Fetal alcohol syndrome Flashcards
What is the incidence of FAS?
0.97/1000 live births
43/1000 live births among heavy drinkers
What is ARBD?
Alcohol-related birth defects
What is ARND?
Alcohol-related neurodevelopmental defects
What brain lesions are associated with alcohol exposure in utero?
- Microcephaly
- Cerebral dysgenesis
- Abnormal glial and neuronal migration
- Holoprosencephaly
- Agenesis or hypoplasia of the corpus callosum
- Absent olfactory lobes
- Hypoplasia of the hippocampus
- Abnormal or absent of basal ganglia
9, Hypoplastic or absent caudate nuclei
What is the threshold of alcohol intake where neurodevelopmental affects were noted?
> 15mL alcohol per day, more than 5 drinks per occasion on average at least once a week
What maternal factors affected cognitive deficits in a group of alcohol-exposed infants?
- Maternal age
2. Amount of alcohol consumed
What is the triad of features associated with FAS?
Must have documented exposure to alcohol in utero
- Pre and post-natal growth deficiency
- A characteristic pattern of facial abnormalities
- CNS dysfunction
What are the typical abnormal facial features associated with FAS?
- Short palpebral fissures
- Increased intercanthal distance
- Flattened face with short nose
- Absent or hypoplastic filtrum
- Bow shaped mouth with a thin upper lip
What are the infant diagnostic criteria associated with FAS?
History of prenatal alcohol exposure
Facial abnormalities
Growth retardation-height, weight, head circumference
Hypotonia, increased irritability
Jitteriness, tremulousness, weak suck
Difficulty ‘habituating’, getting used to stimulation
What are the preschool diagnostic criteria associated with FAS?
History of alcohol exposure, growth retardation, facial abnormalities
Friendly, talkative and alert
Temper tantrums and difficulty making transitions
Hyperactive; may be oversensitive to touch or over-stimulation
Apparent skill levels may appear to be higher than their tested levels of ability
Attention deficits, developmental delays-speech, fine motor difficulties
What are the middle childhood diagnostic criteria associated with FAS?
History of alcohol exposure, growth retardation, facial abnormalities
Hyperactivity, attention deficit, impulsiveness
Poor abstract thinking
Inability to foresee consequences of actions
Lack of organization and sequencing
Inability to make choices
Lack of organization skills
Inappropriate behaviour:
- Overly affectionate
- Lack of inhibitions
- Communication problems
- Lack of social skills to make and keep friends
- Unresponsive to social clues
- Uses behaviour as communication
- Difficulty making transitions
Academic problems-reading and mathematics
Behaviour problems-‘stretched toddler’
What are the adolescent and adult diagnostic criteria associated with FAS?
History of alcohol exposure, growth retardation, facial abnormalities
Intelligence Quotient-average to mildly retarded with wide range; continued school difficulties
Difficulty with adaptive and living skills
Attention deficits, poor judgment, impulsivity lead to problems with employment, stable living and the law
Serious life adjustment problems-depression, alcoholism, crime, pregnancy and suicide
What is the management approach to FAS?
- Change drinking attitudes in school-aged youth
- Identify at-risk drinkers
- Identify at-risk infants
- Early intervention to prevent secondary problems
- Develop a more precise and definitive diagnosis
Who is an abstainer?
Consume no alcohol
Who is a low-risk drinker?
Consume one to two standard drinks per day, three times a week or less. Alcohol has no effect on their health. They do not use alcohol while driving, while pregnant, when breastfeeding or with certain medications.
Who is an at-risk drinker?
Consume one to two standard drinks per day, three times a week or less. Alcohol has no effect on their health. They do not use alcohol while driving, while pregnant, when breastfeeding or with certain medications.
Who is a problem drinker?
Consume more than 21 standard drinks per week and may experience negative consequences (behavioural, family, medical, mental health, employment, legal, etc) from such drinking
What is a screening tool for problem drinking?
