Working to Prevent Working to Prevent Fetal Alcohol Spectrum DisordersFetal Alcohol Spectrum Disorders

Through High School and Through High School and Middle School CurriculaMiddle School Curricula

This presentation was designed for use in This presentation was designed for use in

Upper Level High School Science Classes.Upper Level High School Science Classes.

FASD

Indiana FASDPreventionTaskforce

Fetal Alcohol Spectrum Fetal Alcohol Spectrum DisordersDisorders

Why a person should NOT drink alcohol Why a person should NOT drink alcohol if she COULD get pregnant!if she COULD get pregnant!

FASD

Indiana FASDPreventionTaskforce

Fetal Alcohol Spectrum Fetal Alcohol Spectrum Disorders (FASD)Disorders (FASD)

Possible Diagnoses– Fetal alcohol syndrome (FAS)

– Partial FAS (pFAS)

– Alcohol-related neurodevelopmental disorder (ARND)

– Alcohol-related birth defects (ARBD)

+ =

FAE (fetal alcohol effects) is an older term used to describe the last three listed above.

FASD

On any given day in the On any given day in the United States…United States…

• Approximately 11,000 babies are born

• 4 of these babies are born with spina bifida

• 1 of these babies is HIV positive

• 100 of these babies are born with a FASD

• 3 of these babies are born with muscular dystrophy

• 10 of these babies are born with Down syndrome

• 20 of these babies are born with FAS

From the Executive Summary of the IOM Report. FAS Community Resource Center. http://www.come-over.to/FASCRC

FASD

The Prevalence of FAS and FASDThe Prevalence of FAS and FASD

Eustace LW 2003; Substance Abuse and Mental Health Services Administration; and the Centers for Disease Control and Prevention

FASD

• The prevalence of FAS is estimated to be about 1 in 500 to 1 in 1000 births

• The prevalence of FASD is estimated to be

nearly 1 in 100 births

How much is too much?How much is too much?

• The more alcohol consumed during pregnancy, the higher the risk for adverse effects– Binge drinking is particularly harmful!

• No amount of alcohol has been proven ‘safe’ to consume during pregnancy

• Every FASD is 100% preventable!

FASD

What is a Drink?What is a Drink?

A Binge is four or more drinks on one occasion for a woman; five or more for a man

A Drink is 12 ounces of beer, five ounces of wine, or 1.5 ounces of hard liquor

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FASD

The Effect of Alcohol onThe Effect of Alcohol on a Baby’s Development a Baby’s Development

• Alcohol freely crosses the placenta from the mother to the baby

• Blood alcohol levels of the baby are equal to that of the mother, within minutes of consumption

• The critical period is the entire pregnancy

FASD

The Effect of Alcohol onThe Effect of Alcohol on a Baby’s Development a Baby’s Development

Brain and nervous system

Heart

Limbs

Lips and palate

Ears

Eyes

Figure from http://www.fda.gov/cber/gdlns/rvrpreg_fig1.gif

Development of the brain is occurring throughout the pregnancy, which means that alcohol exposure

at any point may cause brain damage.

FASD

The Diagnosis of FASThe Diagnosis of FAS

Defined by four criteria:1. Exposure to alcohol while in the womb

2. Characteristic facial features

3. Growth problems

4. Involvement of the central nervous system (the brain)

FASD

FASD Facial Features: FASD Facial Features: Smooth Philtrum and Thin Upper LipSmooth Philtrum and Thin Upper Lip

Thin upper lipSmooth philtrum(little to no groove above upper lip)

NOTE: Although these features are associated with fetal alcohol syndrome, they may also be seen in people who do not have a FASD.

FASD

FAS Facial Features: FAS Facial Features: Short Palpebral Fissures (Eye Openings)Short Palpebral Fissures (Eye Openings)

Eyes are measured from the outer corner to the inner corner

FASD

The Effect of Alcohol The Effect of Alcohol on Growthon Growth

• Alcohol consumption increases the risk for having a baby with growth problems

• After birth, exposed children may continue to have a decreased growth rate and subsequent short stature

Day and Richardson, 2004, AJMG 127C:28-34. www.cdc.gov/growthcharts

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Alcohol Affects Alcohol Affects Overall Brain SizeOverall Brain Size

Photo by Sterling Clarren, MDhttp://www.come-over.to/FAS/FASbrain.htm

Brain of a healthy baby

Brain of a baby exposed to alcohol

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Alcohol Affects Brain StructureAlcohol Affects Brain StructureFASD

http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm

• Certain parts of the developing brain are highly susceptible to damage by exposure to alcohol

The Effect of Alcohol on the The Effect of Alcohol on the Corpus CallosumCorpus Callosum

• The corpus callosum is a transverse band of nerve fibers that connect the two hemispheres of the brain

