Children with Fetal Alcohol Syndrome

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Fetal Alcohol SyndromeFetal alcohol syndrome is among the most commonly known causes of mental retardation and is a major public health problem. What is it, how does it affect people, what can we do about it? These are the issues that will be discussed in this lecture.

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Historical view of alcohol as a teratogenFoolish, 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

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Fetal Alcohol SyndromeSpecific pattern of facial features Pre- and/or postnatal growth deficiency Evidence of central nervous system dysfunction Photo courtesy of Teresa Kellerman

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FAS – Only the tip of the icebergFetal alcohol syndrome Fetal alcohol effects Clinical suspect but appear normal Normal, but never reach their potentialAdaped from Streissguth

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Incidence of FAS (rates per 1000) Alaska 0.2 non AI/AN 3 AI/AN Aberdeen 2.7 AI/AN BDMP 0.7 Atlanta 0.1 0.3 full % partial IOM 0.6-3 IOM 2 - 8.5 AI/AN Seattle 2.8 Cleveland 4.6 Roubaix 1.3-4.8 Seattle (FAS and ARND) 9.1 South Africa (Wellington) 48

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Streissguth, 1994 Facies in Fetal Alcohol Syndrome

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Courtesy of Ann StreissguthGrowing up with FAS

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Brain damage resulting from prenatal alcoholphoto: Clarren, 1986

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CerebrumCerebellumCorpus CallosumMattson et al., 1994Change in brain size

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Corpus callosum abnormalitiesMattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

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General Intellectual Performance FSIQVIQPIQStandard scoreIQ scaleNCPEAFAS*******Mattson, S.N., 1997.

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Neuropsychological PerformanceMattson, et al., 1998

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213Move only one piece at a time using one hand and never place a big piece on top of a little pieceStarting positionEnding positionMattson, et al., 1999 Executive functioning deficits

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Secondary Disabilities Individuals with FAS/FAE have a range of secondary disabilities – disabilities that the individual is not born with, and which could be ameliorated with appropriate interventions. Streissguth, et al., 1996

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Many studies simply could not be done on humans Confounding factors can rarely be controlled in human studies Alcohol is rarely the only drug used Many abnormalities occur at low rates Epidemiological studies are extremely time consuming and expensiveAnimal models and prenatal alcohol

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Animal models – Example of the comparability of effectsGrowth retardation Facial characteristics Heart, skeletal defects Microcephaly Reductions in basal ganglia and cerebellar volumes Callosal anomalies Hyperactivity, attentional problems Inhibitory deficits Impaired learning Perseveration errors Feeding difficulties Gait anomalies Hearing anomalies Driscoll, et al., 1990; Samson, 1986;

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Adapted from Sulik & Johnston, 1982 Facial features of FAS in the mouse

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Alcohol and the CerebellumPictures courtesy of James West

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Possible mechanisms for alcohol’s effects Impaired progression through cell cycle Impaired glia development - migration, neurotropic factor production, myelination Impaired cell adhesion Alterations in cell membranes Altered production of or responsiveness to factor that regulate growth, cell division, or cell survival Altered regulation of intracellular calcium Increased production of free radicals

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Courtesy of Michael Charness from Ramanathan et al., 1996

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Risk FactorsDose 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

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Treatment and PreventionVery little research done on these topics Many children with FAS treated for their individual symptoms (e.g. stimulants for ADHD) Animal data indicates that early intervention with environmental variables might have a beneficial effect Warning labels may not be reaching the women most likely to have a child with FAS Intensive, case-management approaches appear to work very well.

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Remediation of prenatal alcohol effectsNumber of slipsKlintsova AY., 1998

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Prevention – The Birth to 3 ProgramParent-child assistance program Intensive home visitation model for the highest risk mothers Paraprofessional Advocates Paired with client for 3 years following the birth of the target Baby Link clients with community services Extensively trained and closely supervised Maximum caseload of 15 Outcomes Fewer alcohol/drug affected children Reduced foster care placement Reduced dependence on welfare Grant, T.M., 1999; Ernst, C. C., et al. 1999

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SummaryFetal Alcohol Syndrome is a devastating developmental disorder that affects children born to women who abuse alcohol during pregnancy. Although FAS is entirely preventable, and in spite of our increasing knowledge about the effects of prenatal alcohol exposure, children continue to be born exposed to high amounts of alcohol. It’s consequences affect the individual, the family, and society. Its costs are tremendous, both personally and financially. Effective treatment and prevention strategies must be developed and made available.

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Last Updated: 8th March 2018

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