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

2. 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

3. 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.”

4. 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): doi: /jama

5. 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

6. 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

7. 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)

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

9. Low Birth Weight Source: Clinical Advisor
Low Birth Weight Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders.

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

11. Vision Issues Source: Clinical Advisor
Vision Issues Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders.

12. 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

13. Brain Size Source: The Clinical Advisor
Brain Size Source: The Clinical Advisor. Fetal Alcohol Spectrum Disorders.

14. 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).

15. Fetal Alcohol Syndrome
Vignettes (Fetal Alcohol Syndrome, National Academies Press:1996. Page 54)

16. 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

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

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

19. 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

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

21. Early Intervention

22. 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

23. 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)

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

25. Resources
Fetal Alcohol Syndrome Diagnostic and Prevention Network (UW),
National Organization on Fetal Alcohol Syndrome Washington State (Mill Creek),
Fetal Alcohol Drug Unit (UW),