Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure

Alcoholic Hepatitis

At a glance......









User Review


5
(1 vote)


Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure/Fetal alcohol syndrome is one of a spectrum of disorders under the umbrella term of fetal alcohol spectrum disorder (FASD). There is a total of five disorders that comprise fetal alcohol spectrum disorders. They are fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), a neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE), and alcohol-related birth defects (ARBD). All of these fetal alcohol spectrum disorders are used to classify the wide-ranging physical and neurological effects that prenatal alcohol exposure can inflict on a fetus.

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during their pregnancy.[rx] Problems may include an abnormal appearance, short height, low body weight, small head size, poor coordination, low intelligence, behavior problems, and problems with hearing or seeing.[rx][rx] Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors and have trouble with alcohol or other drugs.[rx] The most severe form of the condition is known as fetal alcohol syndrome (FAS).[rx] Other types include partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). Some accept only FAS as a diagnosis, seeing the evidence as inconclusive with respect to other types.[rx]

Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities caused by prenatal alcohol exposure. Prenatal alcohol use is common in the UK, but the FASD prevalence was unknown. Prevalence estimates are essential for informing FASD prevention, identification, and support.

Types of FASDs

Different terms are used to describe FASDs, depending on the type of symptoms.

  • Fetal Alcohol Syndrome (FAS) –  FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome of drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) 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. 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).
  • Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE) – 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.

FASDs

Causes of Fetal Alcohol Syndrome

  • Smoking, drinking alcohol or taking certain street drugs during pregnancy.
  • Having certain medical conditions, such as being obese or having uncontrolled diabetes before and during pregnancy.
  • Taking certain medications, such as isotretinoin (a drug used to treat severe acne).
  • Having someone in your family with a birth defect. To learn more about your risk of having a baby with a birth defect, you can talk with a clinical geneticist or a genetic counselor.
  • Being an older mother, typically over the age of 34 years.

These potential causes include

  • Familial microsomia
  • Constitutional developmental retardation
  • Prenatal deficiency states
  • Skeletal dysplasia
  • Hormonal disorders
  • Genetic syndromes
  • Chronic diseases
  • Malabsorption
  • Malnutrition
  • Neglect

Fetal alcohol syndrome: confirmed alcohol exposure

  • alcohol exposure
  • the facial pattern of short palpebral fissures ≤10 percentile, thin upper lip vermillion, smooth philtrum
  • evidence of pre/postnatal growth retardation
  • evidence of neurocognitive deficits

Fetal alcohol syndrome: no confirmed alcohol exposure as above but no alcohol exposure found

  • Partial fetal alcohol syndrome – confirmed alcohol exposure not all of the above features are present but neurocognitive and some facial features needed
  • Alcohol-related birth defect confirmed maternal alcohol consumption – as well as some but not all of the facial features, are present, however, the behavioral features or structural abnormalities are more pronounced
  • Alcohol-related neurodevelopmental disorder – confirmed maternal alcohol consumption with the absence of growth retardation or facial features and with the neurocognitive features being prominent

Methods of diagnosis of facial abnormalities: note all of these require careful history taking and evidence of growth retardation to make the diagnosis [

  • Gestalt – facial pattern recognition requires experience and clear history. Issues of accuracy and inconsistency often found
  • D score method – a computational method for facial pattern based on careful measurements of abnormalities: requires a high degree of training and skill restricting practice to a few
  • 4-digit scoring method and facial photographic recognition software – apply areas of history and facial recognition to four 4-point Likert scales to establish a diagnosis. Requires minimal training and can be used easily by all in clinical settings

Core areas of psychological deficits [

  • Hyperactivity
  • Attention deficits
  • Sustained attention
  • Focused attention
  • Cognitive flexibility
  • Planning difficulties
  • Learning/memory problems
  • New memories not consolidated
  • Lower IQ
  • Arithmetic difficulties
  • Receptive language difficulties
  • Verbal processing problems
  • Social understanding difficulties

Common secondary difficulties are seen [

  • Psychiatric problem
  • Disrupted school experience
  • The trouble with the law
  • Confinement
  • Inappropriate sexual behavior
  • Alcohol/drug problems

Age-related diagnostic criteria for fetal alcohol syndrome and/or atypical fetal alcohol syndrome

