Fetal Alcohol Spectrum Disorders Fetal Alcohol Syndrome Fetal Alcohol Effects Alcohol-Related Neurodevelopmental Disorder Alcohol-Related Birth Defects

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, behavioral, and/or learning disabilities with possible lifelong implications.” National Organization on Fetal Alcohol Syndrome terminology, 2004

FASD History Thoughts and concerns regarding alcohol consumption’s effects on procreation or pregnancy are not new (centuries old), though reportedly different1,2 First ‘official’ documentation in 1899 Breakthrough in 1960’s and 1970’s: In 1968 Dr. Paul Lemoine studied 127 children with features and symptoms related to prenatal alcohol exposure In 1970’s further study in Seattle termed the condition “fetal alcohol syndrome” 1Source: Clarren, Sterling K. Recognition of Fetal Alcohol Syndrome. JAMA. 1981;245(23):2436-2439. doi: 10.1001/jama.1981.03310480052033 2Abel, Ernest L.. "Was the Fetal Alcohol Syndrome Recognized by the Greeks and Romans?." Alcohol and Alcoholism 34.6 (1999): 868-872. Was the Fetal Alcohol Syndrome Recognized by the Greeks and Romans?. Web. 20 Feb. 2014.

FASD Prevalence Morgan Fawcett (YouTube, 0-1:55) Approximated Among United States births: < 10 in 100,000 born with HIV 1.5 in 1000 born with Down Syndrome 6 in 1000 born with Fetal Alcohol Spectrum Disorder Morgan Fawcett (YouTube, 0-1:55) Source: Centers for Disease Control

Fetal Alcohol Syndrome (FAS) Affects .2-1.5 babies per 1000 (CDC) FAS is the leading cause of intellectual delay FAS is the leading cause of birth defects Caused by a mother’s heavy drinking during pregnancy Central nervous system (brain, spinal cord) damage Untreated, this primary disability can lead to secondary disabilities Environmental issues complicate the condition Many FAS-affected children in foster care Prevalence: 60 out of 1000* FAS is irreversible *Lange, Shannon, Kevin Shield, Jurgen Rehm, and Svetlana Popova. "Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Meta-analysis." Pediatrics 142.4 (2013): e980-e995. Pediatrics.org. Web. 7 Nov. 2013.

Four Fetal Alcohol Syndrome Criteria Growth problems Specific facial features Central nervous system damage or dysfunction Prenatal alcohol exposure 4-Digit Diagnostic Code (WA State Diagnostic & Prevention Network)

Growth Problems Growth retardation Bone growth - prenatally and postnatally Height Weight Head circumference Heart malformations

Low Birth Weight Source: Clinical Advisor Low Birth Weight Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#4

Low Birth Weight (example only; not due to FASD) Source: Beginbeforebirth.org

FAS Physical Characteristics Facial characteristics Small head Small eyes Large cheeks Thin upper lip Flat nose Clinical presentation (AAFP, 2005)

Vision Issues Source: Clinical Advisor Vision Issues Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#2

Fetal Alcohol Syndrome (FAS) Cognitive Characteristics Learning differences Visual-spatial learning Objects on table (remembered, not placed correctly) Slower reaction times (eye movements - geometric patterns) Difficulty planning, organizing Difficulty letting go of problem-solving strategies, even when they do not work Memory deficits Early stages, rather than recall (different from Down’s Syndrome) Attention deficits May be misdiagnosed ADHD May focus and maintain attention well, but shift attention poorly Source: NIAAA, Alcohol Alert, December 2000

Brain Size Source: The Clinical Advisor Brain Size Source: The Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrum-disorders/slideshow/585/#1

Fetal Alcohol Syndrome Vignettes (Fetal Alcohol Syndrome, National Academies Press:1996. Page 54) http://books.nap.edu/books/0309052920/html/54.html#pagetop

Fetal Alcohol Effects (FAE) Those affected with prenatal alcohol exposure Those without all the symptoms of FAS Growth deficiencies Behavior problems Substance abuse Cognitive deficits Some facial features FAE now known as two diagnoses: Alcohol-Related Neurodevelopmental Disorder, Alcohol-Related Birth Defects

Alcohol-Related Neurodevelopmental Disorder Issues related to nervous system: Communication problems Memory problems Learning differences Visual & spatial skill problems Problems with motor skills

Alcohol-Related Birth Defects Defects in major organ systems: Abnormal development Underdevelopment Heart Kidneys Eyes, ears Skeleton

Is Any Amount of Alcohol Considered Safe? There is no “safe” amount of alcohol consumption (Chart: MN Department of Health) Most physicians will recommend pregnant women abstain from alcohol consumption According to American Pregnancy Association: 2-4 drinks, frequently, can lead to FAE 5-6 drinks, frequently, can lead to FAS According to Fetal Alcohol Syndrome (Institute of Medicine; National Academies Press: 1996, p. 68) Effects of mild alcohol intake are controversial Existing research suggests alcohol bingeing related to FAS Experiment in Alaska bars (NBC, 2014)

Protective Factors Early diagnosis Special education Social services Nurturing environment Absence of violence (National Center on Birth Defects and Developmental Disabilities)

Early Intervention

Common Issues Among FAS Babies Sleep disturbances Poor sucking response Crying Underdevelopment Toilet training challenges Distractibility, difficulty following directions Disobedience Source: Teresa Kellerman, Coordinator, FAS Resource Center

Screening In September 2012, American Academy of Pediatrics recommended all children be screened for Fetal Alcohol Syndrome At Emory University, Experts Try New Approach to Treating Fetal Alcohol Syndrome (CBS Atlanta, September 2012)

Affected Individuals Randy (ARND) Matt (FAS) Stefanie (FAS) Sinja (FAS; English child living in Germany) The Story of Iyal (YouTube, 3:49)

Fetal Alcohol Syndrome: A Biological Basis (Youtube.com) FAS: Real People Fetal Alcohol Syndrome: A Biological Basis (Youtube.com)

Resources Fetal Alcohol Syndrome Diagnostic and Prevention Network (UW), 206-598-0555 National Organization on Fetal Alcohol Syndrome Washington State (Mill Creek), 206-940-2832 Fetal Alcohol Drug Unit (UW), 206-543-7155