Wednesday, May 07, 2008

FASD Fact of the Day: Fetal Alcohol Spectrum Disorders 101

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term that includes several specific diagnoses of children affected by prenatal exposure to alcohol. Terminology describing the diagnoses associated with prenatal alcohol exposure has changed over the years. Previous terms have included Fetal Alcohol Effects (FAE) and Minimal Brain Dysfunction (MBD). The new term FASD emphasizes the wide continuum of clinical effects that can occur when a woman drinks alcohol during pregnancy. Included within Fetal Alcohol Spectrum Disorders are Fetal Alcohol Syndrome (FAS), Alcohol Related Neurodevelopmental Disorder (ARND), and Alcohol Related Birth Defects (ARBD).

  • Fetal Alcohol Syndrome (FAS)
    Children whose mothers drink alcohol during pregnancy can suffer a wide range of physical, mental, behavioral, and learning disabilities that fall into the broad continuum of Fetal Alcohol Spectrum Disorders. Fetal Alcohol Syndrome is one of these disorders. Children with Fetal Alcohol Syndrome (FAS) have specific facial features, growth abnormalities and changes in the central nervous system.

  • Alcohol Related Neurodevelopmental Disorder (ARND)
    Children with Alcohol Related Neurodevelopmental Disorder (ARND) were exposed to alcohol prenatally. They are similar to children with FAS in regard to central nervous system and growth abnormalities, but they do not show all of the characteristic facial features required for a diagnosis of FAS.

  • Facial Features
    Children with FAS demonstrate all three of the characteristic facial features, while children with ARND may have one or two:

    • Thin upper lip

    • Flattened elongated philtrum (groove or crease running from the bottom of the nose to the top of the lip)

    • Short palpebral fissures (small eye openings)

    In addition, children with FASD may have other features such as:

    • Epicanthal folds (extra skin folds coming down around the inner angle of the eye)

    • Small mouth with a narrow high arched palate

    • Small teeth with poor enamel

    • Small chin

    • Low set or malformed ears

    These changes can vary in severity, but usually persist over the life of the child. Most people will not recognize any differences when they see the child, but someone with experience in working with children prenatally exposed to alcohol will be able to detect the changes.

    Children with Fetal Alcohol Spectrum Disorders also may have a variety of malformations of major organs including:

    • The heart, kidneys, eyes, and ears

    • Vision problems, with a good number of people having an eye that turns in or a lazy eye.

    • Predisposition to ear infections and a high rate of hearing loss (eighth nerve deafness)

  • Growth Abnormalities
    Children with Fetal Alcohol Syndrome demonstrate poor growth in height or weight at some point during their lives. Babies born to mothers who use alcohol have a lower than average birth weight. As children with FAS grow, they tend to continue to be small for their age. Children with ARND may or may not demonstrate growth abnormalities.

  • Central Nervous System Changes
    Children with FASD have significant structural and functional changes in their brains resulting in varying degrees. FASD can cause:

    • Microcephaly (small head size)

    • Lower IQ

    • Behavioral problems

    • Emotional problems and learning problems

    Areas of the brain that are particularly susceptible to the effects of alcohol include those responsible for:

    • Executive functioning

    • Emotional and behavioral regulation, and

    • Cognitive functioning

    Damage to the brain associated with the alcohol exposure can result in a variety of dysfunctions including:

    • Difficulty applying learning to new situations

    • Poor problem solving skills

    • Difficulty understanding and following directions

    • Difficulty with transitions

    • Trouble interpreting social cues

    • Problems regulating responses to sensation

    • Poor motor planning and

    • Issues with attention and hyperactivity (ADHD)

    Many behaviors seen in children with FASD are the result of brain damage and not willful misconduct. Examples include:

    • The child who repeatedly forgets his homework

    • Cannot stand in line and wait his turn, or

    • Has difficulty following the rules of a baseball game

    When the relationship between these behaviors and the neurological deficits resulting from FASD is not recognized, the children often begin to feel incompetent and their caregivers may become frustrated, thinking that the child is “defiant” or “unmotivated”. Once families begin to understand the source of the behaviors and use strategies to help the children, improvements in all areas can be achieved.

    Children with FASD experience a range of primary difficulties associated with prenatal alcohol exposure, including:

    • Cognitive and executive dysfunction

    • Attentional and regulatory difficulties, and

    • Problems with mood and behavior

    Research has demonstrated that throughout adolescence and adulthood individuals diagnosed with Fetal Alcohol Syndrome and Alcohol Related Neurodevelopmental Disorder are at increased risk for the development of an array of “secondary disabilities” associated with the primary effects of prenatal alcohol exposure including:

    • Mental health problems

    • Disrupted school experiences

    • Trouble with the law

    • Confinement

    • Inappropriate sexual behavior and

    • Alcohol and drug problems

  • Alcohol Related Birth Defects (ARBD)
    Children with ARBD were exposed to alcohol prenatally and have associated physical findings but no central nervous system dysfunction. Children with ARBD can have malformations of major organs such as the heart, kidneys, eyes and ears, and other issues such as vision problems, a predisposition to ear infections, a higher than average rate of hearing loss and poor enamel coating of the teeth.

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