Do I Have Fetal Alcohol Syndrome? - [] 2024: Bistro Le Duc

Do I Have Fetal Alcohol Syndrome
Cause and Prevention – FASDs can occur when a person is exposed to alcohol before birth. Alcohol in the mother’s blood passes to the baby through the umbilical cord. There is no known safe amount of alcohol during pregnancy or when trying to get pregnant.

There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful, including all wines and beer. To prevent FASDs, a woman should avoid alcohol if she is pregnant or might be pregnant.

This is because a woman could get pregnant and not know for up to 4 to 6 weeks. Do I Have Fetal Alcohol Syndrome It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use will improve the baby’s health and well-being. Resources are available, FASDs are preventable if a baby is not exposed to alcohol before birth.

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 Shorter-than-average height Small head size Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

Different FASD diagnoses are based on particular symptoms and include:

Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. People with FAS have central nervous system (CNS) problems, minor facial features, and growth 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 trouble getting along with others. 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. Do I Have Fetal Alcohol Syndrome People with ND-PAE have problems with thinking, behavior, and life skills. ND-PAE occurs from being exposed to alcohol during pregnancy. : ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30-day period of pregnancy) or more than 2 alcoholic drinks in one sitting.

The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD).

Prenatal alcohol exposure; although confirmation is not required to make a diagnosis Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination) Lower-than-average height, weight, or both Abnormal facial features (e.g., smooth ridge between nose and upper lip)

FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches.

Diagnosis before 6 years of age Loving, nurturing, and stable home environment during the school years Absence of violence Involvement in special education and social services

If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs.

To find doctors and clinics in your area visit the from FASD United (formerly NOFAS). At the same time as you ask the doctor for a referral to a specialist, call your state or territory’s early intervention program to request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation.

You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age: If your child is younger than 3 years old, Call your and say: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”Find your state’s early intervention contact information,

If your child is 3 years old or older, contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.

Can you have slight fetal alcohol syndrome?

By: Vincent C. Smith, MD, MPH, FAAP & Renee Turchi, MD, MPH, FAAP The term fetal alcohol spectrum disorders, or FASDs, describes a broad group of conditions that an individual can have as a result of prenatal alcohol exposure. Alcohol alters the development of the brain and many other body organs of the developing fetus.

Can doctors tell if a baby has fetal alcohol syndrome?

Diagnosis – Diagnosing fetal alcohol syndrome requires expertise and a thorough assessment. Early diagnosis and services can help improve your child’s ability to function. To make a diagnosis, your doctor:

Discusses drinking during pregnancy. If you report the timing and amount of alcohol consumption, your obstetrician or other health care provider can help determine the risk of fetal alcohol syndrome. Although doctors can’t diagnose fetal alcohol syndrome before a baby is born, they can assess the health of the mother and baby during pregnancy. Watches for signs and symptoms of fetal alcohol syndrome in your child’s initial weeks, months and years of life. This includes assessing physical appearance and distinguishing features of your baby and monitoring your child’s physical and brain growth and development.

The doctor also may assess for:

Cognitive ability and learning and language development difficulties Health issues Social and behavioral problems

Many features seen with fetal alcohol syndrome may also occur in children with other disorders. If fetal alcohol syndrome is suspected, your pediatrician may refer your child to a developmental pediatrician, a neurologist or another expert with special training in fetal alcohol syndrome for evaluation and to rule out other disorders with similar signs and symptoms.

How much alcohol causes FAS?

What causes foetal alcohol syndrome? – Studies have shown that heavy drinking during pregnancy, usually measured as repeatedly consuming more than around five units of alcohol (2 large glasses of wine) per day, carries the greatest risk of a baby being affected with FAS.

Can you have fetal alcohol syndrome and be smart?

HOW DOES FASD AFFECT THIS AREA? Researchers have found that on average people with FASD generally have intelligence levels in the borderline to low average range, as measured on IQ tests. This means that they tend to have somewhat lower intellectual abilities overall.

These lower IQ scores show up at a very young age and generally continue throughout a person’s lifespan.
However, this average is not necessarily representative of individuals with FASD as there is a large range of IQ scores in this population, from very high (above average) to very low (intellectual disability).

Moreover, many researchers report that intellectual abilities in individuals with FASD are often unevenly developed, meaning that their full scale IQ score may not be the best indicator of how an individual may function. For instance, IQ can be divided into a verbal domain and a visual domain.

Individuals with FASD often have much higher scores in one domain over another. They might be much better at doing verbal tasks than visual/non-verbal tasks or vice versa. However, the number of people who have a better verbal IQ is about the same as the number of people who have a better visual IQ. How do we know whether the difficulties experienced by people with FASD are due to fetal alcohol exposure or a generally lower IQ? Researchers have compared individuals with FASD to individuals with no prenatal alcohol exposure, but similar IQ scores,

A number of similarities and differences have been found:

Similar ability to switch mental concepts and strategies when requirements are changedSimilar ability to quickly give verbal responsesSimilar fine motor skills Similar ability to keep their attention focused on somethingSimilar language skills (i.e. understanding and expressing language)Some similarities in tasks combining visual and spatial abilitiesSimilar ability to remember verbal information, although some deficits in verbal learning and memory are worse for children with FASD.Children with FASD have more difficulty quickly giving non-verbal responses.Children with FASD have more problems with social behaviours and thoughts, attention, delinquency, and aggression ( adaptive behaviour and externalizing behaviour )

WHAT COULD HAPPEN IF THE RELATIONSHIP BETWEEN FASD AND IQ IS NOT UNDERSTOOD? Although many people with FASD have an IQ within the “normal” range, they often are not able to function within the “normal” range for their age. That is, they may have average IQ, but below average adaptive function.

Can you have FASD without facial features?

