Working to Prevent Fetal Alcohol Spectrum Disorders Through High School and Middle School Curricula This presentation was designed for use in Middle School and High School Introductory Biology, Health, Family and Consumer Science Classes FASD Indiana FASD Prevention Taskforce

Fetal Alcohol Spectrum Disorders Why a person should NOT drink alcohol if she COULD get pregnant! FASD Indiana FASD Prevention Taskforce

Fetal Alcohol Spectrum 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 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. FASD

The 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? 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 = FASD

The Effect of Alcohol on 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 on a Baby’s Development Brain and nervous system Heart Limbs Lips and palate Ears Eyes Figure from 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 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: Smooth Philtrum and Thin Upper Lip Thin upper lip Smooth 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: Short Palpebral Fissures (Eye Openings) Eyes are measured from the outer corner to the inner corner FASD

The Effect of Alcohol on 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: FASD

Alcohol Affects Overall Brain Size Photo by Sterling Clarren, MD Brain of a healthy baby Brain of a baby exposed to alcohol FASD

Alcohol Affects Brain Function Developmental delays Learning difficulties Mental retardation Speech/language disorders Problems with memory, perception, and the senses FASD

FAS Normal Malbin D 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 function 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 7 years 8 years 11 years 16 years 18 years Skill Developmental Age Equivalent Adapted from:

Primary vs. Secondary Disabilities 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 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 FASD

Secondary Disabilities Streissguth AP, et al. 2004

The Long Term Consequences of FAS Only 3% of children lived with biological mother Poor behavior was common Average academic function was between 2 nd and 4 th grade Independent living was uncommon among adults with FAS FASD Streissguth et al. 1991

For More Information Fetal Alcohol Spectrum Disorders: Trying Differently Rather Than Harder, by Diane Malbin, MSW. Available at Fetal Alcohol Syndrome: A Parents Guide to Caring for a Child Diagnosed with FAS, by Leslie Evans, MS, et al. Available for download at 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 FASD

References Alan Guttmacher Institute. Facts on American teens’ sexual and reproductive health. The Centers for Disease Control and Prevention. Fetal alcohol spectrum disorders. Day NL and Richardson GA An analysis of the effects of prenatal alcohol exposure on growth: A teratologic model. American Journal of Medical Genetics Part C. 127C: Eustace LW, et al Fetal alcohol syndrome: A growing concern for healthcare professionals. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 32: The Institute of Medicine Report on FAS. IOMsummary.htm Lupton C, et al Cost of fetal alcohol spectrum disorders. American Journal of Medical Genetics Part C. 127C: Mattson SN, et al. Teratogenic effects of alcohol on brain and behavior. National Institute on Alcohol Abuse and Alcoholism. arh25-3/ htm Streissguth AP, et al Fetal alcohol syndrome in adolescents and adults. Journal of the American Medical Association. 265(15): Streissguth AP, et al Risk factors for adverse life outcomes in fetal alcohol sydnrome and fetal alcohol effects. Developmental and Behavioral Pediatrics 25(4): Substance Abuse and Mental Health Services Administration Fact Sheets. FASD

Helpful Websites National Organization on Fetal Alcohol Syndrome- Fetal Alcohol Syndrome, Education and Training Services, Inc.- The FASD Center for Excellence, Substance Abuse and Mental Health Services Administration- FASlink- The Arc- The Centers for Disease Control and Prevention- FASD

Indiana Resources The Fetal Alcohol Syndrome Center of Indiana - Indiana University Medial Center 975 West Walnut Street, IB 130 Indianapolis, IN Phone: Fax: Provides diagnosis, education and patient advocacy for those affected with prenatal alcohol exposure. CNS - Center for Neurobehavioral Sciences 3010 E. State Ft. Wayne, IN Phone: Toll Free: Provides 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 Resources Indiana Department of Health - IN Perinatal Network (IPN), Prenatal Substance Use Prevention Program (PSUPP) 2 N Meridian Street; Indianapolis, IN Phone: Fax: Referrals and early intervention for substance-using pregnant women. Training for professionals. Indiana Protection and Advocacy Services 4701 N Keystone Avenue, Suite 222, Indianapolis, IN Phone: or Fax: Statewide agency for persons with developmental disabilities. FASD

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 Medicine Indiana State Department of Health Indiana Department of Education University of Indianapolis