• An underdevelopment of the corpus callosum is frequently reported in kids with a FASD

FASD

http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm

Spadoni AD, et al. 2007

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• Corpus callosum abnormalities have been linked to deficits in attention, intellectual functioning, verbal memory, and executive and psychosocial functioning

Normal Absent

The Effect of Alcohol on the The Effect of Alcohol on the Corpus CallosumCorpus Callosum

Spadoni AD, et al. 2007

The Effect of Alcohol on the The Effect of Alcohol on the HippocampusHippocampus

• The hippocampus, which plays a critical role in memory formation, may also be affected in individuals with a FASD

FASD

http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm

Spadoni AD, et al. 2007

The Effect of Alcohol on the The Effect of Alcohol on the CerebellumCerebellum

• The cerebellum, which is involved in motor abilities, balance, and sensory perception, may be smaller than average in affected individuals

FASD

http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm

Spadoni AD, et al. 2007

The Effect of Alcohol on the The Effect of Alcohol on the Basal GangliaBasal Ganglia

• The basal ganglia are a group of nerve cells (including the caudate and lenticular nucleus circled on the diagram) located deep inside the brain

• They are involved in movement and procedural learning

• The basal ganglia are smaller than expected in kids with a FASD

FASD

http://pubs.niaaa.nih.gov/publications/arh25-4/288-298.htm

Spadoni AD, et al. 2007

What is seen when the brain has What is seen when the brain has been affected by been affected by

exposure to alcohol?exposure to alcohol?

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Cognitive deficits or developmental discrepancies– Low IQ (including mental retardation) – Significant developmental delays– Specific learning disabilities (esp. with math and/or

visual spatial deficits)– Discrepancy between verbal and non-verbal skills– Slowed movements or reaction (slow information

processing)

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Executive functioning deficits– Poor organization, planning, or strategy use– Concrete thinking– Lack of inhibition– Difficulty grasping cause and effect– Inability to delay gratification– Difficulty following multi-step instructions– Poor judgment– Inability to apply knowledge to new situations

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Motor functioning delays or deficits– Delayed motor milestones– Difficulty with writing or drawing– Clumsiness – Balance problems– Tremors– Poor dexterity– Poor suck in infancy

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Attention and hyperactivity– Inattentive– Easily distracted– Difficulty calming down– Overly active– Difficulty completing tasks– Trouble with transitions– May have “on” and “off” days

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Social skills problems– Lack of stranger fear– Naiveté and gullibility– Easily taken advantage of– Inappropriate choice of friends, preferring younger

friends– Immaturity– Superficial interactions– Inappropriate sexual behaviors– Difficulty understanding the perspective of others

FASD

Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Central Nervous Systemand the Central Nervous System

• Other– Sensory problems– Pragmatic language problems (difficulty

reading facial expressions)– Memory deficits– Difficulty responding appropriately to common

parenting practices

FASD

FASNormal

Malbin D. 2002

To summarize, differences in brain function may appear as:– Taking longer to process information– Problems remembering things– Difficulties with generalizing, forming associations, and

understanding abstract concepts– Problems understanding consequences or cause-and-effect

A teenager with a FASD, who is 18 years old, may A teenager with a FASD, who is 18 years old, may function at the level of a child or adolescentfunction at the level of a child or adolescent

Emotional maturity

Comprehension

Social skills

Concepts of money and time

Living skills

Reading ability

Physical maturity

6 years

6 years

7 years

8 years

11 years

16 years

18 years

Skill Developmental Age Equivalent

Adapted from: www.efsmanitoba.com/html/Final%20Paper%20Defining%20Needs%20of%20women%20with%20FAS_E2.htm

Primary vs. Secondary Primary vs. Secondary DisabilitiesDisabilities

• Primary disabilities result from brain damage due to the alcohol exposure

• Secondary disabilities develop over time due to lack of intervention and unmet needs – They are believed to be preventable

FASD

Secondary Disabilities in FASDSecondary Disabilities in FASD

• Mental health issues• Disrupted school

experiences• Inappropriate sexual

behavior• Trouble with the law• Confinement in jail or

treatment facilities

• Alcohol and drug problems• Dependent living• Employment problems

http://come-over.to/FAS/

FASD

Secondary DisabilitiesSecondary Disabilities

www.fasdcenter.samhsa.gov; Streissguth AP, et al. 2004

The Long Term The Long Term Consequences of FASConsequences of FAS

• Only 3% of children lived with biological mother

• Poor behavior was common

• Average academic function was between 2nd and 4th grade

• Independent living was uncommon among adults with FAS

FASD

Streissguth et al. 1991

For More InformationFor More Information

• Fetal Alcohol Spectrum Disorders: Trying Differently Rather Than Harder, by Diane Malbin, MSW. Available at www.FASCETS.org.