Table 1: – Recommendations for the diagnosis of fetal alcohol spectrum disorder (FASD) *


Recommendation	Strength of recommendation †	Quality of evidence †
1.0	Screening, referral and support
1.1	All pregnant and postpartum women should be screened for alcohol use with validated measurement tools by service providers who have received appropriate training in their use.10 Women at risk of heavy alcohol use should receive early, brief interventions (i.e., counselling and/or other services).	Strong	High
1.2	Referral of individuals for a possible FASD diagnosis should be made whenever there is evidence of, or suspected prenatal alcohol exposure at levels associated with, physical or developmental effects.	Strong	Moderate
1.3	Abstinence from alcohol should be recommended to all women during pregnancy to ensure the safest outcome for the fetus, and appropriate support should be provided, as indicated.	Strong	High
2.0	Medical assessment ‡
2.1	The diagnostic process should include compiling a social and medical history and complete physical examination.	Strong	High
2.2	Confirmation of prenatal alcohol exposure requires documentation that the biological mother consumed alcohol during the index pregnancy based on: reliable clinical observation; self-report; reports by a reliable source; medical records documenting positive blood alcohol concentrations; alcohol treatment; or other social, legal or medical problems related to drinking during the pregnancy. The presence of all three facial features has such high specificity to alcohol exposure and FASD that confirmation of alcohol exposure is not required.11 The presence of fewer than three facial features does not have the same degree of specificity and therefore requires other confirmation.	Strong	Moderate
3.0	Sentinel facial features
3.1	The following three sentinel facial features must be present because of their specificity to prenatal alcohol exposure: Palpebral fissure length ≥ 2 SDs below the mean (< third percentile). Philtrum rated 4 or 5 on 5-point scale of the University of Washington Lip–Philtrum Guide.12 Upper lip rated 4 or 5 on 5-point scale of the University of Washington Lip–Philtrum Guide.12	Strong	High
4.0	Neurodevelopmental assessment
4.1	A diagnosis of FASD is made only when there is evidence of pervasive brain dysfunction, which is defined by severe impairment in three of more of the following neurodevelopmental domains: motor skills; neuroanatomy/neurophysiology; cognition; language; academic achievement; memory; attention; executive function, including impulse control and hyperactivity; affect regulation; and adaptive behaviour, social skills or social communication.	Strong	High
4.2	Severe impairment is defined as a global score or a major subdomain score on a standardized neurodevelopmental measure that is ≥ 2 SDs below the mean, with appropriate allowance for test error. In some domains, large discrepancies among subdomain scores may be considered when a difference of this size occurs with a very low base rate in the population (≤ 3% of the population). Clinical assessment with converging evidence from multiple sources and DSM-V diagnostic criteria 13 for certain disorders may also be considered in specific domains that are not easily assessed by standardized tests. For example, in the affect regulation domain, the following diagnoses may be taken as an indication of severe impairment: major depressive disorder (with recurrent episodes), persistent depressive disorder, disruptive mood dysregulation disorder, separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, agoraphobia or generalized anxiety disorder). A domain-by-domain discussion of how these criteria are operationalized is outlined in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.141593/-/DC1 ).	Strong	Moderate
5.0	Nomenclature and diagnostic criteria
5.1	A diagnosis of FASD may be made if an individual meets either of the two sets of criteria below: 5.1.1 FASD with sentinel facial features Simultaneous presentation of the three sentinel facial features (see section 3.0); AND Prenatal alcohol exposure confirmed or unknown; AND Evidence of impairment in three or more of the identified neurodevelopmental domains (see section 4.0) or, in infants and young children, evidence of microcephaly. OR 5.1.2 FASD without sentinel facial features Evidence of impairment in three or more of the identified neurodevelopmental domains (see section 4.0); AND Confirmation of prenatal alcohol exposure, with the estimated dose at a level known to be associated with neurodevelopmental effects.	Strong	High
5.2	At risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure 5.2.1 This is not a diagnosis; this is a designation that should be given to individuals when: There is confirmation of prenatal alcohol exposure, with the estimated dose at a level known to be associated with neurodevelopmental effects; Central nervous system criteria from 5.1.1 and 5.1.2 are not met; There is some indication of neurodevelopmental disorder in combination with a plausible explanation as to why the neurodevelopmental assessment results failed to meet the criteria for substantial impairment (e.g., patient was too young; incomplete assessment). 5.2.2 This designation may also be considered for individuals with all three sentinel facial features as described in 5.1.1 who do not yet have documentation or evidence of the requisite three or more neurodevelopmental domain criteria or true microcephaly. This designation should never be considered when prenatal alcohol exposure is confirmed absent.
6.0	The diagnostic team
6.1	Core team members across the lifespan: For infants (< 18 mo) Pediatrician/physician Child development specialist who has the skill set to conduct physical and functional assessments (e.g., speech-language pathologist, physiotherapist, occupational therapist, clinical psychologist) For preschoolers (18 mo–5 yr) Pediatrician/physician Occupational therapist Speech-language pathologist Psychologist For school-aged children (6 yr–age of majority) Pediatrician/physician with expertise in FASD and differential diagnosis Occupational therapist Speech-language pathologist Psychologist For adults Physician Psychologist Speech-language pathologist/psychologist with expertise in language assessment	Strong	High
7.0	Special considerations in neurodevelopmental assessment of infants and young children
7.1	Infants and young children with all three sentinel facial features and microcephaly should be given a diagnosis of “FASD with sentinel facial features”; these children have a high risk of neurodevelopmental disorder.11, 14 They should also be referred to a clinical geneticist.	Strong	High
7.2	Infants and young children with all three facial features may be given a diagnosis of “FASD with sentinel facial features” if they undergo a comprehensive neurodevelopmental assessment and show deficits in three or more brain domains. Infants and young children with confirmed prenatal alcohol exposure may be given a diagnosis of “FASD without sentinel facial features” if they undergo a comprehensive neurodevelopmental assessment and show deficits in three or more brain domains.	Strong	Moderate
7.3	Infants and young children with confirmed prenatal alcohol exposure but who do not meet the criteria for FASD should be designated as “At risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure.” Those with all three facial features but no microcephaly should be referred to clinical genetics.	Strong	High
7.4	A complete neurodevelopmental assessment should be recommended at an age-appropriate time for all infants and young children with confirmed prenatal alcohol exposure and/or all three facial features.	Strong	High
8.0	Special considerations in neurodevelopmental assessment of adolescents and adults
8.1	Recommendations following the assessment must address basic and immediate needs of the client, and assist them in accessing required resources.	Strong	Moderate
9.0	Management and follow-up
9.1	Individuals with FASD and their caregivers should be linked to resources that can improve outcomes. However, just because availability of services is limited, an individual should not be denied an assessment and management plan. Often the diagnosis is the impetus that leads to the development of resources.	Strong	Low
9.2	When young adults are transitioning to independent living situations, it may require that they undergo a reassessment to identify changes in their adaptive function and to make subsequent adjustments to their management plan.	Strong	Low

Diagnostic algorithm for fetal alcohol spectrum disorder (FASD). *Assessment conclusive = clinician conducting the neurodevelopmental assessment is satisfied that the session was a true representation of the person’s ability and that any deficits reported were not due to extenuating circumstances.

Assessments may be inconclusive for children under six years of age, because some domains cannot be assessed with confidence until the person is older or because of other confounding factors, such as temporary life stress or illness; see the text for more information. †Microcephaly is not the only pathway to diagnosis for infants and young children; these individuals may also receive other FASD diagnoses, as specified elsewhere in the algorithm, if they show three areas of substantial impairment on neurodevelopmental tests.

