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Fas d the Basics
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FETAL ALCOHOL
SPECTRUM DISORDERS
The Basic s
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Fetal Alcohol Spectrum Disorders(FASD): The Basics
This presentation is broken into five sections:
1. Understanding Fetal Alcohol Spectrum Disorders
(FASD)
2. Individuals With An FASDStrengths,Difficulties, and Approaches
3. Prevention and Risk Reduction
4. Resources5. Conclusion
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Section 1: Understanding FetalAlcohol Spectrum Disorders (FASD)
Section 1 includes:
Fetal Alcohol Spectrum Disorders (FASDs)
Diagnostic Terminology
Facts About FASDs
Facts About Alcohol Use Among Pregnant Women
Cause of FASDs
Whats a Standard Drink?
Economic Costs of FAS
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Fetal Alcohol SpectrumDisorders (FASD)
Umbrella term describing the rangeof effects that can occur in anindividual whose mother drankalcohol during pregnancy.
May include physical,mental, behavioral, and/orlearning disabilities withpossible lifelong
implications.
Not a diagnosis.
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Diagnostic Terminology
Fetal Alcohol Syndrome (FAS)
The term FAS was first used in 1973 by Dr. DavidSmith and Dr. Ken Lyons Jones at the University ofWashington.
While FASD describes a range of disorders, FAS is aspecific birth defect caused by alcohol use whilepregnant.
FAS is a diagnosis: It is medical diagnosis Q86.0 in theInternational Classification of Diseases (ICD-10).
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Other Diagnostic Terminology
Pregnancy
+
Alcohol
May result in
Alcohol-relatedneurodevelopmentaldisorder (ARND)
Partial FAS (pFAS)
Fetal alcohol effects (FAE)
Alcohol-related birthdefects (ARBD)
Static encephalopathy (anunchanging injury to thebrain)
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Facts About FASDs
FASDs are the leading known cause of preventablemental retardation.1
FASDs effect an estimated 40,000 newborns eachyear in the United States.2
FASDs are more common than autism.3
The effects of FASDs last a lifetime.
People with an FASD can grow, improve, andfunction well in life with proper support.
FASDs are 100% preventable.
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Facts About FASDs
No amount of alcohol consumption during pregnancy is proven
to be safe.1
FASDs are not caused by the biological fathers alcohol use.
FASDs are not caused intentionally by the mother:
Many women simply may not know when they are first
pregnant or may not be aware of the harm that alcohol
consumption during pregnancy can cause.
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Facts About Alcohol UseAmong Pregnant Women
Nearly 12 percent of pregnant women report usingalcohol in the past month.
Past-month alcohol use among pregnant women andrecent mothers aged 15 to 44 did not change significantly
between 2002-2003 and 2006-2007.
Nearly 16 percent of pregnant women aged 15 to 17 usedalcohol in the past month, and they consumed an averageof 24 drinks in that month (i.e., they drank on an averageof 6 days during the past month and had an average ofabout four drinks on the days that they drank).
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Cause of FASDs
The sole cause of FASDs is the fetus being exposed to
alcohol during the pregnancy.
Alcohol is a teratogen: A drug or other substance
capable of interfering with the development of a fetus,
causing birth defects.
Of all the substances of abuse (including cocaine,
heroin, and marijuana), alcohol produces by far the most
serious neurobehavioral effects in the fetus.
IOM Report to Congress, 1996
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Cause of FASDs
All alcoholic beverages are harmful.
Binge drinking is especially harmful.*
While its true that not every woman who drinks during
pregnancy will have a child with an FASD, that does notmean that these disorders are rare or random.
Any time a pregnant woman consumes alcohol, it
becomes possible that her baby will have an FASD.
*Binge = 4 or more standarddrinks on one occasion for wom
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Whats A Standard Drink?
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Whats a Standard Drink?
In recent research, frequent drinkers and the
majority of women reported drinking larger-
than-standard drinks:
Daily drinkers were consuming drinks that wereanywhere from three to six times the size of a standard
drink.
The majority of drinkers underestimated the number of
fluid ounces they were consuming by about 30%.
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Economic Costs of FAS
FAS alone is estimated to cost the United
States nearly $4 billion each year.
The average lifetime cost for each child withFAS is almost $3 million.
