“Fetal Alcohol Spectrum Disorders- FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications.” http://depts.washington.edu/fasdpn/htmls/fasd-fas.htm
There are a number of subtypes based on a ‘spectrum’ within this disorder, of FASD, including Partial Fetal Alcohol Syndrome (pFAS), Alcohol-Related Neurodevelopmental Disorder (ARND), Alcohol-Related Birth Defects (ARBD), and Fetal Alcohol Effect (FAE).
Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and difficulty in social situations.
Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.
Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones, or with hearing. They might have a mix of these.
“In general, diagnoses under the FASD umbrella involve a range of clinical manifestations, including physical, behavioral, and/or learning problems. Children with any of the FASDs need to be identified, diagnosed, monitored, and referred for appropriate care and services or further evaluations as indicated. Effects related to each of the FASD diagnoses are lifelong and affect not only the child, but also his or her family and the wider community.”
Many families don’t know their child is within this spectrum of FASD, they can not figure out why they are have the learning or behavior difficulties they seem to display in school or at home. Nor do not know how to recognize the signs and many Doctors do not know how to diagnosis this Disorder; therefore, it goes undiagnosed which causes confusion in school as to the child’s abilities. It also inhibits services, and insurance or supplemental coverage for FASD. Because so many other disorders have co-morbid characteristics, children may be first diagnosed with Auditory Processing problems, attention problems, language disorders or Oppositional Defiance Disorder.
Drinking Among Women Age 15 to 44 In the United States:
• 1 in 2 reports any alcohol use in the past month.
• Approximately 1 in 4 reports binge drinking (defined as 5 or more drinks on one occasion).
• About 1 in 20 reports heavy alcohol use (defined as binge drinking on at least 5 days in the last month).
Drinking Among Pregnant Women In the United States:
• 1 in 30 pregnant women reports high-risk drinking (defined as 7 or more drinks per week, or 5 or more drinks on any one occasion).
• 1 in 9 pregnant women binge drink in the first trimester.
• 1 in 30 pregnant women drink at levels shown to increase the risk of FASD.
• More than 1 in 5 pregnant women report alcohol use in the first trimester, 1 in 14 in the second trimester, and 1 in 20 in the third trimester.
• Those who are unmarried and over 30 tend to have the highest rates of alcohol use in pregnancy. However, in 2004, the rate of past month binge drinking among pregnant women age 15 to 17 (8.8%) was more than twice that of pregnant women age 26 to 44 (3.8%).
Prevalence: How Many Cases of FASD Are There?
Each year in the United States, an estimated 40,000 babies are born with an FASD, making these disorders more common than new diagnoses of autism spectrum disorder (Centers for Disease Control and Prevention, 2010), and a leading preventable cause of intellectual disabilities (Abel & Sokol, 1987). Recent in-school studies suggest that cases of FASD among live births in the U.S., previously reported as approximately 9 per 1,000 (Sampson et al., 1997) could, in reality, be closer to 50 per 1,000 (May, 2009). In addition, recent retrospective analyses of hospital admissions data indicate that under-reporting of alcohol misuse or harm by women may further disguise true prevalence rates (Morleo et al., 2011).
Financial Impact: What Does FASD Cost?
The cost factor of raising a child with an FASD is significant. Amendah and colleagues (2011) found that, for a child with identified FAS, incurred health costs were nine times higher than for children without an FASD. Lupton and colleagues (2004) have estimated the lifetime cost of caring for a person with FAS to be at least $2 million, and the overall annual cost of FASD to the U.S. healthcare system to be more than $6 billion.
The following neurodevelopmental characteristics are commonly associated with FASD. No one or two is necessarily diagnostically significant; many overlap characteristics of other diagnoses, e.g. ADD/ADHD, learning disabilities, and others.
Typical primary characteristics in children, adolescents, and adults include:
* Memory problems
* Difficulty storing and retrieving information
* Inconsistent performance (“on” and “off”) days
* Impulsivity, distractibility, disorganization
* Ability to repeat instructions, but inability to put them into action (“talk the talk but don’t walk the walk”)
* Difficulty with abstractions, such as math, money management, time concepts
* Cognitive processing deficits (may think more slowly)
* Slow auditory pace (may only understand every third word of normally paced conversation)
* Developmental lags (may act younger than chronological age)
* Inability to predict outcomes or understand consequences
Many people with FASD have strengths which mask their cognitive challenges.
* Highly verbal
* Bright in some areas
* Artistic, musical, mechanical
* Friendly, outgoing, affectionate
* Determined, persistent
* Good with younger children
Preventable Secondary Characteristics:
In the absence of identification, people with FASD often experience chronic frustration. Over time, patterns of defensive behaviors commonly develop. These characteristics are believed to be preventable with appropriate supports.
* Fatigue, tantrums
* Irritability, frustration, anger, aggression
* Fear, anxiety, avoidance, withdrawal
* Shut down, lying, running away
* Trouble at home, school, and community
* Legal trouble
* Drug / Alcohol abuse
* Mental health problems (depression, self injury, suicidal tendencies)
WHAT POTENTIAL PROBLEMS DO PEOPLE WITH AN FASD FACE?
People with an FASD are vulnerable to a range of difficulties, such as failure in school, substance abuse, mental illness, and involvement in the criminal justice system. A study conducted by the University of Washington shows the percentage of persons age 6 to 51 with an FASD who had difficulties in the following areas:
• 94% had mental health problems.
• 83% of adults experienced dependent living.
• 79% of adults had employment problems.
• 60% of those age 12 and older had trouble with the law.
• 50% experienced inpatient treatment for mental health or substance abuse problems or spent time in prison.
• 45% engaged in inappropriate sexual behavior.
• 43% had disrupted school experiences (e.g., dropped out).
• 24% of adolescents, 46% of adults, and 35% overall had alcohol and drug problems.
THIS DOESN’T HAVE TO HAPPEN…WAYS TO REMEDIATE/REHABILITATE:
* Spend time encouraging independence
* Create ways to help them feel successful
* Engage them in Music at young age (encouraging an out let for expression)
* Social programs that encourage talking about their concerns
* Brain remediation games that assist with:
– Speed Processing
– Language Processing (Expressive and Receptive)
– Auditory Processing (Reception, Association, Sequential Memory, Discrimination)
– Divided and Diverted Attention
– Working Memory
– Executive Function Skills ( Problem solving, Critical Thinking, Reasoning, Deduction)
– Cognitive Switching
– Left/Right Orientation
– Internal Organization
* A method of relaxation/ stress management
It is important we learn more about this disorder and share this knowledge. We do NOT need to place blame! The large majority of women would not ever do anything to hurt their child knowingly. They may not have known they were pregnant at the time they drank or they may have been very young, and did not know better, they may be Moms that have been taught to think it won’t matter to just have a couple of drinks.
We need to support our youth and help them understand the potential impression they have on their fetus and it’s success.
It does take a whole village to raise our children, please tolerate differences…and yet teach yourself so you can help the younger generation learn what MIGHT happen if they are not careful.
FASD is 100% preventable! Help us to educate the youth…BE AWARE if you are within child bearing age, PLEASE think before drinking!
If you believe your child may have the symptoms of FASD call your local Neurologist for a Diagnosis. If you need remediation activities to help your child, stay tuned in for future Blog entries on activities or contact me at http://www.cognitive-connections.com
Just another thought by Dr. Lise’