Infants
  History of prenatal alcohol exposure
  Facial abnormalities
  Growth retardation – height, weight, head circumference
  Hypotonia increased irritability
  Jitteriness, tremulousness, weak suck
  Difficulty ‘habituating’, getting used to stimulation
Preschool
  History of alcohol exposure, growth retardation, facial abnormalities
  Friendly, talkative and alert
  Temper tantrums and difficulty making transitions
  Hyperactive; may be oversensitive to touch or over-stimulation
  Attention deficits, developmental delays – speech, fine motor difficulties
  Apparent skill levels may appear to be higher than their tested levels of ability
Middle childhood
  History of alcohol exposure, growth retardation, facial abnormalities
  Hyperactivity, attention deficit, impulsiveness
  Poor abstract thinking
  Inability to foresee consequences of actions
  Lack of organization and sequencing
  Inability to make choices
  Lack of organizational skills
  Inappropriate behavior
    Overly affectionate – does not discriminate between family and strangers
    Lack of inhibitions
    Communication problems
      Lack of social skills to make and keep friends
      Unresponsive to social clues
      Uses behavior as communication
    Difficulty making transitions
  Academic problems – reading and mathematics
  Behaviour problems – ‘stretched toddler’
Adolescent and adult
  History of alcohol exposure, growth retardation, facial abnormalities
  Intelligence Quotient – average to mildly retarded with wide range; continued school difficulties
  Difficulty with adaptive and living skills
  Attention deficits, poor judgment, impulsivity lead to problems with employment, stable living and the law
  Serious life adjustment problems – depression, alcoholism, crime, pregnancy and suicide

 

Symptoms of Fetal Alcohol Syndrome

FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways and can range from mild to severe.

A person with an FASD might have:

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

Physical defects

Physical defects may include:

  • Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
  • Deformities of joints, limbs, and fingers
  • Slow physical growth before and after birth
  • Vision difficulties or hearing problems
  • Small head circumference and brain size
  • Heart defects and problems with kidneys and bones

Brain and central nervous system problems

Problems with the brain and central nervous system may include:

  • Poor coordination or balance
  • Intellectual disability, learning disorders and delayed development
  • Poor memory
  • The trouble with attention and with processing information
  • Difficulty with reasoning and problem-solving
  • Difficulty identifying consequences of choices
  • Poor judgment skills
  • Jitteriness or hyperactivity
  • Rapidly changing moods

Social and behavioral issues

Problems in functioning, coping and interacting with others may include:

  • Difficulty in school
  • Trouble getting along with others
  • Poor social skills
  • Trouble adapting to change or switching from one task to another
  • Problems with behavior and impulse control
  • Poor concept of time
  • Problems staying on task
  • Difficulty planning or working toward a goal

Other conditions may commonly co-occur with FAS, stemming from prenatal alcohol exposure. However, these conditions are considered alcohol-related birth defects[rx] and not diagnostic criteria for FAS.

  • Heart – A heart murmur that frequently disappears by one year of age. A ventricular septal defect is most commonly seen, followed by an atrial septal defect.
  • Bones – Joint anomalies including abnormal position and function, altered palmar crease patterns, small distal phalanges, and small fifth fingernails.
  • Kidneys – Horseshoe, aplastic, dysplastic, or hypoplastic kidneys.
  • Eye –  Strabismus, optic nerve hypoplasia[rx] (which may cause light sensitivity, decreased visual acuity, or involuntary eye movements).
  • Occasional problems – ptosis of the eyelid, microphthalmia, cleft lip with or without a cleft palate, webbed neck, short neck, tetralogy of Fallot, coarctation of the aorta, spina bifida, and hydrocephalus.

Or

  • Cardiac – atrial septal defects, ventricular septal defects, aberrant great vessels, Tetralogy of Fallot.
  • Skeletal – Hypoplastic nails, shortened fifth digit, radioulnar synostosis, joint contractures, camptodactyly, clinodactyly, pectus excavatum and carinatum, Klippel-Feil syndrome, hemivertebrae, scoliosis.
  • Renal –Aplastic, dysplastic, hypoplastic kidneys, horseshoe kidneys, ureteral duplications, hydronephrosis.
  • Ocular – Strabismus, refractive problems secondary to small globes, retinal vascular anomalies.
  • Auditory – Conductive hearing loss, neurosensory hearing loss.

