1. Fetal Alcohol Spectrum Disorder: A Preventable Epidemic Barry S Parsonson PhD Explore & Applied Psychology International

2. FASD: Causes FASD is caused by maternal consumption of alcohol during pregnancy; Alcohol affects developing neural and physical systems differentially according to timing in relation to fetal development stage, amounts consumed and duration of exposure; The minimum amount causing some effect is currently not known, hence advice against all alcohol consumption when pregnant; FASD is thus entirely preventable!

3. FASD Diagnosis There are four internationally agreed classes of FASD based on assessment of severity using a 4-digit code relating to FAS characteristics; FAS, PFAS, ARND, & ARBD: In each case, confirmed evidence of maternal prenatal alcohol misuse is required; DSM-V does not include FASD as a diagnosis although it is described and identified as a “Condition for further study”!

4. FASD Diagnosis 1-FAS Fetal Alcohol Syndrome (FAS) is the most severe form. It includes: Facial Anomalies (small eye slits, thin upper lip, smooth philtrum) and Microcephaly; Growth Deficiency (height or weight <10%ile) CNS Damage with evidence of structural and/or functional brain abnormality; Confirmed Prenatal Alcohol Exposure (needed if cluster of facial anomalies not present).

5. Facial Anomalies of FAS

6. FASD Diagnosis 2-PFAS Partial Fetal Alcohol Syndrome (PFAS) is characterised by: Growth Deficiency (height or weight <10%ile) CNS Damage with evidence of structural and/or functional brain abnormality; Confirmed Prenatal Alcohol Exposure (Reliable evidence of maternal alcohol misuse).

7. FASD Diagnosis 3- ARND Alcohol Related Neurodevelopmental Disorder (ARND) is characterised by: CNS Damage: Evidence of structural or functional brain abnormality; Confirmed Prenatal Alcohol Exposure (Reliable evidence of maternal alcohol misuse).

8. FASD Diagnosis 4-ARBD Alcohol Related Birth Defects (ARBD) is classified by: Physical Defects: Heart, Kidney or other anomalies present at Birth; Confirmed Prenatal Alcohol Exposure: Reliable evidence of maternal Alcohol Misuse.

9. FASD Prevalence A Base Rate of 1% of the School Age population is estimated from a number of US, Canadian and European Studies; Some communities have rates of up to 8.5%; Preliminary NZ data lead to guesstimates of at least 3000 school-age children with FASD; Accurate data are difficult to obtain and probably underestimate the true situation. FASD is now the most common cause of ID.

10. Post-Natal FASD Effects on Cognition & Learning Executive functioning (Planning, attention) Memory (encoding, rote, working & spatial) Reasoning (verbal, abstract, numerical) Language (learning, comprehension, meaning) Sensorimotor (visual/motor integration, visual-spatial processing) Attention (short span, distractible, often ADHD labelled)

11. Distribution of IQ Scores

12. FASD Effects on Communication & Sensory Functioning Delayed Language Development Impaired receptive & expressive language Difficulties in language production & comprehension affect learning Poor social communication affects relationship building Hearing disorders found common in a small FAS clinic sample

13. FASD Behavioural Effects Physical Aggression Lying and Confabulation Impulsiveness and hyperactivity Cheating, stealing, bullying & animal cruelty Lack of remorse Emotional lability Substance abuse & self-harming

14. FASD Lifespan Effects Collectively, these Cognitive, Learning, Social, Communication and Behavioural deficits have lifetime effects. Data from samples indicate: Family life (85% of children in foster care FASD) Educational achievement (60% excluded) Mental Health (87% 5-13 y.o.; 23% adults suicide) Criminality (60% of FASD teens, many Prisoners) Relationship and Employment difficulties are common.

15. Discussion Questions How do we, as a profession, intervene by way of increasing awareness and promoting prevention? Education? Who, when, how? Increase Political and Public awareness? What strategies might work? What about the “Binge Drinking” Culture – Does it contribute? If so, how to change that? What can we offer to those on the FASD spectrum? In Schools, Prisons, the Community?