1. www.faseout.ca 2008 Alcohol Use and Pregnancy and Fetal Alcohol Spectrum Disorder

2. www.faseout.ca 2008 Alcohol is a Teratogen A teratogen is a substance that interferes with the normal development of the fetus Specifically, alcohol is a neurobehavioural teratogen – alcohol can damage the brain and change behaviour

3. www.faseout.ca 2008 Teratology: Four Outcomes to Exposure Malformations (facial, heart, skeletal) Growth Deficiency (small) Functional Deficits (learning and behavioural problems) Death (stillbirth, miscarriage)

4. www.faseout.ca 2008 Effects of Alcohol in Pregnancy Alcohol freely crosses the placenta Adverse effects to the fetus occur at levels at or below those that are toxic to women Fetal elimination of alcohol is poor Increased risk for low birth weight Harm can be caused before a woman knows she is pregnant

5. www.faseout.ca 2008 First Trimester First Month: heart, lungs, limbs, face, ears, eyes, spinal cord, and brain begin to form Second Month: toes and eyelids form and brain grows quickly and directs body’s movements Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work

6. www.faseout.ca 2008 Second Trimester Fourth Month: The placenta is fully formed and fetal movement may be felt by woman Fifth Month: Eyelashes, eyebrows and scalp and hair appear. Fetal heartbeat can be heard Sixth Month: Eyes open and close. Lungs, brain and other organs continue to develop

7. www.faseout.ca 2008 Third Trimester In the third trimester, the fetus grows quickly in weight and length Lungs and other major organs mature to support life The brain continues to grow and develop and remains vulnerable to the damage that alcohol can cause

8. www.faseout.ca 2008

9. Drinking in Perspective In general women: may drink alcohol before they realize they’re pregnant may not know alcohol is harmful to the developing fetus may drink because it is the social/cultural norm may drink to self-medicate

10. www.faseout.ca 2008 No one can predict which infants born to mothers who drink will be affected, nor can anyone predict how severe these effects will be.

11. www.faseout.ca 2008 Factors Involved in FASD The stage in the pregnancy at which alcohol is consumed The amount of alcohol consumed during the pregnancy Other factors such as maternal age, stress, nutrition, smoking, and the use of other drugs (prescribed or street drugs) Fetal susceptibility to alcohol

12. www.faseout.ca 2008 Standard drinks = 0.5 oz alcohol 12 oz (341 mL) can of beer (5% alcohol) 12 oz (341 mL) bottle of cooler (5% alcohol) 5 oz (142 mL) glass of wine (12% alcohol) 1.5 oz (43 mL) distilled spirits (40% alcohol) 3 oz (85 mL) fortified wine e.g. sherry or port (18% alcohol )

13. www.faseout.ca 2008 Paternal Role Effects on the Fetus: the effects of father’s drinking on the fetus are not fully known Effects on Pregnancy: Alcohol can result in lower sperm count and abnormal sperm, which may effect fertility. If alcohol-affected sperm does fertilize an egg, the likelihood of miscarriage is higher than if the sperm were not alcohol-affected

14. www.faseout.ca 2008 Paternal Role: Social Effects Women most often drink with their partners Men who drink heavily are unlikely to provide the necessary emotional support and care for their pregnant partners A man’s drinking after the baby is born could adversely affect the nurturing home environment needed to raise a child

15. www.faseout.ca 2008 What is Fetal Alcohol Spectrum Disorder?

16. www.faseout.ca 2008 Fetal Alcohol Spectrum Disorder (FASD) FASD is a combination of mental and physical disabilities FASD is a lifelong condition FASD is caused by maternal alcohol consumption during pregnancy

17. www.faseout.ca 2008 Diagnostic Terms Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol Effects (pFAS) Alcohol Related Neurodevelopmental Disorder (ARND) Alcohol Related Birth Defects (ARBD)

18. www.faseout.ca 2008 Fetal Alcohol Syndrome Recognized and documented in Nantes, France and Seattle, Washington 1968 – 1973

19. www.faseout.ca 2008 Characteristics of FAS Facial anomalies Evidence of growth restriction (may be apparent prenatally and/or postnatally), (below the 10 th percentile) and microcephaly Central nervous system abnormalities

20. www.faseout.ca 2008 FAS Features

21. www.faseout.ca 2008 ARND/pFAS: The invisible disability Physical characteristics FASD unremarkable Disappear: become less prominent over time Adolescent & Adult Diagnosis often more difficult

22. www.faseout.ca 2008 Alcohol-Related Neuro- Developmental Disorder (ARND) Individuals with ARND present with neuro- cognitive dysfunction and complex patterns of behaviour, and have a confirmed exposure to alcohol prenatally Individuals with ARND may not demonstrate any of the facial features or growth restrictions associated with the full syndrome

