Title: THE TRUTH AND CONSEQUENCES OF FETAL ALCOHOL SPECTRUM DISORDERS
1THE TRUTH AND CONSEQUENCES OFFETAL ALCOHOL
SPECTRUM DISORDERS
- Deborah E. Cohen, Ph.D.
- Director, Office for Prevention of Mental
Retardation - and Developmental Disabilities
2Fetal Alcohol Spectrum Disorders
- Appreciation is extended to Edward Riley, Ph.D.,
University of California, San Diego, and Chair,
National Task Force on Fetal Alcohol Syndrome,
for making his slides available to me.
3Fetal Alcohol Syndrome
- Specific pattern of facial features
- Pre- and/or postnatal growth deficiency
- Evidence of central nervous system dysfunction
Jones, et al, 1973 Jones Smith, 1973 Lemoine
et al., 1968 photo Streissguth, 1997
4Streissguth, 1994
5(No Transcript)
6Differential Diagnosis of Physical Features Found
in Fetal Alcohol Syndrome
7Differential Diagnosis of Physical Features Found
in Fetal Alcohol Syndrome (cont)
8Differential Diagnosis of CNS and Behavioral
Feature Found in Fetal Alcohol Syndrome
9Whats Drinking?A mere pause from thinking.
Byron, 1824
10Risk Factors
- Dose of alcohol
- Pattern of exposure - binge vs chronic
- Developmental timing of exposure
- Genetic variation
- Maternal characteristics
- Synergistic reactions with other drugs
- Interaction with nutritional variables
11Historical views of alcohol as a teratogen
- Foolish, drunken, or harebrain women most often
bring forth children like unto themselves
Aristotle in
Problemata - Behold, thou shalt conceive and bear a son And
now, drink no wine or strong drink. - Judges 137
Rosett, 1984
12Contemporary HX of FASD
- In 1973, Ken Jones and David Smith described the
cluster of effects and coined the term, Fetal
Alcohol Syndrome. - In 1989, Congress passed legislation requiring
warning labels to be put on bottles. - In 1998, Congress passed the Fetal Alcohol
Syndrome Prevention Act and established the
National Task Force. - In 2004, CDC, NIAAA SAMHSA reached consensus on
the use of FASD.
13Medical Indicators of Alcohol/Drug Dependence in
Pregnant Women
- Eclampsia
- Spontaneous Abortion
- Poor Nutrition
- Liver Damage
- Abruptio Placentae
- Intrauterine Growth Retardation
- Breech Presentation
- Preterm Labor
14Social and Medical Impacts
- Poor Neonatal Outcomes, including the risk of
preterm labor, FASD, stillbirth, mental
retardation, hyperactivity, growth retardation,
Sudden Infant Death Syndrome (SIDS), and
permanent developmental problems - Poor Maternal Outcomes, including pre-term labor,
abruptions, spontaneous abortions, STDs, HIV/AIDs
15(No Transcript)
16Live Births in New Jersey 1997-2001
- According to several studies it is estimated that
between 5.8 and 11 of pregnant women use drugs
and/or alcohol during their pregnancy. - National Estimates of Substance Use During
Pregnancy. - 5 of 115,000 11 of 115,000
- 5,750 12,650
- According to the Electronic Birth
Certificate. - Drinking 1.30 Drug Use 1.70
- 1,495 1,950
17Incidence of FAS (rates per 1000)
- Seattle 2.8
- Cleveland 4.6
- Roubaix 1.3-4.8
- Seattle
- (FAS and ARND) 9.1
- South Africa (Wellington) 78
- Alaska 0.2 non AI/AN
- 3 AI/AN
- Aberdeen 2.7 AI/AN
- BDMP 0.7
- Atlanta 0.1
- 0.3 full partial
- IOM 0.6-3 IOM 2 - 8.5
AI/AN
18FAS Only the tip of the iceberg
- Fetal alcohol syndrome
- Fetal Alcohol Spectrum Disorders - FAE, ARND
- Clinical suspect but appear normal
- Normal, but never reach their potential
19Prenatal exposure to alcohol, at least in high
doses, can cause permanent changes in the brain
- These changes in brain may cause or contribute to
many of the behavioral problems seen in
individuals exposed to alcohol. - These changes in brain are not due to poor
postnatal environments, being in foster care, or
a host of other possibilities. - Knowing what brain areas are involved might
enable us to develop better treatment strategies.
