Transcript Diapositive 1

Fetal Alcohol Spectrum Disorder
(FASD)
Reducing alcohol-related harm through a nonjudgmental approach
Dr. Samuel Harper
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
Screening for problematic drinking
Must be systematic
Open questions
Nonjudgmental attitude
T-ACE
Is my baby going to be okay?
Doctor, can you tell her to stop drinking?
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.
FASD, what is it?
It stands for Fetal Alcohol Spectrum Disorder (FASD).
This is a generic term rather than a clinical diagnosis.
FASD includes:
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•
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FAS
Partial FAS
Alcohol-Related Birth Defects (ARBD)
Alcohol-Related Neurodevelopmental Disorder (ARND)
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
(cont’d)
D.
Neurodevelopmental anomalies of the central nervous system
•
Small head circumference at birth
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Structural brain anomalies
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Mild to severe neurological disorders
E.g.: impaired fine motor skills, neurosensory hearing loss, poor tandem gait and
poor hand-eye coordination
Dysmorphic features
Dysmorphic features
- Smooth philtrum
- Thin upper lip
Dysmorphic features
- Short palpebral fissures
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
Alcohol-related birth defects (ARBD)
List of systems affected by birth defects, including
malformations and dysplasias:
• Cardiac
• Skeletal
• Renal
• Ocular
• Auditory
Alcohol-Related Neurodevelopmental Disorder
(ARND)
Presence of A or B or both
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
(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.
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
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
• 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
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
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
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
Protection factors
Early diagnosis
Stability in place of residence
Not having witnessed or been a victim of violence
Nadia V.
I am unable to stop drinking…
I feel really guilty…
Harm reduction
Reducing the negative consequences of drinking and
using drugs
Establishing a trusting relationship
Increasing self-esteem
Taking baby steps
Building on successes
Harm reduction
Believing in herself
Relapse is normal
Working on the causes of drug and alcohol use
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