Fetal Alcohol Syndrome

When Alcohol affects a child in the womb; and the life long effects for its future

By Jessica Rogers Alexandrina Goodman Taylor Smith

Did you know?

That the number one cause of mental retardation is 100% preventable?(cspinet) Did you know 1 in every 750 babies born has some sort of delay pertaining to this syndrome? (cspinet) Did you know there is an increased risk for later alcohol, tobacco, and drug dependence in adults if they are exposed to alcohol prenatally? (cspinet)

Fetal Alcohol Syndrom

What is FAS? Characteristics of FAS What causes FAS? How is FAS diagnosed? Implications for Development and Family Functioning Evidence-Based strategies and Approaches for working with a child who has FAS Revelance to Young children with Part C/B Services

What is FAS?
FAS; Fetal Alcohol Syndrome is when Alcohol, a teratogen, is consumed by the pregnant mother and it crosses the placenta and is absorbed by the developing fetus. It can cause a big range of effects from miscarriage, stillbirth, malformations, growth deficiency, and central nervous system dysfunction.
(Sampson)

What is FAS? (cont.)

What is FAS compared to FAE?
FAS- Fetal Alcohol Syndrome, is when alcohol during pregnancy has caused enough damage to a fetus that it would need lifelong treatment and care. Ex. Deformations, more evidence on the face structure, and those with complex brain dysfunction. (LCSC) FAE- Fetal Alcohol Effects, is when alcohol during pregnancy has caused effects in development that does not necessarily need life long treatment and care. Ex. Mild to moderate ranges of ADD and ADHD, higher probability to becoming addicted to drugs/alcohol/ other substances, and behavioral problems. (LCSC)

Characteristics of FAS
Physical Characteristics Facial features:
(nsnet) Short Palprbral fissures (eye lid separation) Flat midface (cheek) Short nose (and could be slightly turned upward) Indistinct philtrum Thin upper lip Epicanthal folds Low nasal bridge Minor ear anomalies Micrognathia (abnormally small lower jaw)
Courtesy of nsnet.org

Characteristics of FAS (cont.)

Physical (brain):
Significantly smaller Less groves and bumps Smoother on the outside (no ridges, where cells had died from alcohol) Deformed Alcohol stopped development; and killed once healthy cells.

Characteristics (cont.)
Unseen Characteristics:
Typically Lower IQ 50-115 Delayed motor and speech development Decreased cognitive abilities Behavioral Problems Interpersonal Skills
(CPS)

What are the causes of FAS?

Fetal Alcohol Syndrome is caused by what the name states, Alcohol. But depending on how much Alcohol was consumed and the timing of the consumption is how you can try to estimate the effects that Alcohol will have on the infant. FAS is a spectrum disorder, so from FAE (Fetal Alcohol Effects) to full blown FAS (Fetal Alcohol Syndrome), each case is different and may produce its own specific problems. There are 4 factors that are to be considered when a mother drinks alcohol and the risk of Fetal Alcohol Syndrome spectrum disorders.

What are the causes of FAS?

4 Factors affect how severe the damage will be to the unborn baby: (from USASK)
1. The time in the pregnancy at which alcohol is consumed.
The first three months are crucial for a growing fetus, but alcohol at any point in a pregnancy can be detrimental to the baby s development. Consumption of alcohol at the time of a specific development is going on is when that particular development may be affected. Remember though, that the baby s brain is constantly growing throughout the pregnancy.

2. The amount of alcohol consumed during the pregnancy.

Heavy drinking is associated with full blown FAS as well as being linked to stillborns and spontaneous abortions. There is NO SET LIMIT on how much alcohol a pregnant woman can drink without hurting the baby. (See below) "Binge" drinking (drinking more than 5 alcoholic beverages a day) , which sharply raises the amount of alcohol in the blood, greatly increases the risk to the baby.

3. Individual susceptibility to alcohol.

How well a baby is able to deal with alcohol in its system is determined by genetics. The same factors also determine how fast the ethanol can be broken down in the body.

4. Nutrition.
Alcohol affects how the placenta transfers important nutrients necessary for fetal growth. Good nutrition for the fetus is important throughout the entire pregnancy. (USASK)

How is FAS diagnosed?

A definitive diagnosis of FAS is difficult to make because there are no biochemical markers and the manifestations of this condition are so variable CPS The 4-digit Diagnostic Code provides a reproducible, objective, consistent and precise method for the diagnosis of FAS. Four criteria are assessed, quantified and assigned a rating of 1 to 4 for each criteria, depending on the degree of abnormality: impaired growth; (smaller head circumference, smaller body stature, impaired motor development)(cps) facial abnormalities;( mentioned earlier) (cps) abnormal brain function; (lower cognitive ability, delay, impaired social and emotional development ) (cps) degree of maternal drinking; still NO amount of Alcohol is deemed safe of risk (cps)

How is FAS diagnosed?

