Alcohol Can Hurt an Unborn Baby

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Alcohol Can Hurt an Unborn Baby

• Fetal Alcohol Spectrum
• Disorders (FASD)
• Education Prevention

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• Of all the substances of abuse (including
  cocaine, heroin, and marijuana), alcohol produces
  by far the most serious neurobehavioral effects
  in the fetus.
• IOM Report to Congress 1996

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Fetal Alcohol Spectrum Disorders

• FASD in an umbrella term describing the range
  of effects that can occur in an individual whose
  mother drank alcohol during pregnancy.

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Terminology
Pregnancy
Alcohol

• Fetal Alcohol Syndrome (FAS)
• Fetal Alcohol Effects (FAE)
• Alcohol-Related Birth Defects (ARBD)
• Alcohol-Related Neurodevelopmental Disorder
  (ARND)
• Partial FAS (pFAS)

May result in
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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 fathers alcohol use
• Not a new disorder

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FASD

• These effects may include
• Physical
• Mental
• Behavioral
• And/or learning disabilities with possible
  lifelong implications

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The sole cause of FASD is women drinking
alcoholic beverages during pregnancy!
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Alcohol and Women

• If a woman is pregnant, it does not matter
  what form the alcohol comes in.
• Wine spritzers
• Alcohol pops
• Beer
• Wine coolers
• Light beer, nonalcoholic beer
• Energy Drinks

Check labels for alcohol content.
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FASD and Alcohol

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

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• Alcohol is by far the most commonly abused
  substance by female adolescents with 36.5 of
  girls ages 12-17 reporting alcohol use.
• Approximately 20 of sexually active teenage
  girls ages 15-19 become pregnant each year in the
  U.S.
• In 2004, the rate of binge drinking in the past
  month among pregnant women ages 15 to 17 was
  (8.8) more than twice that of pregnant women
  ages 26 to 44 (3.8).
• U.S. Department of Health and Human Services
• Substance Abuse and Mental Health Services
  Administration
• 2007

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2005 Message to Women from the U.S. Surgeon
General

• No amount of alcohol consumption can be
  considered safe during pregnancy.
• Alcohol can damage a fetus at any stage of
  pregnancy.
• The cognitive deficits and behavioral problems
  resulting from prenatal alcohol exposure are
  lifelong.
• Alcohol-related birth defects are completely
  preventable.

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• The sooner a pregnant woman stops drinking
  alcohol, the better the outcome for the baby.

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Extent of Exposure
All newborns in the U.S.
All exposed newborns
5 Other
5 Cocaine
17 Marijuana
73 Alcohol
Source National Institute on Drug Abuse, 1991
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On any given day in the United States

• 10,657 babies are born
• 1 baby will be born HIV positive
• 3 babies will be born with Muscular Dystrophy
• 4 babies will be born with Spina Bifida
• 10 babies will be born with Down Syndrome
• 20 babies will be born with FAS
• 100 babies will be born with Alcohol Related
  Neurodevelopmental

• Disorder

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The Cost of Fetal AlcoholSyndrome (FAS)

• Costs associated with caring for persons with FAS
  in the United States may be as high as
• 6 billion.
• The lifetime cost for each individual with FAS is
  2 million or more, depending on how the costs
  are calculated.
• One prevented case of FAS can save 2 million or
  more.

Source Lupton, et al., 2004
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Economic Costs of FAS

• One prevented case of FAS saves
• 130,000 in the first 5
  years
• 360,000 in 10 years
• 587,000 in 15 years
• More than 1 million in 30 years

Increased savings through prevention
Lupton, Burd, and Harwood (2004)
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People who have brain damage as well as
characteristic facial features and slowed growth
are described as having Fetal Alcohol Syndrome
(FAS)
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Diagnosing Fetal Alcohol Syndrome

• Prenatal maternal alcohol
• use
• Growth deficiency
• Central nervous system
• abnormalities
• Dysmorphic features
• Short palpebral fissures
• Indistinct philtrum
• Thin upper lip

Source Astley, S.J. 2004. Diagnostic Guide for
Fetal Alcohol Spectrum Disorders The 4-Digit
Diagnostic Code, Third Edition. Seattle
University of Washington Publication Services, p.
114.
Caucasian
African American
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8 Months Old
Newborn
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8 Years Old
7 Years Old
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5 Years Old
18 Years Old
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8 Years Old
18 Years Old
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20 Years Old
30 Years Old
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For Diagnosis in Utah

• Division of Medical Genetics
• University of Utah
• Department of Pediatrics
• 801-581-8943

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Early diagnosis can help prevent secondary
disabilities such as mental health problems,
dropping out of school, trouble with the law and
substance abuse.Fetal Alcohol Syndrome
Diagnostic Prevention Network
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Potential Secondary Disabilities

• Mental health problems
  90
• Disrupted school experience 60
• Trouble with the law
  60
• Inappropriate sexual behavior 50
• Alcohol and drug problems 30
• Dependent living
  83
• Problems with employment 79
• 
  Streissguth

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Alcohol Interferes With Brain Growth and
Development

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Thought Process with FASD

• Prenatal alcohol exposure can effect the
  neurochemical balance (or wiring) of the brain,
  so that messages are not transmitted as
  efficiently or as accurately as they should be.

