Fetal Alcohol Spectrum Disorders and Impact on Brain Development Sara H. Wenger, M.S. Education and Outreach Services Jewish Family and Children

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Fetal Alcohol Spectrum Disorders and Impact on
Brain DevelopmentSara H. Wenger, M.S.Education
and Outreach ServicesJewish Family and
Childrens Service
267-256-2050 www.jfcsphilly.org
info_at_jfcsphilly.org
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WHAT IS FASD?

• Umbrella term describing the range of
• effects that can occur in an individual
• whose mother drank alcohol during
• pregnancy.
• May include physical, mental, behavioral,
• and/or learning disabilities with possible
• lifelong implications.
• Not a diagnosis

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FASD Spectrum

• Fetal alcohol effects (FAE)
• Alcohol-related birth defects (ARBD)
• Alcohol-related neurodevelopmental disorder
• (ARND)
• Partial FAS (pFAS)
• Fetal Alcohol Syndrome (FAS)

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Fetal Alcohol Spectrum Disorder

• It is the leading cause of mental retardation in
  the West.
• FASD is preventable.

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Maternal Alcohol Consumption

• Each year over 40,000 American children are
  born with defects because their mother drank
  alcohol when pregnant.

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Incidence of FASD

• The range of FASD is more common than disorders
  such as Autism and Down Syndrome.
• Generally accepted incidence rates for FASD are 1
  in 100 live births.

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According to the CDC, NIAAA, Surgeons General
Report

• There is no known amount of alcohol that is
  safe for a woman to drink during pregnancy.

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Fetal Alcohol Syndrome

• FAS is a serious combination of birth defects
  seen in the offspring of women who have been
  heavy drinkers (usually at a rate of six or more
  drinks per day) throughout pregnancy.

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Fetal Alcohol Effects

• Refers to symptoms of children with a history of
  prenatal alcohol exposure (mothers drank
  approximately 14 drinks per week) but not all of
  the physical or behavioral symptoms of FAS.

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Alcohol is a Teratogen

• A teratogen is any substance that produces birth
  defects by influencing fetal development.
• Alcohol crosses the placenta and enters the
  fetus, causing the level of alcohol in the fetus
  to approximate the mothers alcohol level.

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Alert!

• There is ever-increasing recognition that
  alcohol is the most common chemical teratogen
  presently causing malformations and mental
  deficiency in the human offspring.

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One drink per day throughout pregnancy adds up to
39 baby bottles full of booze.
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Alcohol Teratogenesis in the Brain

• Alcohol has the most detrimental effect on both
  brain development and function.
• The infant is not only born with a smaller brain
  size, but the teratogenic effect of alcohol both
  reduces the number of brain neurons as well as
  alters their distribution.
• This results in mental deficiency.

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How Does Fetal Alcohol Damage Occur?

• Alcohol is a FOOD, a DRUG and a POISON
  (toxin). It results in
• Direct toxic effects on tissues
• Interference w/ fetal nutrition
• Interference w/ fetal oxygen supply
• Interference w/ growth-signaling chemicals

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Risk Factors of Maternal Alcohol Consumption

• The alcohol a pregnant woman drinks reaches the
  fetus within a few minutes.
• Alcohol passes through the placenta. This
  exposure can cause a lifetime of damage.
• The central nervous system and the brain grow
  throughout pregnancy and are affected during any
  stage of development.

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The Brain

• The portion of the central nervous system
  responsible for
• The interpretation of sensory impulses
• The coordination and control of bodily functions
• The exercise of emotion and thought.

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Fetal Brain DevelopmentFetal brain cells are
generated at about 250,000 per minute.
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Alcohol Exposure During Stages of Pregnancy

• First Trimester
• Alcohol interferes with the migration and
  organization of brain cells.

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Second Trimester

• Heavy drinking during the second trimester,
  particularly from the 10th-20th week after
  conception, seems to cause more clinical features
  of FAS than at other times during pregnancy.

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Third Trimester

• During the 3rd trimester, the hippocampus is
  greatly affected, leading to problems with
  encoding visual and auditory information.
• The hippocampus plays a fundamental role in
  memory.

