1.  Teratogen: a substance capable of interfering with fetal development  Teratology: the biological study of birth defects  Toxicology: the science of dealing with the effects and detection of poisons

2. Historical view of alcohol as a teratogen  Foolish, drunken, or harebrain women most often bring forth children like unto themselves Aristotle in Problemata  Behold, thou shalt conceive and bear a son: And now, drink no wine or strong drink. Judges 13:7 Rosett, 1984

3.  Fetal alcohol syndrome Term first used in 1973 by Drs. Smith and Jones A medical diagnosis (760.71) in the International Classification of Diseases (ICD)

6. http://www.aafp.org/afp/20050715/279.html

7.  Fetal alcohol syndrome  Fetal alcohol effects  Clinical suspect but appear normal  Normal, but never reach their potential Adapted from Streissguth

8.  Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy  May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications  Not a diagnosis

9. Other Diagnostic Terminology Pregnanc y + Alcohol May result in Alcohol-related neurodevelopmental disorder (ARND) Partial FAS (pFAS) Fetal alcohol effects (FAE) Alcohol-related birth defects (ARBD) Static encephalopathy (an unchanging injury to the brain)

10.  No one knows for certain how many individuals are born each year with an FASD – estimates of 6/1000.  No one knows how many individuals are living with an FASD. Photo property of SAMHSA.

11.  The sole cause of FASD is women drinking alcoholic beverages during pregnancy  Alcohol is a teratogen “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.

12.  FASDs are the leading known cause of preventable mental retardation.  FASDs effect an estimated 40,000 newborns each year in the United States.  FASDs are more common than autism.  The effects of FASDs last a lifetime.  People with an FASD can grow, improve, and function well in life with proper suppor t.  FASDs are 100% preventable.

13. FSIQVIQPIQ 40 55 70 85 100 115 Standard score IQ scale NC PEA FAS * * * ** * * Mattson, S.N., 1997.

14. 2 1 3 1 2 3 Group 0 2 4 6 Rule Violations NC PEA FAS P<0.001 Move only one piece at a time using one hand and never place a big piece on top of a little piece Starting position Ending position Mattson, et al., 1999

15. photo: Clarren, 1986

17. *** ** CerebrumCerebellum 75 80 85 90 95 100 PEA FAS <p 0.001 p < 0.010 Cerebrum Cerebellum Corpus Callosum Mattson et al., 1994

18. Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

19.  Lower IQ  Impaired ability in reading, spelling, and arithmetic  Lower level of adaptive functioning

20.  hyperactivity, response inhibition deficits, attentional problems, motor coordination deficits, executive function (planning) problems,

21. Clinical Implications…..  Poor judgement  Attention deficits  Arithmetic disabilities  Memory deficits  Problems with abstract thought  Impulsivity  Easily victimized  unfocused or distractible  difficulty handling $$  difficulty learning from experience  difficulty under- standing consequences  poor frustration tolerance

22.  = Age 6+  = Age 12+  = Age 21+ Percent of Persons With FAS or FAE Who Had Secondary Disabilities

23. Show many similar characteristics to human studies. Courtesy: Ed Riley

24.  mammals ◦ rodents (rats, mice, guinea pigs) ◦ pig ◦ sheep ◦ primates  nonmammalian models ◦ chicks ◦ round worm ◦ zebra fish ◦ fruit flies

25.  Growth retardation  Facial characteristics  Heart, skeletal defects  Microcephaly  Similar CNS deficits  Hyperactivity, attentional problems  Inhibitory deficits  Impaired learning  Perseveration errors  Feeding difficulties  Gait anomalies Animal models – Example of the comparability of effects Driscoll, et al., 1990; Samson, 1986;