Other – Virtually every malformation has been described in some patients with FAS. The etiologic specificity of most of these anomalies to alcohol teratogenesis remains uncertain. Evidence of CNS abnormalities in at least one of the following:

  • Decreased cranial size at birth
  • Structural brain abnormalities (e.g., microcephaly, cerebellar hypoplasia)
  • Neurological hard or soft signs (as age-appropriate), such as impaired fine motor skills, neurosensory hearing loss, poor tandem gait, poor eye-hand coordination.
  • Evidence of a complex pattern of behavior or cognitive abnormalities that are inconsistent with developmental level and cannot be explained by familial background or environment alone, such as learning difficulties, deficits in school performance, poor impulse control, problems in social perception, deficits in higher-level receptive and expressive language, poor capacity for abstraction or metacognition, specific deficits in mathematical skills; or problems in memory, attention, or judgment.

Diagnosis of Fetal Alcohol Syndrome

The “4-Digit Diagnostic Code” allows for mid-range gradations in growth deficiency (between the 3rd and 10th percentiles) and severe growth deficiency at or below the 3rd percentile.[rx] Growth deficiency (at severe, moderate, or mild levels) contributes to diagnoses of FAS and pFAS, but not ARND or static encephalopathy.

Growth deficiency is ranked as follows by the “4-Digit Diagnostic Code [rx]

  • Severe – Height and weight at or below the 3rd percentile.
  • Moderate – Either height or weight at or below the 3rd percentile, but not both.
  • Mild – Either height or weight or both between the 3rd and 10th percentiles.
  • None – Height and weight both above the 10th percentile.

Ranking FAS facial features is complicated because the three separate facial features can be affected independently by prenatal alcohol. A summary of the criteria follows:[rx][rx]

  • Severe – All three facial features ranked independently as severe (lip ranked at 4 or 5, philtrum ranked at 4 or 5, and PFL two or more standard deviations below average).
  • Moderate – Two facial features ranked as severe and one feature ranked as moderate (lip or philtrum ranked at 3, or PFL between one and two standard deviations below average).
  • Mild – A mild ranking of FAS facial features covers a broad range of facial feature combinations:
    • Two facial features ranked severe and one ranked within normal limits,
    • One facial feature ranked severe and two ranked moderate, or
    • One facial feature ranked severe, one ranked moderate and one ranked within normal limits.
  • None – All three facial features ranked within normal limits.

The “4-Digit Diagnostic Code” also allows for an FASD diagnosis when only two functional domains are measured at two standard deviations or worse.[rx] The “4-Digit Diagnostic Code” further elaborates the degree of CNS damage according to four ranks:

  • Definite – Structural impairments or neurological impairments for FAS or static encephalopathy.
  • Probable – Significant dysfunction of two standard deviations or worse in three or more functional domains.
  • Possible –  Mild to moderate dysfunction of two standard deviations or worse in one or two functional domains or by the judgment of the clinical evaluation team that CNS damage cannot be dismissed.
  • Unlikely – No evidence of CNS damage.

The four diagnostic systems list various CNS domains that can qualify for functional impairment that can determine an FASD diagnosis

  • Evidence of a complex pattern of behavior or cognitive abnormalities – consistent with a developmental level in the following CNS domains – Sufficient for a pFAS or ARND diagnosis using IOM guidelines[rx]
    • Learning disabilities, academic achievement, impulse control, social perception, communication, abstraction, math skills, memory, attention, judgment
  • Performance at two or more standard deviations on standardized testing – in three or more of the following CNS domains – Sufficient for a FAS, pFAS or static encephalopathy diagnosis using 4-Digit Diagnostic Code[rx]
    • Executive functioning, memory, cognition, social/adaptive skills, academic achievement, language, motor skills, attention, activity level
  • General cognitive deficits (e.g., IQ) – at or below the 3rd percentile on standardized testing – Sufficient for a FAS diagnosis using CDC guidelines[rx]
  • Performance at or below the 16th percentile on standardized testing – in three or more of the following CNS domains – Sufficient for a FAS diagnosis using CDC guidelines[rx]
    • Cognition, executive functioning, motor functioning, attention and hyperactive problems, social skills, sensory processing disorder, social communication, memory, difficulties responding to common parenting practices
  • Performance at two or more standard deviations on standardized testing – in three or more of the following CNS domains – Sufficient for a FAS diagnosis using Canadian guidelines
    • Cognition, communication, academic achievement, memory, executive functioning, adaptive behavior, motor skills, social skills, social communication

Healthcare professionals look for the following signs and symptoms when diagnosing FAS

Abnormal facial features

A person with FAS has three distinct facial features:

  • The smooth ridge between the nose and upper lip (smooth philtrum)
  • Thin upper lip
  • The short distance between the inner and outer corners of the eyes, giving the eyes a wide-spaced appearance.