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Signs and Symptoms of FAS

• A baby may be born drunk and addicted to alcohol.
• Baby will have low birth weight and short length.
• Baby will have a small head, flattened nose, thin
  upper lip, small eyes.
• Baby has permanent damage to the brain and
  central nervous system.

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The Baby with FAS

• Failure to thrive they lose weight, have poor
  sucking reflexes, no desire to eat.
• Baby may have trouble sleeping does not develop
  a regular schedule irritable, squirmy, difficult
  to soothe.
• Baby may be slow to talk, learning language is a
  lifelong problem slow to walk and to be
  toilet-trained.

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Maternal Alcohol Use and Fetal Development

• The most common characteristics of children
  born with FAS are as follows
• Growth deficiency
• Craniofacial abnormalities
• Musculoskeletal defects
• Cardiac disease
• Nervous system abnormalities
• Neuro-developmental delay
• Mental deficiency

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Dysmorphic Features
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Children with FAS

• Friendly and outgoing, sometimes to their
  disadvantage.
• Impulsive poor judgment.
• Hyperactive cannot sit still.
• Falls behind peers socially and academically.
• Easily manipulated by others.

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The Child with FAS

• Average IQ is 65.
• Physically smaller.
• Learning disabilities
• Difficulty matching words and behaviors
• Difficulty mastering new skills or remembering
  something recently learned (tying shoelaces)
• Spotty memory
• Inflexibility of thought
• Difficulty predicting outcomes
• Difficulty distinguishing fact from fantasy
• Difficulty distinguishing friends from strangers.

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Fetal Alcohol Effects in Infants

• Lighter weight babies
• Jittery and tremulous
• Difficulties with habituation
• Disrupted sleep patterns
• Abnormal reflexes
• Weaker sucking reflex

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Fetal Alcohol Effects in Children

• Learning and Behavioral Problems
• Difficulty sustaining attention
• Difficulty retaining information
• Difficulty comprehending words
• Difficulty with word recall/organizational skills
• Impulsive behaviors
• Distractible and Inflexible

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Overall Difficulties for Persons with an FASD

• Taking in information
• Storing information
• Recalling information when necessary
• Using information appropriately in a specific
  situation.

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Sensory Integration Issues

• Overly sensitive to sensory input
• Upset by bright lights or loud noises
• Annoyed by tags in shirts or seams in socks
• Bothered by certain textures of food
• Have problems sensing where their body is in
  space.

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Information Processing

• Do not complete tasks or chores and may appear to
  be oppositional
• Have trouble determining what to do in a given
  situation
• Do not ask questions because they want to fit in
• Have trouble with changes in tasks and routine

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Information Processing

• Have trouble following multiple directions
• Say they understand when they do not
• Cannot operationalize what theyve memorized
• Misinterpret others words, actions, or body
  movements
• Literal in their thinking and interpretation

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Some Typical Difficulties Executive Function and
Decision-Making

• Repeatedly break the rules
• Tend not to learn from mistakes or natural
  consequences
• Frequently do not respond to reward systems
• Difficulty entertaining themselves
• Give in to peer pressure
• Naïve, gullible
• Difficulty with abstract concepts

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Self-Esteem and Personal Issues

• Often feel stupid or like a failure
• Seen as lazy, uncooperative and unmotivated
• Have hygiene problems
• Aware theyre different from others
• Often grow up in multiple homes and experience
  multiple losses.

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Impact of FAS on Society

• FAE believed to occur at a rate of approx. 3-5
  per 1,000 live births in the U.S.
• FAS present in approx. 1-3 per 1,000
• Nation spends approximately 4 billion in caring
  for families affected by FAS
• Estimates of lifetime costs range 1.4 million
  in 1988 to 2 million in 2008.

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Impact on Families and Communities

• Emotional
• Legal
• Financial
• Criminal
• Social
• Physical
• Psychological

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Prevention

• Grade appropriate education
• Health Professional education
• Required warning labels on alcoholic beverages
• Public health information campaign
• Chemical dependence treatment programs
• Community support systems
• Improved screening and referral systems