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==Treatment==
==Treatment==
There is no specific cure for FAS as the CNS damage is irreversible leading to permanent disability. Treatment can be focused on halting the progression and behavioral therapy to improve the quality of life. Comprehensive, multi-model approaches based on the needs of the patient is considered as one of the best approach.  
There is no specific cure for FAS as the CNS damage is irreversible leading to permanent disability. Treatment can be focused on halting the progression and behavioral therapy to improve the quality of life.  


*Management of fetal alcohol spectrum disorders classically is divided into two main areas.  
*Management of fetal alcohol spectrum disorders classically is divided into two main areas.  
** '''Pre-conceptual''': Recognition of the dangers of alcohol consumption in pregnancy and the prevention of damage to the fetus.  
** '''Pre-conceptual''': Recognition of the dangers of alcohol consumption in pregnancy and the prevention of damage to the fetus.  
** '''Post diagnosis''': Relates to the management of people who have the condition.  
** '''Post diagnosis''': Relates to the management of people who have the condition.  
* The emphasis on prevention has been the most highly publicized of the two with numerous authors stressing the level of risk that is harmful, early detection of at risk mothers, the need for information sharing between professionals and public as paramount priorities.
Behavioral management of FASD can be summarized in the following table:
* Emerging methods such as the use of routine screening tools such as TWEAK, hair sampling, or meconium testing have been suggested.
* However, the ethical debate around their use is in its infancy thus clarification is required before they can be recommended routinely.
* Research into protective factors during pregnancy has been inconclusive and contradictory.
* The use of vitamin E as a potential antioxidant has been shown beneficial in some studies and ineffective in others.
* Clearly, much has still to de done before conclusive information can be given to mothers contemplating pregnancy.
* For this reason we continue to emphasize the general abstinence message.
*
With regard to children and adults who have fetal alcohol spectrum disorders, much work has been undertaken to categorize difficulties and establish diagnoses. Less research has been undertaken relating to clinical management. This work has mainly involved children in the USA and Canada. Chudley ''et al''.1recently reviewed the Canadian guidance on diagnosing and managing fetal alcohol spectrum disorders. They emphasize early recognition and psychometric testing combined with multidisciplinary intervention approaches.
 
Table 1 shows a possible timeline of groups involved in the management of fetal alcohol spectrum disorders throughout the lifespan of sufferers from a preconception to old age based on our clinical experiences working with fetal alcohol spectrum disorders in the UK. Much of what can be implemented depends on local resources and vision. Preconception prevention aspects involve government and GPs in terms of health promotion and advice; later GPs, obstetricians and others are needed during the pregnancy in addition to routine antenatal care to monitor alcohol use and to provide health advice. It is here that suspected cases can be highlighted and information passed to colleagues in order to maximize early pickup of problems. Simple, regular recording of information about alcohol consumption will facilitate this process and inform future diagnoses. Failure to do so leads to avoidable difficulties and impairments later.
 
Behavioral management of FASD can be summarized in the following table
{| class="wikitable"
{| class="wikitable"
|+
|+
! colspan="4" |Time Period  
! colspan="4" |Time Period For Intervention
|-
|-
!Pre-Conception
!Pre-Conception
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* Management of disabilities  
* Management of disabilities  
|}
|}
{| class="wikitable"
|+
! colspan="2" |Treatment
|-
|Medical interventions
|Due to overlapping symptoms between other diseases such as ADHD, traditional [[Medical model|medical]] interventions (i.e., [[psychoactive drug]]s) are frequently tried.
* '''Stimulants'''
* '''Antidepressants'''
* '''Neuroleptics'''
* '''Anti-anxiety drugs'''
|-
|Behavioral interventions
|Following are behavior and education therapies that have been shown to be effective for some children with FASDs:


===Medical interventions===
'''Good Buddies'''
Traditional [[Medical model|medical]] interventions (i.e., [[psychoactive drug]]s) are frequently tried on those with FAS because many FAS symptoms are mistaken for or overlap with other disorders, most notably [[ADHD]].<ref name="Buxton" /> For instance, an FAS patient who is inattentive, does not complete schoolwork, and cannot stay seated has characteristics that an untrained person could easily mistake as [[ADHD]], especially if the patient is not yet diagnosed with FAS. A common course of action would be a medication referral to a pediatrician, who might recommend a trial of [[Ritalin]] for the symptoms.  
* A children’s friendship training to teach individuals with an FASD appropriate social skills.
 
