Fetal alcohol Spectrum disorder

Question 1

what is some of the history behind FASD?

Answer 1

1968- First scientific report about pregnancy outcomes of alcoholic women
1973- Jones & Smith coined the term “Fetal Alcohol Syndrome” based on shared physical abnormalities
1981- US Surgeon General issued the first public health advisory

Question 2

what is the Epidemiology of FASD?

Answer 2

Incidence (new cases) of .97 of 1000 live births

Prevalence (all cases) of 1% in Canada

Question 3

what is epidemiology?

Answer 3

Epidemiology = “study of patterns of health and illnesses and associated factors at the population level”

Question 4

what are some of the patterns of mothers who drink?

Answer 4

Be single mothers
Have low SES
Lose custody of other children
Have unplanned pregnancies
Have poor access to prenatal care
Have cognitive and mental health problems
Use other substances
Have experienced trauma

Question 5

what are some of the affects of alcohol on the fetus?

Answer 5

Alcohol passes through the placenta and blood brain barrier
Alcohol is toxic to the fetus
Alcohol leads to oxygen deprivation
Alcohol limits cell division and triggers cell death process
May cause an intellectual disability
Can cause miscarriage

Question 6

what are some of the cognitive/developmental effects on the fetus?

Answer 6

May cause an intellectual disability
Range of IQ levels
Cognitive deficits:
Attention
Executive functioning
Visual processing
Motor skills
Social cognition
Academic achievement/learning disabilities
Behavioural and mental health challenges
Adaptive skills

Question 7

how can you Diagnosis of FASD

Answer 7

Developmental history- maternal alcohol use
Physical exam
Psychological testing
Evaluation of behavioural and mental health symptoms

Question 8

what are some of the criteria for FASD?

Answer 8

3 main features:
Prenatal or postnatal growth deficiency
3 cardinal facial features
Central nervous system deficits
With our without confirmed maternal alcohol exposure

Question 9

what are the 3 cardinal facial features of FASD?

Answer 9

Short Palpebral Fissure Length- Distance from inner to outer corner of the eye
Smooth Philtrum- Groove between your nose and upper lip, 3 = average, 4+5 = smooth
Thin Upper Lip- Separate guides for Caucasians and African-Americans, 3 = average, 4 + 5 = thin

Question 10

Central Nervous System Deficits

Answer 10

Small head size at birth (microcephaly)
Neurologic hard signs (physical changes in brain structure)
Neurologic soft signs (impairments in function through assessment)
Seizures

Question 11

what is Partial FAS (pFAS)?

Answer 11

Some facial anomalies

Either growth retardation or CNS abnormalities

Question 12

what is Alcohol-related Birth Defects (ARBD)

Answer 12

Presence of physical anomalies (e.g. heart, skeleton, kidney, vision, hearing)

Question 13

what is Alcohol-related Neurodevelopmental Disorder (ARND)?

Answer 13

Has growth retardation or CNS abnormalities

No facial features

Question 14

what are Psychological Outcomes?

Answer 14

Possible intellectual disability
Scattered profile of abilities
Learning problems
Behavioural challenges
Emotion regulation
Attention

Question 15

what are some deficits associated with Executive Functioning ?

Answer 15

Managing, controlling, and organizing your actions and behaviour”
Impulse control
Memory
Information proce

Question 16

what are some adaptive behavior skill issues?

Answer 16

i.e. Adaptive behaviour
“Ability to perform everyday tasks”
E.g. personal hygiene, domestic chores, public transit
People with FASD had lower daily living skills than people without FASD who were matched for IQ scores

Question 17

what are some other associated symptoms?

Answer 17

Microcephaly
Behavioural abnormalities
Cleft palate

Question 18

Challenges in Diagnosing FASD

Answer 18

Difficult to obtain information about alcohol use in pregnancy
Mothers under-report
Mother may not be present (e.g. adoption)
Mothers may have other comorbid difficulties, or may have taken other substances
Milder cases often missed
Harder to diagnose if physical features are not prominent
In adulthood, facial features and growth may appear normal

Question 19

what are some comorbid disorders

Answer 19

95% lifetime chance of having mental health issues 
ADHD
ODD/CD/Antisocial personality disorder
Anxiety disorders
Mood disorders 
Substance use

Question 20

what are some challanges that people with FASD face?

Answer 20

School disruption
Antisocial behaviour and criminal activity
35% spent time in jail
Social skills and peer relations
Inappropriate sexual behaviour
Sexual abuse, physical abuse, domestic violence
67% victims of abuse

Question 21

what are some interventions?

Answer 21

Parent management training
Educational accommodations
Medication
Training in life skills, social skills, vocational development
Counselling
Behaviour therapy- e.g. visual cues, scheduling aids
Organization and structure

Question 22

how can we prevent FASD?

Answer 22

The best way to avoid FASD
Public education of women of childbearing age
Treatment of substance use disorders
Provide contraception or sexual education
Prenatal care
Early screening and diagnosis