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Fetal Alcohol Spectrum Disorders

Fetal Alcohol Spectrum Disorders (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 disab

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Fetal Alcohol Spectrum Disorders

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    1. Fetal Alcohol Spectrum Disorders Catherine A. Sorensen, Dr. P.H. Hawaii Department of Health Family Health Services Division Fetal Alcohol Spectrum Disorders Office

    2. Fetal Alcohol Spectrum Disorders (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

    3. Fetal Alcohol Spectrum Disorders Fetal Alcohol Syndrome (FAS) With/without confirmed maternal alcohol exposure Partial FAS with confirmed maternal alcohol exposure Alcohol related birth defects (ARBD) Alcohol related neurodevelopmental disorder (ARND) A medical diagnosis (760.71) in the International Classification of Diseases (ICD)

    4. Cause of FASD The sole cause of FASD is women drinking alcoholic beverages during pregnancy Alcohol is a teratogen

    5. Size Matters

    6. Size Matters

    7. FASD and Alcohol All alcoholic beverages are harmful. Binge drinking is especially harmful. There is no proven safe amount of alcohol use during pregnancy.

    8. FASD Facts 100 percent preventable Leading known cause of preventable mental retardation Not caused on purpose Can occur anywhere and anytime pregnant women drink Not caused by biologic father’s alcohol use Not a new disorder

    9. Fetal Alcohol Syndrome Term first used in 1973 by Drs. Smith and Jones at the University of Washington One of the diagnoses used to describe birth defects caused by alcohol use while pregnant

    10. What does FAS look like?

    11. Distinctive facial features

    12. Number of People With an FASD No one knows for certain how many individuals are born each year with an FASD No one knows how many individuals are living with an FASD

    13. Prevalence of FAS/ARND FAS estimated 0.5 and 2.0 live births/1,000 FASD estimated at least 10/1,000 or 1% of all births By Race - Blacks (range, 0.9-1.6); American Indian/Alaska Natives (range, 2.5-5.6) 1.5-3.0 million in US South Africa (FAS & PFAS) 68.0 – 89/1,000 Italy (FASD) 35/1,000; or 2 – 4% of all children

    14. Hawaii FAS/ARND Estimates Estimated rates: FAS - .3; ARND – 1.0 Annual FASD – 22 Total FASD – 1,591 Mental Retardation – 243 (FAS – 146) Heart Defects – 738 (ARND – 568) ADHD – 635 (ARND – 489) Speech Disorders – 1,320 (ARND – 1,016) Cerebral Palsy – 23 Autism - 26

    15. Additional Hawaii Estimates Children in Foster Care – 381 Years in Foster Care – 211 years Mental Illness – 1,114 (ARND – 857; FAS – 257) Years in MH System – 660 years

    16. FAS – Only the tip of the iceberg Other conditions within the spectrum are invisible underneath the surface Symptoms but cause unrecognized Appear normal, but never reach their potential

    17. Economic Costs of FAS FAS alone cost the United States more than $4 billion in 1998 The average lifetime cost for each child with FAS is $2 million $1.6 million for medical care services $0.4 million for loss of productivity

    18. Estimated Economic Costs of for Hawaii Total annual - $4,193, 310 5 Year costs - $16,959,748

    19. How does the alcohol cause harm to the developing fetus? Alcohol passes by mother’s bloodstream through the placenta and into the baby’s circulation Baby has limited ability to metabolize the alcohol Alcohol kills cells Alcohol interferes with maturation of cells Alcohol interferes with migration of cells

    20. The Impact of Alcohol Throughout the Pregnancy

    21. The study of FAS

    22. The study of FAS

    23. FAS and the Brain

    25. FAS and the Brain

    26. FAS and the Brain

    27. FASD Across the Lifespan

    28. Developmental Stages of FAS Newborn Jitteriness, tremors High or low muscle tone Disrupted sleep/wake cycles Poor habituation Poor or weak suck EEG abnormalities Sensitive to sound/noise

    29. Developmental Stages of FAS Infancy “Failure to thrive” Tremulousness Irritability Low muscle tone Feeding problems Sleep problems Developmental delay

    30. Developmental Stages of FAS Preschool Small for age Short attention span Hyperactivity Speech delay Fine/gross motor incoordination Alert, friendly, outgoing nature Need for body contact

    31. Developmental Stages of FAS Early School Years Kindergarten often delayed or repeated Attention deficits Emotional lability Poor impulse control Memory deficit Social intrusiveness Poor peer relationships Achievement good sometimes relative to IQ