‡At risk for neurodevelopmental disorder and FASD, associated with prenatal alcohol exposure. An at-risk designation includes situations where a full neurodevelopmental assessment is not conclusive because of age or situational factors; therefore, FASD may not be the diagnosis.

Clinical judgment is recommended. Note: CNS = central nervous system (yes/no impairment in ≥ 3 brain domains), SFF = sentinel facial features. Clinicians must consider the issue of differential diagnosis when providing a diagnosis of FASD. Diagnosing FASD is often complex because of the presence of multiple risk factors and negative exposures that are substantial contributors to the patient’s symptoms.

No neurodevelopmental deficits are considered pathognomonic for, or specific to, FASD.

Does FASD get worse with age?

Symptoms of fetal alcohol syndrome – Symptoms of babies who have fetal alcohol syndrome include:

Poor growth in the womb Small and underweight at birth Small head and eyes Heart defects, such as a hole in the heart Delayed development Vision or hearing problems

As they grow older, these children may have behavior problems. They may experience learning disabilities, trouble with memory and attention, and hyperactivity. Symptoms tend to get worse as the child grows older. The most serious problem FAS can cause is developmental delay. FAS is the leading cause of preventable developmental delays in the United States.

Do kids with fetal alcohol syndrome look different?

How Does Fetal Alcohol Syndrome (FAS) Affect Children? – Children with fetal alcohol syndrome have facial features such as small eyes, a thin upper lip, and a smooth philtrum (the groove between nose and upper lip). They also can have:

Poor growth. Newborns may have low birth weights and small heads. They may not grow or gain weight as well as other children. Birth defects. FAS can cause heart, bone, and kidney problems. Vision problems and hearing loss are common. Seizures and other neurologic problems, such as learning disabilities, and poor balance and coordination. Delayed development. Kids may not reach milestones at the expected time. Behavioral problems. Babies may be fussy or jittery, and have trouble sleeping. Older children and teens may have:

a lack of coordination and poor fine-motor skills trouble getting along with friends and relating to others learning problems (especially in math), poor memory, and poor problem-solving skills behavior problems such as hyperactivity, poor attention and concentration, and impulsiveness

Children with other FASDs have many of the same problems, but usually to a lesser degree.

What can FASD be misdiagnosed as?

Abstract – Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe the set of conditions that result from prenatal alcohol exposure (PAE) that lead to cognitive impairment, neurodevelopmental delays, socioemotional and behavioral problems, medical complications, and/or secondary disabilities.

In addition, various internalizing and externalizing disorders share similar symptoms with FASD, resulting in misdiagnoses and/or missed diagnosis of FASD.
This is amplified for Black youths due to the later onset of referral for assessment and lower frequency of referral to specialty clinics.
This clinical case report depicts a misdiagnosis and a missed diagnosis of FASD in a 10-year-old African American patient, who was referred for neuropsychological evaluation.

Diagnoses at the time of referral included attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and disruptive mood dysregulation disorder (DMDD). Upon completion of a comprehensive evaluation, the patient’s diagnoses changed to neurodevelopmental disorder associated with prenatal alcohol exposure, intellectual disability (ID), ADHD, and unspecified depressive disorder, leading to referral to appropriate interventions.

The goal of this clinical case report is to increase clinician understanding of FASD and its clinical presentation, inform clinicians about the diagnostic and systemic factors that contribute to misdiagnosis and missed diagnosis of FASD, and to demonstrate the importance of an accurate diagnosis of FASD.

By depicting the diagnostic challenges in an African American youth, the authors hope to bring awareness to the racial and ethnic disparities in the diagnosis of neurodevelopmental disabilities, specifically FASD in minority youth. Keywords: Prenatal alcohol exposure, fetal alcohol spectrum disorders, fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, misdiagnosis, missed diagnosis, Black youths Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe the set of conditions that result from prenatal alcohol exposure (PAE).1 FASD includes fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD).2 These conditions can cause structural changes in the brain, physical abnormalities, cognitive impairment, neurodevelopmental delays, socioemotional and behavioral problems, medical complications, and secondary disabilities (e.g., school failure, delinquency, incarceration).2 FASD is the most common preventable cause of developmental disabilities and birth defects in the United States.3, 4 FASD is a major social, economic, and public health concern.2, 4 In 2014, the estimates of the prevalence of FASD were 0.5 to two per 1,000 births, and 4.5 per 1,000 births per year for pFAS, ARND, and ARBD.2 Currently, the estimated prevalence for the entire spectrum is 10 per 1,000 births.5 Current research indicates that there are differences in prevalence rate for FASD across racial/ethnic groups.6 Notably, it is estimated that seven percent of children with FASD have never been diagnosed and seven percent of children with FASD have been misdiagnosed.5 Attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), oppositional defiant disorder (ODD), conduct disorder (CD), reactive attachment disorder (RAD), and communication disorders have many common symptoms with FASD in neurocognitive domains, as well as academic, adaptive, behavioral, emotional, and social functioning domains.7, 8 Thus, the similarities in the clinical presentations between FASD and the noted diagnoses result in can misdiagnoses and/or missed diagnosis of FASD.

Stoler and Holmes (1999) analyzed the medical records of women and infants for prenatal alcohol effects and found underrecognition of the effects of alcohol, which subsequently led to underdiagnosis.9 More recently, Chasnoff, Wells, and King (2015) assessed the rate of misdiagnosis and missed diagnosis of FASD within foster and adoption populations.7 Diagnoses at the time of the referral commonly included ADHD, ODD, RAD, and posttraumatic stress disorder (PTSD).

Following comprehensive and multidisciplinary diagnostic evaluations, results indicated a misdiagnosis rate of 6.4 percent and a missed diagnosis rate of 80.1 percent for FASD. Participants eventually diagnosed with FASD required significant changes in their interventions and therapy services.

Overall, evidence suggests that the mental health needs of minority children are largely unmet.10, 11 There are racial and ethnic disparities in screening, diagnostic assessment, and access to formal mental health services.
Specifically, African American males are misdiagnosed with externalizing disorders, and neurodevelopmental disorder diagnoses are missed.

For example, Black youths are more likely to be diagnosed with CD and ODD than their white counterparts.12, 13, 14 This is amplified in the juvenile justice and foster care systems in which youth of color are overrepresented and diagnosed with more historically stigmatizing mental health disorders, which lead to poorer outcomes, compared to white youths.15, 16 Furthermore, evidence indicates that minority youths, including Black youths, are referred to neurodevelopmental specialty clinics less frequently for evaluation and treatment, delaying the age of diagnosis and implementation of effective interventions.17 ADHD is 40 percent less likely to be diagnosed in Black males, and compared to white males, they are 32 percent less likely to receive psychiatric treatment for ADHD.12 In addition, significant delays have been reported in the diagnosis of autism for African American children (7.9 years) compared to white children (6.3 years).11 Overall, due to the diagnostic process for FASD requiring an interdisciplinary evaluation and documented mental health disparities, identifying FASD in minority youths requires not only an understanding of FASD symptoms, but also consideration of the systemic issues.