23. www.faseout.ca 2008 Partial Fetal Alcohol Syndrome (PFAS) with confirmed alcohol exposure This diagnostic term is used when the person presents with central nervous system dysfunction and most (but not all of the growth and/or facial features of FAS), and has a confirmed prenatal alcohol exposure

24. www.faseout.ca 2008 Diagnostic Process Information is collected regarding the individual – physical, social, academic, and adaptive skill history If possible, the physician, along with a psychologist and other specialists, will assess the individual in order to make an appropriate diagnosis

25. www.faseout.ca 2008 Possibility of Misdiagnosis Since FASD is not a mental health diagnosis, it might not be considered or recognized The symptom presentation of individuals with FASD is similar to that of many other mental health diagnoses

26. www.faseout.ca 2008 Possibility of Misdiagnosis Individuals may be diagnosed with a mental health disorder without closely examining the total picture Even when FASD is recognized, another diagnosis is often used in order to get reimbursement for treatment

27. www.faseout.ca 2008 Benefits to a diagnosis Parents and professionals often find their ability to cope improves when they understand problems are most likely caused by brain damage not the person’s choice to be inattentive or uncooperative

28. www.faseout.ca 2008 Primary Disabilities Are the direct result of structural and/or functional damage to individuals While they can be evident in certain physical characteristics, it is the direct damage to the brain that has the greatest effect on the person

29. www.faseout.ca 2008 Primary Disabilities: Organ Anomalies Cardiac anomalies Joint and limb anomalies Neurotubal defects Anomalies of the urogenital system Hearing disorders Visual problems Severe dental malocclusions

30. www.faseout.ca 2008 Primary Disabilities: Central Nervous System Tremors Poor suck Hypotonic/Hypertonic Irritability Developmental delay

31. www.faseout.ca 2008 Primary Disabilities: Central Nervous System Cognitive problems Fine motor issues Hyperactivity Restlessness Poor ability to focus attention

32. www.faseout.ca 2008 Primary Disabilities Generalized damage to the brain typically has a significant impact on: cognitive processing emotional regulation

33. www.faseout.ca 2008 Primary Disabilities: Central Nervous System Cognitive problems –Verbal IQ –Performance IQ –Scatter in Cognitive Skills –Specific Learning Disabilities –Memory Deficits –Executive Functioning

34. www.faseout.ca 2008 Primary Disabilities: Central Nervous System Fine motor issues Hyperactivity Restlessness Poor ability to focus attention

35. www.faseout.ca 2008 Primary Disabilities: Central Nervous System Poor Judgement Impulsiveness Sleep disturbances Extreme anxiety Depression Aggressiveness Other Behavioural Problems

36. www.faseout.ca 2008 Executive functions of the prefrontal cortex  working memory  planning  time perception  internal ordering  self-monitoring  regulation of emotion  motivation  inhibition

37. www.faseout.ca 2008 Emotional Regulation Emotional instability For example, going from a calm to an agitated state (unexplained anger, laughing, crying) without apparent explanation

38. www.faseout.ca 2008 Emotional Regulation Deficits in emotional regulation are partly explained by poor inhibition and deficits in sensory integration (SI) Deficits in SI result in confusion in the interpretation of incoming sensations Individuals can become easily overwhelmed by relatively commonplace events/circumstances

39. www.faseout.ca 2008 Strategies Need to Address the Whole Being Mental, physical, emotional, spiritual and sexual well being

40. www.faseout.ca 2008 Strategies for Success Observe patterns of behaviour Identify strengths, skills and interests Reframe the interpretation of behaviours Provide structure rather than control Establish routines and consistency

41. www.faseout.ca 2008 Strategies for Success Build transitions into every routine Model behaviours Provide simple instructions or cues Identify behaviours which indicate the accumulation of frustration Help develop skills for expressing feelings

42. www.faseout.ca 2008 Strategies for Success Provide specific support for social skill development Understand the various forms of communication Include as many sensory modalities as possible to facilitate integration of information and experience

43. www.faseout.ca 2008 Strategies for Success Consider information processing abilities Re-evaluate expectations and goals for the individual: clarify whose needs are being met by the goals Clarify goals and values for education/job training and independence

44. www.faseout.ca 2008 Resources Canadian Centre on Substance Abuse www.ccsa.ca/fas www.ccsa.ca/fas Public Health Agency of Canada www.publichealth.gc.ca/fasd www.publichealth.gc.ca/fasd Motherisk, The Hospital for Sick Children www.motherisk.org www.motherisk.org Saskatchewan Prevention Institute www.preventioninstitute.sk.ca www.preventioninstitute.sk.ca

45. www.faseout.ca 2008 Thank you!