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Economic Costs of FAS
One prevented case of FAS saves:
$130,000 in the first 5years
$360,000 in 10 years
$587,000 in 15 years
More than $1 million in 30 yearsIncreased savings
through prevention
0
200000
400000
600000
800000
1000000
5 10 15 30
ears
$
Saved
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Section 2: Individuals With an FASDStrengths, Difficulties, and Approaches
Section 2 includes: Primary Disabilities That Can Occur in Persons With an
FASD Typical Strengths of Persons With an FASD
Typical Difficulties for Persons With an FASD Risks of Not Accurately Identifying and Treating an
FASD Factors Associated With Reduced Life Complications
Identifying an FASD Possible Signs of an FASD Trends in Treatment
P i Di biliti Th t C
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Primary Disabilities That CanOccur in Persons With an FASD
Lower IQ
Impaired ability in
reading, spelling, and
arithmetic
Lower level of
adaptive functioning
Typical Strengths of Persons
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Typical Strengths of PersonsWith an FASD
Friendly and cheerful
Likable
Desire to be liked
Helpful
Verbal
Determined
Have points ofinsight
Hard working
Every day is a newday!
Typical Difficulties For
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Typical Difficulties ForPersons With an FASD
Sensory: May be overly sensitive to bright lights,
certain clothing, tastes and textures in food,
loud sounds, etc.
Physical: Have problems with
balance and motor
coordination (may seemclumsy).
Typical Difficulties For
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Typical Difficulties ForPersons With an FASD
Information Processing:
Do not complete tasks or chores and may appear to beoppositional
Have trouble determining what to do in a given situation
Do not ask questions because they want to fit in
Have trouble with changes in tasks and routine
Typical Difficulties For
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Typical Difficulties ForPersons With an FASD
Have trouble following multiple directions
Say they understand when they do not
Have verbal expressive skills that often exceedtheir verbal receptive abilities
Cannot operationalize what theyvememorized (e.g., multiplication tables)
Misinterpret others words, actions, or bodymovements
How do I
straighten
my room?
Information Processing:
Typical Difficulties For
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Typical Difficulties ForPersons With an FASD
Tend not to learn from
mistakes or natural
consequences
Frequently do not respondto reward systems (points,levels, stickers, etc.)
Have difficulty
entertaining themselves
Nave, gullible (e.g., may
walk off with a stranger)
Struggle with abstract
concepts (e.g., time, space,
money, etc.)
Im late!
Im late!
Executive Function and Decision-Making: Repeatedly
break the rules
Give in to peer
pressure
Typical Difficulties For
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Typical Difficulties ForPersons With an FASD
Self-Esteem and Personal Issues:
Function unevenly in school, work, and developmentOften feel stupid or like a failure
Are seen as lazy, uncooperative, and unmotivatedHaveoften been told theyre not trying hard enough
May have hygiene problems
Are aware that theyre different from others
Often grow up living in multiple homes and experience
multiple losses
Ri k f N t A t l
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Risks of Not AccuratelyIdentifying and Treating an FASD
For the individual with an FASD:
Unemployment
Loss of family
Homelessness
Jail Premature death
Increased substance abuse
Wrong treatment or
intervention is used
For the family:
Loss of family Increased substance use
Premature death
Financial strain
Emotional stress
Factors Associated With
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Factors Associated WithReduced Life Complications
Stable home
Early diagnosis
No violence againstoneself
More than 2.8 years in
each living situation
Recognized disabilities
Diagnosis of FAS
Good quality home fromages 8 to 12
Basic needs met for at
least 13 percent of life
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Identifying an FASD
Only trained professionals can diagnose a disorder fromthe FASD spectrum. Ideally, diagnosis is done by a teamthat may include:
Geneticists
Developmental pediatricians Neurologists Dysmorphologists (physicians specializing in birth defects Education consultants
Psychologists, psychiatrists, and social workers Occupational therapists Speech and language specialists
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Possible Signs of an FASD
Signs that may suggest the need for FASDassessment include:
Sleeping, breathing, or feeding problems Small head or facial or dental irregularities
Heart defects or other organ dysfunction Deformities of joints, limbs, and fingers Slow physical growth before or after birth Vision or hearing problems
Mental retardation or delayed development Behavior problems Maternal alcohol use
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Trends in Treatment
Strategies to assist persons with an FASD and theirfamilies continue to increase dynamically:
SAMHSAs FASD Center for Excellence provides a variety
of materials for families, providers, and educators:
http://fasdcenter.samhsa.gov In addition to materials, the National Organization on Fetal
Alcohol Syndrome (NOFAS) provides a directory of FAS
resources: www.nofas.org/resource/directory.aspx
The Centers for Disease Control and Prevention (CDC) arecurrently researching new approaches to FASD at sites acros
the country.
Section 3: Prevention and
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Section 3: Prevention andRisk Reduction
Section 3 includes:
Prevention Starts With Asking!