Misdiagnosis and/or missed diagnosis of FASD may lead to secondary disabilities, which are conditions that arise due to the adverse impact of the primary symptoms of FASD. Examples of secondary disabilities are school failure, delinquency, incarceration, and psychiatric problems, such as depression and substance use.

Furthermore, it may lead to incorrect behavioral and pharmacological treatments, caregiver stress, and disrupted placements within the foster care system.7, 8, 18 These factors could lead to less stability and poorer prognosis for individuals with FASD.

The goal of this clinical case report is to increase clinician understanding of FASD and its clinical presentation, inform clinicians about the diagnostic and systemic factors that contribute to misdiagnosis and a missed diagnosis of FASD, and demonstrate the importance of an accurate diagnosis of FASD.

By depicting the diagnostic challenges an African American youth experienced, the authors hope to bring awareness to the racial and ethnic disparities in the diagnosis of neurodevelopmental disabilities, specifically FASD, in minority youths.

Is FAS 100% preventable?

Background – Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental deficits in the United States. It can cause a range of intellectual and behavioral problems, which appear at any time during childhood and last a lifetime.

Fetal Alcohol Spectrum Disorders is an umbrella term for a range of physical, cognitive, and behavioral disorders caused by prenatal alcohol exposure. Recent prevalence studies estimate that approximately 1 to 5 percent of U.S. first-grade children have FASD. Individuals with FASD experience a unique combination of day-to-day challenges, which may include medical, behavioral, educational, and social problems.

People with FASD may have difficulty in areas of 1) neurocognition (i.e. global intellectual impairment, executive function deficits, poor working memory, learning problems); 2) self-regulation (i.e. impulse control problems, impaired mood or behavioral regulation, attention deficits, organization difficulties); and 3) adaptive functioning (i.e.

Communication issues, problems with daily living, poor social skills, gross or fine motor delay).
FASD are 100% preventable if a developing fetus is not exposed to alcohol.
Given that approximately half of all pregnancies in the United States are not planned, the U.S.
Surgeon General recommends that women who are pregnant, might be pregnant, or consider becoming pregnant should abstain from alcohol.

Despite these guidelines, approximately 1 in 9 pregnant women report drinking alcohol in the past 30 days and about one third who report consuming alcohol engage in binge drinking, a pattern of consumption most harmful to the developing fetus.

Do I have FASD or ADHD?

People with FASD typically have trouble with overstimulation. People with ADHD typically have trouble with understimulation. People with FASD may have issues with speech, language, and memory. People with ADHD typically do not.

What is the average IQ of someone with FASD?

Chapter 5: The FASD Student & Learning Issues – Understanding Fetal Alcohol Spectrum Disorders (FASD) While certain behavioral and educational characteristics have been identified with FASD, it is important to note that this is a varied population. FASD students cross all socioeconomic backgrounds.

Students with FASD are affected differently, and they must be treated individually.
Each FASD student is unique, presenting strengths and weaknesses.
The intellectual abilities of students with FASD differ tremendously.
While FASD is the leading cause of mental retardation, IQ scores fall within the range of 20 to 120, with the mean falling within the borderline of mental retardation.

ARND has a higher range and its mean is in the low-average range. Many students with FASD have intellectual abilities in the normal range. However, FASD students with IQ scores in the average range can still have serious organic brain damage and express characteristic behavioral and learning difficulties associated with this disability.

As discussed in Chapter 4, FASD students are placed in a variety of educational settings, depending upon their individual needs. There are success stories of young FASD students who thrive in school. These students are able to learn; however, they learn differently. With the support of educational modifications and/or accommodations, some students have graduated high school; others have even gone on to college.

Adults with FASD can be found in a variety of occupations, such as teachers, artists, counselors, administrators, musicians, and computer programmers. I would like teachers to know that we learn differently than others. Simple tasks like taking notes are very difficult.

Teachers need to explain things in simple words.
Lasser, 1999) As educators become increasingly familiar with FASD, more students will be identified.
In the past, these students were not identified and misdiagnosed.
Some of them were diagnosed late.
For FASD, behavior and learning issues can be puzzling and frustrating for the educator, the student, and the parents.

In addition to the varied intellectual range exhibited by these students, there are learning difficulties common to FASD students. In this chapter the following learning difficulties are discussed in detail along with effective strategies for addressing each problem:

Difficulty with information-processing and memory Attention difficulties Difficulty with abstract thought and conceptual thinking Math difficulties—especially computational math Reading and writing difficulties—especially reading comprehension and organization of writing Problems with executive function

: Chapter 5: The FASD Student & Learning Issues – Understanding Fetal Alcohol Spectrum Disorders (FASD)

Does FASD look like ADHD?

Study: FASD Often Confused with ADHD, But Symptoms More Severe Fetal alcohol spectrum disorder (FASD) and attention-deficit hyperactivity disorder (ADHD) share many attributes, and children with FASD are often misdiagnosed as having ADHD. However, a recent study found that children with FASD have a harder time understanding social information than their peers with ADHD, and are at a higher risk of psychiatric problems, reported July 17.

These problems can lead to even more serious behavioral problems, including lying and stealing, according to researchers. “It is imperative that these children receive assistance in social and emotional processing domains, specifically targeting interventions to deal with their unique deficits,” said Joanne Rovet, co-author of the study and a University of Toronto professor. The study is set to appear in the October 2009 edition of the journal,

: Study: FASD Often Confused with ADHD, But Symptoms More Severe

Do all alcoholics have babies with FASD?

20 myths about fetal alcohol spectrum debunked What I’ll be doing tonight is hopefully dispelling the top 20 myths related to FASD as I’ve come across them in the last few years working in this area. The main themes I’ll be focusing on are the prevalent diagnostic issues related to fetal alcohol, spectrum disorder, some information about the drinking guidelines, and why drinking is particularly harmful to the developing fetus.

How we diagnose FASD, and the symptoms of FASD and what we can do about it.
Of course, my present notes have disappeared off the screen, but that’s okay, because there’s just one little bit I want to read to you right at the beginning.
It’s likely that the possible dangers of drinking in pregnancy have been suspected for many years, as there is even a quote in the Bible which says, “Behold, thou shall conceive and bear a son, and now drink no wine or strong drink.” And that was in Judges 13:7.

In 1726, the Royal College of Decisions started a petition asking the government to place restrictions on alcohol consumption and cold gin that cause weak feeble and distempered children. It wasn’t until 1973, that a couple of researchers, Jones and Smith coined the term Fetal Alcohol Syndrome to describe a group of children born to alcoholic mothers.