    32. Developmental Stages of FAS Middle School School achievement maximum High risk for truancy, dropout Apparently good verbal skills Impulsive nature Lack of social inhibition

    33. FAS in Adolescents and Adults

    34. Intellectual Function Chronologic Age – 18 yr 11 mo Mean FS IQ= 68 (range 20-105) 66 (FAS) 73 (FAE) 58% had IQ < 70 Receptive Language - 8yr 2 mo

    35. Adaptive Function Mean chronologic age 17 years Communication 7.09 years Daily Living 9.01 years Socialization 6.07 years Behavior Composite 7.06 years

    36. Academic Function Mean Chronologic age 18 years Reading grade equivalent 4.05 grade Spelling grade equivalent 3.07 grade Arithmetic grade equivalent 2.08 grade

    38. Overall Difficulties for Persons With an FASD Taking in information Storing information Recalling information when necessary Using information appropriately in a specific situation

    39. Typical Difficulties for Persons With an FASD Sensory Integration Issues Are overly sensitive to sensory input Upset by bright lights or 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 (i.e., clumsy)

    40. Typical Difficulties for Persons With an FASD Memory Problems Multiplication Time sequencing

    41. Typical Difficulties for Persons With an FASD Information Processing Say they understand when they do not Have verbal expressive skills that often exceed their level of understanding Misinterpret other’s words, actions, or body movements Have trouble following multiple directions

    42. Typical Difficulties for Persons With an FASD Information Processing Problems 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

    43. Typical Difficulties for Persons With an FASD Go with strangers Repeatedly break the rules Do not learn from mistakes or natural consequences Frequently do not respond to point, level, or sticker systems Have trouble with time and money Give in to peer pressure

    44. Typical Difficulties for Persons With an FASD Self-Esteem and Personal Issues Function unevenly in school, work, and development Experience multiple losses Are seen as lazy, uncooperative, and unmotivated Have hygiene problems

    45. Typical Difficulties for Persons With an FASD Other Issues Cannot entertain themselves Have trouble changing tasks Do not accurately pick up social cues

    46. Think Younger An 18 year old with an FASD may: Talk like a 20 year old Look like an 18 year old Read like a 16 year old Comprehend like a 6 year old Have the social skills of a 7 year old Have the emotional maturity of a 6 year old

    47. FASD and Secondary Disabilities

    48. FASD Secondary Disabilities, University of Washington Study 415 individuals: FAS or PFAS Age range: 6 to 51 94% Mental health 43% Disrupted school experiences 60% 12 years and older trouble with law 50% experienced confinement in jail or treatment facilities

    49. FASD Secondary Disabilities, University of Washington Study, continued 45% engaged in inappropriate sexual behavior 24% of adolescents, 46% of adults, and 35% overall had alcohol and drug problems 83% of adults dependent living situation 79% of adults had employment problems

    50. Strategies To Improve Outcomes for Individuals With an FASD Structure Simplify the individual’s environment Provide a lot of one-to-one physical presence Take steps to avoid sensory triggers Provide one direction or rule at a time and review rules regularly Provide and use cues Don’t use idioms

    51. Strengths of Persons With an FASD Friendly Likable Desire to be liked Helpful Determined Have points of insight Not malicious

    52. Strengths of Persons With an FASD Cuddly and cheerful Happy in an accepting and supportive environment Loving, caring, kind, sensitive, loyal, and compassionate Energetic and hard working Fair and cooperative Spontaneous, curious, and involved

    53. Prevention is the Only Solution Primary prevention Prevention of secondary disabilities

    54. Education for all areas that care for individuals with FASD Health Education Social and community services Legal and financial services

    55. Paradigm Shift

    56. “A pregnant woman never drinks alone” Washington State Pregnancy and Health Program

    57. Resources SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov Centers for Disease Control and Prevention FAS Prevention Team: www.cdc.gov/ncbddd/fas National Institute on Alcohol Abuse and Alcoholism (NIAAA): www.niaaa.nih.gov/ National Organization on Fetal Alcohol Syndrome (NOFAS): www.nofas.org National Clearinghouse for Alcohol and Drug Information: ncadi.samhsa.gov These sites link to many other Web sites.

    58. Contact Information Catherine Sorensen Hawaii Dept. of Health 808.733.9018 Catherine.sorensen@doh.hawaii.gov

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