Growth problems

  • Children with FAS have height, weight, or both that are lower than normal (at or below the 10th percentile). These growth issues might occur even before birth. For some children with FAS, growth problems resolve themselves early in life.

Central nervous system problems

  • The central nervous system is made up of the brain and spinal cord. It controls all the workings of the body. When something goes wrong with a part of the nervous system, a person can have trouble moving, speaking, or learning. He or she can also have problems with memory, senses, or social skills. There are three categories of central nervous system problems:

Structural

FAS can cause differences in the structure of the brain. Signs of structural differences are:

  • Smaller-than-normal head size for the person’s overall height and weight (at or below the 10th percentile).
  • Significant changes in the structure of the brain as seen on brain scans such as MRIs or CT scans.

Neurologic

  • There are problems with the nervous system that cannot be linked to another cause.  Examples include poor coordination, poor muscle control, and problems with sucking as a baby.

Functional

  • The person’s ability to function is well below what’s expected for his or her age, schooling, or circumstances. To be diagnosed with FAS, a person must have:

Cognitive deficits (e.g., low IQ), or significant developmental delay in children who are too young for an IQ assessment. Or Problems in at least three of the following areas:

  • Cognitive deficits (e.g., low IQ) – or developmental delays. Examples include specific learning disabilities (especially math), poor grades in school, performance differences between verbal and nonverbal skills, and slowed movements or reactions.
  • Executive functioning deficits – These deficits involve the thinking processes that help a person manage life tasks. Such deficits include poor organization and planning, lack of inhibition, difficulty grasping cause and effect, difficulty following multistep directions, difficulty doing things in a new way of thinking of things in a new way, poor judgment, and inability to apply knowledge to new situations.
  • Motor functioning delays – These delays affect how a person controls his or her muscles. Examples include delay in walking (gross motor skills), difficulty writing or drawing (fine motor skills), clumsiness, balance problems, tremors, difficulty coordinating hands and fingers (dexterity), and poor sucking in babies.
  • Attention problems or hyperactivity – A child with these problems might be described as “busy,” overly active, inattentive, easily distracted, or having difficulty calming down, completing tasks, or moving from one activity to the next. Parents might report that their child’s attention changes from day to day (e.g., “on” and “off” days).
  • Problems with social skills – A child with social skills problems might lack a fear of strangers, be easily taken advantage of, prefer younger friends, be immature, show inappropriate sexual behaviors, and have trouble understanding how others feel.
  • Other problems – Other problems can include sensitivity to taste or touch, difficulty reading facial expression, and difficulty responding appropriately to common parenting practices (e.g., not understanding cause-and-effect discipline)
  • Mother’s Alcohol Use during Pregnancy – Confirmed alcohol use during pregnancy can strengthen the case for FAS diagnosis. Confirmed absence of alcohol exposure would rule out the FAS diagnosis. It’s helpful to know whether or not the person’s mother drank alcohol during pregnancy. But confirmed alcohol use during pregnancy is not needed if the child meets the other criteria.
Tests used to measure intelligence may include
  Bayley Scales of Infant Mental and Motor Development (Bayley) resulting in a Mental Development Index
  Stanford Binet – yields Intelligence Quotient (IQ)
  Wechsler Scales – yield IQ

  • Wechsler Preschool and Primary Scales of Intelligence (WPPSI and WPPSI-R [revised])

  • Wechsler Intelligence Scale for Children (WISC and WISC-R [revised])

  • Wechsler Adult Intelligence Scales

Tests used to measure attention and hyperactivity include:
  Taland Letter cancelling test
  WISC-R digit span
  Wisconsin Card Sorting Test (WCST) – indicates shifting attention
  Attention deficit hyperactivity disorder comprehensive Teacher’s Rating Scale (ACTeRS) [
Tests of learning and memory include:
  Brazelton Scale – habituation [
  Pediatric Early Elementary Examination (PEEX) [
  Pediatric Examination of Educational Readiness (PEER) [
  Brigance [,
Tests of language include:
  Denver Development Screening Test (DDST)
  Word Span
  Naming
  Word comprehension
  Woodstock Reading Mastery
Tests of motor abilities include:
  DDST
  WISC-R
  PEEX [
  PEER [
Tests of social skills and behavior include:
  Vineland Adaptive Behaviour Scales (VABS)[
  Fetal Alcohol Behavior Scale (FABS) [
  FAS\atypical FAS Scale [
  ACTeRS [
Tests of Visual-spatial difficulties include:
  Beery Developmental Test of Visual-Motor Integration
  Frostig Developmental Test of Visual Perception
  PEEX [
  PEER [

