Teratogens

1
Teratogens

• Fetal Alcohol Syndrome
• Cocaine and Nicotine
• HIV/AIDS
• Revised 6.08
• Development of Young Children with
  Disabilities872.514 (61)Carol Ann Heath

2
Substance abuse is defined as

• A maladaptive pattern of using certain drugs,
  alcohol, medications, and toxins despite their
  adverse consequences.
• Barker, R.L. (1995). The social work dictionary,
  3rd edition (pp. 370). Washington, DC NASW
  Press.

3

• Research on fetal alcohol syndrome and on the
  developmental defects linked to pregnant women's
  use of marijuana and cocaine have focused
  attention on the problem of maternal substance
  abuse.

4

• Most cocaine users are "polydrug" users.
• Almost all of them smoke cigarettes, smoke
  marijuana occasionally, and use alcohol. Some use
  other drugs like heroin and methamphetamine.
• Alcohol and cigarettes are much more serious
  problems than cocaine in this country.

5

• Lack of accurate estimates
• Prenatal substance exposure has significant,
  negative effects on developing children and
  infants
• Drug-abusing women and their children are
  particularly hard to reach
• Social service and drug treatment systems either
  do not have the appropriate family orientation to
  serve this population or simply do not have the
  capacity to do so.

6
History of Fetal Alcohol Syndrome

• 1968 - 127 children born in France to alcoholic
  parents show multiple effects alcohol can have on
  developing fetus
• 1973 - Fetal Alcohol Syndrome defined
• 1979 - Diagnosis of FAS established by Research
  Society on Alcoholism
• 1981 - Surgeon General Recommended abstaining
  from alcohol

7

• There is no known safe amount of alcohol to drink
  while pregnant, and there does not appear to be a
  safe time to drink during pregnancy either.
• Centers for Disease Control

8
Basic Definitions

• Alcohol-related birth defects (ARBD)
• ARBD , a term coined by the Institute of Medicine
  in 1996, is used to describe individuals with
  confirmed maternal alcohol use and one or more
  congenital defects, including heart, bone,
  kidney, vision, or hearing abnormalities.
• Alcohol-related neurodevelopmental disorder
  (ARND)
• ARND , a term coined by the Institute of Medicine
  in 1996, is used to describe individuals with
  confirmed maternal alcohol use,
  neurodevelopmental abnormalities, and a complex
  pattern of behavioral or cognitive abnormalities
  inconsistent with developmental level and not
  explained by genetic background or environment.
  Problems may include learning disabilities,
  school performance deficits, inadequate impulse
  control, social perceptual problems, language
  dysfunction, abstraction difficulties,
  mathematics deficiencies, and judgment, memory,
  and attention problems.
• Attention-deficit/hyperactivity disorder (ADHD)
• The essential features of ADHD are a persistent
  pattern of inattention or hyperactivity/impulsivit
  y that is more frequently displayed and more
  severe than is typically observed in individuals
  at a comparable level of development. Children
  and adolescents with an FASD often meet the
  diagnostic criteria for ADHD. However, they may
  have co-occurring ADHD, or they may exhibit
  symptoms that look like ADHD but are due to other
  difficulties, including FASD.

9

• Fetal alcohol effects (FAE)
• FAE is a term used to describe individuals
  exposed prenatally to alcohol who have some, but
  not all, of the features of FAS. These features
  may include developmental delay, cognitive
  impairments, and/or behavioral abnormalities.
  These individuals often have similar patterns of
  behavior to those with FAS but lack the
  characteristic facial features of FAS. FAE is a
  descriptive term and is not meant to be used as a
  diagnostic term.
• Fetal alcohol spectrum disorders (FASD)
• FASD is an umbrella term describing the range of
  effects that can occur in an individual whose
  mother drank alcohol during pregnancy. These
  effects may include physical, mental, behavioral,
  and/or learning disabilities with possible
  lifelong implications. The term FASD is not
  intended for use as a clinical diagnosis.
• Fetal alcohol syndrome (FAS)
• FAS is the term coined in the United States in
  1973 by Dr. Kenneth Jones and Dr. David Smith at
  the University of Washington to describe
  individuals with documented prenatal exposure to
  alcohol and (1) prenatal and postnatal growth
  retardation, (2) characteristic facial features,
  and (3) central nervous system problems.

