FASD Basic Teaching Tool This PowerPoint is provided by NOFASD Australia to enable others with an interest in the topic to deliver information sessions and increase community knowledge and awareness of FASD ID: 912187
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Slide1
Fetal Alcohol Spectrum Disorder
(FASD)
Basic Teaching Tool
Slide2This PowerPoint is provided by NOFASD Australia to enable others with an interest in the topic to deliver information sessions and increase community knowledge and awareness of FASD.
For further information and support for FASD please visit
www.nofasd.org.au
Slide3Teaching tool objectives
Provide a platform for individuals or groups to learn more about FASD.
Provide the most up to date information about FASD.
Provide a knowledge base of FASD information to enable others to develop their own material and raise community awareness of FASD.
Slide4Teaching tool learning goals
What is FASD
Impact of FASD
Populations at risk
Diagnosis
Challenges
Slide5What is FASD?
Fetal Alcohol Spectrum Disorder (FASD) is the term used to describe the lifelong physical and/or neurodevelopmental disorders that can result from fetal alcohol exposure.
FASD is primarily an
acquired brain injury
that is a symptom of parents either not being aware of the dangers of alcohol use when pregnant or planning a pregnancy, or not being supported to stay healthy and strong during pregnancy.
Slide6What causes FASD?
Alcohol is a neurotoxin (poison) and a teratogen.
A teratogen is an agent that is known to cause birth defects and permanent brain injury to a fetus.
Alcohol is a substance that can cause harm to the developing baby at any time during the pregnancy.
(Bower & Elliott, 2016)
Slide7Effects of alcohol on the fetus
Alcohol freely crosses the placenta and creates a blood alcohol level in the fetus the same or higher than that of the mother.
The fetus has a small unformed liver. It takes longer to metabolise the alcohol so it remains in the baby longer.
The fetus does not have the enzymes required to clear alcohol from the system, causing oxidative stress which can damage DNA.
(Bower & Elliott, 2016;
Roozen
,
Kok
&
Curfs
, 2017)
Slide8FASD is a serious public health issue.
There are more children born each year with FASD than with Autism Spectrum Disorder, Spina Bifida, Cerebral Palsy, Down Syndrome and SIDS combined.
(Mather, Wiles, & O'Brien, 2015)
Impact of FASD
Slide9Impact of FASD
FASD is a complex learning disorder affecting multiple domains of functioning including:
Working memory
Attention
Impulsivity
Learning
Social skills
Language development
(O’Malley, 2008)
Slide10The most common impact is on the brain’s
executive functions
– the ability to plan, learn from experience and control impulses.
Most people living with FASD do not learn from punishment because they cannot generalise rules. In addition, many have impulse control problems.
(Green et al., 2009)
Impact of FASD
Slide11Life and health outcomes
Life expectancy for people with FASD is
34 years
.
19% of deaths caused by mental health issues and suicide.
92% of individuals living with FASD will have a co-occurring mental health issue. The most common are depression and suicidal ideation.
Young people with FASD are 19 times more likely to be incarcerated than those without FASD.
FASD will most commonly be misdiagnosed with ASD, ADHD and CD, leading to inappropriate medication and health intervention.
(Thanh & Jonsson, 2016)
Slide12Who is at risk?
Individuals from all cultures and
socio-economic backgrounds are at risk from prenatal alcohol exposure.
Wherever there is alcohol, there is the potential for FASD.
(Bower & Elliott, 2016)
Slide13Australian women and alcohol
50% of Australian women experience an unplanned pregnancy.
(Australian Medical Association, 2016)
59% of Australian women drink at some time during their pregnancy.
(Colvin et al., 2007)
Estimates indicate that 1 in every 13 women who consume alcohol during pregnancy will have a child with FASD.
(Lange et al., 2017)
Slide14Partners and alcohol
Research has shown that 38% of Australian women would be less likely to drink alcohol if their partner or spouse encouraged them to cut back or stop drinking during their pregnancy, and 30% would cease drinking if their partner stopped drinking completely.
(
Peadon
, Payne, Henley et al., 2011)
Slide15Partners and alcohol
Recent research also points to a link between alcohol and poor sperm development, meaning the onus is on expectant fathers too. A myriad of studies show that alcohol consumption by biological fathers is significantly linked to health problems in their children.
(Lucia & Moritz, 2017)
Slide16No alcohol at all when planning, possibly pregnant, throughout pregnancy and when breastfeeding.
There is
no safe time
to drink alcohol during pregnancy and there is
no safe amount
.
The WHO & NHMRC recommends
Slide17Maternal alcohol use
FASD is not the result of an uncaring act. No one intentionally harms their child; no one causes FASD on purpose. There is no blame.
FASD can be the by-product of trauma, addictions, and/or a lack of information.