20Brain damage resulting from prenatal alcohol
photo Clarren, 1986
21Brain Regions Affected by Alcohol
22Possible mechanisms for alcohols effects
- Impaired progression through cell cycle
- Impaired glia development - migration,
neurotropic factor production, myelination - Impaired cell adhesion
- Alterations in cell membranes
- Altered production of or responsiveness to factor
that regulate growth, cell division, or cell
survival - Altered regulation of intracellular calcium
- Increased production of free radicals
23EFFECTS ON FOURCELLULAR PROCESSES
- 1. CELL PROLIFERATION
- 2. CELL MIGRATION
- 3. CELL DIFFERENTIATION
- 4. CELL TERMINATION
24Facial features of FAS in the mouse
Adapted from Sulik Johnston, 1982
25Stages of Embryogenesis
Cell Differentiation
Cell Proliferation
Cell Migration
Gastrulation
Continued Growth
Degree of Sensitivity
Implantation
Functional Maturation
Fertilization
Histogenesis
Birth
Organogenesis
0 10 20 30 40 50 60
70 80 90 280
Days
Embryonic Period
Fetal Period
26(No Transcript)
27(No Transcript)
28(No Transcript)
29Subcortical Structures
Caudate
Lenticular
Thalamus
PEA
FAS
p
lt
0.001
p
lt 0.010
p
lt 0.050
30Cranial Vault
31(No Transcript)
32(No Transcript)
33(No Transcript)
34Growing up with FAS
Courtesy of Ann Streissguth
35General Intellectual Performance
NC
PEA
FAS
Standard score
FSIQ
VIQ
PIQ
IQ scale
Mattson, S.N., 1997.
36Executive Functioning Deficits
Move only one piece at a time using one hand and
never place a big piece on top of a little piece
1
3
2
Starting position
Ending position
Mattson, et al., 1999
37Neuropsychological Performance
Mattson, et al., 1998
38Secondary Disabilities
- Individuals with FAS/FAE have a range of
secondary - disabilities disabilities that the individual
is not born with, and which could be ameliorated
with appropriate interventions.
Streissguth, et al., 1996
39- Cognitive/Intellectual functioning
- Activity and Attention
- Learning and memory
- Language and communication
- Motor abilities
- Spatial and processing abilities
- Other neuropsych/executive functioning
- Sensory motor Integration
- Social skills and adaptive
- Mental Health
40 Clinical Implications of Impairments for
Individuals with FASD
- Poor judgment and decision making, which
increases susceptibility to being victimized
Innocent Delinquents - Attention deficits, which increase
distractibility and lack of focus - Arithmetic disability, which leads to difficulty
in handling money - Memory impairment, which makes learning from
experience difficult
41Clinical Issues Cont.
- Difficulty abstracting, which makes it difficult
to understand the consequences of ones behavior - Disorientations of time and space, which
complicate accurately perceiving social cues,
missing appointments - Impulsivity and poor self-regulation, which
decreases tolerance for frustration, and makes
them quick to anger
42 Clinical Implications of Impairments for
Individuals with FASD
- Poor judgment and decision making, which
increases susceptibility to being victimized
Innocent Delinquents - Attention deficits, which increase
distractibility and lack of focus - Arithmetic disability, which leads to difficulty
in handling money - Memory impairment, which makes learning from
experience difficult
43Clinical Issues Cont.
- Poor habituation which results in drowning in
stimulation, emotional overload, shutting down
and behaving irrationally - Perseveration which leads to doing the same thing
over and over again - Poor judgment which leads to trusting anybody and
behaving irrationally - Difficulty with self reflection which leads to
not being able to express ones needs and not
getting help
44Reconceptualizing the Behavior of Persons with
FASD
- It may be helpful for professionals, family
members, and caretakers to reconceptualize how
they view the behavior of a child with FAS/ARND - From seeing a child as ? To understanding a
child as -
- Wont Cant
- Bad Frustrated, defensive, challenged
- Lazy Tries hard
- Lies Fills in
-
45Reconceptualizing the Behavior of the Person with
FASD
- Doesnt try Exhausted or cant start
- Mean Defensive, hurt, abused
- Doesnt care Cant show feelings
- Refuses to sit still Over-stimulated
- Fussy, demanding Oversensitive
- Resisting Doesnt get it
- Attention getting Needs contact, support
46Common Positive Characteristics of Persons with
FASD
- Cuddly, cheerful, tactile, friendly and happy
- Caring, kind, loyal, nurturing and compassionate
- Trusting, loving, determined, committed and
persistent - Curious, involved, fair and cooperative
- Energetic, hard working and athletic
- Artistic, musical and creatively intelligent
- Kind with younger children and animals.
47(No Transcript)
48For More Information Aboutthe Office for
Prevention and FASD
- Visit
- http//www.state.nj.us/humanservices/ofp.html
- http//www.beintheknownj.org and
- http//www.beintheknownj.net