Alcohol Can Hurt an Unborn Baby Fetal Alcohol Spectrum Disorders (FASD) Education & Prevention

“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

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.

Terminology Pregnancy + Alcohol May result in Fetal Alcohol Syndrome (FAS) Fetal Alcohol Effects (FAE) Alcohol-Related Birth Defects (ARBD) Alcohol-Related Neurodevelopmental Disorder (ARND) Partial FAS (pFAS)

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 father’s alcohol use Not a new disorder

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

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

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.

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

 Alcohol is by far the most commonly abused substance by female adolescents with 36.5% of girls ages reporting alcohol use.  Approximately 20% of sexually active teenage girls ages 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

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.

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

Extent of Exposure All newborns in the U.S. All exposed newborns 19% Substance Exposed 81% Not Exposed 73% Alcohol 17% Marijuana 5% Cocaine 5% Other Source: National Institute on Drug Abuse, 1991

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

The Cost of Fetal Alcohol Syndrome (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

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 Lupton, Burd, and Harwood (2004) Increased savings through prevention

People who have brain damage as well as characteristic facial features and slowed growth are described as having Fetal Alcohol Syndrome (FAS)

Diagnosing Fetal Alcohol Syndrome Prenatal maternal alcohol use Growth deficiency Central nervous system abnormalities Dysmorphic features Short palpebral fissures Indistinct philtrum Thin upper lip CaucasianAfrican American Source: Astley, S.J Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code, Third Edition. Seattle: University of Washington Publication Services, p. 114.

Newborn 8 Months Old

7 Years Old 8 Years Old

5 Years Old18 Years Old

8 Years Old18 Years Old

20 Years Old30 Years Old

For Diagnosis in Utah Division of Medical Genetics University of Utah Department of Pediatrics

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

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

Alcohol Interferes With Brain Growth and Development

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.

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

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 Vol. 18T

Typical Difficulties for Persons With an FASD 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 I’m late! Executive Function Deficits

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.

Left Brain/Right Brain The Corpus Callosum Left Brain Language Math Logic Right Brain Spatial abilities Face recognition Visual imagery Music

Effects of Alcohol on the Brain A B C A.Magnetic resonance imaging showing the side view of a 14-year-old control subject with a normal corpus callosum B.12-year-old with FAS and a thin corpus callosum C.14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum Source: Mattson, et al., 1994

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 MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

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

Overall Difficulties for Persons With an FASD Taking in information Storing information Recalling information when necessary Using information appropriately in a specific situation 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. “Don’t ride in all streets” Difficulty Generalizing Information

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

TIMELINES AND FASD Actual age: 18 Developmental Age Expressive Language Comprehension Money, time concepts Emotional maturity Physical Maturity Social Skills Living Skills (D. Malbin) Research of Streissguth, Clarren et al.

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?

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

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

FASD & Skills Talking the talk vs. Walking the walk Knows what to do in emergency Recognize the emergency Knows how to use the telephone Does not make unauthorized calls Can recite the rulesCan follow the rules when necessary Knows to listen to police, guards Responds appropriately to police when confronted

FASD & Skills Talking the talk vs. walking the walk Knows not to talk to strangers Can identify who is a stranger Knows the skills of a jobCan perform the job skills when needed Knows right from wrongCan avoid situations where they may end up in trouble Knows safe sex techniques Can negotiate safe sex at the time of having sex

Psychosocial Deficits & Problem Behaviors Adaptive problems Disruptive Delinquent Poor socialization Poor communication Poor consistency Poor compliance

FASD in Adolescents and Adults: Implications Poor judgment Easily Victimized Attention deficits Unfocused, distractible Arithmetic disability Can’t handle $$ Memory problems Doesn’t learn from experience Difficulty abstracting/generalizing-----Doesn’t understand consequences, fails to think ahead, plan Disoriented in time and space Fails to perceive social cues Poor frustration tolerance Quick to anger

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

Prevention Is the Only Solution! We have never met a woman who drank through her pregnancy to hurt her baby. I don’t think she exists. -Clarren, S. 2002

Mother’s 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

Successful Interventions for Students with FASD

Eight Magic Keys 1.Concrete 2.Consistency 3.Repetition 4.Routine 5.Simplicity 6.Specific 7.Structure 8.Supervision

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

Resources SAMHSA FASD Center for Excellence: fasdcenter.samhsa.gov fasdcenter.samhsa.gov Centers for Disease Control and Prevention FAS Prevention Team: National Institute on Alcohol Abuse and Alcoholism (NIAAA): National Organization on Fetal Alcohol Syndrome (NOFAS): National Clearinghouse for Alcohol and Drug Information: ncadi.samhsa.govncadi.samhsa.gov These sites link to many other Web sites.

Contact Information Pat Smith Weber Human Services Utah Fetal Alcohol Coalition