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

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Presentation on theme: "Fetal Alcohol Spectrum Disorders (FASD) Washington D.C."— Presentation transcript:

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 15 ARND 63 Total 78

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 LocationPopulationFASD Rates _________________________________________________________________ North DakotaLive Births1.1% Site 1Prenatal care1/17 = 6% Child tracking Site 2Kindergarten studentsFAS = 1/98 students FASD = 17.6 – 22 per 1,000 children North DakotaStatewide 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 Age27.4 Education10.6 Unmarried63% Smoker82% Alcoholic10+ years Heavy Drinker> 10 day + Treatment> 3 (45%) Minority53% Poor+ Poor Diet+ Parity3 Prenatal (1 st )1 Prenatal visits<3 Maternal Deaths2.8%

8 THE DADS Age30.8 Education10.9 Unmarried63% Alcoholic12 + years Heavy Drinker+ Treatment> 3 Minority60% Poor+

9 THE CHILDREN Age Diagnosis7.1 years Older Sibs2 Younger2 Birth Defects15% Cerebral Palsy6% Mental Retardation25% ADHD75% Out of Home85% Head Injury15% FASD Deaths Dead Sibling 2.4% 4.5%

10 Severity Effect on Subsequent Births

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


13 MATERNAL RISK SCORE SCORE ____ Age Over 25 years ____Unmarried, Divorced, Widow, Living with PartnerCheck 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 thanCheck here, 2 drinks /drinking day Add 20 ____Age First Drunk Less Than 15 years ____In Treatment Over Three Times ____In Treatment in Last 12 MonthsCheck any one, ____Previous Child With FASD, Add 35 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 45 per drinking day) ____Uses Inhalants, Sniffs or Illegal Drugs Score Risk Category Recommendations 0 None Standard Prenatal Care 5 Low Standard Prenatal Care Moderate Standard Prenatal Care and Patient Education on FAS High High Risk pregnancy, Alcohol-Drug Abuse Treatment Very HighHigh 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) 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 Low High FASD Diagnostic Age in Years Birth Criteria are Age Dependent

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

28 Ikonomidou C, et al. Science 287: , 2000.

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

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

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

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







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


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 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?


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