Fetal alcohol syndrome

Question 1

What is the incidence of FAS?

Answer 1

0.97/1000 live births

43/1000 live births among heavy drinkers

Question 2

What is ARBD?

Answer 2

Alcohol-related birth defects

Question 3

What is ARND?

Answer 3

Alcohol-related neurodevelopmental defects

Question 4

What brain lesions are associated with alcohol exposure in utero?

Answer 4

1. Microcephaly
2. Cerebral dysgenesis
3. Abnormal glial and neuronal migration
4. Holoprosencephaly
5. Agenesis or hypoplasia of the corpus callosum
6. Absent olfactory lobes
7. Hypoplasia of the hippocampus
8. Abnormal or absent of basal ganglia
   9, Hypoplastic or absent caudate nuclei

Question 5

What is the threshold of alcohol intake where neurodevelopmental affects were noted?

Answer 5

> 15mL alcohol per day, more than 5 drinks per occasion on average at least once a week

Question 6

What maternal factors affected cognitive deficits in a group of alcohol-exposed infants?

Answer 6

1. Maternal age

2. Amount of alcohol consumed

Question 7

What is the triad of features associated with FAS?

Answer 7

Must have documented exposure to alcohol in utero

1. Pre and post-natal growth deficiency
2. A characteristic pattern of facial abnormalities
3. CNS dysfunction

Question 8

What are the typical abnormal facial features associated with FAS?

Answer 8

1. Short palpebral fissures
2. Increased intercanthal distance
3. Flattened face with short nose
4. Absent or hypoplastic filtrum
5. Bow shaped mouth with a thin upper lip

Question 9

What are the infant diagnostic criteria associated with FAS?

Answer 9

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

Question 10

What are the preschool diagnostic criteria associated with FAS?

Answer 10

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

Question 11

What are the middle childhood diagnostic criteria associated with FAS?

Answer 11

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’

Question 12

What are the adolescent and adult diagnostic criteria associated with FAS?

Answer 12

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

Question 13

What is the management approach to FAS?

Answer 13

1. Change drinking attitudes in school-aged youth
2. Identify at-risk drinkers
3. Identify at-risk infants
4. Early intervention to prevent secondary problems
5. Develop a more precise and definitive diagnosis

Question 14

Who is an abstainer?

Answer 14

Consume no alcohol

Question 15

Who is a low-risk drinker?

Answer 15

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.

Question 16

Who is an at-risk drinker?

Answer 16

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.

Question 17

Who is a problem drinker?

Answer 17

Consume more than 21 standard drinks per week and may experience negative consequences (behavioural, family, medical, mental health, employment, legal, etc) from such drinking

Question 18

What is a screening tool for problem drinking?

Answer 18

T-ACE

1. How much alcohol do you drink before you feel its effects? (TOLERANCE) –> >2 drinks = 2
2. Has anyone ANNOYED you by saying you should cut down on your drinking? = 1
3. Have you ever thought you should CUT DOWN? = 1
4. Have you ever had a drink to get going in the morning? (EYE OPENER) = 1

Total score >2 is at risk drinking behavior

Question 19

What is the cognitive and behavioral profile of children with FAS and/or atypical FAS?

Answer 19

1. Lack of organization: (Sequencing, Inability to make choices)
2. Poor abstract thinking
3. Inability to foresee consequences
4. Impulsive
5. Inappropriate behaviour (Excessive friendliness, Lack of inhibitions)
6. Inability to learn from previous experiences
7. Communication problems (Unresponsive to social clues, Inability to make and keep friends, Use behaviour as communication)
8. Difficulty with adaptive living skills

Question 20

How is a definitive diagnosis of FAS made?

Answer 20

4-digit Diagnostic Code
(1 to 4 for each criteria):

1. Impaired growth
2. Facial abnormalities)
3. Abnormal brain function
4. Degree of maternal drinking

Question 21

What are some tests used to measure intelligence?

Answer 21

1. Bayley Scales of Infant Mental and Motor Development (Bayley) resulting in a Mental Development Index
2. Stanford Binet – yields Intelligence Quotient (IQ)
3. 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

Question 22

What are some tests used to measure attention and hyperactivity?

Answer 22

1. Taland Letter cancelling test
2. Wisc-R digit span
3. Wisconsin Card Sorting Test (WCST) – indicates shifting attention
4. Attention deficit hyperactivity disorder comprehensive Teacher’s Rating Scale (ACTeRS)

Question 23

What are some tests of learning and memory?

Answer 23

1. Brazelton Scale – habituation
2. Pediatric Early Elementary Examination (PEEX)
3. Pediatric Examination of Education Readiness (PEER)
4. Brigance

Question 24

What are some test of language?

Answer 24

1. Denver Development Screening Test (DDST)
2. Word Span
3. Naming
4. Word comprehension
5. Woodstock Reading Master

Question 25

What are some tests of motor abilities?

Answer 25

1. DDST
2. WISC-R
3. PEEX
4. PEER

Question 26

What are some tests of social skills and behavior?

Answer 26

1. Vineland Adaptive Behaviour Scales (VABS)
2. Fetal Alcohol Behavior Scale (FABS)
3. FAS\atypical FAS Scale
4. ACTeRS

Question 27

What are some tests of visual-spatial difficulties?

Answer 27

Beery Developmental 1. Test of Visual-Motor Integration

2. Frosting Development Test of Visual Perception
3. PEEX
4. PEER

Question 28

What are long term objectives of early childhood intervention and education?

Answer 28

1. establishing and maintaining a sense of self-worth
2. establishing acceptable interpersonal behaviour
3. fostering independence
4. teaching children how to make acceptable decisions.

Question 29

What are strategies for dealing with difficult behaviors in FAS?

Answer 29

1. Keep tasks simple
2. Use concrete examples
3. Keep instructions simple and give them one at a time
4. Concentrate on life skills

Question 30

What are the CPS recommendations re: FAS?

Answer 30

1. Primary prevention of FAS should involve school-based educational programs; early recognition; treatment of at-risk women; and community-sponsored, culturally-centred programs.
2. Health care providers should ask women about their drinking habits, whether or not they are pregnant.
3. 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.
4. If behavioural or physical abnormalities consistent with FAS are identified, intervention should begin without delay, even before a definitive diagnosis is made.
5. Intervention programs should involve the child’s family and community.
6. 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.
7. 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.
8. Interventions should continue to be evaluated for effectiveness.
9. 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.
10. Individuals and groups providing diagnostic and treatment services should take a culturally based, holistic approach.