* Children with FASDs often have difficulty learning subtle social skills from their own experiences; those kinds of skills are typically “learned by osmosis” on the playground, such as how to slip into a group, appropriate sharing, or dealing with teasing.  
Medications are often important in treating FAS, but should be used in conjunction with other intervention approaches to address the multiple disabilities that arise from FAS.
* This intervention uses a group format to teach age-appropriate social skills over 12 weekly sessions for parent and child. Sessions are organized around and toward each child hosting a play date with a classmate or peer.
 
'''Families Moving Forward (FMF) program to provide support for families who deal with challenging FASD behaviors'''
===Behavioral interventions===
* This intervention is most appropriate for children with severe, clinically significant behavior problems based in part on positive behavior support techniques.  
Traditional [[Behaviorism|behavioral]] interventions are predicated on learning theory, which is the basis for many parenting and professional strategies and interventions.<ref name="MalbinTry" /> Along with ordinary parenting styles, such strategies are frequently used by default for treating those with FAS, as the diagnoses [[Oppositional Defiance Disorder]] (ODD), [[Conduct Disorder]], [[Reactive attachment disorder|Reactive Attachment Disorder]] (RAD), etc. often overlap with FAS (along with [[ADHD]]), and these are sometimes thought to benefit from behavioral interventions. Frequently, a patient's poor academic achievement results in [[special education]] services, which also utilizes principles of learning theory, [[behavior modification]], and outcome-based education.
* It is a feasible, low-intensity, sustained model of supportive consultation with a parent or caregiver (rather than directly with the child).
 
* The intervention lasts 9 to 11 months, with at least 16 every-other-week sessions, typically lasting 90 minutes each.
Because the "learning system" of a patient with FAS is damaged, however, behavioral interventions are not always successful, or not successful in the long run, especially because overlapping disorders frequently stem from or are exacerbated by FAS.<ref name="MalbinTry" /> Alfie Kohn (1999) suggests that a rewards-punishment system in general may work somewhat in the short-term but is unsuccessful in the long-term because that approach fails to consider content (i.e., things "worth" learning), community (i.e., safe, cooperative learning environments), and choice (i.e., making choices versus following directions). While these elements are important to consider when working with FAS and have some usefulness in treatment, they are not alone sufficient to promote better outcomes.<ref name="MalbinTry" /> Kohn's minority challenge to behavioral interventions does illustrate the importance of factors beyond learning theory when trying to promote improved outcomes for FAS, and supports a more multi-model approach that can be found in varying degrees within the advocacy model and neurobehavioral approach.
* Services are carried out by mental health providers with specialized training.
 
'''Math Interactive Learning Experience (MILE) program to help with mathematics difficulty'''
===Developmental framework===
* Deficits in mathematical functioning have been reported consistently among alcohol-affected individuals.
Many books and handouts on FAS recommend a developmental approach, based on [[developmental psychology]], even though most do not specify it as such and provide little theoretical background. Optimal human development generally occurs in identifiable stages (e.g., Jean Piaget's [[theory of cognitive development]], [[Erik Erikson]]'s stages of psychosocial development, [[John Bowlby]]'s [[Attachment theory|attachment framework]], and other developmental stage theories). FAS interferes with normal development,<ref name="McCreight" /> which may cause stages to be delayed, skipped, or immaturely developed. Over time, an unaffected child can negotiate the increasing demands of life by progressing through stages of development normally, but not so for a child with FAS.<ref name="McCreight" />
* The MILE program is designed to improve the child’s mathematical knowledge and skill.
 
* Children complete 6 weeks of one-to-one tutoring using specifically adapted materials (eg, vertical number line, timers, etc.) that are appropriate to their academic level.
By knowing what developmental stages and tasks children follow, treatment and interventions for FAS can be tailored to helping a patient meet developmental tasks and demands successfully.<ref name="McCreight" /> If a patient is delayed in the [[adaptive behavior]] domain, for instance, then interventions would be recommended to target specific delays through additional education and practice (e.g., practiced instruction on tying shoelaces), giving reminders, or making accommodations (e.g., using slip-on shoes) to support the desired functioning level. This approach is an advance over behavioral interventions, because it takes the patient's developmental context into account while developing interventions.
* Parents also receive training on behavioral regulation techniques to optimize the child’s readiness to learn.
 