• Fetal Alcohol Syndrome: A Parents Guide to Caring for a Child Diagnosed with FAS, by Leslie Evans, MS, et al. Available for download at http://otispregnancy.org/pdf/FAS_booklet.pdf

• Fetal Alcohol Syndrome, Fetal Alcohol Effects: Strategies for Professionals, by Diane Malbin, MSW. Hazelden Foundation, Center City, MN.

• Fetal Alcohol Syndrome: Practical Suggestions and Support for Families and Caregivers, by Kathleen Tavenner Mitchell, MHS, LCADC, and the National Organization on Fetal Alcohol Syndrome. Available at http://www.nofas.org/estore

FASD

ReferencesReferences

• Alan Guttmacher Institute. Facts on American teens’ sexual and reproductive health. www.guttmacher.org/pubs/fb_ATSRH.htm

• The Centers for Disease Control and Prevention. Fetal alcohol spectrum disorders. www.cdc.gov/ncbddd/fas/fasprev.htm

• Day NL and Richardson GA. 2004. An analysis of the effects of prenatal alcohol exposure on growth: A teratologic model. American Journal of Medical Genetics Part C. 127C:28-34.

• Eustace LW, et al. 2003. Fetal alcohol syndrome: A growing concern for healthcare professionals. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 32:215-221.

• The Institute of Medicine. 1996 Report on FAS. http://www.come-over-.to/FAS/ IOMsummary.htm• Lupton C, et al. 2004. Cost of fetal alcohol spectrum disorders. American Journal of Medical

Genetics Part C. 127C:242-50.• Mattson SN, et al. Teratogenic effects of alcohol on brain and behavior. National Institute on

Alcohol Abuse and Alcoholism. http://pubs.niaaa.nih.gov/publications/ arh25-3/185-191.htm• Spadoni AD, et al. 2007. Neuroimaging and fetal alcohol spectrum disorders. Neuroscience and

Biobehavioral Reviews 31:239-245.• Streissguth AP, et al. 1991. Fetal alcohol syndrome in adolescents and adults. Journal of the

American Medical Association. 265(15):1961-7. • Streissguth AP, et al. 2004. Risk factors for adverse life outcomes in fetal alcohol sydnrome and

fetal alcohol effects. Developmental and Behavioral Pediatrics 25(4):228-238.• Substance Abuse and Mental Health Services Administration Fact Sheets.

http://www.fasdcenter.samhsa.gov/grabGo/factSheets.cfm

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Helpful WebsitesHelpful Websites

• National Organization on Fetal Alcohol Syndrome- www.nofas.org

• Fetal Alcohol Syndrome, Education and Training Services, Inc.- www.fascets.org

• The FASD Center for Excellence, Substance Abuse and Mental Health Services Administration- www.fascenter.samhsa.gov

• FASlink- http://www.acbr.com/fas/• The Arc- http://www.thearc.org/fetalalcohol.html• The Centers for Disease Control and Prevention-

http://www.cdc.gov/ncbddd/fas/default.htm

FASD

Indiana ResourcesIndiana Resources

• The Fetal Alcohol Syndrome Center of Indiana - Indiana University Medial Center

975 West Walnut Street, IB 130Indianapolis, IN 46202Phone: 317-274-2450  Fax: 317-274-2387  Provides diagnosis, education and patient advocacy for those

affected with prenatal alcohol exposure.

• CNS - Center for Neurobehavioral Sciences3010 E. StateFt. Wayne, IN 46805Phone: 260-471-2300  Toll Free: 1-800-901-8416Provides therapy, education and patient advocacy for those

affected with prenatal alcohol exposure. Organizes a support group for parents and caregivers (and other interested parties) of those with a FASD.

FASD

Indiana ResourcesIndiana Resources

• Indiana Department of Health - IN Perinatal Network (IPN), Prenatal Substance Use Prevention Program (PSUPP)

2 N Meridian Street; Indianapolis, IN 46204Phone: 317-233-1269 Fax: 317-233-1300

Referrals and early intervention for substance-using pregnant

women. Training for professionals.

• Indiana Protection and Advocacy Services4701 N Keystone Avenue, Suite 222, Indianapolis, IN 46205 Phone: 800-622-4845 or 317-722-5555

       Fax: 317-722-5564Statewide agency for persons with developmental

disabilities.www.in.gov/ipas

FASD

www.health.state.mn.us/fas/catalog

Slides developed by: Lisa J. Spock, Ph.D., C.G.C.Gordon Mendenhall, Ed.D.

Assisted by: David D. Weaver, M.D.Becky Kennedy, M.Ed.James M. Ignaut, M.A., M.P.H., C.H.E.S.

Supported by: Indiana University School of MedicineIndiana State Department of HealthIndiana Department of EducationUniversity of Indianapolis