T-ACE
- How much alcohol do you drink before you feel its effects? (TOLERANCE) –> >2 drinks = 2
- Has anyone ANNOYED you by saying you should cut down on your drinking? = 1
- Have you ever thought you should CUT DOWN? = 1
- Have you ever had a drink to get going in the morning? (EYE OPENER) = 1
Total score >2 is at risk drinking behavior
What is the cognitive and behavioral profile of children with FAS and/or atypical FAS?
- Lack of organization: (Sequencing, Inability to make choices)
- Poor abstract thinking
- Inability to foresee consequences
- Impulsive
- Inappropriate behaviour (Excessive friendliness, Lack of inhibitions)
- Inability to learn from previous experiences
- Communication problems (Unresponsive to social clues, Inability to make and keep friends, Use behaviour as communication)
- Difficulty with adaptive living skills
How is a definitive diagnosis of FAS made?
4-digit Diagnostic Code
(1 to 4 for each criteria):
- Impaired growth
- Facial abnormalities)
- Abnormal brain function
- Degree of maternal drinking
What are some tests used to measure intelligence?
- Bayley Scales of Infant Mental and Motor Development (Bayley) resulting in a Mental Development Index
- Stanford Binet – yields Intelligence Quotient (IQ)
- Wechsler Scales – yields IQ
- Wechsler Preschool and Primary Scales of Intelligence (WPPSI and WPPSI-R [revised])
- Wechsler Intelligence Scale for Children (WISC and WISC-R [revised])
- Wechsler Adult Intelligence Scales
What are some tests used to measure attention and hyperactivity?
- Taland Letter cancelling test
- Wisc-R digit span
- Wisconsin Card Sorting Test (WCST) – indicates shifting attention
- Attention deficit hyperactivity disorder comprehensive Teacher’s Rating Scale (ACTeRS)
What are some tests of learning and memory?
- Brazelton Scale – habituation
- Pediatric Early Elementary Examination (PEEX)
- Pediatric Examination of Education Readiness (PEER)
- Brigance
What are some test of language?
- Denver Development Screening Test (DDST)
- Word Span
- Naming
- Word comprehension
- Woodstock Reading Master
What are some tests of motor abilities?
- DDST
- WISC-R
- PEEX
- PEER
What are some tests of social skills and behavior?
- Vineland Adaptive Behaviour Scales (VABS)
- Fetal Alcohol Behavior Scale (FABS)
- FAS\atypical FAS Scale
- ACTeRS
What are some tests of visual-spatial difficulties?
Beery Developmental 1. Test of Visual-Motor Integration
- Frosting Development Test of Visual Perception
- PEEX
- PEER
What are long term objectives of early childhood intervention and education?
- establishing and maintaining a sense of self-worth
- establishing acceptable interpersonal behaviour
- fostering independence
- teaching children how to make acceptable decisions.
What are strategies for dealing with difficult behaviors in FAS?
- Keep tasks simple
- Use concrete examples
- Keep instructions simple and give them one at a time
- Concentrate on life skills
What are the CPS recommendations re: FAS?
- Primary prevention of FAS should involve school-based educational programs; early recognition; treatment of at-risk women; and community-sponsored, culturally-centred programs.
- Health care providers should ask women about their drinking habits, whether or not they are pregnant.
- Health care providers play an important role in identifying babies or children with FAS. They should become familiar with the screening tools that are available to diagnose the condition in children at various ages.
- If behavioural or physical abnormalities consistent with FAS are identified, intervention should begin without delay, even before a definitive diagnosis is made.
- Intervention programs should involve the child’s family and community.
- FAS diagnostic and treatment services require a multidisciplinary approach, involving physicians, psychologists, early childhood educators, teachers, social service professionals, family therapists, nurses and community support circles.
- Diagnostic and treatment services should be publicly funded and available to all Canadians, regardless of their ethnicity, status (eg, status and nonstatus aboriginals), place of residence or income.
- Interventions should continue to be evaluated for effectiveness.
- To ensure that all children have access to the appropriate services and support, cooperation is required at various levels and across various sectors: federal government; provincial ministries of health, social services and education; and local community groups.
- Individuals and groups providing diagnostic and treatment services should take a culturally based, holistic approach.