'''Parents and Children Together (PACT) a neurocognitive habilitation program to improve self-regulation and executive function'''
===Advocacy model===
* Building upon techniques developed from the brain injury literature, this intervention used 12 weekly sessions with parents and children to address and improve behavior regulation and executive function (that is, planning, organizing, and understanding of others).  
The [[advocacy]] model takes the point of view that someone is needed to actively mediate between the environment and the person with FAS.<ref name="FASGuide" /> Advocacy activities are conducted by an advocate (for example, a family member, friend, or [[Case management|case manager]]) and fall into three basic categories. An advocate for FAS: (1) interprets FAS and the disabilities that arise from it and explains it to the environment in which the patient operates, (2) engenders change or accommodation on behalf of the patient, and (3) assists the patient in developing and reaching attainable goals.<ref name="FASGuide" />
* It uses a particularly engaging metaphor of “how does my engine run” to teach children awareness of their current behavioral state and specific techniques for optimizing that state for the current situation.
 
|-
The advocacy model is often recommended, for example, when developing an Individualized Education Program (IEP) for the patient's progress at school.
|Parent Training
 
|Children with FASDs might not respond to the usual parenting practices. However, the following parenting tips are recommended:
An understanding of the developmental framework would presumably inform and enhance the advocacy model, but advocacy also implies interventions at a systems level as well, such as educating schools, social workers, and so forth on best practices for FAS. However, several organizations devoted to FAS also use the advocacy model at a [[community practice]] level as well.
* Concentrate on child’s strengths and talents
 
* Accepting child’s limitations
===Neurobehavioral approach===
* Be consistent with discipline, school, behaviors of the child
The neurobehavioral approach focuses on the [[Neurology|neurological]] underpinnings from which [[behavior]]s and [[Cognition|cognitive processes]] arise.<ref name="MalbinTry" /> It is an integrative perspective that acknowledges and encourages a multi-modal array of treatment interventions that draw from all FAS treatment approaches. The neurobehavioral approach is a serious attempt at shifting single-perspective treatment approaches into a new, coherent paradigm that addresses the complexities of problem behaviors and cognitions emanating from the CNS damage of FAS.
* Using of concrete language and examples
 
* Employment of stable routines
The neurobehavioral approach's main proponent is Diane Malbin, MSW, a recognized speaker and trainer in the FASD field, who first articulated the approach with respect to FASD and characterizes it as "''Trying differently rather than trying harder''." The idea to ''try differently'' refers to trying different perspectives and intervention options based on effects of the CNS damage and particular needs of the patient, rather than ''trying harder'' at implementing behavioral-based interventions that have consistently failed over time to produce improved outcomes for a patient. This approach also encourages more strength-based interventions, which allow a patient to develop positive outcomes by promoting success linked to the patient's strengths and interests.<ref name="MalbinTry" />
* Being specific and elaborative
 
* Using visual aides, music, and hands-on activities
===Public health and policy===
* Using positive reinforcement often (praise, incentives)
Treating FAS at the [[public health]] and [[public policy]] levels promotes FAS prevention and diversion of public resources to assist those with FAS.<ref name="FASGuide" /> It is related to the advocacy model but promoted at a systems level (rather than with the individual or family), such as developing community education and supports, state or province level prevention efforts (e.g., screening for maternal alcohol use during [[OB/GYN]] or prenatal medical care visits), or national awareness programs. Several organizations and state agencies in the U.S. are dedicated to this type of intervention.<ref name="agencies" />
|-
|Alternative therapies
|
* Biofeedback
* Auditory training
* Relaxation therapy, visual imagery, and meditation (especially for sleep problems and anxiety)
* Creative art therapy
* Yoga and exercise
* Acupuncture and acupressure
* Massage, Reiki, and energy healing
* Vitamins, herbal supplements, and homeopathy
* Animal-assisted therapy
|}


==Prevention==
==Prevention==

Revision as of 21:46, 8 September 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Fetal alcohol spectrum disorders (FASDs) are a group of disorders that encompass fetal alcohol syndrome (FAS), partial fetal alcohol syndrome, alcohol-related birth defects (ARBD), alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). The most potent risk factor for FASD's include prenatal exposure to alcohol. FASD's is the leading preventable cause of birth defects and intellectual and neurodevelopmental disabilities in children. Early recognition, diagnosis, and therapy for FASD is associated with improved outcomes.