Brief Interventions Can = Prevention
Public Health Messaging We Can All Talk About Alcohol Use
Who Needs To Know
Raise Awareness in Schools Raise Awareness in the Community
P ti St t With A ki !
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Prevention Starts With Asking!
Ask all women of childbearing age aboutalcohol use:
Ask routinely at every medicalappointment.
Ask at appointments in various systems.
Ask in a nonjudgmental manner.
Use effective screening tools.
Ask about possible prenatal exposure.
Imbed questions about alcohol use in general health questions(e.g., wearing seat belts, taking vitamins, smoking, etc.).
Brief Intervention
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Brief InterventionCan = Prevention
Research shows that brief interventions can help reducealcohol use among women of childbearing age, whether
pregnant or non-pregnant.
Typical brief interventions include outreach, screening,
referral, and other activities that promote the health of themother (and, among pregnant women, the fetus).
Brief interventions have been effectively implemented by
health professionals in primary care, emergency, andsubstance abuse treatment settings, and also on
campuses.
D
O
D
O
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O
N
O
T
T
A
K
E
T
H
E
D
R
I
N
K
O
N
O
T
T
A
K
E
T
H
E
R
I
S
K
W C All T lk Ab t Al h l U
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We Can All Talk About Alcohol Use
Talk about the effects of alcohol on an individualand on a fetus:
Begin at an early age, suchas elementary school.
Indicate that stoppingdrinking at any time duringpregnancy will help thefetus.
We Can All Talk About Alcohol Use
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We Can All Talk About Alcohol Use
Convey the message to women:
Say No to Alcohol.
For You, and for Your Baby.
Who Needs To Know
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Who Needs To Know
EVERYONE!
While FASD awareness may seem like
its just about women who are
pregnant, its not. Anyone who canhelp a woman remain alcohol-free
during pregnancy should know:
Men, women, family, friends, health
care providers, educators
EVERYONE!
Raise Awareness in Schools
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Raise Awareness in Schools
Ask the school to put up posters
about drinking and pregnancy.
Include information about
FASDs in health, science, and
physical education classes.
Hold an assembly to talk
about the effects of alcohol
on a person and on a baby.
Raise Awareness
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in the Community
Post FASD information indoctors offices, treatmentcenters, and community centers.
Promote FASD Awareness Day(September 9). Visit the Web
site www.fasday.com forinformation.
Discuss FASD in yourcommunity; at work, at church,anywhere. Awareness can havea positive impact on everyone.
Section 4: Resources
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Section 4: Resources
SAMHSA FASD Center for Excellence:fasdcenter.samhsa.gov
Centers for Disease Control and Prevention FASPrevention Team: www.cdc.gov/ncbddd/fas
National Institute on Alcohol Abuse and Alcoholism(NIAAA): www.niaaa.nih.gov/
National Organization on Fetal Alcohol Syndrome(NOFAS): www.nofas.org NOFAS Resource Directory:
www.nofas.org/resource/directory.aspx National Clearinghouse for Alcohol and Drug
Information (NCADI):ncadi.samhsa.gov
Section 5: Conclusion
http://fascenter.samhsa.gov/http://www.cdc.gov/ncbddd/fashttp://www.niaaa.nih.gov/http://www.nofas.org/http://www.nofas.org/resource/directory.aspxhttp://ncadi.samhsa.gov/http://ncadi.samhsa.gov/http://www.nofas.org/resource/directory.aspxhttp://www.nofas.org/http://www.niaaa.nih.gov/http://www.cdc.gov/ncbddd/fashttp://fascenter.samhsa.gov/ -
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Section 5: Conclusion
Section 5 includes:
The Benefits of Identification and Treatment of
FASDs
What is Needed
The Benefits of Identification and
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Treatment of FASDs
Helps decrease anger and frustration forindividuals, families, providers, andcommunities by helping them understand thatnegative behavior results from the disabilityand is not willful.
Helps people with an FASD succeed byfocusing on their strengths and what willhelp them, not on their weaknesses andwhat theyve done wrong.
Helps improve outcomes.
Helps prevent future births of children withan FASD.
What is Needed
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What is Needed
We must move from viewing the
individual as failing if s/he does not do
well in a program to viewing the program
as not providing what the individual needs
in order to succeed.
Dubovsky, 2000
What is needed to adequately address FASDsis a paradigm shift in how we think:
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Thank you for taking time
to learn about FASDs!
For more information about FASDs, including
topics such as diagnosis and treatment, please
visit http://www.fascenter.samhsa.gov.