They had very distinctive facial features and poor prenatal, postnatal growth and who later developed problems with learning. By 2000, it was recognized that alcohol exposure in utero may result in neuro developmental problems, and so the term FASD was coined. You can see from this picture there’s a little child being held upside down and probably can’t see very well, but he does have the classic dysmorphic facial features of FASD, and I’ll talk about those in a moment.

We’ve known that alcohol for a very long time causes problems, and one of the common myths we come across is the belief that it’s only a problem in indigenous communities around the world. That’s just simply not the case. Well, it’s a problem in those communities, and there’s been a lot of research and focus on those groups.

It’s a problem that affects all sectors of society. Within Australia, one prevalent study which captured reporting by pediatricians found a prevalence of about,06 per 1000 live births. And I think that’s likely to be an underestimate. I’ll talk about the reasons why in a moment. James Fitzpatrick, PhD, looking at the little one project actually found much higher rates in the Fitzroy Valley, so 120 per 1000 in seven to nine year olds.

There’s also data that shows that alcohol related birth defects around the pool prevalence of 10.2 per 1000. It’s a huge problem. FASD probably occurs in around one to five out of 1000 births around the world. You can see here a diagram that shows the percentages of women that drink during pregnancy among the general population.

The countries in blue, particularly the very dark blue, like Russia have very high rates.
And you can see there’s also very high rates in South Africa as well.
Australia is up there too.
A recent US study also found that the prevalence rates are much higher, about 11.3 to 50 per 1000.
That means that there’s probably around 1.2 million people in Australia currently affected by FASD, and that’s an underestimate.

It’s also often thought that FASD only affects women from low socio-economic backgrounds. We know that’s not the case. We know that around 60% of women in Australia drink during pregnancy. Half of those, 30% do stop, when they realize that they’re pregnant, but the rest continue to drink throughout their pregnancy.

Women from middle to higher socio-economic groups tend to actually There’s a high proportion of those women that continue to drink, it’s just that those from low socio-economic groups tend to drink a bit more. The percentage is still up there, and what’s really concerning, is that it’s estimated that about 50% of women don’t realize that they’re pregnant.

And so many women continue and it did happen to me, and my daughter knows that, they don’t realize that they’re pregnant, and they might go to a party and have a few drinks. That’s really quite common. The other problem is a lot of women will occasionally have a binge drink.

We know that binge drinking is particularly toxic to the developing fetus.
There is data that shows that women from middle to high economic groups do drink quite a lot within Australia.
This was a table taken from a study back in 2010, and as you can see, the middle and highest income families, 38% from the middle sector drank during pregnancy and 51, nearly 52% in the high sector.

I think these women can afford alcohol, and there’s something about Australian culture, I think, we do have an unhealthy relationship with alcohol. That tension between probably known for very long time that alcohol is not great for the baby and yet we still for many different reasons continue to drink during pregnancy, and so that message isn’t getting across.

Another myth is that FASD really goes undiagnosed.
We know those diagnosed are the tip of the iceberg, and this is because there’s an absence of routine screening.
Health professionals typically don’t ask women whether they drink during pregnancy.
It’s an uncomfortable topic, it’s a confronting topic at times, particularly if the health professional themselves is drunk during pregnancy, or their friends have, or other family members have.

And so there’s a tendency to sweep it under the carpet. That’s the sound of my alarm, and I suddenly thought, “Oh, my goodness. I was supposed to be somewhere.” It’s swept under the carpet. There’s a lot of shame and stigma around drinking during pregnancy, and the only way we can overcome that stigma is by having these two types of talks and actually having those difficult conversations with our family and friends, but also our clients.

There’s a lack of confidence and awareness about the Australian diagnostic guidelines or other international diagnostic guidelines that we have, and I’m going to cover those in a moment. There is also a lack of diagnostic services. There’s a few clinics and teams around Australia who are working and doing fantastic work in this area, but we know that clinicians generally lack confidence.

I was in Darwin last week talking to a group of psychologists, school psychologists, and they were saying that part of the problem for them is that the services are just so splintered. So even if they can do one part of the assessment, because a multidisciplinary assessment is recommended, and it’s a bit like the assessment we do for autism, then it becomes really problematic, and it becomes really fragmented, and services don’t talk to each other.

There’s also because you don’t need the fetal features to have FASD.
That’s another problem and another myth that I’m going to go through in a moment.
That means a lot of children go unnoticed, and they’re sitting in our classrooms with learning and other types of thinking problems, and no one actually joins the dots and realizes that it’s probably because their mother drank alcohol during pregnancy.

The main myth, I think, is that it’s safe to drink alcohol during pregnancy, and the fact is that researchers really don’t know what a safe level is. The recommendations are that no drinking is safe during pregnancy, that alcohol affects the growing fetus throughout the whole development, and its impacts has an adverse effect on the nervous system, and I’m going to talk about that in a moment.

There’s a myth that it’s okay to drink alcohol after the first trimester. But like I said, alcohol continues to affect the baby or the growing fetus right the way through. As you can see from this chart, which shows the developing baby’s vulnerability to alcohol related defects during specific periods of development.

If you look at the top brow, you’ll see that the central nervous system is developing from week three, right the way through to week 38. And sure, if a woman drinks during the second and third week of the pregnancy, you’ll get those dysmorphic facial features.

But if they drink from week four right the way through week 38, they’re not going to get the facial features, but they’re potentially going to have a child with FASD.
The other thing to emphasize too is just because a woman had a few drinks during pregnancy doesn’t necessarily mean that they’re going to have a child with FASD.

We really don’t know why it is that some women are more vulnerable to the effects of alcohol than others. And some of the ideas around that are possibly that it’s because the woman might have poor nutrition or be highly stressed, and we know that cortisol can affect the growing fetus, particularly if there’s significant levels of trauma and other adverse events, or they could be genetic vulnerabilities, and so on, that we really don’t know.

It really is like playing Lotto.
You don’t know where you go get lucky and not have a child that’s affected.
The guidelines really are, it’s probably better off just not taking that risk.
These guidelines have been adopted within Australia and also by the Australian Medical Association, who promote the notion or the guideline that maternal alcohol consumption can harm the developing fetus or breastfeeding baby.

I feel women who are pregnant or planning a pregnancy, not drinking is the safest option, and that’s also the case for women who are breastfeeding. But I know myself when I had a baby. What did everyone do? My family and friends got me bottles of champagne.

