1. Fetal Alcohol Spectrum Disorder (FASD) Reducing alcohol-related harm through a nonjudgmental approach Dr. Samuel Harper

2. Nadia V. Nadia V., 20 years old First baby Has been drinking alcohol since she was 12 years old Smokes pot to fall asleep Mother had drinking problems, she received foster care multiple times Spouse drinks and smokes pot in an occasional, “social” manner

3. Screening for problematic drinking Must be systematic Open questions Nonjudgmental attitude T-ACE

4. Is my baby going to be okay? Doctor, can you tell her to stop drinking?

5. Epidemiology of FASD The prevalence of FAS in the United States: 1 to 3/1000 live births FASD: 9.1 for 1000 live births In Canada, there are no national statistics. It is estimated that nine children out of one thousand have FASD.

6. FASD, what is it? It stands for Fetal Alcohol Spectrum Disorder (FASD). This is a generic term rather than a clinical diagnosis. FASD includes: FAS Partial FAS Alcohol-Related Birth Defects (ARBD) Alcohol-Related Neurodevelopmental Disorder (ARND)

7. What is FAS? A.A mother’s confirmed exposure to alcohol B.Presence of characteristic impairments in the facial features such as short palpebral fissures and anomalies in the premaxillary region C.Prenatal or postnatal delayed growth

8. (cont’d) D.Neurodevelopmental anomalies of the central nervous system Small head circumference at birth Structural brain anomalies Mild to severe neurological disorders E.g.: impaired fine motor skills, neurosensory hearing loss, poor tandem gait and poor hand-eye coordination

9. Dysmorphic features - Smooth philtrum - Thin upper lip

10. Dysmorphic features - Short palpebral fissures

11. What is partial FAS? A. Mother’s confirmed exposure to alcohol B.Presence of certain characteristic facial features Presence of C, D or E C.Presence of prenatal or postnatal delayed growth D.Neurodevelopmental anomalies of the central nervous system E.The presence of a complex series of behavioural or cognitive anomalies that are incompatible with the level of development and which cannot be fully explained by family history or the environment

12. Alcohol-related birth defects (ARBD) List of systems affected by birth defects, including malformations and dysplasias: Cardiac Skeletal Renal Ocular Auditory

13. Alcohol-Related Neurodevelopmental Disorder (ARND) A.Neurodevelopmental anomalies of the central nervous system Small head circumference at birth Structural brain anomalies Mild or severe neurological disorders E.g.: impaired fine motor skills, neurosensory hearing loss, poor tandem gait and poor hand-eye coordination Presence of A or B or both

14. (cont’d) B.The presence of a complex series of behavioural or cognitive anomalies that are incompatible with the level of development and which cannot be fully explained by family history or the environment.

15. Causes of FASD Alcohol consumption during pregnancy is the only cause of FASD Genetics and nutrition have an impact on the risk The consequences of a same exposure can vary greatly from one person to another and from one fetus to another

16. FASD can be 100% avoided Alcohol causes malformations and we have no idea if there is a safe amount of alcohol that a pregnant woman can drink The danger exists throughout pregnancy The father’s consumption is NOT a cause of FASD

17. All alcoholic beverages are harmful "Binge drinking" is particularly damaging The risk increases with maternal age No amount of alcohol during pregnancy is proven safe

18. Primary disabilities Intelligence (IQ) Hyperactivity Inattention Executive functioning and abstract reasoning Expressive and receptive communication Adaptive behaviour, social skills and communication Learning and memory difficulties

19. Secondary disabilities Mental health problems Interrupted education Legal problems Deviant sexual behaviour Incarceration or treatment centre stays Problems related to drug and alcohol use Dependency related to the activities of daily living Employment difficulties

20. Risk factors IQ exceeding 70 Individuals with a dx other than FAS are often more at risk Exposure to violence (physical and/or sexual abuse) Occurs in 72% of individuals with FASD

21. Protection factors Early diagnosis Stability in place of residence Not having witnessed or been a victim of violence

22. Nadia V. I am unable to stop drinking… I feel really guilty…

23. Harm reduction Reducing the negative consequences of drinking and using drugs Establishing a trusting relationship Increasing self-esteem Taking baby steps Building on successes

24. Harm reduction Believing in herself Relapse is normal Working on the causes of drug and alcohol use

25. Nadia V. Had managed to reduce her consumption of alcohol and then quit drinking altogether Had stopped smoking cannabis because she wanted to breastfeed Gave birth to Océane