History

  • In 1899. Dr William Sullivan, a Liverpool prison physician was the first to report a case study describing an association between maternal alcohol use and fetal damage in female prisoners.[1]
  • In 1968, Fetal alcohol syndrome was discovered and separated as a entire new diseases at the University of Washington’s Harborview Medical Center in Washington.
  • By 1973, sufficient research evidence had accrued to devise basic diagnostic criteria such that FAS became established as a diagnostic entity.[2][3]
  • In 1973, Dr keneth Lyons Jones and David W Smith professors of University of Washington Medical School in Seattle was the first to introduce the term Fetal alcohol syndrome.[4]
  • By 1978, 245 cases of FAS had been reported by medical researchers, and the syndrome began to be described as the most frequent known cause of mental retardation.
  • In 1981, The US Surgeon General issued the first public health advisory that alcohol during pregnancy is responsible birth defects.
  • In 1989, US Congress mandated warning labels about potential birth defects on alcohol products.

Classification

According to American Academy of Pediatrics fetal alcohol spectrum disorders (FASDs) encompasses group of disorders based upon the manifestations into 5 sub types.

  • Fetal alcohol syndrome (FAS)
  • Partial fetal alcohol syndrome
  • Alcohol-related birth defects (ARBD)
  • Alcohol-related neurodevelopmental disorder (ARND)
  • Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE).

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fetal alcohol spectrum disorders
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fetal alcohol syndrome (FAS)
 
 
 
Partial fetal alcohol syndrome
 
 
 
Alcohol-related birth defects (ARBD)
 
 
 
 
Alcohol-related neurodevelopmental disorder (ARND)
 
 
 
Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
A▪ Confirmed maternal alcohol exposure.
B▪ Evidence of characteristic pattern of facial anomalies
C▪ Evidence of growth retardation
D▪ Evidence of CNS abnormalities
 
 
 
A, B, C, D and
E▪ Evidence of a complex pattern of behavior or cognitive abnormalities
 
 
 
▪ Cardiac
▪ Skeletal
▪ Renal
▪ Ocular
▪ Auditory
▪ Other
 
 
 
 
A,B, D, and E
▪ No growth retardation
 
 
 
Behavioral abnormalities predominant with no growth retardation
 
 
 
 

Pathophysiology

  • Drinking alcohol during pregnancy is the most potent etiological factor for the development of fetal alcohol syndrome disorders.
  • The developing embryo is susceptible to dysmorphogenisis during the first few weeks of pregnancy.
  • Alcohol can pass through umbilical cord to the baby effecting morphogeneisis leading to
    • Miscarriage
    • Stillbirth
    • Behavioral, and intellectual disabilities..

Risk Factors

The most potent risk factor in the development of FASD's include prenatal exposure of alcohol. Other risk factors include:

  • Alcohol consumption
  • Increase in maternal age
  • Maternal genotype|
  • Increase in parity/gravidity
  • Higher birth order of the child
  • Low socioeconomic status

Epidemiology and Demographics

Prevalence

  • According to National Institute on Alcohol Abuse and Alcoholism study, CDC and AAP it is estimated that FASD's is prevalent in 2-5% of children in the United States.
  • CDC released a fact sheet in 2016, according to which prevalence of fetal alcohol syndrome is believed to be 1 in 20 children.
  • Comprehensive data on the number of individuals with an FASD in the general population of the Unites States, or by state, race or ethnicity, is currently not available.
  • Journal of the American Medical Association published the results of a National Institute on Alcohol Abuse and Alcoholism study that measured the prevalence of fetal alcohol spectrum disorders (FASD) among first-grade students in four US communities. 
    • Over 6,500 children were evaluated and the most conservative estimate for FASD ranged from 1 to 5 percent, or 1 in 20 students. 
  • Data from the Centers for Disease Control and Prevention (CDC) asserts that 10 percent of pregnant women report drinking alcohol and 3 percent report binge drinking, putting over 100,000 births in the US each year at high risk for FASD.
Source: CDC

Differential Diagnosis

Fetal alcohol syndrome must be differentiated from other genetic diseases, with similar manifestations such as smooth philtrum, thin vermillion border and small palpebral fissures. American academy of pediatrics and CDC reviewed and recommended 9 genetic diseases that has to screened and differentiated from FAD's which include Aarskog syndrome, Williams syndrome, Noonan syndrome, Dubowitz syndrome, Brachman-DeLange syndrome, Toluene syndrome, Fetal hydantoin syndrome, Fetal valproate syndrome, and Maternal PKU fetal effects.