10
Fetal Alcohol Syndrome Defined

• 1. Pre/Postnatal growth deficiency
• Prenatal growth retardation (less than 10th
  percentile)
• Postnatal growth retardation (less than 10th
  percentile)

11
Fetal Alcohol Syndrome Defined

• 2. Central Nervous System Abnormalities
• Mental retardation Hypotonia
• Irritability in infancy Poor suck
• Hyperactivity Seizures
• Attention deficits
• Tremulousness

12
Fetal Alcohol Syndrome Defined

• 3. Craniofacial Abnormalities
• Microcephaly Short palpebral fissures
• Flat midface Indistinct philtrum
• Thin upper lip Epicanthal folds
• Low nasal bridge Minor ear anomalies
• Short Nose
• Micrognathia

13
Occasional Anomalies

• Cleft lip or palate
• Small teeth with faulty enamel
• Limited joint movements
• Cardiac
• Renogenital
• Skeletal

14
Spectrum of Abnormalities

• Physical anomalies and mental retardation
• Fetal Alcohol Effects (FAE)
• normal or typical appearance
• mild cognitive deficits
• behavior problems
• No overt signs or symptoms

15
Incidence

• 1 in 200 births for alcohol related defects
• 1-2 in 1000 for FAS
• 3-5 in 1000 for FAE
• 5-10 of women may drink at levels high enough to
  place fetus at risk
• Chronic alcoholics have a 30-40 chance of having
  a child with related effects
• 75 chance of second child affected
• Risk increases with age

16
Performance

• 80 Mental Retardation
• 50 Fine motor issues
• 80 Infant irritability, hyperactivity, attention
  deficits
• 50 Hypotonia, poor coordination
• Speech delay
• Cognitive, behavioral, psychosocial problems

17
Development

• Within first two years developmental delays
  become evident
• School age - fine motor impairments
• Adolescents - 2/3 will experience behavioral and
  emotional problems
• IQ - average for FAS is 67

18
FAS is now recognized as the leading known cause
of mental retardation in the United States
19
Intervention

• Early Intervention Program
• Speech therapy
• Physical therapy
• Special Education
• Occupational therapy
• Case manager
• Behavior management

20
Smoking

• The percentage of births to women who reported
  smoking during pregnancy dropped substantially
  during the 1990s, from 19.5 percent in 1989 to
  10.2 percent in 2004 (preliminary estimate).

21

• Smoking during pregnancy is associated with many
  adverse outcomes for children, such as premature
  birth, low birthweight, intrauterine growth
  retardation, stillbirth and infant mortality

22

• "The hyperkinetic syndrome is the result of
  several causes and the effect of any single agent
  is difficult to discern. Although the apparent
  association with heavy maternal smoking, in
  methylphenidate (Ritalin)-sensitive cases, does
  not predicate a causal connection, it does
  justify a careful assessment of the possible role
  of tobacco addiction in the etiology of this
  common disorder.
• R. Denson, M.D.,  J.L. Nanson, M.A.,   M. A.
  McWatters, R.N.University of Saskatchewan,
  Canada

23
Child Test Scores Lower When Mothers SmokeA
Study of 2nd and 5th Grade Students

• This study of a large sample of children gives
  insights into the real dangers of smoking during
  pregnancy. Known as the National Child
  Development Study, in Britain, there were over
  9,000 children measured to determine the effects
  of their mothers smoking either 0, 10, or more
  than 10 cigarettes per day during pregnancy. When
  each child reached 7 and 11 years, there were a
  number of tests given to evaluate math ability,
  reading ability and general physical
  measurements. Results showed children of mothers
  who smoked 10 or more cigarettes a day are on
  average 1.0 centimeters shorter and between three
  and five months behind in reading, mathematics,
  and general ability when compared to the
  offspring of non-smokers, after allowing for
  associated social and biological factors (see
  fig.1 2).