And that’s really common.
We have to be thinking about our role as well in supporting women not to drink during that time.
Another myth is that only children of women who are alcoholics, or very heavy drinkers, who have children with FASD, and that’s not the case either.
In fact, I’ve even had people say to me, “Oh, I thought because I was not an alcoholic, but I drank regularly, I had built up quite a tolerance to alcohol that I was passing on that tolerance to the growing baby, and it would be okay.” There’s lots of misinformation and one of the problems is there’s lots of confusing messages out there, for example, on the internet, and so on.

Then another myth is that the placenta then filters out harmful substances. We know that’s simply not the case. In fact, the growing baby is actually more at risk of the effects of alcohol, so they can be exposed to high levels and for longer got as well.

Alcohol is incredibly toxic to the growing fetus, and there’s been over 4000 studies, at least, which is documented how dangerous alcohol is. In fact, the Institute of Medicine made it very clear that of all the substances of dependence including cocaine, heroin, and marijuana, alcohol produces by far the most serious neurobehavioral effects in the fetus.

This is because alcohol causes a whole host of different problems, and I’m not going to go through all of them tonight, but they include things like it actually kills brain cells, it reduces their growth, it causes what we describe as migrational areas and brain development.

By that I mean that certain cells are supposed to develop in one part of the brain, but they actually pop up in other parts of the brain.
There’s also an inhibition of nerve growth factor and it disrupts neurotransmitters.
That means that these children are more at risk of problems with regulating their emotions, they’re more at risky problems with depression and anxiety, and also it disrupts their sleep as well.

There are some seats down here if you’re uncomfortable on the stair. Are you all right? Okay. Another myth is that some types of alcohol are safer than others, and again, that’s not the case. If you’re pregnant and you’re drinking beer instead of spirits, thinking that you’re actually doing the right thing, that’s actually, it’s not the case.

That one standard drink is 10 grams of alcohol.
It’s a standard drink regardless of what Sorry.
Regardless of what has been drunk.
Another myth is that it’s the mother’s fault.
I can’t emphasize enough how important it is for us to move away from the idea that it’s just as simple as that.
The situation is a lot more complex.

Women drink for a whole host of different reasons. Addiction is a huge issue for a lot of women, and so if they go and see a GP, and the GP says, “Oh, you’ve got to stop drinking during pregnancy.” We all know if you think about our own struggles with coffee addiction or whatever, and nicotine or whatever.

We know that it’s actually really hard to give up drinking alcohol. Women need support, they need access to resources like psychologists and other people that can actually help them with their addiction. Even if it means reducing the amount that they’re drinking during pregnancy, that’s really important.

We also know that women can be under a lot of stress. They might be psychosocial stresses, they might be under pressure from the partner who is a heavy drinker to drink as well, or they might have been misinformed or not given the right information about the drinking issue, or they maybe have even been told by their doctor that it’s okay to drink.

I think it’s important, as I said earlier, for us to try and overcome the shame and stigma around this condition by having those conversations in a really non judgmental way and not blaming the mother. Because if we do that, they will be more likely to come forward and talk about it. Community initiatives like this one, which was on the Pregnant Pause Initiative, which was around making the pledge to go alcohol free during your pregnancy, or the pregnancy of a loved one, is a really nice initiative.

It’s a way of supporting women not to drink. Kathleen Mitchell, Vice President of the NOFAS Association in the States makes a really important point. This is her picture here with her biological daughter who has FASD. “In over 20 years of working on FASD prevention, I have never met a mom who intentionally wanted to harm her unborn baby.

Either she didn’t know the alcohol was harmed during pregnancy, or she needed help to stop drinking.” Another myth, and this is a nice picture of, who I know is in the audience, but I don’t know where she is. She is our pediatrician. One of our pediatricians. Is that children grow out of FASD. FASD is a lifelong disability.

It’s caused by the brain impairments that are the pathological process of alcohol affecting the brain, and so it’s something that that person will always have. It doesn’t necessarily mean that they can overcome some of the challenges associated with it, and it’s a spectrum disorder, so we know that some people are going to be affected more than others, but that child is going to have problems their entire life.

At the moment, I’m not convinced that our funding bodies necessarily understand that, and so we need to do more about advocating that these individuals get the support that they need.
As I mentioned earlier, there’s also a myth that all children with FASD will have unusual facial features and look different.

The three typical dysmorphic facial features are the thin upper lip, the smooth philtrum, which is the groove above the lip, and also the space between the eyes called the palpebral fissure length. It’s not uncommon for people to have one of these or two of these features, so don’t panic if you suddenly realize your husband has a thin upper lip.

You might offend them if you suggest they have FASD.
But we know in our own research at Patches, that around 20% of the children we’ve diagnosed with FASD actually do have the three facial features.
But this 80% that don’t, and that’s out of 220 of all the kids that we’ve given that diagnosis.
One of the other problems is because it’s not a disability that you can physically see.

Many of these children look neurotypical. It is often overlooked, and this is why it’s called invisible disability. A young boy I was working with captured this really well by saying, “Because they can’t see my brain, I feel they can’t see I have a disability.

I have no scars, I don’t limp.
I look normal.
But I have all these problems with my thinking and the way I act.” It’s really important that we help children understand why it is they’re having the difficulties that they’re having.
But of course, that’s difficult, because it does mean that they have to face such repercussions within the family system.

Another myth is that because there is no cure, there is no point giving a diagnosis. We know that there’s so many different treatment options and other things that we can do to help these individuals and this is captured really well. I’m just going to pull up a video now by a young man with FASD.

He talks about the importance of FASD diagnosis behavior.
It’s just a three to so minutes video, but I think it’s really important to highlight.
It’s been a common problem in our travels around Australia trying to teach people how to diagnose FASD.
There’s been a real reluctance for a whole range of reasons, and hopefully you can see with the video from, some of the important reasons why it’s important.

But I also think it’s important because it helps young people to make a sense of themselves. It reduces the impact of cognitive and educational difficulties, it reduces children’s involvement with the justice system, because we know kids with FASD have much higher rates of becoming involved with Corrective Services.

In fact, the average age that they get involved is about 12 years.
I’m going to talk more about that in a moment.
It also reduces the impact of the common comorbidities that can occur in FASD because these children are at risk of a range of different medical and neuropsychological conditions.
And by knowing I have FASD, it means that we can properly assess and diagnose them and monitor them for that.

It also creates a paradigm shift in attitudes. People view a child with FASD very differently if they know there’s this brain based problem that’s contributing to their challenging behaviors. And hopefully will also open the doors for services and treatment.

As a 15 year old boy with FASD said, he was part of our Banksia Hill Detention Center prevalence project of Oh, thank God This is what he said after a feedback session.
Oh, Thank God.
That means I’m not the problem, I have a problem.
I can deal with that.” I believe people have the right to know if that’s the condition and we shouldn’t be pretending that it’s not.

