Prenatal Toxin Exposure and Fetal Alcohol Syndrome

Prenatal Toxins

• These are substances the developing fetus is exposed to, leading to birth defects.
• Teratogens are substances negatively affecting fetal development.
• Drugs, radiation, infections, and chemicals like pesticides are all prenatal toxins.

Fetal Alcohol Syndrome (FAS)

• Alcohol is the most common prenatal toxin and the leading cause of birth defects.
• Alcohol consumption during pregnancy impairs fetal brain development.
• Brain development impairment can cause reduced brain size and agenesis of the corpus callosum.
• Children with FAS often experience prenatal and postnatal growth deficiencies.
• Other symptoms include craniofacial malformations and heart defects.
• Musculoskeletal problems include congenital dislocations, flexion contractures at the elbow, low muscle tone, fine and gross motor dysfunction, and cervical spine abnormalities.
• CNS-related symptoms: hyperactivity, poor attention, behavior issues, intellectual disability, learning problems, and sensory integrative/processing problems.
• Executive function problems, like memory, sequencing, and judgment, become apparent as they age.
• The severity of fetal problems depends on the amount and timing of alcohol consumed during pregnancy.
• A milder form is known as alcohol-related neurodevelopmental disorder.

Neonatal Abstinence Syndrome (NAS)

• NAS includes behavioral and physiological effects on infants exposed to drugs.
• Prenatal NAS is caused by the mother's discontinuation of drugs during pregnancy.
• Postnatal NAS results from discontinuing medications given directly to the infant for pain.
• Medically treating newborns with prenatal NAS is difficult, as mothers might use various unreported drugs, often coupled with alcohol, poor prenatal care, and nutrition.
• Drugs such as narcotics, cocaine, marijuana, methamphetamines, and tobacco cross the placenta, leading to addicted infants who must undergo withdrawal.
• Long-term exposure effects depend on the drug type and quantity, exposure duration, and the mother's drug metabolism.
• In addition to addiction, affected babies are at risk for prematurity, low birth weight, brain damage, microcephaly, limb abnormalities, gastro-urinary abnormalities, heart defects, breathing difficulties, and early death.
• Parenting these infants is challenging due to their irritability, hypertonia, feeding problems, high activity levels, and difficulty calming down during withdrawal.
• As they age, these children may exhibit intellectual disabilities and learning deficits.

Role of Occupational Therapy (OT)

• OT focuses on addressing CNS deficits and musculoskeletal problems.
• These deficits impact self-care skills, school activities, and play, all addressed in OT.

OT Treatment Interventions

• Sensory strategies and diet based on Sensory Integration Theory can help calm or arouse the child as needed, aiding behavior organization.
• Motor coordination activities improve fine and gross motor skills, using playground equipment, visual motor tasks (bubbles, catching, throwing), and bilateral coordination activities.
• Visual skills are enhanced through puzzles, hidden objects, mazes, and integrating writing, tracing, and cutting into playful activities.
• Self-care skills, such as donning clothes, buttoning, and tying shoes, are addressed depending on the child's age.

Trauma-Related and Stressor-Related Disorders

• Includes Reactive Attachment Disorder, Posttraumatic Stress Disorder, and Adjustment Disorder.
• Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster, characterized by initial shock and denial, followed by unpredictable emotions, flashbacks, strained relationships, and physical symptoms.
• Trauma occurs when an experience overwhelms our capacity to cope, leading to difficulties in successful participation due to fear and/or anxiety
• Everyone experiences trauma differently, and factors contribute to the development of a disorder.

Temperament

• Personality develops through nature (genetics) and nurture (environmental influences).
• Temperament is the genetic predisposition in personality, influencing behavioral style, reactivity, and self-regulation.

Nine Characteristics of Temperament

• Sensory Threshold: stimulation level needed to evoke a response.
• Activity Level: general motor activity during wakefulness and sleep.
• Intensity: expressiveness of emotions.
• Rhythmicity: predictability of bodily functions.
• Adaptability: ease of adjusting to change/transition.
• Mood: basic disposition.
• Approach/Withdrawal: reaction to new places/situations.
• Persistence: ability to handle obstacles.
• Distractibility: ease of being distracted.

