., Johnson, K.A., Cohen, D.E., National Task Force on FAS/FAE. Fetal alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention; 2004, p.8.

10 Diagnostic Schemas 4-digit code / University of Washington
National Task Force / The Centre for Disease Control and Prevention (CDC) Canadian Guidelines Revised Institute of Medicine (IOM)

11 All four schemas look to the three distinct areas
Prenatal and/or postnatal growth deficiency Central nervous system dysfunction Characteristic pattern of facial anomalies (differ on how many need to be present) Photo by Sterling Clarren, MD

12 Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code (2004)
Allows for a full assessment to be undertaken by a multi-disciplinary team of professionals The 4-Digit code of 4444 indicates a diagnosis of FAS, at the most extreme end of the FASD. Code of 1111 would indicate: normal development, no signs of facial deformities, no CNS concerns and no prenatal exposure to alcohol. This therefore allows for 256 Diagnostic Codes which can be logically grouped in 22 Diagnostic Categories

13 Physician Sections pertaining to growth, structural & neurological measures of the CNS, facial features and other physical findings. Occupational Therapist, Psychologist, speech language pathologist and/or other team members complete sections pertaining to psychometric measures of CNS function. All members participate in the derivation of the 4-Digit Code and intervention plan.

14 Lets start at the beginning…
While there is NO safe time to consume alcohol while pregnant this figure shows the critical periods of fetal development. Red shows the period when major structural abnormalities occur and the yellow shows functional deficits and minor structural abnormalities. - Russell Family Fetal Alcohol Disorders Association

15 Presenting symptoms of FAS
Documentation of all three facial abnormalities Smooth philtrum Thin vermillion Small palpebral fissures Documentation of growth deficits Documentation of Central Nervous System (CNS) abnormality As mentioned before FAS is seen to be at the higher end of the FASD continuum and to receive a diagnosis of FAS the following must be present.. Smooth philtrum – no groove between the upper lip and nose. Thin vermillion – thin upper lip Small palpebral fissures – small eye opening Pre or postnatal weight or height at or below the 10th percentile Children with neurodevelopmental disorders don't learn from their mistakes and they don't understand cause and consequence and they can't be disciplined in the normal way. - Photograph

16 Facial Dysmorphia Based on racial norms
Must exhibit all three characteristic facial features

17 Thin vermillion border
Smooth philtrum Thin vermillion border (University of Washington Lip-Philtrum Guide rank 4 or 5) No groove between the lip and the nose

18 Photo reprinted with permission from Susan Astley, University of Washington:

19 Small palpebral fissures – at or below 10th percentile
Photo reprinted with permission from Susan Astley, University of Washington:

20 Specific measurement tools and instructions are used to guide correct diagnosis

21 Growth Documentation of growth deficits:
Confirmed prenatal or postnatal height or weight, or both, at or below the 10th percentile, documented at any one point in time (adjusted for age, sex, gestational age, and race or ethnicity). Australasian Paediatric Endocrine Group Australian and New Zealand Growth Charts US Growth Charts (Centre for Disease Control) The WHO Child Growth Standards

22 Central Nervous System
Central Nervous System Structural Head circumference at or below the 10th percentile adjusted for age and sex Clinically significant brain abnormalities observable through imaging. Neurological Neurological problems not due to a postnatal insult or fever, or other soft neurological signs outside normal limits. Functional Global cognitive or intellectual deficits representing multiple domains of deficit (or significant developmental delay in younger children) – performance below the 3rd percentile Functional deficits below the 16th percentile (in at least three domains) See below for a table to assist with identifying Functional CNS deficits. Source: Adapted from Bertrand,J., Floyd, R. L., Weber, M. K., O'Connor, M., Riley, E. P.,Johnson, K. A., Cohen, D. E., & National Task Force on FAS/FAE. Fetal alcohol syndrome: Guideiines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention;2004.

23 What does a healthy brain do?


25 Comorbidity To increase the difficulty in achieving a correct diagnosis, a number of disorders are often comorbid with FAS. Autism Conduct Disorder (CD) Oppositional Defiant Disorder (ODD) Anxiety Disorders Adjustment Disorders Sleep Disorders Depression

26 Face & Emotion Processing Retrieval Daily Living Skills
Set Shifting Verbal Fluency Basic Motor Control IQ Problem Solving Complex Motor Skills Focused Attention Static Balance FASD ADHD Shifting Attention Social Skills Sustained Attention Verbal Encoding Communication Skills Face & Emotion Processing Retrieval Daily Living Skills Parent reports of behaviour Mattson, Crocker & Nguyen, 2011

27 Fetal Alcohol Syndrome Summary
100% Preventable 0% Curable BUT with early diagnosis and appropriate intervention individuals with FAS do have the potential to do well. Major Public Health Concern –vs- Moral Panic? 0.2 to 1.5 cases of FAS occur every 1,000 live births in USA. If FAS and ARND were added together – 9.1 cases for every 1,000 live births in USA. That would be nearly 1 in 100. ARND – Alcohol Related Neurodevelopmental Disorder A biomarker is a term used to describe a test such as blood, urine or faeces to identify the severity or presence of a disease.

28 There is no biomarker for the diagnosis of Fetal Alcohol Syndrome.
Summary Con’t…. There is no biomarker for the diagnosis of Fetal Alcohol Syndrome. The effects of FAS may include physical, behavioural and/or learning difficulties. Comorbidity with a number of other disorders can complicate diagnosis. To ensure accurate diagnosis a Multidisciplinary Team approach is best.

29 References Armstrong, E. M., & Abel, E. L. (2000). Fetal alcohol syndrome: The origins of a moral panic. Alcohol & Alcoholism, 35(3), pp Astley, S. J. P. D. (2004). Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The four digit diagnostic code (Third ed., pp. 123). Seattle, WA: University of Washington. Bertrand, J., Floyd, R. L., Weber, M. K., O'Connor, M., Riley, E. P., Johnson, K. A., & Cohen, D. E. (2004). Fetal Alcohol Syndrome: Guidelines for referral and diagnosis. 62. Retrieved from Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice. (pp. 274). Washington, DC: U.S. Government Printing Office. Mattson, S. N., Crocker, N., & Nguyen, T. T. (2011). Fetal Alcohol Spectrum Disorders: Neuropsychological and Behavioural Features. [Review]. Neuropsychology Review, 21, doi: /s O'Connor, M. J., & Paley, B. (2009). Psychiatric conditions associated with prenatal alcohol exposure. Developmental Disabilities Research Review, 15(3), 10. Paley, B., & O’Connor, M. J. (2011). Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders. Alcohol Research & Health, 34(1),

30 Riley, E. P. , Infante, M. A. , & Warren, K. R. (2011)
Riley, E. P., Infante, M. A., & Warren, K. R. (2011). Fetal Alcohol Spectrum Disorders: An overview. [Overview]. Neuropsychology Review, 21, doi: /s x Stratton, K., Howe, C., & Battaglia, F. C. (1996). Fetal Alcohol Syndrome: Diagnosis, epidemiology, prevention, and treatment (pp. 230). Retrieved from Telethon Institute for Child Health Research. (). Alcohol Pregnancy & FASD. Retrieved from t/fetal-alcohol-spectrum-disorders-(fasd).aspx

31 Helpful Links
Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code Brief outline of Diagnostic Criteria Australasian Paediatric Endocrine Group

32 FEEDBACK I invite you to complete and the Feedback Form also located on this site to enhance further presentations. Thank You

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