 

Treatment of Fetal Alcohol Syndrome

No one treatment is right for every child, as FASD and its constellation of symptoms differ from one child to another. FASDs need a medical home to provide, coordinate, and facilitate all the necessary medical, behavioral, social, and educational services.

Many types of available treatments include but are not limited to:

  • Developmental services
  • Educational interventions
  • Behavior modification
  • Parent training
  • Social skills training
  • Medications and other medical therapies
  • Transition planning
  • Advocacy in school and the workplace
  • Referral for community support services
  • Coordination across the specialists, partners, and needed supports
  • Primary care in a high-quality medical home setting with care integration

Treatment plans should be adaptable to the child’s and family’s needs, plus include close monitoring and follow-up.

Types of Treatments


Medical Care

People with FASDs have the same health and medical needs as people without FASDs. Like everyone else, they need well-baby care, vaccinations, good nutrition, exercise, hygiene, and basic medical care. But, for people with FASDs, concerns specific to the disorder must also be monitored and addressed either by a current doctor or through referral to a specialist. The types of treatments needed will be different for each person and depend upon the person’s symptoms.

Types of medical specialists might include

  • Pediatrician
  • Primary care provider
  • Dysmorphologist
  • Otolaryngologist
  • Audiologist
  • Immunologist
  • Neurologist
  • Mental health professionals (child psychiatrist and psychologist, school psychologist, behavior management specialist)
  • Ophthalmologist
  • Plastic surgeon
  • Endocrinologist
  • Gastroenterologist
  • Nutritionist
  • Geneticist
  • Speech-language pathologist
  • Occupational therapist
  • Physical therapist

Medication

No medications have been approved specifically to treat FASDs. But, several medications can help improve some of the symptoms of FASDs. For example, medication might help manage high energy levels, inability to focus, or depression.

Following are some examples of medications used to treat FASD symptoms:

  • Stimulants – This type of medication is used to treat symptoms such as hyperactivity, problems paying attention, and poor impulse control, as well as other behavioral issues.
  • Antidepressants – This type of medication is used to treat symptoms such as sad mood, loss of interest, sleep problems, school disruption, negativity, irritability, aggression, and anti-social behaviors.
  • Neuroleptics – This type of medication is used to treat symptoms such as aggression, anxiety, and certain other behavior problems.
  • Anti-anxiety drugs – This type of medication is used to treat symptoms of anxiety. Medications can affect each child differently. One medication might work well for one child, but not for another. To find the right treatment, the doctor might try different medications and doses. It is important to work with your child’s doctor to find the treatment plan that works best for your child.

Behavior and Education Therapy

Behavior and education therapies can be important parts of treatment for children with FASDs. Although there are many different types of therapy for children with developmental disabilities, only a few have been scientifically tested specifically for children with FASDs.

Following are behavior and education therapies that have been shown to be effective for some children with FASDs:

  • Good Buddies – A children’s friendship training to teach individuals with an FASD appropriate social skills  – Children with FASDs often have difficulty learning subtle social skills from their own experiences; those kinds of skills are typically “learned by osmosis” on the playground, such as how to slip into a group, appropriate sharing, or dealing with teasing. This intervention uses a group format to teach age-appropriate social skills over 12 weekly sessions for parent and child. Sessions are organized around and toward each child hosting a play date with a classmate or peer.[rx]
  • Families Moving Forward (FMF) program to provide support for families who deal with challenging FASD behaviors  –   This intervention is most appropriate for children with severe, clinically significant behavior problems based in part on positive behavior support techniques. It is a feasible, low-intensity, a sustained model of supportive consultation with a parent or caregiver (rather than directly with the child). The intervention lasts 9 to 11 months, with at least 16 every-other-week sessions, typically lasting 90 minutes each. Services are carried out by mental health providers with specialized training.[rx] 
  • Math Interactive Learning Experience (MILE) program to help with mathematics difficultyDeficits in mathematical functioning have been reported consistently among alcohol-affected individuals. The MILE program is designed to improve the child’s mathematical knowledge and skill. Children complete 6 weeks of one-to-one tutoring using specifically adapted materials (eg, vertical number line, timers, etc.) that are appropriate to their academic level. Parents also receive training on behavioral regulation techniques to optimize the child’s readiness to learn.[rx]
  • Parents and Children Together (PACT) a neurocognitive habilitation program to improve self-regulation and executive function – Building upon techniques developed from the brain injury literature, this intervention used 12 weekly sessions with parents and children to address and improve behavior regulation and executive function (that is, planning, organizing, and understanding of others). It uses a particularly engaging metaphor of “how does my engine run” to teach children awareness of their current behavioral state and specific techniques for optimizing that state for the current situation.[rx]