Temperament Patterns

• Easy: adaptable, positive mood, moderate activity/intensity, interested in new things.
• Difficult: negative mood, intense, low adaptability.
• Slow to warm up: doesn't adapt well to change, withdraws in new settings, shy but adapts over time.

Temperament Assessment

• Temperament is assessed through observation, parent interviews, and behavioral checklists.
• Understanding temperament can help defuse negative emotions and adapt the environment.
• OT addresses children with disabilities and developmental delays, which can result in exaggerated temperament traits.
• Occupational therapy helps with emotional regulation, addressing influences like parents, siblings, teachers, toys, TV, home, neighborhood, friends, and school.
• Matching and encouraging the child enhances OT interventions.

Attachment

• Attachment plays an early role in social-emotional development.
• Attachment is the emotional bond formed between an infant and parent in the first year.
• An infant's emotional tie to a caregiver promotes survival.
• The infant's relationship with caregiver begins as innate signals to meet primary needs.
• This bond becomes the foundation for social, emotional, and cognitive development.
• The attachment system provides the infant's first coping mechanism and a comforting mental presence.
• It allows the infant to separate from the caregiver without distress and begin exploring the world.
• Attachment is the base for a child’s ability to survive independently.

Age of Development for Attachment

• 0 to 3 months: Indiscriminate.
• 3 to 6 months: Prefers familiar caregiver.
• 6 months plus: Separation anxiety.
• 3 years: Flexible, understands when parents will return.

Attachment Styles

• Secure attachment: Parent is a secure base; the child actively seeks contact upon return.
• Avoidant attachment: The child is not too attached initially and is slow to greet the the parent when they return..
• Resistant attachment: The child is distressed when the parent returns, and both clings to and is angry and difficult to comfort.
• Disorganized/disoriented attachment: Reflects significant insecurity; the child is depressed and displays contradictory behaviors.

Attachment Disorder

• The child avoids eye contact and doesn't smile.
• The child doesn't reach out to be picked up
• The child rejects attempts to be calmed, soothed and connected to.
• The child doe not seem to care that they are left alone
• The child cries inconsolably.
• The child doesn't cooor make sounds
• The child doesn't follow with their eyes
• The child is uninterested int interactive games or toys
• The child spends time rocking or comforting themselves
• The child fails to gain weight
• The child doesn't seek comfort or assistance
• The child dislikes being comforted
• The child is detached
• The child displays defiant behavior
• The child show social hesitancy
• The child likes to be with strangers over family

Attachment Disorder Causes

• Attachment disorders result from negative early relationship experiences.
• Repeated abandonment, isolation, powerlessness, or lack of care make children unable to depend on others.
• Associated risk factors include child maltreatment, institutional care, caregiver changes, and prolonged separation.

Reactive Attachment Disorder

• Attachment is markedly delayed and the child seldom interacts with the caregiver or other people.
• Signs include an aversion to touch, control issues, anger problems, and an undeveloped conscience.

Disinhibited Social Engagement Disorder (DSED)

• Diagnosed after 9 months when an infant is expected to have formed selective attachment.
• The child is overly friendly to strangers, does not reference their caregiver, and goes off with unknown people.
• Signs include a lack of inhibition and difficulty showing genuine care and affection.

Child Maltreatment/Abuse

• Causes include neglect, maltreatment.
• Neglect occurs families when parents use / abuse drugs or alcohol.
• Also present in parents with mental health problems.
• Estimated 3 million cases of abuse in 2004.

Different Types of Child Abuse

• Neglect involves withholding nutrition, shelter, clothing, medical care, or supervision and is the most common type.
• Physical abuse involves physical punishment causing injury, such as shaking, punching, kicking, throwing, biting, or burning.
• Shaken baby syndrome is a severe condition that is often fatal.
• Emotional abuse includes withholding affection, criticism, chronic humiliation, or threats of harm.
• Sexual abuse involves using a child for sexual gratification.

Behavior of Abused Children

• Children exhibit apathy and appear depressed.
• Children also actively appear demanding and aggressive towards others
• Children display anxiety and are fearful, immature, and needy.
• Often experience problems with schoolwork and establishing appropriate social relationships due to abuse.
• OT practitioners must report abuse/neglect to Child Protective Services, with failure to report leading to penalties.