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Organic Brain Damage

• Several regions of the brain are seriously
  affected by prenatal alcohol exposure in terms of
  ability to function.

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Organic Brain Damage

• Cortex Frontal Lobes----The most noteworthy
  damage to the brain occurs in the prefrontal
  cortex, which controls the Executive Functions.
• Executive Functions control thinking,
  reasoning, planning, emotions, problem solving,
  speech, impulses and judgment.
• Alcohol Health Research World- 1994 Vol. 18T

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Typical Difficulties for Persons With an FASD
Executive Function Deficits

• 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

Im late! Im late!
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Organic Brain Damage

• Corpus Callosum ---
• Connects the hemispheres for the brain and
  allows information to be transmitted between
  them.
• It allows both hemispheres to know what happens
  on both sides of the body.

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Left Brain/Right BrainThe Corpus Callosum
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Effects of Alcohol on the Brain
A B C

• Magnetic resonance imaging showing the side view
  of a 14-year-old control subject with a normal
  corpus callosum
• 12-year-old with FAS and a thin corpus callosum
• 14-year-old with FAS and agenesis (absence due to
  abnormal development) of the corpus callosum

Source Mattson, et al., 1994
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FAS and the Brain

A
These two images are of the brain of a 9-year-old
girl with FAS. She has agenesis of the corpus
callosum, and the large dark area in the back of
her brain above the cerebellum is essentially
empty space.
Source Mattson, S.N. Jernigan, T.L. and Riley,
E.P. 1994. MRI and prenatal alcohol exposure
Images provide insight into FAS. Alcohol Health
Research World 18(1)4952.
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Organic Brain Damage

• Hippocampus ----- Memory, short term to long term
  recall, spatial relationships
• Cerebellum ----- Balance, coordination, posture
• Basil ganglia --- Controls unwanted movement to
  allow wanted movement

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Overall Difficulties for Persons With an FASD

• Taking in information
• Storing information
• Recalling information when necessary
• Using information appropriately in a
  specific situation

Information
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Difficulty Generalizing Information

• The Student May
• . Learn information as isolated entities,
  unrelated, fragmented
• . Be extremely concrete
• . Not transfer learned information into new
  contexts
• . Need re-teaching in a different location
  to understand general rule, i.e. Dont ride in
  all streets

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Primary Disabilities of Persons With an FASD

• Lower IQ
• Impaired ability in reading,
  spelling, and math
• Lower level of adaptive functioning more
  significantly impaired than IQ

Permission to use photo on file.
Streissguth, et al. (1996)
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TIMELINES AND FASD

• Actual age 18 Developmental Age
• Expressive Language------------------------20
• Comprehension---------6
• Money, time concepts------8
• Emotional maturity-----6
• Physical Maturity---------------------------18
• Social Skills------------------7
• Living Skills------------------------11
• (D. Malbin) Research of Streissguth,
  Clarren et al.

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Typical Difficulties for Persons With a FASD

• Information Processing Problems
• Say they understand when
  they do not
• Have verbal expressive skills that often exceed
  their level of understanding
• Misinterpret others words, actions, or body
  movements
• Have trouble following multiple directions

YES! (How do you straighten up? Make sure the
bed/chair is straight?)
Straighten up your room and put your toys away.
Do you understand?
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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

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Difficulty translating information from one
modality into appropriate behavior

• Hearing into action
• Seeing into writing
• Thinking into speaking, action
• Speaking into behavior ----Talking the talk
• vs. walking the walk

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FASD Skills Talking the talk vs. Walking the
walk
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FASD SkillsTalking the talk vs. walking the
walk
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Psychosocial Deficits Problem Behaviors

• Adaptive problems
• Disruptive
• Delinquent
• Poor socialization
• Poor communication
• Poor consistency
• Poor compliance

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FASD in Adolescents and Adults Implications

• Poor judgment ---------------------------- Easily
  Victimized
• Attention deficits---------------------------Unfoc
  used, distractible
• Arithmetic disability-----------------------Cant
  handle
• Memory problems-------------------------Doesnt
  learn from
• 
  experience
• Difficulty abstracting/generalizing-----Doesnt
  understand
• consequences,
  fails to think ahead, plan
• Disoriented in time and space--------- Fails to
  perceive
• 
  social cues
  
• Poor frustration tolerance---------------Quick to
  anger

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• Fetal Alcohol Spectrum Disorders is Not an
  Excuse
• It is a Reason!

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Prevention Is the Only Solution!

• We have never met a woman who drank through her
  pregnancy to hurt her baby.
• I dont think she exists.

-Clarren, S. 2002
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Mothers Profile

• Studies of maternal alcohol consumption
  consistently report that women who have one
  child, and continue to drink, have progressively
  more severely fetal alcohol affected children
  with subsequent pregnancies.
• -May, Hymbaugh, Aase, Samet

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Successful Interventions for Students with FASD
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Eight Magic Keys

• Concrete
• Consistency
• Repetition
• Routine
• Simplicity
• Specific
• Structure
• Supervision

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Closing Thought

• Just knowing a person has this disability and
  trying different interventions can make a big
  difference
• REMEMBER THE STARFISH STORY

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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.

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Contact Information

• Pat Smith
• Weber Human Services
• 801-625-3792
• pats_at_weberhs.org
• Utah Fetal Alcohol Coalition
• www.utahfetalalcohol.org