Syndrome Overlapping features Differentiating features
Aarskog syndrome
  • Small nose with anteverted nares
  • Broad philtrum
  • Maxillary hypoplasia
  • Wide-spaced eyes
  • Rounded face
  • Down-slant to palpebral fissures
  • Widow's peak
  • Crease below lower lip
  • Incomplete out folding of upper helices
  • Dental eruption problems
Williams syndrome
  • Short palpebral fissures
  • Anteverted nares
  • Long philtrum
  • Depressed nasal bridge
  • Epicanthal folds
  • Wide mouth with full lips
  • Stellate pattern of the iris
  • Periorbital fullness
  • Connective tissue disorders
Noonan syndrome
  • Low nasal bridge
  • Wide-spaced eyes
  • Epicanthal folds
  • Down-slant to palpebral fissures
  • Keratoconus
  • Wide mouth
  • Protruding upper lip
Dubowitz syndrome
  • Short palpebral fissures
  • Wide-spaced eyes
  • Epicanthal folds
  • Shallow supraorbital ridge with nasal bridge near the level of the forehead
  • Broad nasal tip
Brachman-DeLange syndrome
  • Long philtrum
  • Thin vermillion border
  • Anteverted nares
  • Depressed nasal bridge
  • Single, bushy eyebrow extending across forehead
  • Long eyelashe
  • Downturned mouth
  • High-arched palate,
  • Short limbs
Toluene syndrome
  • Short palpebral fissures
  • Mid-face hypoplasia
  • Smooth philtrum
  • Thin vermillion border
  • Micrognathia
  • Large anterior fontanel
  • Down-turned mouth corners
  • Hair patterning abnormalities
  • Bifrontal narrowing
  • Ear abnormalities
Fetal hydantoin syndrome
  • Wide-spaced eyes
  • Depressed nasal bridge
  • Short nose with bowed upper lip
Fetal valproate syndrome
  • Epicanthal folds
  • Anteverted nares
  • Long philtrum with thin vermilion border
  • Wide-spaced eyes
  • High forehead
  • Infraorbital crease or groove
  • Small mouth
Maternal PKU fetal effects
  • Epicanthal folds
  • Short palpebral fissures
  • Long underdeveloped philtrum
  • Thin vermillion border
  • Small upturned nose
  • Round facies
  • Prominent glabella

The following tables summarizes the differential diagnosis of individual features associated with FAS

Differential diagnosis of individual features associated with FAS
Smooth philtrum
  • Cornelia de Lange syndrome
  • Floating-Harbor syndrome
  • Geleophysic dysplasia
  • Opitz syndrome
  • Toluene embryopathy
Thin Vermillion border
  • Miller-Dieker (Lissencephaly) syndrome
  • Fetal Valproate syndrome
  • Geleophysic dysplasia
  • Cornelia de Lange syndrome
  • Toluene embryopathy
Small palpebral fissures
  • Campomelic dysplasia
  • DiGeorge sequence
  • Dubowitz syndrome
  • Duplication 10q sequence
  • Duplication 15q sequence
  • FG syndrome
  • Maternal phenylketonuria (PKU) fetal effects
  • Oculodentodigital syndrome
  • Opitz syndrome
  • Trisomy 18 syndrome
  • Williams syndrome
  • Velocardiofacial syndrome
  • Toluene embryopathy

Diagnosis

FASD is clinical diagnosis and there are no specific diagnostic laboratory findings associated with FASD. However, American Academy of Pediatrics and CDC brought up a diagnostic criteria

Diagnostic criteria for Fetal alcohol spectral disorders

Components of Diagnostic criteria For FASD's
Growth deficiency
  • Prenatal or postnatal height or weight (or both) at or below the 10th percentile[5]
Facial features
  • Smooth philtrum
  • Thin vermillion border
  • Small palpebral fissures
Central nervous system damage Structural
  • Head circumference (OFC) at or below the 10th percentile adjusted for age and sex.
  • Clinically significant brain abnormalities observable through imaging.
Neurological Neurological problems not due to:
  • Postnatal insult or
  • Fever or
  • Other soft neurological signs outside normal limits.
Functional Global cognitive or intellectual deficits representing multiple domains of deficit with performance below the 3rd percentile
Functional deficits below the 16th percentile in at least three of the following domains:
  • Cognitive or developmental deficits or discrepancies
  • Executive functioning deficits
  • Motor functioning delays
  • Problems with attention or hyperactivity
  • Social skills
  • Other, such as sensory problems, pragmatic language problems, memory deficits, etc.
Maternal alcohol exposure
  • Confirmed prenatal alcohol exposure
  • Unknown prenatal alcohol exposure

