FETAL ALCOHOL SPECTRUM DISORDERS The Basics

DEFINITION OF ALCOHOLISM  PRIMARY  DISEASE  OFTEN PROGRESSIVE AND FATAL  IMPAIRED CONTROL  PREOCCUPATION  ADVERSE CONSEQUENCES  DENIAL

ALCOHOL USE IN TEENS  50.9% of Americans aged 12 or older reported being current drinkers of alcohol in a 2006 survey, with youths aged 12 to 17 alcohol use being 16.6%  Among youths aged 12 to 17 in 2006 who were heavy drinkers, 56.7% were also current illicit drug users  Among youth aged 12 to 17 the percentage of males who were current drinkers(16.3%) was similar to the rate for females(17.0%)

ADOLESCENT PREGNANCY  Adolescents are more likely to engage in high risk behaviors, such as unprotected sex, when they are under the influence of alcohol or drugs.

Fetal Alcohol Spectrum Disorders (FASD)  Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy  May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications  Not a diagnosis

Terminology  Fetal alcohol syndrome Term first used in 1973 by Drs. Smith and Jones at the University of Washington One of the diagnoses used to describe birth defects caused by alcohol use while pregnant A medical diagnosis (760.71) in the International Classification of Diseases (ICD)

Terminology Pregnanc y + Alcohol May result in Fetal alcohol effects (FAE) Alcohol-related birth defects (ARBD) Alcohol-related neurodevelopmental disorder (ARND) Partial FAS (pFAS)

Reprinted with permission, Streissguth A.P., & Little, R.E.

FASD Facts: 100% PREVENTABLE  Leading known cause of preventable mental retardation  Not caused on purpose  Can occur anywhere and anytime pregnant women drink  Not caused by biologic father’s alcohol use  Not a new disorder

Cause of FASD  The sole cause of FASD is women drinking alcoholic beverages during pregnancy.  Alcohol is a teratogen. “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” —IOM Report to Congress, 1996.

FASD and Alcohol  All alcoholic beverages are harmful.  Binge drinking is especially harmful.  There is no proven safe amount of alcohol use during pregnancy.

FASD and Alcohol  Binge = 3 or more drinks on one occasion  Drink = 12 ounces of beer, 5 ounces of wine, or 1 ounce of hard liquor ==

EFFECTS OF ALCOHOL  Weeks 1 – 8: Nervous system damage  Days 15 – 25: Brain Damage  Third week after conception: Highest risk of producing FAS, including facial abnormalities  Third month: Rapid growth period  During this entire trimester, structural damage can occur

SECOND TRIMESTER (3 RD TO 6 TH MONTH)  Organs vulnerable to functional defects, especially:  CNS  Eyes  Teeth  Period of rapid growth occurs in 3 rd month and continues until after birth

THIRD TRIMESTER (6 TH through 9 th month)  Rapid growth continues  Immune system develops  Risk of birth defects and damage to the developing brain

HOW DOES ALCOHOL CAUSE BRAIN DAMAGE  Excessive cell death  Reduced cell proliferation  Migrational errors in brain development  Inhibition of nerve growth factor  Disruption of neurotransmitters

FAS and the Brain Permission to use photo on file.

FAS and the Brain ABC A B C A. Magnetic resonance imaging showing the side view of a 14- year-old control subject with a normal corpus callosum; B. 12- year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

FAS and the Brain A These two images are of the brain of a 9-year-old girl with FAS. She has agenesis of the corpus callosum, and the large dark area in the back of her brain above the cerebellum is essentially empty space. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

BEHAVORIAL EFFECTS FOLLOWING PRENATAL ALCOHOL EXPOSURE  Hyperactivity, reactivity  Attention deficit disorders, distractibility  Lack of inhibition  Mental retardation, learning difficulties  Perseveration

BEHAVIORS, CONTINUED  Feeding difficulties  Gait abnormalities  Poor fine/gross motor skills  Developmental delays (motor, social, language)  Hearing abnormalities

LIFE LONG EFFECTS  Children with FASD face many challenges and frustrations  Infants and toddlers have developmental problems and delays.  They may have poor muscle tone, be extremely irritable, abnormal sleep/wake cycles, disordered attachment, and feeding difficulties

LIFE LONG EFFECTS  In toddlers there may be language delays, head banging, delayed motor skills, hyperactivity, cognitive delays and mental retardation  In preschoolers, hyperactivity short attention span, aggressiveness, poor articulation and slow vocabulary development

LIFE LONG EFFECTS  Children of school age will have many challenges throughout their school years  They may look different and act different than their peers, which effects self esteem and social interactions

LIFE LONG EFFECTS  The symptoms often seen are poor memory, attention deficits, learning disabilities, language problems, poor impulse control, increased aggressiveness and poor judgment  FASD is often undiagnosed and the child will have continuing difficulties

General Issues With FASD  Often undiagnosed among persons without FAS facial features  More difficulties seen in those without FAS facial features and with higher IQs  Adaptive functioning more impaired than intelligence

Systems of Care

Economic Costs of FAS/FASD  FASD cost the United States more than $6 billion in  The average lifetime cost for each child with FAS is $2 million. $1.6 million for medical care services $0.4 million for loss of productivity Lupton, Burd, and Harwood (2004) Increased costs

IMPORTANT  Early evaluation and proper diagnosis will enable interventions that will enhance the quality of life for those effected by prenatal exposure