Parent Training

Children with FASDs might not respond to the usual parenting practices. Parent training has been successful in educating parents about their child’s disability and about ways to teach their child many skills and help them cope with their FASD-related symptoms. Parent training can be done in groups or with individual families. Such programs are offered by therapists or in special classes.

Although each child is unique, the following parenting tips can be helpful:[rx]

  • Concentrate on your child’s strengths and talents
  • Accept your child’s limitations
  • Be consistent with everything (discipline, school, behaviors)
  • Use concrete language and examples
  • Use stable routines that do not change daily
  • Keep it simple
  • Be specific-say exactly what you mean
  • Structure your child’s world to provide a foundation for daily living
  • Use visual aids, music, and hands-on activities to help your child learn
  • Use positive reinforcement often (praise, incentives)
  • Supervise: friends, visits, routines
  • Repeat, repeat, repeat

Families might need support from a family counselor or therapist. Parents might also benefit from local support groups, in which parents of children with FASDs can discuss concerns, ask questions, and find encouragement.

Alternative Approaches

With any disability, injury, or medical condition, many untested therapies become known and are promoted by informal networks. These therapies are referred to as alternative treatments. Before starting such a treatment, check it out carefully, and talk to your child’s doctor. Your child’s doctor will help you weigh the risks and benefits of these therapies.

Some of the alternative treatments used for people with FASDs include:

  • Biofeedback
  • Auditory training
  • Relaxation therapy, visual imagery, and meditation (especially for sleep problems and anxiety)
  • Creative art therapy
  • Yoga and exercise
  • Acupuncture and acupressure
  • Massage, Reiki, and energy healing
  • Vitamins, herbal supplements, and homeopathy
  • Animal-assisted therapy