Diagnostic criteria for Fetal alcohol syndrome

4 diagnostic criteria had been developed in the recent times to diagnose fetal alcohol syndrome

  • Four digit code
  • Hoyme- Revised IOM
  • Chudley–Canadian
  • National Task Force/CDC
Fetal alcohol syndrome
Facial Characterstics Growth retardation CNS involvement
Four digit code Simultaneous presentation of
  • Short palpebral fissures (≤2 SD)
  • Thin vermillion border
  • Smooth philtrum
 Height or weight ≤10th percentile
  • Head circumference (OFC) ≥2 SD below
  • Significant abnormalities in brain structure or
  • Evidence of hard neurological findings or
  • Significant impairment in ≥3 domains of brain function
Hoyme–Revised IOM ≥2 of the following
  • Short palpebral fissures
  • Thin vermillion border
  • smooth philtrum
 Height or weight ≤10th percentile
  • Head circumference (OFC) ≤10th percentile or
  • Structural brain abnormality
Chudley–Canadian Simultaneous presentation of
  • Short palpebral fissures
  • Thin vermillion border
  • Smooth philtrum
 Height or weight or disproportionately low weight-to-height ratio (≤10th percentile) Evidence of ≥3 impairments in the following CNS domains
  • Hard and soft neurologic signs
  • Executive functioning and abstract reasoning
  • Attention deficit/hyperactivity
National Task Force/CDC Simultaneous presentation of
  • Short palpebral fissures (≤10th percentile)
  • Thin vermillion border
  • Smooth philtrum
 Height or weight ≤10th percentile at any point in time.
  • Head circumference (OFC) ≤10th percentile or
  • Structural brain abnormality or
  • Neurological problems or
  • Other soft neurological signs outside normal limits or functional impairment as evidenced by global cognitive or intellectual deficits

History and Symptoms

Symptoms of FASDs[6][7][8]
Alcohol exposure CNS abnormalities Facial anomalies Growth retardation
Fetal alcohol syndrome (FAS) + Severe + +
Partial fetal alcohol syndrome + Severe + -
Alcohol-related neurodevelopmental disorder (ARND) + Severe - -
Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). + Moderate -

Common symptoms of FASDs include :[9][10][9][3][8][6][7]

  • Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)
  • Small head size
  • Shorter-than-average height
  • Low body weight
  • Poor coordination
  • Hyperactive behavior
  • Difficulty with attention
  • Poor memory
  • Difficulty in school (especially with math)
  • Learning disabilities
  • Speech and language delays
  • Intellectual disability or low IQ
  • Poor reasoning and judgment skills
  • Sleep and sucking problems as a baby
  • Vision or hearing problems
  • Problems with the heart, kidneys, or bones

Prognosis

Prognosis
Primary disabilities
Secondary disabilities
  • Mental health problems — Diagnosed with ADHD, Clinical Depression, or other mental illness, experienced by over 90% of the subjects
  • Disrupted school experience — Suspended or expelled from school or dropped out of school, experienced by 60% of the subjects (age 12 and older)
  • Trouble with the law — Charged or convicted with a crime, experienced by 60% of the subjects (age 12 and older)
  • Confinement — For inpatient psychiatric care, inpatient chemical dependency care, or incarcerated for a crime, experienced by about 50% of the subjects (age 12 and older)
  • Inappropriate sexual behavior — Sexual advances, sexual touching, or promiscuity, experienced by about 50% of the subjects (age 12 and older)
  • Alcohol and drug problems — Abuse or dependency, experienced by 35% of the subjects (age 12 and older)
  • Dependent living — Group home, living with family or friends, or some sort of assisted living, experienced by 80% of the subjects (age 21 and older)
  • Problems with employment — Required ongoing job training or coaching, could not keep a job, unemployed, experienced by 80% of the subjects (age 21 and older)
Protective factors and strengths Eight factors were identified as universal protective factors that reduced the incidence rate of the secondary disabilities:[13][1]
  • Living in a stable and nurturant home for over 72% of life
  • Being diagnosed with FAS before age six
  • Never having experienced violence
  • Remaining in each living situation for at least 2.8 years
  • Experiencing a "good quality home" (meeting 10 or more defined qualities) from age 8 to 12 years old
  • Having been found eligible for developmental disability (DD) services
  • Having basic needs met for at least 13% of life
  • Having a diagnosis of FAS (rather than another FASD condition)

