Fetal Alcohol Syndrome (FAS)

• Fetal Alcohol Syndrome is a condition caused by alcohol exposure during pregnancy

Triad Features

• Growth deficiency
• Facial anomalies
• Central Nervous System (CNS) deficiency.
• The correlation between maternal alcohol use and its effects on fetal development was not accepted until this triad was identified.

Alcohol Effects

• It affects emotion
• It affects behavior
• It affects development
• It affects adaptive functioning
• Cognitive skills are affected
• Learning capabilities are changed
• Impacts the structure of the body and brain

Leading Preventable Cause

• Intellectual disability
• Birth defects

Fetal Alcohol Spectrum Disorder (FASD)

• Encompasses a number of diagnostic categories
• Diagnoses can be classified using the Hoyme et al. (2005) system:
• FAS with confirmed maternal alcohol exposure includes two characteristic facial abnormalities, prenatal or postnatal growth deficiency, and evidence of CNS abnormalities.
• FAS without confirmation of maternal alcohol exposure includes all physical and neurodevelopmental characteristics of FAS with suspected prenatal exposure that cannot be confirmed.
• Partial fetal alcohol syndrome (pFAS) with confirmation of maternal alcohol exposure includes confirmed maternal alcohol use, two or more characteristic facial abnormalities, and either growth deficiency or CNS/neurodevelopmental abnormalities.
• Alcohol-related birth defects (ARBD) includes confirmed maternal alcohol use, congenital abnormalities in one or more organ systems, and at least two characteristic facial abnormalities.
• Alcohol-related neurodevelopmental disorder (ARND) includes confirmation of maternal alcohol exposure, evidence of CNS/neurodevelopmental abnormalities, and normal growth patterns with typical facial features.

Identification

• Identification often occurs during birth or infancy in severely impacted cases
• Cases are more frequently identified during preschool through school-age years
• Assessments can be accurately evaluated using standardized neuropsychological tests
• Assessments of:
• Cognition
• Speech and language
• Attention
• Fine and gross motor skills
• Behaviour

Prevalence

• It is a leading preventable cause of birth defects and intellectual disability
• Imposes a significant societal burden
• The estimated cost in 2002 was $2 million
• The estimation range $.5 - $4 million
• The cost doesn't include medical expenses, behavioural health services, criminal justice services or support for family

US Figures

• US cases range from .5-9.1 per 1,000 live births (2014)
• 2.4-4.8% reported in school settings in middle-class communities
• Rates are higher in communities where high alcohol consumption is societally accepted
• Figures are likely higher since FASD isn't always diagnosed or reported.

Maternal risk factors

• No known safe amount of alcohol use during pregnancy so when a mother drinks so does the infant
• The alcohol is quickly absorbed by the stomach, enters the bloodstream, and crosses the placenta.
• Alcohol concentrations in the fetus are similar to the mother's
• Fetus excretes alcohol through fetal urine and into the amniotic fluid.
• Alcohol is then reabsorbed
• Alcohol is toxic to cells, causing cell death, tissue damage, and interfering with cell growth.
• Fetal livers can't detoxify alcohol like adult livers.

Disorders that mimic FASD

• ADD/ADHD
• Conduct disorder
• Neuroimaging can help with diagnoses because FASD cognitive and behavioural difficulties are a result of alcohol-induced brain damage
• Methods include, but are not limited to:
• MRI
• fMRI
• DTI
• EEG
• MEG
• Greater volume reductions in the alcohol-exposed brain are more apparent in the corpus callosum, the caudate nucleus, and the cerebellum compared to other areas of the brain.
• ARND showed volume reductions in multiple regions (frontal, parietal, and temporal lobes)

Cognitive Behavioral Outcomes

• Elementary Function
• Includes basic sensory and cognitive processes like responses to orienting responses, unexpected noise or visual stimuli, or eyeblink conditioning
• Complex Functions
• Evaluated in clinical assessments like intellectual, attention, executive function, language and memory and learning
• Behavioural observations
• A broad range of behavioral problems

Interventions

• Stable, nurturing home

• Lack of multiple placements

• Quality parenting

• Early diagnosis (before age 6) and intervention positively impact outcomes in patients with disorder

• Interventions include:

• Parent Assisted Children's Friendship Training

• Language and Literacy Training

• Math Interactive Learning experience.

• Self-Regulation

• Novel therapies.

• Medications

• Working Memory Strategies.

• Avoiding exposure to violence, physical and sexual abuse, and neglect.

• FASD is 100% preventable

Fetal Alcohol Syndrome (FAS) arises from prenatal alcohol exposure, leading to growth deficiency, facial abnormalities, and CNS dysfunction. Alcohol impacts fetal emotion, behavior, development, cognition, and learning. FAS is a leading preventable cause of intellectual disability and birth defects, with FASD encompassing various diagnostic categories.