Prevention

  • Be sure to see your healthcare provider regularly and start prenatal care as soon as you think you might be pregnant.
  • Get 400 micrograms (mcg) of folic acid every day, starting at least one month before getting pregnant.
  • Don’t drink alcohol, smoke, or use “street” drugs.
  • Talk to a healthcare provider about any medications you are taking or thinking about taking. This includes prescription and over-the-counter medications and dietary or herbal supplements. Don’t stop or start taking any type of medication without first talking with a doctor.
  • Learn how to prevent infections during pregnancy.
  • If possible, be sure any medical conditions are under control, before becoming pregnant. Some conditions that increase the risk of birth defects include diabetes and obesity.
  • Get 400 micrograms (mcg) of folic acid every day – Folic acid is a B vitamin. If a woman has enough folic acid in her body at least one month before and during pregnancy, it can help prevent major birth defects of the developing brain and spine (anencephaly and spina bifida). Women can get folic acid from fortified foods or supplements, or a combination of the two, in addition to a varied diet rich in folate.
  • See a healthcare professional regularly – A woman should be sure to see her doctor when planning a pregnancy and start prenatal care as soon as she thinks that she is pregnant. It is important to see the doctor regularly throughout pregnancy, so a woman should keep all her prenatal care appointments. If you are trying to have a baby or are just thinking about it, it is not too early to start getting ready for pregnancy.
  • Avoid alcohol at any time during pregnancy – Alcohol in a woman’s bloodstream passes to the developing baby through the umbilical cord. There is no known safe amount of alcohol use during pregnancy or while trying to get pregnant. There is also no safe time during pregnancy to drink. All types of alcohol are equally harmful, including wine and beer. Drinking alcohol during pregnancy can cause miscarriage, stillbirth, and a range of lifelong physical, behavioral. These disabilities in the child, which occur because the mother drank alcohol during the pregnancy, are known as fetal alcohol spectrum disorders (FASDs). The best advice for women is to stop drinking alcohol when trying to get pregnant.
  • Avoid smoking cigarettes – The dangers of smoking during pregnancy include preterm birth, certain birth defects (cleft lip or cleft palate), and infant death. Even being around tobacco smoke puts a woman and her pregnancy at risk for problems. Quitting smoking before getting pregnant is best. For a woman who is already pregnant, quitting as early as possible can still help protect against some health problems for the baby, such as low birth weight. It’s never too late to quit smoking.
  • Avoid marijuana and other drugs – A woman who uses marijuana or other drugs during pregnancy can have a baby who is born preterm, of low birth weight or has other health problems, such as birth defects. Marijuana is the illicit drug most commonly used during pregnancy. Since we know of no safe level of marijuana use during pregnancy, women who are pregnant, or considering becoming pregnant, should not use marijuana, even in states where marijuana is legal. Women using marijuana for medical reasons should speak with their doctor about alternative therapy with pregnancy-specific safety data.
  • Prevent infections – Some infections that a woman can get during pregnancy can be harmful to the developing baby and can even cause birth defects. Check out our 10 tips for preventing infections before and during pregnancy.
  • Avoid overheating and treat fever promptly – During pregnancy, a woman should avoid overheating and treat fever promptly. Overheating can increase a woman’s chance of having a baby with a neural tube defect. It can be caused by a fever or exposure to excessive temperatures (like getting in a hot tub) that increases a woman’s core temperature. Protecting against infections, treating fever promptly, limiting environmental exposures known to increase core body temperatures (like getting in a hot tub), and consuming 400 micrograms (mcg) of folic acid every day can help reduce the chance of having a baby born with a neural tube defect.[rx]
  • Keep diabetes under control – Poor control of diabetes during pregnancy increases the chances for birth defects and other problems for the pregnancy. It can also cause serious complications for the woman. Proper healthcare before and during pregnancy can help prevent birth defects and other poor outcomes.
  • Strive to reach and maintain a healthy weight – A woman who is obese (a body mass index [BMI] of 30 or higher) before pregnancy is at a higher risk for complications during pregnancy. Obesity also increases a pregnant woman’s risk of several serious birth defects. Even if a woman is not actively planning a pregnancy, getting healthy can help boost her health and her mood. If a woman is overweight or obese, she should talk with her doctor about ways to reach a healthy weight before she gets pregnant.
  • Talk to a healthcare provider about taking any medications – We know that certain medications can cause serious birth defects if they are taken during pregnancy. For many medications taken by pregnant women, safety has been difficult to determine. Despite the limited safety data, some medications are needed to treat serious conditions. If a woman is pregnant or planning a pregnancy, she should not stop taking medications she needs or begins taking new medications without first talking with her healthcare provider. This includes prescription and over-the-counter medications and dietary or herbal products.

The Canadian Paediatric Society recommends that the following measures be taken to prevent, diagnose and manage FAS

  • Primary prevention of FAS should involve school-based educational programs; early recognition; treatment of at-risk women; and community-sponsored, culturally-centered programs. Health care providers should ask women about their drinking habits, whether or not they are pregnant.
  • Health care providers play an important role in identifying babies or children with FAS. They should become familiar with the screening tools that are available to diagnose the condition in children at various ages.
  • If behavioral or physical abnormalities consistent with FAS are identified, intervention should begin without delay, even before a definitive diagnosis is made.
  • Intervention programs should involve the child’s family and community.
  • FAS diagnostic and treatment services require a multidisciplinary approach, involving physicians, psychologists, early childhood educators, teachers, social service professionals, family therapists, nurses, and community support circles.
  • Diagnostic and treatment services should be publicly funded and available to all Canadians, regardless of their ethnicity, status (eg, status and nonstatus aboriginals), place of residence or income.
  • Interventions should continue to be evaluated for effectiveness.
  • To ensure that all children have access to the appropriate services and support, cooperation is required at various levels and across various sectors: federal government; provincial ministries of health, social services and education; and local community groups.
  • Individuals and groups providing diagnostic and treatment services should take a culturally based, holistic approach.


References

Alcohol-Related Birth Defects (ARBD)


Print Friendly, PDF & Email

Sharing to Spread to the World

Leave a Reply

Your email address will not be published.