(
Rutman
, 2013)
Slide18FASD is an umbrella term
Slide19Two types of FASD diagnosis
(Bower & Elliott, 2016)
Slide20Both medical diagnoses in Australia include severe impairment in
at least 3
of the following developmental domains:
(Bower & Elliott, 2016)
Two types of FASD diagnosis
Slide2183% of individuals living with FASD do not display sentinel facial features.
FASD facial features
(
Aros
., et al, 2012)
Slide22The ‘spectrum’ of birth defects
Is due to:
The quantity of alcohol consumed
How frequently it was consumed
Timing of consumption during the pregnancy
Other influencing factors can include maternal age, nutritional deficiencies and ability to metabolise alcohol, socio-economic background and co-morbidity of other physical and mental illnesses.
(May & Gossage, 2011)
Slide23In addition, people with FASD may also be mis-diagnosed, under-diagnosed or present with co-diagnosis with the following disorders:
Autism Spectrum Disorder
ADHD
Reactive Attachment Disorder
Conduct Disorder
Oppositional Defiant Disorder
Mis-diagnosis or co-diagnosis
(Stevens, Nash,
Koren
, &
Rovet
, 2013)
Slide24Benefits of diagnosis
The correct diagnosis provides a lens through which we can gain an understanding of the whole story and formulate targeted treatment plans.
Recognition of FASD provides an alert for the possibility of other underlying medical conditions.
Recognition of the depth of the problem is imperative for future prevention.
Slide25Benefits of diagnosis
Having a diagnosis means we can work with the individual in a way that meets their needs.
Increases an individual’s access to FASD specific clinicians and services.
There is less chance of incorrect medication being prescribed.
Increased knowledge means a stronger ability to advocate.
Slide26FASD Diagnostic Instrument
The Australian FASD Diagnostic Instrument was published in May 2016.
A copy is available on the Australian Paediatric Surveillance Unit website:
http://www.apsu.org.au/assets/Uploads/20160505-rep-australian-guide-to-diagnosis-of-fasd.pdf
Slide27FASD indicators
Friendly, likeable, “talk the talk” & seem to want to please, but often don’t follow through.
Appear very bright but exhibit immature behaviour when stressed or under pressure.
Good expressive language but history of poor school performance.
Not living with family of origin, unstable accommodation/homelessness.
Relationship problems, financial issues, contact with the legal system.
Slide28FASD indicators
May have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiance Disorder (ODD), Reactive Attachment Disorder (RAD), a Mental Health diagnosis, other dependency e.g. problem gambling.
Inconsistent attendance, and a history of being turned away from other programmes.
May give inconsistent versions of events (confabulation).
Slide29Challenges of living with FASD
May be functioning at an age much lower than their chronological age.
May experience difficulty following instructions.
May become easily confused and distracted.
May be impulsive.
May be easily irritated, leading to temper tantrums.
May repeat mistakes on many occasions.
May not recognise danger, leading to unsafe actions.
May have trouble distinguishing reality from fantasy.
May have poor memory and other executive functioning difficulties.
Slide30Children and adults with FASD typically lack social skills, such as:
Listening
Asking for help
Waiting their turn
Sharing
People with FASD can be naïve and gullible, and can be easily led by peers. They need constant supervision to develop patterns of appropriate behaviour.
Difficulties with social skills
Slide31Making and keeping friends is a huge challenge, which often leads to social exclusion.
Often less developmentally mature than peers.
Don
’
t understand subtleties of different kinds of relationships.
Poor understanding of social etiquette or personal space, for example standing too close.
These challenges are the result of learning difficulties.
Difficulties with social skills
Slide32Dysmaturity
A classic sign of FASD – individuals appear to be acting 6, 8, 16, and 20 all at the same time.
An individual may have the language skills of a 20 year old but the social skills of a 7 year old.
Slide33Secondary conditions
Children and adults living with FASD often experience additional difficulties including:
Alcohol and/or drug misuse
Mental health challenges
Trouble at school, including suspensions
Incomplete education
Fatigue and anxiety
Crime
Inappropriate sexual behaviour
Slide34Secondary conditions
Children and adults living with FASD often experience additional difficulties including:
Poverty and homelessness
Anger and aggression
Withdrawing and avoidance
Early unplanned pregnancy
Poor self-esteem
Isolation
Depression and suicidal tendencies
Slide35With appropriate support from parents and carers the learning and quality of life outcomes for individuals with FASD can be vastly improved.
Individuals living with FASD also have
strengths.
Many have exceptional skills and abilities in one or more areas, which often masks the severity of symptoms in other areas.
