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

Fetal Alcohol Spectrum Disorders In mid-April of 2004, the National Organization on Fetal Alcohol Syndrome (NOFAS) brought together experts to create terminology addressing the broad effects associated with prenatal alcohol exposure

Fetal Alcohol Spectrum Disorders As a result, a definition for Fetal Alcohol Spectrum Disorders (FASD) was developed: “ (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.”

FASD History Knowledge of the harm linked between alcohol and a fetus is not new (centuries old) 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” \ Source: Clarren, Sterling K. Recognition of Fetal Alcohol Syndrome. JAMA. 1981;245(23):2436-2439. doi: 10.1001/jama.1981.03310480052033

FASD Prevalence Approximated On any given day in the United States, 10,657 babies are born… 1 of these babies is HIV positive 10 of these babies are born with Down Syndrome 20 of these babies are born with Fetal Alcohol Syndrome 100 of these babies are born with an alcohol related disorder (1 out of 100) Source: FAS Community Resource Center

Fetal Alcohol Syndrome (FAS) Affects 1-3 babies per 1000 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 FAS is irreversible

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

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 disabilities (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

FAS Behavioral Problems Poor impulse control Difficulties with social interaction Inappropriate sexual behavior Substance abuse Problems with the law The mechanisms of fetal brain damage have been studied in animals and in nerve cells (i.e., neurons) grown in culture (32). Within the fetus, embryonic cells destined to become brain neurons grow in number, move to their ultimate locations, and mature into a wide variety of functionally distinct neuronal cell types, eventually forming connections with other brain cells in a predetermined pattern. Alcohol metabolism is associated with increased susceptibility to cell damage caused by potentially harmful substances called free radicals. Free radical damage can kill sensitive populations of brain cells at critical times of development in the first trimester of pregnancy (33,34). Other animal experiments suggest that the third trimester may also represent a particularly sensitive period for brain cell damage associated with FAS (35).Alcohol or its metabolic breakdown products can also interfere with brain development by altering the production or function of natural regulatory substances that help promote the orderly growth and differentiation of neurons (32). Research using animals or cell cultures show that many of alcohol's adverse effects on brain cells can be prevented by treatments aimed at restoring the balance of regulatory substances upset by alcohol (36,37). Promising results have also been obtained in similar experiments by administering substances (i.e., antioxidants) that help protect cells against free radical-induced cell damage (38).

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 disabilities (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

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

Affected Individuals Randy (ARND) Matt (FAS) Stefanie (FAS) Sinja (FAS; English child living in Germany) Patrichia Rose (FAS) David with Fetal Alcohol Syndrome (video, 2:48)

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