FASD -

Fetal Alcohol
Spectrum Disorder
Carli Newberry, Stephanie Janzen & Taylor Leslie
EDPS 651 Fall 2012
Presentation Overview:
1. Facts & Statistics
2. How Alcohol Affects the Fetus
3. Cultural Perspectives
4. Symptoms
5. Diagnostic Criteria
6. History
7. Prevention & Intervention

Did You Know ... ?
FASD is 100 % Preventable however,
9 babies in every 1,000 born in Canada have FASD
Higher in some northern isolated aboriginal
communities, 25 to 200 per 1,000 live births
Underlying causes: family violence, poverty, stress &
lack of coping strategies, social pressure, poor role
models, los self-esteem, little knowledge about impact
of alcohol.
Higher prevalence of drinking among women with
higher incomes and high ages (+35)
Geographic diversity
Cost over a lifetime estimated at $1.5 million per person
with FASD
Why there are so few stats .

What is FASD?
How Alcohol Affects the Unborn Baby
When a mother drinks, so does her baby
Periods of Fetal Development
Drinking Attitudes
Country Standar
d
Drink
Guidelines
Australia 10g For women who are pregnant or planning to become
pregnant, not drinking is the safest option
Canada 13.6g If you are pregnant of planning to become pregnant ... The
safest choice is to drink no alcohol at all(2)
France 10g Pregnant women should avoid drinking alcohol (5)
Switzerland 10-12g Recommend that women do not drink alcohol. If they do
decide to drink, do not drink more than one glass per day and
dont drink everyday
UK 8g Pregnant women or women trying to conceive should avoid
drinking alcohol. If they do choose to drink, to minimise the
risk to the baby, they should not drink more than 1 to 2 units of
alcohol once or twice a week and should not get drunk
Retrieved from: http://www.icap.org/Table/InternationalGuidelines OnDrinkingAndPregnancy
How Much is Safe?
There is no guaranteed safe level
of alcohol at anytime during
pregnancy!
No Two Brains Are Alike
FASD = Structural Damage
Effects of Alcohol on Developing Brains
Right Orbital Frontal Cortex
Attachment, Self Reflection, Theory of
Mind, Planning

Corpus Callosum
Thinner in individuals with FASD
Attention, intellectual functioning,
reading, learning, verbal memory,
executive functioning, psychosocial
functioning

Amygdala
perceives threats, many faces seem
threatening, puts individual into
fight/flight/fright
Effects of Alcohol on Developing Brain
Hippocampus
Poor memory storage

Basal Ganglia
Decreased perceptual skills

Cerebellum
Decreased size, learning
deficits, poor motor skills,
poor balance and coordination
Effects of Alcohol on Developing Brain
Frontal Lobes
Mental retardation
Attention deficits
Hyperactivity
Poor impulse control
Problems in social perception
Speech and language delays or deficits
Poor capacity for abstract thinking
Specific deficits in math skills
Problems in memory, attention, or judgment
Problems with cause and effect
Problems anticipating consequences
Problems changing behavior or response in different situations



What do you think the average IQ
would be for individuals with FASD?
Approximately 90
This is an OVERestimate
Primary vs. Secondary Symptoms

Primary symptoms are neurologically based
Reflect differences in brain structure and function

Secondary symptoms are the manifestation of
primary symptoms in an unfit environment
Secondary Symptoms
School problems
Mental health conditions
Substance abuse
Truancy
Criminal activity
Trouble attaining and
keeping employment
Victimization
Inappropriate sexual behaviours

Common Misinterpretations of Normal Responses in
Students with FASD
Behavior Misinterpretation Accurate Interpretation
Non Compliance Stubborn/Attention
Seeking
Doesnt Understand
Trouble Translating
Verbal
Repeats Mistakes Wilful Misconduct Cant link Cause/Effect
Trouble Generalizing
Poor Social Judgement Poor Parenting
Wilful Misconduct
Not able to interpret
Social Cues from Peers

