Fetal alcohol Spectrum disorder Flashcards
what is some of the history behind FASD?
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
what is the Epidemiology of FASD?
Incidence (new cases) of .97 of 1000 live births
Prevalence (all cases) of 1% in Canada
what is epidemiology?
Epidemiology = “study of patterns of health and illnesses and associated factors at the population level”
what are some of the patterns of mothers who drink?
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
what are some of the affects of alcohol on the fetus?
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
what are some of the cognitive/developmental effects on the fetus?
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
how can you Diagnosis of FASD
Developmental history- maternal alcohol use
Physical exam
Psychological testing
Evaluation of behavioural and mental health symptoms
what are some of the criteria for FASD?
3 main features: Prenatal or postnatal growth deficiency 3 cardinal facial features Central nervous system deficits With our without confirmed maternal alcohol exposure
what are the 3 cardinal facial features of FASD?
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
Central Nervous System Deficits
Small head size at birth (microcephaly)
Neurologic hard signs (physical changes in brain structure)
Neurologic soft signs (impairments in function through assessment)
Seizures
what is Partial FAS (pFAS)?
Some facial anomalies
Either growth retardation or CNS abnormalities
what is Alcohol-related Birth Defects (ARBD)
Presence of physical anomalies (e.g. heart, skeleton, kidney, vision, hearing)
what is Alcohol-related Neurodevelopmental Disorder (ARND)?
Has growth retardation or CNS abnormalities
No facial features
what are Psychological Outcomes?
Possible intellectual disability Scattered profile of abilities Learning problems Behavioural challenges Emotion regulation Attention
what are some deficits associated with Executive Functioning ?
Managing, controlling, and organizing your actions and behaviour”
Impulse control
Memory
Information proce
what are some adaptive behavior skill issues?
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
what are some other associated symptoms?
Microcephaly
Behavioural abnormalities
Cleft palate
Challenges in Diagnosing FASD
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
what are some comorbid disorders
95% lifetime chance of having mental health issues ADHD ODD/CD/Antisocial personality disorder Anxiety disorders Mood disorders Substance use
what are some challanges that people with FASD face?
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
what are some interventions?
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
how can we prevent FASD?
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
