Transcript Fetal Alcohol Spectrum Disorder

Alcohol Use and Pregnancy
and Fetal Alcohol Spectrum
Disorder
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Alcohol is a Teratogen
• A teratogen is a substance that interferes with
the normal development of the fetus
• Specifically, alcohol is a neurobehavioural
teratogen – alcohol can damage the brain and
change behaviour
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Teratology:
Four Outcomes to Exposure
• Malformations (facial, heart, skeletal)
• Growth Deficiency (small)
• Functional Deficits (learning and behavioural
problems)
• Death (stillbirth, miscarriage)
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Effects of Alcohol in Pregnancy
• Alcohol freely crosses the placenta
• Adverse effects to the fetus occur at levels at or
below those that are toxic to women
• Fetal elimination of alcohol is poor
• Increased risk for low birth weight
• Harm can be caused before a woman knows
she is pregnant
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First Trimester
• First Month: heart, lungs, limbs, face, ears, eyes,
spinal cord, and brain begin to form
• Second Month: toes and eyelids form and brain
grows quickly and directs body’s movements
• Third Month: Most major organs and the face
are developed. Bones continue to grow and
kidneys start to work
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Second Trimester
• Fourth Month: The placenta is fully formed and
fetal movement may be felt by woman
• Fifth Month: Eyelashes, eyebrows and scalp and
hair appear. Fetal heartbeat can be heard
• Sixth Month: Eyes open and close. Lungs, brain
and other organs continue to develop
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Third Trimester
• In the third trimester, the fetus grows quickly in
weight and length
• Lungs and other major organs mature to support
life
• The brain continues to grow and develop and
remains vulnerable to the damage that alcohol
can cause
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Drinking in Perspective
In general women:
• may drink alcohol before they realize they’re
pregnant
• may not know alcohol is harmful to the
developing fetus
• may drink because it is the social/cultural norm
• may drink to self-medicate
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No one can predict which infants born to mothers
who drink will be affected, nor can anyone
predict how severe these effects will be.
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Factors Involved in FASD
• The stage in the pregnancy at which alcohol is
consumed
• The amount of alcohol consumed during the
pregnancy
• Other factors such as maternal age, stress,
nutrition, smoking, and the use of other drugs
(prescribed or street drugs)
• Fetal susceptibility to alcohol
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Standard drinks = 0.5 oz alcohol
12 oz (341 mL) can of beer (5% alcohol)
12 oz (341 mL) bottle of cooler (5% alcohol)
5 oz (142 mL) glass of wine (12% alcohol)
1.5 oz (43 mL) distilled spirits (40% alcohol)
3 oz (85 mL) fortified wine e.g. sherry or port
2008
(18% alcoholwww.faseout.ca
)
Paternal Role
• Effects on the Fetus: the effects of father’s
drinking on the fetus are not fully known
• Effects on Pregnancy: Alcohol can result in
lower sperm count and abnormal sperm, which
may effect fertility. If alcohol-affected sperm does
fertilize an egg, the likelihood of miscarriage is
higher than if the sperm were not alcoholaffected
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Paternal Role: Social Effects
• Women most often drink with their partners
• Men who drink heavily are unlikely to provide the
necessary emotional support and care for their
pregnant partners
• A man’s drinking after the baby is born could
adversely affect the nurturing home environment
needed to raise a child
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What is Fetal Alcohol Spectrum
Disorder?