The 4-digit Diagnostic Code is given by a group of physicians and psychologists. Using a scale of 1-4
1- Absent brain dysfunction- best possible outcome; no brain impairments. 2-Possible brain dysfunction- neurobehavioral disorder; based on observations of the child, that suggests possible brain damage. 3-Probable brain dysfunction- characterized as static encephalopathy 4- Definite brain dysfunction- also characterized as static encephalopathy IQ score lower than 60 and abnormal results from various brain imaging . (Cps) The four digits (of 1-4) are then put into 4 digit code to determine FAS diagnosis. An example of this code is 1111 which is normal typically developing to 4444 which means unequivocal FAS

Implications of Development
Since FAS is a spectrum disorder (meaning effects are varied from person to person) it is difficult to say what a typical FAS child will come out to be. This is a list from the Canadian Pediatric Society of a list of typical implications of a child who is affected by FAS:
Lack of organization Sequencing Inability to make choices Poor abstract thinking Inability to foresee consequences Unresponsive to social clues Inability to make and keep friend Impulsive Inappropriate behavior Excessive friendliness Lack of inhibitions Inability to learn from previous experiences Communication problems Unresponsive to social clues Use behavior as communication Difficulty with adaptive living skills

Implications of Development
From the list, you can see a wide variety of cognitive and emotional effects, but since FAS is affects children in different ways, you may a few of those effects or all of those effects. Children with FAS also have impaired gross motor and fine motor abilities, not to mention speech delays as well. The best chances for children with fully diagnosed FAS is to introduce Early Intervention Services as soon as possible.

Family Functioning with FAS

Infants:
Infants are said to be quit difficult to manage and often become victims of abuse because caregivers get frustrated and a sense of giving up. Parents and caregivers need to know the specifications of a child with FAS and how to handle an infant with FAS. A few studies have proved that infants with FAS do not handle transitions easily and need a very strict routine. Early Intervention, is said to be the best opportunity for the infant and family to become stable and normal. Since FAS is diagnosed after infancy, studies suggest that caregivers should not wait to get a diagnosis to begin Early Intervention. Caregivers need to become familiar with the demands of an infant with FAS and get to work fulfilling the needs of the child.

Family Functioning with FAS

Toddler and Child: If a toddler or child is found to have FAS, for best outcomes later in life, Early Intervention needs to start immediately. Success is determined how involved the family is in the child s early intervention and play a crucial role in the child s progress. Families should work together and support the child with FAS as much as possible. Since FAS is a spectrum disorder and not all cases are ever the same, it is crucial to get a very individualized IFSP to cover what the child needs. The child, besides the cognitive and motor delays may also experience a low self worth and low self esteem (even if they do not yet comprehend FAS). Families should work hard to encourage their child in any little achievement made and be slow to anger at the problems and mistakes they come across. (DM, Burgess)

Evidence Based Strategies for Children with FAS

There are four long term objectives that are at the top of IFSPs for children who have FAS:

establishing and maintaining a sense of self-worth; establishing acceptable interpersonal behavior; fostering independence; and teaching children how to make acceptable decisions.

Early J. Hinde outlined approaches to specific behaviors in 1-3 year olds. He stated the top four strategies for working with children who have FAS is to:

Keep tasks simple Use concrete examples. Keep instructions simple and give them one at a time. Concentrate on life skills.

Evidence Based Strategies for children with FAS

J. Kleifield wrote in the University of Alaska Press:
Within an early childhood intervention program, these children (children with FAS) may be taught to function within their limitations, learn how to make proper choices, develop acceptable interpersonal skills, master basic life skills and, above all, maintain self-esteem. Such educational intervention often means scaling down academic expectations and emphasizing training for future self-sufficiency. Programming for success can result in improved learning and enhanced self-image, which in turn can decrease acting out behaviors.

FAS is not curable but children with FAS can be taught and can learn just like other children given the chance and the intervention opportunities. (cps)

Relevance for children with part B/C services

Part C services:
Early Intervention for infants and toddlers. If a child is diagnosed early on, and is able to take part in Part C services of IDEA, he or she receives an IFSP that will be completely individualized for the child with FAS and the family of the child. Keeping in mind what are the child s short term and long term needs. Children with FAS need a strict routine, and the providers should meet with the child at his or her most convenient time frames. Intervention needs to be intensive and leave no room for abstract thinking (at this point), by using concrete examples and modeling. Service Providers are also teaming up with the family to teach them how to handle behavioral issues as well as emotional issues. Service Providers are also there to offer suggestions and aid to the parents. For example, since infants with FAS have difficult times habituating, a service provider may suggest moving the baby s crib from the street side of the house to the garden side. Just to drown out some of the noise that comes with living on the street.

Relevance for children with part B/C services Part B services:

Conclusion
Conclusion