We shouldn’t be diagnosing FASD because of the stigma and concerns about the repercussions for the family. And yet we come across that view time and time again, when we travel around Australia, China, encourage clinicians to use the new diagnostic guidelines.

Anne Russell, who is a mother herself with two children that have FASD and she’s written this excellent book, which I’m reading at the moment, Alcohol And Pregnancy, says that, “I think if we do that, the child is sacrificed so that the mom does not have to bear any guilt.
We don’t do that with any other disability in the world.

We are throwing away any chance the child might have for a better life we when do that. People have no idea what they are sentencing the child to, when doctors choose this route. To make a choice to condemn a child to a life where he or she has a significant invisible disability with no one to turn to, no support, no understanding that he or she has a disability, no friends who understand.

I don’t imagine any mother would want that for a child if she had the choice.” Okay. I’ll go to this myth now. Another myth that I’ve come across is that they are no diagnostic guidelines in Australia. In fact, James and I sat in a conference last year where somebody was giving a presentation about FASD in the diagnostic guidelines, and not even referring This was in Perth.

Not even referring to the Australian diagnostic guidelines, but talking about the American ones. We do have diagnostic guidelines. They were produced in May 2016, and I believe that any health professional working in Australia needs to know what they are and be adopting those guidelines.

And this is recognized by the Commonwealth government, who recently allocated several million dollars with a funding so that clinicians can start to learn and become more confident in learning how to diagnose FASD. We’ve been lucky enough at Patches, and this has been led by James Fitzpatrick to deliver this project.

Our manager, Anne Hawkins, is sitting on a step up there, I think, to try and spread the word. THis is a three project, and it also involves the UWA graduate certificate in FASD diagnosis. What are the diagnostic guidelines? I don’t have time to go into them in a lot of depth, you can download them at the link above here, which is also on the FASD hub website.

Basically, they’re based on the Canadian guidelines, and they have been simplified so that you can either have FASD with three sentinel facial features. If a child has three facial features, you don’t need confirmation that the mom drank during pregnancy as it’s highly likely that she did and that this is FASD.

Although, in addition to that you do need evidence of impairment in three or more neurodevelopmental domains. I’ll describe what those domains are in a moment. All the infants and young children, if their children are very small, that needs to be evidence of a smaller head conference.

Or you can have FASD without sentinel facial features.
That means no facial features, one facial feature or two.
And there also needs to be confirmation that mom drank at a level that’s estimated to be a toxic dose and associated with neurodevelopmental effects.
And we know that the more the mother drinks, that’s likely to be the case.

The FASD diagnosis, there’s 10 neurodevelopmental domains that we look at. The first one is whether there is severe impairment in brain structural neurology, and that includes, as I’ve just mentioned, the abnormal head circumference, whether there’s brain abnormalities that shown on imaging, a seizure disorder, or significant neurological diagnoses that can’t be explained by a head injury or something like that.

But you don’t necessarily have to have those difficulties, because a child might have three difficulties in three or more of these domains that I’ve got listed here.
Impairment is defined under the Australian guidelines as the child doing worse than 97% of the children their age.
We ascertain that by giving tests like neuropsychological tests to determine where the child is in relation to other children their age, and a whole different range of different types of skills and abilities.

We found in our own research at Patches that the majority of these children do have quite significant executive functioning and impulse control and hyperactivity problems. They also have difficulties with attention, academic achievement, both expressive and receptive language problems, adaptive behavior so their daily living skills and so on, social skills, social communication, memory, their thinking and IQ, their ability to regulate their emotions, and their mental skills.

As I said before, children with FASD, there’s a myth that children with FASD are naughty or lazy. I think that happens because people aren’t realizing that those neurodevelopmental domains are impaired or an understanding why the child is having the problem they are, or they’re not really picking up on the different types of comorbidities that can occur with FASD.

And with our own cohort, we’ll be presenting this data in a lot more detail in the next FASD National Conference, which is in Perth in November. But just as a quick snapshot, we know that a high proportion of these children are going to have co-morbid conditions like language disorders, ADHD, sleep disturbance, mood problems.

About a third will have intellectual disability.
They’re also at risk of hearing problems, specific learning disabilities, visual impairments, conduct disorders, and oppositional defiant disorders.
And you can see the percentages they’re based on our own cohort from WA in Northern territory, and I think it ranges somewhere between 2 and 31 years of age.

These individuals are also at a much higher risk of suicide. They’re really vulnerable, and those with FASD demonstrate characteristics of features that are commonly thought to be respected for suicide. They’re more likely to be at risk of mental illness, they’re more likely to develop problems with alcohol and substance abuse themselves, more likely to be impulsive.

In many ways, it’s that perfect storm. We have all those Neuro psychological difficulties, all those problems with ethic regulation. They’re misunderstood. People aren’t understanding or understanding the reasons why they’re having the problems they are, and so they are much more likely to have suicidal behaviors.

One of the problems with these kids too is that they have quite significant social problems, and that’s why they’re often misdiagnosed as having Autism Spectrum Disorder. They can have significant difficulties with social skills, they’re likely to be socially vulnerable, overly trusting and immature, they’re often scapegoated and bullied, and have a lack of self awareness with poor boundaries.

They also lack empathy because they don’t show that theory of mind. They have difficulty saying things from another person’s perspective, and that can lead to inappropriate social interactions. It can also lead to problems with interactions with the place and in situations escalating because they’re not understanding the social nuances within a particular interaction.

Fetal Alcohol Syndrome, Causes, Signs and Symptoms, Diagnosis and Treatment.

There’s a myth that all children with FASD have an intellectual disability like my brother here who has Down Syndrome. But as I said earlier, that’s not the case at all. We know that only a third of these kids will have intellectual disability. Having said that, FASD is the leading preventable cause of intellectual disability in the Western world if we think if women didn’t drink during pregnancy, how many millions of children will we be saving from a sentence like this in terms of having a severe intellectual disability with an IQ less than 70.

One of the other complicating factors is that there’s often a discrepancy with children with FASD between the IQ. They might have an average IQ, but they have significant problems with their academic functioning, or their adaptive functioning so they can’t apply their intelligence in a way that means that they can be functional in society.

They might have difficulty, for example, coping in an emergency, or they exhibit really poor reasoning and judgment because of the underlying executive functioning problems that they have. There’s not a correlation between the three facial features and the severity of the cognitive impairment.

A child can have no facial features, but actually still be very severely affected by the cognitive difficulties that occur in FASD.
There’s also a myth that all individuals with FASD are the same, but that’s actually not the case, and partly it’s because alcohol affects children and the baby differently depending on how much the mother had the dose, the frequency, and the timing, and so on.

You get this mixed profile. Each child really needs to be seen and assessed on their own merit because they’re going to have a different level of strengths and weaknesses, and they’re also potentially going to have discrepancies in terms of the actual physical age and how they are.