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Fetal Alcohol Spectrum Disorder
(FASD)
• FASD is a combination of mental and physical
disabilities
• FASD is a lifelong condition
• FASD is caused by maternal alcohol
consumption during pregnancy
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Diagnostic Terms
• Fetal Alcohol Syndrome (FAS)
• Partial Fetal Alcohol Effects (pFAS)
• Alcohol Related Neurodevelopmental Disorder
(ARND)
• Alcohol Related Birth Defects (ARBD)
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Fetal Alcohol Syndrome
Recognized and documented in Nantes, France
and Seattle, Washington
1968 – 1973
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Characteristics of FAS
• Facial anomalies
• Evidence of growth restriction (may be apparent
prenatally and/or postnatally), (below the 10th
percentile) and microcephaly
• Central nervous system abnormalities
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FAS Features
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ARND/pFAS:
The invisible disability
• Physical characteristics FASD unremarkable
• Disappear: become less prominent over time
• Adolescent & Adult Diagnosis often more difficult
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Alcohol-Related NeuroDevelopmental Disorder (ARND)
• Individuals with ARND present with neurocognitive dysfunction and complex patterns
of behaviour, and have a confirmed
exposure to alcohol prenatally
• Individuals with ARND may not
demonstrate any of the facial features or
growth restrictions associated with the full
syndrome
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Partial Fetal Alcohol Syndrome
(PFAS) with confirmed alcohol
exposure
This diagnostic term is used when the
person presents with central nervous
system dysfunction and most (but not all of
the growth and/or facial features of FAS),
and has a confirmed prenatal alcohol
exposure
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Diagnostic Process
• Information is collected regarding the individual
– physical, social, academic, and adaptive skill
history
• If possible, the physician, along with a
psychologist and other specialists, will assess
the individual in order to make an appropriate
diagnosis
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Possibility of Misdiagnosis
• Since FASD is not a mental health diagnosis, it
might not be considered or recognized
• The symptom presentation of individuals with
FASD is similar to that of many other mental
health diagnoses
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Possibility of Misdiagnosis
• Individuals may be diagnosed with a mental
health disorder without closely examining the
total picture
• Even when FASD is recognized, another
diagnosis is often used in order to get
reimbursement for treatment
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Benefits to a diagnosis
Parents and professionals often find their ability
to cope improves when they understand
problems are most likely caused by brain
damage not the person’s choice to be inattentive
or uncooperative
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Primary Disabilities
• Are the direct result of structural and/or
functional damage to individuals
• While they can be evident in certain physical
characteristics, it is the direct damage to the
brain that has the greatest effect on the person
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Primary Disabilities:
Organ Anomalies
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Cardiac anomalies
Joint and limb anomalies
Neurotubal defects
Anomalies of the urogenital system
Hearing disorders
Visual problems
Severe dental malocclusions
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Primary Disabilities:
Central Nervous System
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Tremors
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Poor suck
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Hypotonic/Hypertonic
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Irritability
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Developmental delay
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Primary Disabilities:
Central Nervous System
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Cognitive problems
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Fine motor issues
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Hyperactivity
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Restlessness
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Poor ability to focus attention
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Primary Disabilities
Generalized damage to the brain typically has a
significant impact on:
• cognitive processing
• emotional regulation
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Primary Disabilities:
Central Nervous System
Cognitive problems
–Verbal IQ
–Performance IQ
–Scatter in Cognitive Skills
–Specific Learning Disabilities
–Memory Deficits
–Executive Functioning
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Primary Disabilities:
Central Nervous System
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Fine motor issues
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Hyperactivity
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Restlessness
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Poor ability to focus attention
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Primary Disabilities:
Central Nervous System
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Poor Judgement
Impulsiveness
Sleep disturbances
Extreme anxiety
Depression
Aggressiveness
Other Behavioural Problems
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Executive functions of
the prefrontal cortex
 working memory
 self-monitoring
 planning
 regulation of
emotion
 time perception
 internal ordering
 motivation
 inhibition
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Emotional Regulation
Emotional instability
For example, going from a calm to an agitated
state (unexplained anger, laughing, crying)
without apparent explanation
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Emotional Regulation
• Deficits in emotional regulation are partly
explained by poor inhibition and deficits in
sensory integration (SI)
• Deficits in SI result in confusion in the
interpretation of incoming sensations
• Individuals can become easily overwhelmed by
relatively commonplace events/circumstances
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Strategies Need to Address the
Whole Being
Mental, physical,
emotional,
spiritual and
sexual well being
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Strategies for Success
• Observe patterns of behaviour
• Identify strengths, skills and interests
• Reframe the interpretation of behaviours
• Provide structure rather than control
• Establish routines and consistency
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Strategies for Success
• Build transitions into every routine
• Model behaviours
• Provide simple instructions or cues
• Identify behaviours which indicate the
accumulation of frustration
• Help develop skills for expressing feelings
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Strategies for Success
• Provide specific support for social skill
development
• Understand the various forms of communication
• Include as many sensory modalities as possible
to facilitate integration of information and
experience
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Strategies for Success
• Consider information processing abilities
• Re-evaluate expectations and goals for the
individual: clarify whose needs are being met by
the goals
• Clarify goals and values for education/job
training and independence
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Resources
• Canadian Centre on Substance Abuse
www.ccsa.ca/fas
• Public Health Agency of Canada
www.publichealth.gc.ca/fasd
• Motherisk, The Hospital for Sick Children
www.motherisk.org
• Saskatchewan Prevention Institute
www.preventioninstitute.sk.ca
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Thank you!
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