Strengths
Slide36Individuals with FASD can be:
Creative
Athletic
Caring
Determined
Friendly
Artistic
Generous
Helpful
Willing
Strengths
Slide37For further information about any aspect of FASD:
Visit the National Organisation for Fetal Alcohol Spectrum Disorders (NOFASD) website:
www.
nofasd.org.au
Email
admin@nofasd.org.au
Call
1300 306 238
Slides updated 1
st
July 2018
Slide38FASD – Fetal Alcohol Spectrum Disorder
FAS – Fetal Alcohol Syndrome
pFAS
– Partial Fetal Alcohol Syndrome
ND/AE – Neurobehavioral Disorder/Alcohol Exposed
ARND - Alcohol-Related Neurodevelopmental Disorder
ND-PAE – Neurodevelopmental Disorder - Prenatal Alcohol Exposure
SE/AE - Static Encephalopathy/Alcohol Exposed
ASD – Autism Spectrum Disorders
ADHD – Attention-Deficit Hyperactivity Disorder
CD – Conduct Disorder
ODD – Oppositional Defiant Disorder
RAD - Reactive Attachment Disorder
Glossary
Slide39References
Aros
, S., Kuehn, D.,
Cassorla
, F.,
Avaria
, M.,
Unanuie
, N.,
Hendriquez
, C., …
Kleinsteuber
, K. (2012). A prospective cohort study of the prevalence of growth, facial, and central nervous system abnormalities in children with heavy prenatal alcohol exposure.
Alcoholism: Clinical and Experimental Research, 36
(10), 1811-1819. doi:10.1111/j.1530-0277.2012.01794.x
Bower, C., Elliott, E. J. (2016).
Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD)
. Australia: Department of Health. Retrieved from http://alcoholpregnancy.telethonkids.org.au/australian-fasd-diagnostic-instrument/australian-guide-to-the-diagnosis-of-fasd
Colvin, L., Payne, J., Parsons, D.,
Kurinczuk
, J. J., & Bower, C. (2007). Alcohol consumption during pregnancy in non-indigenous West Australian women.
Alcoholism - Clinical and Experimental Research, 31
, 276-284.
Green, C.,
Mihic
, A.,
Nikkel
, S., Stade, B., Rasmussen, C., Munoz, D., & Reynolds, J. (2009). Executive function deficits in children with fetal alcohol spectrum disorders (FASD) measured using the
cambridge
neuropsychological test automated battery (CANTAB).
Journal of Child Psychology and Psychiatry
,
50
(6), 688-697. doi:10.1111/j.1469-7610.2008.01990.x
Slide40References
Lange, S., Probst, C., Gerrit, G., Jurgen, J., Larry, L., & Popova, S. (2017). Global prevalence of fetal alcohol spectrum disorders among children and youth: A systematic review and meta-analysis.
JAMA Paediatrics, 171(10)
. doi:10.1001/jamapediatrics.2017.1919
Lucia, D., & Moritz, K. (2017, November 6). It’s not just mums who need to avoid alcohol when trying for a baby.
The Conversation,
Retrieved from https://theconversation.com/ca
Marie Stopes International Australia (2008).
Real choices: Women, contraception and unplanned pregnancy.
Melbourne, Australia: Author. Retrieved from http://www.mariestopes.org.au/research/australia/australia-real-choices-key-findings
Mather, M., Wiles, K., & O'Brien, O. (2015). Should women abstain from alcohol throughout pregnancy.
BMJ, 351
.
doi
:
https://doi.org/10.1136/bmj.h5232
May, P., & Gossage, J. (2011). Maternal risk factors for fetal alcohol spectrum disorders: Not as simple as it seems.
Alcohol Research and Health
,
34
(11), 15-26.
Slide41References
O'Malley, K. (2008).
ADHD and fetal alcohol spectrum disorders (FASD)
. Nova Science Publishers.
Peadon
, E., Payne, J., Henley, N.,
D'Antoine
, H.,
Bartu
, A., O'Leary, C., Bower, C., & Elliott, E. (2011). Attitudes and behaviour predict women's intention to drink alcohol during pregnancy: The challenge for health professionals.
BMC Public Health, 10
, 510-517. doi:10.1186/1471-2458-11-584
Thanh, N., & Jonsson, E. (2016). Life expectancy of people with fetal alcohol syndrome.
Journal of Population Therapeutics and Clinical Pharmacology
,
23
(1), 53-59.
Roozen
, S.,
Kok
, G., &
Curfs
, L. (2017).
Fetal Alcohol Spectrum Disorders: Knowledge Synthesis
. Maastricht:
Datawyse
Maastricht University Press.
Rutman
, D. (2013). Voices of women living with FASD: Perspectives on promising approaches in substance use treatment, programs and care.
First peoples child and family review
,
8
(1), 107-121.
Stevens, S., Nash, K.,
Koren
, G., &
Rovet
, J. (2013). Autism characteristics in children with fetal alcohol spectrum disorders.
Child Neuropsychology
,
19
(6), 579-87. doi:1080/09297049.2012.727791