They might be 18 years old, but they could have the comprehension and social maturity of a six year old and the expressive language of a 20 year old. That’s why assessment is so important because we can’t tell how an individual is unless we actually put them through a series of tests and work out what their strengths and weaknesses are.

I’m just going to pick up speed a little bit because I’m aware of the time and that we need to finish by 7:30. These are some of the typical thinking problems that might occur with children with FASD. They have a patchy memory, they’re distractible, they’re concrete thinkers, they can’t abstract or reason in a conceptual way.

They have trouble coping with change, they’re impulsive, have poor judgment, and they have difficulty predicting outcomes the same with consequences of their actions. It’s assessment is really important, and I’ve got here a photo of some of the neuro psychologists that we’ve had the pleasure of working with over the last couple of years, assisting us in the assessment of children with FASD.

Assessment is very important for a number of different reasons as I’ve already highlighted. We use the assessment to then guide our intervention and treatment options. It can help tease out those differential diagnosis and comorbidities, we can look and see whether the child actually does have the features that are typical of a person with FASD, we can establish a baseline from which we can monitor their progress.

There’s lots of different treatment options available. Again, I don’t have time to go into all of them, but Dudley and other colleagues at Telethon kids Institute produced a fantastic critical review of the literature where they highlighted some really key points when we’re working with families with FASD.

The first one is that a multidisciplinary approach is ideal, with a key worker, that we have to have a systems approach. We have to have a coordinated approach between families, schools, and therapy partnerships. We need to give carers and families access to respond and support.

We have to complete these interventions in a culturally safe way, think about their medical needs, and be particularly mindful during their transitions from adolescence into adulthood, another key point in their lives.
We know that cycle education is really important, helping parents understand why it is their children are having the problems that they’re having, and being aware that the interventions are going to change over time and need to be flexible.

We also need to focus on that attachment between carers, parents, and their children and look at a strengths-based approach in combining a domain general approach with a domain specific approach. It really needs to be well considered and thought out, and utilizing lots of different strategies, being the child’s frontal lobe for them, teaching new skills and content, teaching strategies that they can apply in real life, learning contexts, and keeping things as predictable as possible.

Providing opportunities for guided extended practice, and so on.
There’s a lot we can do.
At Patches, we offer the alert program which actually targets emotional regulation in children.
We’ve also developed a care support program that focuses on that attachment between children and their parents, or carers, and also incorporates psycho education so that they are understanding the effects that trauma, or maltreatment, or ADHD, or FASD, or any of the other comorbidities that the child might have, and the impact.

This program is turning out to be really successful, and I’ve just included here in our success story. This is a testimonial from a mother in Kununurra, and that’s where I took the photo of the baobab tree. ” I was referred to the Carer Support Program when my 10 year old who is living with FASD and ADHD started to have nuclear tantrums.

Through the program, I learned not to see my son’s tantrums as a power struggle between my child and I, but as an opportunity for me to parent.
I now use play and curious questioning in conversations with my children every day.
The simple phrase is that I to encourage him to think about his behavior, and the act of me applying at consequences through story has helped achieve some wins and behavior change.

He feels shame, and there are consequences for acceptable behavior, but we are not ripped apart in the process. What I particularly love is my 11 year old daughter is now mirroring the curious questioning when she is playing with her brothers.” I thought it was a really nice example of how some of these treatment options can be really successful.

Children with FASD are eligible for services through the NDIS, providing this evidence of a functional impairment in certain areas like communication, social interaction, learning mobility, self care, and self management. It really is a myth that there is no hope for individuals with FASD, even though we do know that many of these people will have adverse long term outcomes, as I’ve mentioned, difficulties with the law, substance abuse, and so on, disrupted education.

There’s a lot that we can still do to assist. Although we do have to be mindful that many children and adults sitting in our jails have FASD. That was highlighted by the recent prevalence study that I was privileged enough to be involved in at the Banksia Hill detention center where we found that a third of young people had FASD, and not only that, 9 out of 10 of those kids had some type of severe brain impairment, not necessarily FASD.

We’re failing these children, and we need to as a society, really be thinking about how we can better support them, how they can better recognize their brain impairments, and keep them out of jail to begin with. There is hope. There’s a lot we can do as a community, and I’ve highlighted here some of the things that we can do.

We need to continue the excellent prevention efforts that organizations like the Telethon kids Institute have been involved in, we need to improve our diagnosis in multidisciplinary assessment, we need to focus on children in our schools. Because if we can keep them in school away from antisocial peer groups, they’re less likely to get involved in the justice system, they are less likely to develop a whole range of different mood problems, and so on.

We need to provide diversionary programs. I personally believe that every child that comes into contact with Corrective Services should have an assessment and also children in child protection. Because worldwide data shows that about 80% of kids in child protection are likely to have FASD. These kids need improved access to services and improved government recognition so that they can have funding through Medicaid, private health insurance, and so on.

Finally, I believe first is a significant public health issue, but there’s something that all of us can do in this room, because we need to work together to improve awareness and understanding about this condition. If you think that the lifetime cost of an individual with FASD is thought to range between about 2.2 Australian dollars to 3.3 million dollars based on American data, then if we just help prevent one woman from drinking heavily during pregnancy, we’re actually potentially reducing the financial and other non financial cost of this condition, and that money, millions of dollars, can then be channeled into funding therapy and research as well.

We can all be first day champions and promote that message in an understanding and non judgmental way.
If you’re interested in further information about FASD, you can go to the FASD Australian hub website which has fantastic resources that’s taken over from the Telethon Kids website to provide this information.

: 20 myths about fetal alcohol spectrum debunked

Can people with FAS be successful?

Fetal alcohol spectrum disorder (FASD) is often overlooked and understudied. Caused by prenatal alcohol exposure, it is sometimes referred to as an “invisible disorder.” But FASD is the most common preventable cause of developmental disability, Many who have it experience lifelong behavioural, intellectual, neurological and mental health difficulties.

Individuals with FASD and their families also face persistent stigma, negative stereotypes and harmful biases, due to public misunderstandings. Negative public attitudes are detrimental to people living with FASD, impacting their self-esteem and beliefs in their own capabilities. Research shows that with the right supports, individuals with FASD can live productive and successful lives,

However a common, and often inaccurate, misconception is that these individuals are destined to be lifelong “burdens” on health and social systems. As FASD researchers, we want to dispel common misunderstandings about children and youth with FASD, and offer some evidence-based truths.

What is mild fetal alcohol syndrome?

Overview – Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother’s pregnancy. Fetal alcohol syndrome causes brain damage and growth problems. The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are not reversible.

Do kids with fetal alcohol syndrome look different?

Children with other FASDs have many of the same problems, but usually to a lesser degree.