1. Fetal Alcohol Syndrome Disorders 19th November 2014
Fetal Alcohol Syndrome Disorders 19th November 2014
Follow us on and join in the conference conversation at #fasd14

2. “In pregnancy: No alcohol - no risk” But why?
Dr Maggie Watts
Director of Public Health
NHS Western Isles
FASD professionals study event
November 2014

3. Baby Jo
Born ?36 weeks
Baby under 10th centile for head circumference and weight
Congenital heart disease
Irritable; failure to habituate
Poor sleep pattern
Feeding problems
Failure to thrive

4. Toddler Jamie ADD with or without hyperactivity Language delay
Developmental delay – fine motor skill impairment
Impulsivity
Distractible
Poor memory
Incorrigible
Violent behaviours

5. Schoolgirl Jane Unable to sit still or pay attention
Multiple sensory overload
Doesn’t have friends
Doesn’t learn from mistakes
Can’t do complex problem solving (maths)
Information processing deficits
Can’t sort – numbers, sequencing
Verbal learning poor

6. Schoolboy Jack May have recorded learning disability; IQ < 70
Can’t read social cues
Repeats instructions but doesn’t follow them
Lies, cheats, steals – in trouble with police
School failure
Suspended from school on multiple occasions
Sexually inappropriate

7. Young man John Can’t keep time – job interview, attendance at work
Sensory overload
Socially and sexually inappropriate
Attention deficits; memory problems
Poor money management; can’t keep tenancy
Alcohol and drug problems
Mental health problems e.g. depression
Suicide

8. What is the common factor throughout these scenarios?
All these children could have organic brain damage caused by prenatal alcohol exposure.
Did anyone ask about mum’s drinking in pregnancy at the time? Or at any time since?

9. The commonest preventable cause of mental retardation
FASD is expensive
FASD is common
FASD is preventable

10. What is FASD?
Continuum of permanent lifelong birth defects caused by maternal consumption of alcohol during pregnancy including, but not only, FAS
Describes the full range of disabilities that may result from prenatal alcohol exposure

11. What is FAS? Most recognisable diagnosis under the FASD umbrella
No specific diagnostic tests
Triad of clinical manifestations:
- facial anomalies
- growth retardation
- neuro-developmental abnormalities
And robust history of prenatal alcohol
Low nasal bridge
Small head
Epicanthic folds
Short palpebral fissures
Railtrack ears
Smooth philtrum
Short nose
Thin vermilion
Micrognathia

12. Why is FASD an issue?
Estimated worldwide prevalence of FAS of per 1,000 live births
With 56,014 live births in Scotland (2013), presents potential of
babies born in the year affected with FAS
Approx 440 –1800 children under the age of 16
And times more with FASD

13. Scotland’s drinking is a cause for concern
Scotland consumes just under 12 litres of pure alcohol per adult annually
Self-reported use of alcohol accounts for 55% of total sales
More than 2 in 5 women aged years self report drinking above recommended limits
Scottish Health Survey 2011

14. What is a unit of alcohol?
750 ml Bottle of wine (13%) = 9.8 units
Standard measure of wine (125ml) =1.2 units
70cl bottle spirits (40%) = 28 units
Standard measure (35ml) = 1.4 units
2l cider (5%) = 10 units
750 ml Buckfast (15%) = 11.3 units
Recommended maximum intake:
3-4 units daily for men and 2-3 units for women with two days a week alcohol-free (ie 21 units for men and 14 units for women weekly)
Pictures: Wikepedia

15. Drinking in pregnancy
Chief Medical Officer for Scotland advice – AVOID ALCOHOL WHEN PREGNANT OR CONTEMPLATING PREGNANCY.
In national surveys, 25-50% of women report consuming some alcohol during pregnancy
In practice, up to 60% of women report drinking alcohol in the three months before attending for antenatal booking appointment
Growing up in Scotland research and Infant feeding survey 2005

16. Alcohol affects development

17. Risk factors Dose of alcohol Pattern of exposure - binge vs chronic
Developmental timing of exposure
Genetic variation
Maternal characteristics
Synergistic reactions with other drugs
Interaction with nutritional variables
No alcohol, no risk

18. How common is FASD in Scotland?
In the UK….
We don’t actually know as we don’t have national systems to collect and record information about fetal alcohol harm
Scottish paediatric passive surveillance programme for FAS in children under 6 years of age
Experience from around the world – if you look for FASD, you will find plenty

19. Diagnosis is
necessary
Diagnosis is
possible
Diagnosis is
meaningful

20. Diagnosis is possible REQUIRES A MULTIDISCIPLINARY TEAM
We can do it – we have screening tools, coding and assessments as well as training.
Environment and Health – Paediatrics
Temperament and Mood – CAMHS
Cognitive processing
Clinical Psychology
Educational Psychology
Neuropsychology
Speech and Language Pathology
Occupational Therapy
Education

21. Diagnosis is necessary for prevention and to reduce secondary disabilities
Diagnosis before age 6
Diagnosis of FAS not “FAE”: recognisable vs. invisible disability
Stable, nurturing home, 72% of life
Staying in each living situation for at least 3 years
Experiencing a good quality home
Eligible for Special Needs/Disability services
No experience of violence against self
Having basic needs met for at least 13% of one’s life
Streissguth et al,1996

22. Diagnosis is meaningful
Availability of expert advice
Skills training
Particular concerns:
Fostering and adoption
Childcare services
Education and social work

23. Developmental stages of 18 year old child with FASD
How does a child affected by fetal alcohol differ from others?
Physical differences
size, congenital problems
Behaviours, especially when relating to others
aggression
mood swings
emotional lability
attention difficulty
Executive Function
ability to plan
complex problem solving
planning
judgement
arithmetical tasks
working memory
Intelligence
normal or low IQ
Communication and speech
speaking too fast/too much
interrupting
Motor dysfunction
Deficient social interactions
lack of awareness
Unusual physiological responses
sleep disturbances
Hyperactivity
Deficits in verbal learning
Sensory impairment – vision and hearing problems
Modified by Alberta Health Services from Jodee Kulp

24. What about mum? May: be single parent have other children
be drinking; may have drunk throughout pregnancies
be struggling financially, mentally and socially
be unable to cope – child(ren) taken into care
be unable to cope with care system and loss
have fetal alcohol spectrum disorder herself
be dead – through suicide or alcohol and drugs

25. Training - FASD e-learning resource http://www. knowledge. scot. nhs
Training - FASD e-learning resource learning-and-cpd/learning-spaces/fasd.aspx

26. Useful links www.fasaware.co.uk www.nofas-uk.org www.fasdscotland.com
Thanks to my mentors and to the adults and children with FASD who matter so much.

27. Fetal Alcohol Syndrome Disorders 19th November 2014
Fetal Alcohol Syndrome Disorders 19th November 2014
Follow us on and join in the conference conversation at #fasd14