FASD Flashcards
Prevalence of FASD in SA
13.6-20.9%, highest recorded prevalence in the world
What is a teratogen?
A factor that causes malformation in an embryo
Continuous alcohol exposure
- Light: less than 0.5oz a day
- Moderate: 0.5-0.99oz a day
- Heavy: more than 1oz a day
1oz = 2 drinks
Definition of binge drinking
Female: 4 drinks a session
Male: 5 drinks a session
Prenatal factors for FASD (6)
- Maternal health
- Critical period
- Dosage and duration
- Genetic make up
- Mother’s lifestyle
- Metabolising of alcohol, in mother
Postnatal risk factors
Social environment
What is a biomarker?
A biological marker of exposure to alcohol as a foetus.
Example of a biomarker
Fatty acid ethyl ester trapped in meconium
What is a biobehavioral marker?
Behavioural outcome linked to FASD where the neural substrates have been identified and can be studied directly
Pros of biobehavioral markers
It can be used to identify degrees of impairment and can improve diagnosis and treatment
Four different pathologies of FASD
- Fetal alcohol syndrome
- Partial FAS
- Alcohol related neurodevelopmental disorder
- Alcohol related birth defects
Diagnostic criteria for FAS (4)
- Prenatal exposure
- Deficits in central nervous system development and functioning
- Deficient growth pattern
- Craniofacial irregularities
Diagnostic criteria for PFAS (3)
- Prenatal alcohol exposure
- Some characteristic facial features
- Either CNS deficiencies OR cognitive/behavioural deficits OR physical growth symptoms
Diagnostic criteria for Alcohol Related Neurodevelopmental Disorder (2)
- Prenatal alcohol exposure
2. Deficits in CNS: development and/or functioning (cognitive + behavioural difficulties)
Diagnostic criteria for Alcohol Related Birth Defects (2)
- Prenatal alcohol exposure
2. Conventional physical abnormalities
Effects on brain development (2)
- An overall reduction in brain size, particularly the inferior parietal, frontal and perisylvian areas (implicated in language)
- Decreased white matter integrity, compromising internal brain communication
Effects on the cerebellum (2)
- The volume is reduced, which affects finer coordination skills
- Displacement of the anterior vermis (a map-like set up of the body on grey matter)
Effects on the corpus callosum (2)
- The volume is reduced, it may not develop at all
2. Linked to deficits like learning difficulties and impaired information processing
Effects on the basal ganglia (3)
- The volume is reduced
- Cognitive aspects of emotional processing is impaired (theory of the mind etc.)
- Affects the caudate nucleus particularly, which works with storing and processing memory, NB in the feedback mechanism. This deficit creates stunted social engagement.
Effects on the hippocampus and amygdala
The research is new, but suggests a problem with the regulation of fear and emotions
General outcome of task completion in FASD
Smaller networks are compromised, so individuals use wider networks to complete specific tasks
Two components of developmental trajectory
- There is a relationship between facial dysmorphology, bran development size and lowered IQ
- Delayed white matter development in frontal association areas
Effects on attention (3)
- Poor sustained attention
- Impaired performance of tests of working memory
- High comorbidity with ADHD, but the attention impairment is different, FASD = auditory, ADHD = global
Effects on learning and memory (3)
- Impaired audio-verbal learning and memory (encoding, recall is spared)
- Impaired visual spatial learning and memory
- Impairment in prospective memory
Five components of executive functioning that are affected by FASD
- Problem solving and planning
- Working memory
- Set shifting
- Fluency
- Response inhibition
How is response inhibition tested for?
The Stroop test
How is social and emotional processing tested?
Reading the mind in the eyes - given a set of eyes in isolation and then asked to describe what emotions they’re feeling
Effects on language (1)
- Phonological processing difficulties
How are phonological processing difficulties tested?
PhAB - phonological assessment battery. E.g. What is cat with an m? (Mat)
Effects on number processing (2)
- Impaired mental representation and manipulation of numbers
- Wider neural networks are recruited to do simple calculations
Behavioural outcomes of FASD (4)
- Increased internalising and externalising behaviours
- Increased risk for secondary mental disorders
- Increased risk of delinquent behaviour
- Impaired moral decision making
Most affected domain of adaptive functioning
Social competence
Long lasting effects of social competence
It’s arrested, not delayed, it never gets better. It gets worse with age. It’s associated with executive dysfunction.
How are deficits in attention tested?
- NBACK test, (1Back, 2Back etc.); works with working memory, which is linked to attention
How are learning and memory deficits tested?
The water maze test - finding a route out of a maze
How are problem solving and planning deficits measured?
The towers test: three pegs and a structure given. FASD results in perseveration of incorrect strategies, rule violations, less planning time
How are deficits in working memory tested? (3)
- NBACK
- Digit span backwards
- Visual working memory test (Cambridge)
Side note: perform worse in tapping inhibition tasks
How are deficits in set shifting tested? (2)
- STROOP, switching from colour of word to font
2. Wisconsin Card Sorting Test: classifying cards according to different criteria
How are deficits in fluency tested?
Naming within categories
How are deficits in response inhibition tested?
STROOP, saying colours not words
Cognitive areas affected by FASD (11)
- IQ
- Attention
- Learning and memory
- Problem solving and planning
- Working memory
- Set shifting and concept formation
- Fluency
- Response inhibition
- Language
- Number processing