SOURCE British Medical Journal, 4573-575, 1973
24
Negative consequences for child health and
development.

• Infants whose mothers smoke during pregnancy are
  three times more likely to die from Sudden Infant
  Death Syndrome as are babies whose mothers do not
  smoke during pregnancy.

25

• Children born to mothers who smoked while
  pregnant, and possibly children whose
  grandmothers smoked while pregnant, have a higher
  risk of developing childhood asthma.
• In addition, maternal smoking during pregnancy is
  a risk factor for early childhood overweight.

26
Smoking and Ethnicity

• American Indian/Alaska Native women were the most
  likely to smoke during pregnancy, followed by
  non-Hispanic white women and non-Hispanic black
  women.
• In 2004, 18.2 percent of American Indian or
  Alaska Native births, 13.8 percent of
  non-Hispanic white births, and 8.4 percent of
  non-Hispanic black births were to women who
  smoked during pregnancy (based on preliminary
  estimates).
• Few Hispanic or Asian or Pacific Islander women
  smoked during pregnancy. In 2004, 2.2 percent of
  Asian or Pacific Islander births and 2.6 percent
  of Hispanic births were to women who smoked
  during pregnancy.

27
Smoking and Age

• Young women ages 15 to 24 were much more likely
  than older women to smoke during pregnancy.
• In 2003, the most recent year for which estimates
  are available, 15.4 percent of births to teens
  ages 15 to 19 and 16.1 percent of births to women
  ages 20 to 24 were to women who smoked during
  pregnancy, compared with less than 10 percent of
  births to women ages 25 and older.

28
Smoking and Education

• Among women ages 20 and older, those with a
  college degree were the least likely to smoke
  during pregnancy.
• In 2003, the most recent year for which estimates
  are available, less than two percent of births to
  college graduates were to women who smoked during
  pregnancy.
• In contrast, 25.5 percent of women with 9 to 11
  years of education smoked during pregnancy. Women
  with fewer than nine years of education were also
  relatively unlikely to smoke (6.2 percent).

29
Nicotine

• Increases risk of miscarriage
• Intrauterine growth retardation (LBW)
• Effect on fetus related to amount smoked
• Combined with caffeine or alcohol
• Newborn period - subtle neurobehavioral
  abnormalities
• Language and Cognitive deficits?

30
What is cocaine?

• Cocaine is an alkaloid which is derived from coca
  leaves, most of which are grown in South America
  . It is a stimulant drug affecting the central
  nervous system. It makes people feel "high" and
  full of energy. It is similar in its effect to
  methamphetamines.

31
What is "crack"?

• Crack is a processed form of cocaine which has
  been treated so that it can be absorbed into the
  bloodstream more rapidly.

32
Cocaine Use

• Leading Doctors, Scientists, and Researchers
  Request that Media and Policymakers Stop
  Perpetuating Meth Baby Myths

33
What is a "crack baby"?

• There is no such thing as a "crack baby".
• Term invented by the media to describe a baby
  whose mother used cocaine or crack during her
  pregnancy.
• Since both the prenatal exposure and the parents'
  life style are important, such children are
  usually called, "children of substance abusing
  parents.
• Emory Department of Psychiatry and Behavioral
  Sciences, F and Q, Cocaine in Pregnancy

34
Leading CESARFAXU n i v e r s i t y o f M a r y
l a n d , C o l l e g e P a r kA Weekly FAX from
the Center for Substance Abuse ResearchAugust 15,
2005Vol. 14, Issue 33

• Although research on the medical and
  developmental effects of prenatal methamphetamine
  exposure is still in its early stages, our
  experience with almost 20 years of research on
  the chemically related drug, cocaine, has not
  identified a recognizable condition, syndrome or
  disorder that should be termed crack baby nor
  found the degree of harm reported in the media
  and then used to justify numerous punitive
  legislative proposals.