Treatment

There is no specific cure for FAS as the CNS damage is irreversible leading to permanent disability. Treatment can be focused on halting the progression and behavioral therapy to improve the quality of life.

  • Management of fetal alcohol spectrum disorders classically is divided into two main areas.
    • Pre-conceptual: Recognition of the dangers of alcohol consumption in pregnancy and the prevention of damage to the fetus.
    • Post diagnosis: Relates to the management of people who have the condition.

Behavioral management of FASD can be summarized in the following table:

Time Period For Intervention
Pre-Conception During Pregnancy Childhood 0-18 Adult 18+
  • Public education
  • Pre-conception adivce
  • Monitoring of pregnancy
  • Information documentation
  • Correspondence with colleagues
  • Early recognition
  • Diagnosis
  • Psychometric assessment
  • Educational statement
  • Physical investigations
  • Behavioral management (ADHD)
  • Prevention
  • Diagnosis
  • Psychometric assessment
  • Physical investigation if not previously undertaken
  • Investigation of background and history from/ about birth mother if possible
  • Education of others as to level of function
  • Ongoing support
  • Social
  • Financial
  • Educational
  • Emplyoment
  • Management of disabilities
Treatment
Medical interventions Due to overlapping symptoms between other diseases such as ADHD, traditional medical interventions (i.e., psychoactive drugs) are frequently tried.
  • Stimulants
  • Antidepressants
  • Neuroleptics
  • Anti-anxiety drugs
Behavioral interventions Following are behavior and education therapies that have been shown to be effective for some children with FASDs:

Good Buddies

  • A children’s friendship training to teach individuals with an FASD appropriate social skills.
  • Children with FASDs often have difficulty learning subtle social skills from their own experiences; those kinds of skills are typically “learned by osmosis” on the playground, such as how to slip into a group, appropriate sharing, or dealing with teasing.
  • This intervention uses a group format to teach age-appropriate social skills over 12 weekly sessions for parent and child. Sessions are organized around and toward each child hosting a play date with a classmate or peer.

Families Moving Forward (FMF) program to provide support for families who deal with challenging FASD behaviors

  • This intervention is most appropriate for children with severe, clinically significant behavior problems based in part on positive behavior support techniques.
  • It is a feasible, low-intensity, sustained model of supportive consultation with a parent or caregiver (rather than directly with the child).
  • The intervention lasts 9 to 11 months, with at least 16 every-other-week sessions, typically lasting 90 minutes each.
  • Services are carried out by mental health providers with specialized training.

Math Interactive Learning Experience (MILE) program to help with mathematics difficulty

  • Deficits in mathematical functioning have been reported consistently among alcohol-affected individuals.
  • The MILE program is designed to improve the child’s mathematical knowledge and skill.
  • Children complete 6 weeks of one-to-one tutoring using specifically adapted materials (eg, vertical number line, timers, etc.) that are appropriate to their academic level.
  • Parents also receive training on behavioral regulation techniques to optimize the child’s readiness to learn.

Parents and Children Together (PACT) a neurocognitive habilitation program to improve self-regulation and executive function

  • Building upon techniques developed from the brain injury literature, this intervention used 12 weekly sessions with parents and children to address and improve behavior regulation and executive function (that is, planning, organizing, and understanding of others).
  • It uses a particularly engaging metaphor of “how does my engine run” to teach children awareness of their current behavioral state and specific techniques for optimizing that state for the current situation.
Parent Training Children with FASDs might not respond to the usual parenting practices. However, the following parenting tips are recommended:
  • Concentrate on child’s strengths and talents
  • Accepting child’s limitations
  • Be consistent with discipline, school, behaviors of the child
  • Using of concrete language and examples
  • Employment of stable routines
  • Being specific and elaborative
  • Using visual aides, music, and hands-on activities
  • Using positive reinforcement often (praise, incentives)
Alternative therapies
  • Biofeedback
  • Auditory training
  • Relaxation therapy, visual imagery, and meditation (especially for sleep problems and anxiety)
  • Creative art therapy
  • Yoga and exercise
  • Acupuncture and acupressure
  • Massage, Reiki, and energy healing
  • Vitamins, herbal supplements, and homeopathy
  • Animal-assisted therapy