Not Sitting Still Seeking Attention Sensory Overload
Age Appropriate vs. Developmentally Appropriate
Chronological Age Expectations
for 5 year old ...
Developmental Age with FASD
(5 years going on 2 years)
Go to school
Follow 3 Instructions
Interactive, Cooperative Play
Take Turns
Take Naps
Follow 1 Instruction
Parallel Play
My way or No Way
Chronological Age
Expectations for 10 year old ...
Developmental Age with FAS
(10 years going on 6 years)
Reads books without Pictures
Learns from Worksheets
Knows Right from wrong
Gets along with others
Beginning to read with Pictures
Learn by doing
Supervised Play
Developing Sense of Fairness



Diagnosing FASD



Diagnostic Criteria


In Canada, we use a combined approach:
United States Institute of Medicine (IOM)
4-Digit Diagnostic Code

IOM Criteria

4 Digit Diagnostic Code Criteria
Lip-Philtrum Guide

5 point scale for measuring lip
thinness and philtrum smoothness.


These features are measured
independently of one another.






Palpebral fissure length

Characteristic Facial Features in
Different Ethnicities
We use the 4-Digit Diagnostic Code to quantify the
nomenclature from the IOM model of diagnosis.
Which Child has FASD?







A B C D





FAS pF

FAS pFAS ARND
ARND

***All of these children are on the spectrum***
History of the Conceptualization &
Identification of the Disorder
First mention of effects of alcohol on fetus is from
biblical times
Effects of alcohol on fetus first identified in 1714
middle of 19
th
century, Dr. Lancreraux
1973 Drs. Kenneth Jones and David Smith
Abortion recommended to prevent tragic disorder
Muted by further research in the 1980's
1989 best selling book the Broken Cord by
Michael Dorris
1970's and 80's Diagnostic and Expertise
expansion





Explosion of new symptoms (most atypical) due to
fervor of new field.
1981 Surgeon general first advised that women
should not drink during pregnancy
1989 public law implemented requiring warning
labels on all alcoholic beverages in the US
In Canada, adding warning labels to bottles is
voluntary
New research includes exploring the role of certain
nutrients

History of the Conceptualization &
Identification of the Disorder
What were the Problems?
Lack of consistent diagnosis
Lack of diagnostic capacity
No Canadian incidence and prevalence data
No consistent advice to pregnant women from health
care
providers (40% health care providers discuss risk of
alcohol use
during pregnancy)
Lack of confirmed maternal alcohol consumption
Lack of consistent prevention activities
Lack of identification, screening and referral tools
Lack of consistent, accredited training opportunities


Discussion
Should individuals with confirmed FASD be treated
differently in the criminal justice system?

Prevention
100% preventable
Most prevention has focused on education
The democratization of FASD
FASD is a symptom of a larger problem
Other prevention attempts
Intervention
Behavior strategies dont often work
Questions??
References
(1995). Alcohol consumption and related risk factors . Prams gram , 5(4), 1-5. Retrieved
from http://www.ok.gov/health2/documents/PRAMS_Alcohol_95.pdf.pdf
Alcohol consumption among women who are pregnant or who might become
pregnant (2002). http://www.cdc.gov/
American Pregnancy Association (2011). Fetal development . Retrieved from
http://www.americanpregnancy.org/duringpregnancy/fetaldevelopment.htm
Barkley, R. A., & Mash, E. J. (2003). Child psychopathology. (2nd ed.). New
York, NY: The Guilford Press.
C. Christie-Beach (personal communication, September, 2012)
Perreira, K. M., & Cortes, K. E. (2006). Race/ethnicity and nativity differences in
alcohol and tobacco use during pregnancy. American journal of public health,
96(9)
Provincial outreach program for fetal alcohol spectrum disorder (2012).
http://www.fasdoutreach.ca/
Riley, E. P., & McGee, C. L. (2005). Fetal alcohol spectrum disorders: An overview with emphasis on
changes in brain and behavior. Experimental biology and medicine, 230(6), 357-365.
Streissguth , A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D., O'Malley, K., &
Young, J. (2004). Risk factors for adverse life outcomes in fetal alcohol
syndrome and fetal alcohol effects. Developmental and behavioral pediatrics,
25(4)
U.S. department of health and human services. U.S. department of health and human
services , Substance abuse and mental health services administration center for
substance abuse prevention (2007). Effects of alcohol on a fetus . Retrieved from
website: www.samhas.gov


References Continued