35

• The terms ice babies and meth babies lack
  medical and scientific validity
• These labels harm the children to which they are
  applied, lowering expectations for their academic
  and life achievements, discouraging investigation
  into other causes for physical and social
  problems the child might encounter, and leading
  to policies that ignore factors, including
  poverty, that may play a much more significant
  role in their lives.

36

• No such thing as a meth-addicted baby.
• Addiction is defined as compulsive behavior that
  continues in spite of adverse consequences.
• Thus, by definition, babies cannot be addicted
  to methamphetamines or anything else.

37

• physiologic dependence (not addiction) has been
  documented among infants exposed in utero to
  opiates
• no dependence symptoms have been found following
  prenatal cocaine or methamphetamine exposure

38
Cocaine

• Increased risk for premature births, LBW, and
  neurobehavioral abnormalities
• Newborn withdrawal symptoms
• irritability tremors
• restlessness abnormal sleep pattern
• lethargy increased muscle tone
• poor feeding high pitched cry

39
Neurobehavioral Abnormalities

• Sleep state
• Feeding
• Attention
• Irritability
• Low threshold to overstimulation

40
Development

• LBW
• Abnormal muscle tone
• Learning disabilities
• Language delays
• Behavior problems
• Attention deficits
• May be at risk for HIV infection

41
What's the biggest risk for cocaine-exposed
children?

• Two things
• First, neglect and abuse by addicted parents who
  are not able to care for them properly
• Second, labeling by public and professionals who
  confuse the effects of poor caregiving with the
  effects of prenatal exposure.

42
Intervention

• Early Intervention program
• Physical therapy
• Speech therapy
• Special Education
• Behavior management

43
HIV/AIDS
44
History

• Acquired immunodeficiency syndrome (AIDS) first
  described in early 1980s.
• Increasing rates among women and their newborns
• 4th leading cause of death among women 25-44
• Associated with developmental delay in children

45
HIV in Children

• First case reported in 1982
• By 1993, 15,000 children identified born with the
  HIV infection.
• Approximately 7,000 children born in the U.S. are
  at risk for developing HIV.
• 1,000 new cases reported each year of AIDS in
  children under 13.

46
Development

• Near normal development until late in course of
  illness.
• Two patterns of neurodevelopmental outcome
  - 1.
  Progressive encephalopathy
• affects 10-20 of infected infants
• onset of symptoms between 6 and 24 months
• infant will lose developmental milestones
• death within 1-2 years

47
Development Continued

• 2. Period of deterioration followed by a
  plateau of skills.
• HIV infection causes subtle effects on cognitive
  development
• Learning disabilities
• ADHD
• Speech delays (expressive language)

48
Intervention

• Speech therapy
• Physical therapy
• Special education
• Psychological testing
• Behavior management

49
Other factors to consider

• Other biological factors
• drug exposure LBW
• prematurity Failure to Thrive
• Long term hospitalizations
• Family environment
• Neglect

50
Intervention

• Early intervention program
• Physical therapy
• Occupational therapy
• Speech therapy
• Special education
• Psychological evaluations
• Developmental evaluations

51
Educational Implications

• Developmental and environmental issues
• At-risk
• Emotional issues
• Early intervention

52
Resources Used

• The Effects of Substance Abuse on the Development
  of Children Educational Implications
• Author Colleen Meade
• Originally Posted At http//www.teach-nology.com
  /Articles/teaching/abuse/
• Barker, R.L. (1995). The social work dictionary,
  3rd edition (pp. 370). Washington, DC NASW
  Press.
• http//www.fasdcenter.samhsa.gov/educationTraining
  /courses/FASDTheCourse/misc/glossary.cfm