Prevention

The only certain way to prevent FAS is to simply avoid drinking alcohol during pregnancy.[1] Some studies have shown that light to moderate drinking during pregnancy might not pose a risk to the fetus, although no amount of alcohol during pregnancy can be guaranteed to be absolutely safe. The Royal College of Obstetricians and Gynaecologists conducted a study of over 400,000 women, all of whom had consumed alcohol during pregnancy. No case of fetal alcohol syndrome occurred and no adverse effects on children were found when consumption was under 8.5 drinks per week. A review of research studies found that fetal alcohol syndrome only occurred among alcoholics; no apparent risk to the child occurred when the pregnant women consumed no more than one drink per day. A study of moderate drinking during pregnancy found no negative effects and the researchers concluded that one drink per day provides a significant margin of safety, although they did not encourage drinking during pregnancy. A study of pregnancies in eight European countries found that consuming no more than one drink per day did not appear to have any effect on fetal growth. A follow-up of children at 18 months of age found that those from women who drank during pregnancy, even two drinks per day, scored higher in several areas of development. An analysis of seven medical research studies involving over 130,000 pregnancies found that consuming two to 14 drinks per week did not increase the risk of giving birth to a child with either malformations or fetal alcohol syndrome.

In the United States, the Surgeon General recommended in 1981, and again in 2005, that women abstain from alcohol use while pregnant or while planning a pregnancy, the latter to avoid damage in the earliest stages of a pregnancy, as the woman may not be aware that she has conceived.[14] In the United States, federal legislation has required that warning labels be placed on all alcoholic beverage containers since 1988 under the Alcoholic Beverage Labeling Act.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3
  2. ↑
  3. ↑ 3.0 3.1
  4. ↑
  5. ↑
  6. ↑ 6.0 6.1
  7. ↑ 7.0 7.1
  8. ↑ 8.0 8.1
  9. ↑ 9.0 9.1
  10. ↑
  11. ↑
  12. ↑
  13. ↑ 13.0 13.1
  14. ↑

Further reading

  • Astley S (2004). "Fetal alcohol syndrome prevention in Washington State: evidence of success". Paediatric and Perintal Epidemiology. 18 (5): 344–51. doi:10.1111/j.1365-3016.2004.00582.x. PMID 15367321.
  • Astley S, Clarren S (2001). "Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction". Alcohol and Alcoholism. 36 (2): 147–59. doi:10.1093/alcalc/36.2.147. PMID 11259212.
  • Gideon Koren, Idan Roifman, Irena Nullman. Hypothetical Framework; FASD and criminality-causation or association? The limits of evidence based knowledge. Journal of FAS International volume=2, issue=6, year=2004 |http://www.motherisk.org/JFAS/econtent_commonDetail.jsp?econtent_id=59
  • Grant T, Ernst C, Streissguth A (1996). "An intervention with high-risk mothers who abuse alcohol and drugs: the Seattle Advocacy Model". American Journal of Public Health. 86 (12): 1816–7. PMID 9003147.
  • Mattson, S.N., & Riley, E.P. (2002). Neurobehavioral and Neuroanatomical Effects of Heavy Prenatal Exposure to Alcohol, in Streissguth, A.P., & Kanter, J. (Eds.) The Challenge in Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. First published in 1997. ISBN 0-295-97650-0
  • Olegård R, Sabel K, Aronsson M, Sandin B, Johansson P, Carlsson C, Kyllerman M, Iversen K, Hrbek A (1979). "Effects on the child of alcohol abuse during pregnancy. Retrospective and prospective studies". Acta Paediatrica Scandinavica Suppl. 275: 112–21. doi:10.1111/j.1651-2227.1979.tb06170.x. PMID 291283.
  • Ratey, J.J. (2001). A User's Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain. New York: Vintage Books. ISBN 0-375-70107-9.
  • Ulleland CN, Wennberg RP, Igo RP, Smith NJ (1970). "The offspring of alcoholic mothers". Abstract. American Pediatric Society for Pediatric Research.


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