overview of fetal alcohol syndrome 1... · 2016. 3. 19. · understanding fetal alcohol spectrum...
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Welcome!
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ATTC Center of Excellence on Behavioral Health for Pregnant and Postpartum Women and Their Families
ATTC Regional Center Partners:Great Lakes ATTCMid-America ATTCNew England ATTCSoutheast ATTC
Purpose: The Center was established to develop a family-centered national curricula, web-based toolkit, and provide support for national training and resource dissemination.
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Understanding Fetal Alcohol Spectrum Disorders (FASD): Implications for Women’s Treatment
Georgiana Wilton, PhDUniversity of Wisconsin-Madison
School of Medicine and Public HealthDepartment of Family Medicine and Community Health
CoE PPW Webinette 1January 12, 2016
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Webinette Overview
• Fetal Alcohol Spectrum Disorders (FASD) in a Nutshell
• Implications for Women’s Treatment Programs
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Alcohol’s Potential Effect on Pregnancy
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Prenatal Development Flickr.com/2013
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Severity of Effects
Severity of effects depends on:
• dose • pattern • timing
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What is Fetal Alcohol Syndrome (FAS)?
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Fetal Alcohol Syndrome
A specific, yet variable, combination of abnormalities seen in some individuals who were exposed to high levels of alcohol during gestation.
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Major signs leading to a diagnosis of FAS
• Central Nervous System effects
• Small size and weight
• Specific facial features
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Fetal Alcohol Spectrum Disorders (FASD)
• An umbrella term used to describe the range of effects that can occur in individuals who were prenatally exposed to alcohol
• Effects may be physical, mental, behavioral and or learning disabilities
• NOT intended as a clinical diagnosis
FASD Center for Excellence
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Diagnoses under the Umbrella
• Fetal Alcohol Syndrome (FAS)
• Partial FAS (pFAS)
• Alcohol-related neurodevelopmental disorder (ARND)
• Alcohol-related birth defects (ARBD)
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DSM-5
Section II
Neurodevelopmental disorder associated with prenatal alcohol exposure (p. 86)
315.8 (F88)
Section III: Conditions for Further Study
Neurobehavioral disorder associated with prenatal alcohol exposure (p. 798)
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Podcast: The Clinical Exam
https://www.youtube.com/watch?v=044Zxy3_0u8
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Podcast: Foundations of FASD
https://www.youtube.com/watch?v=ARPgT26dg24
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Fetal Alcohol Syndrome
.2-1.5 per 1,000 live birthsMay & Gossage, 2001Review of data from multiple surveillance studies
6 to 9 per 1,000 first gradersMay et al., 2014Screened 70.5% of all first graders with <25% height/weight/head circumference
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Fetal Alcohol Spectrum Disorders
24 to 48 per 1,000 children2.4-4.8%
May et al., 2014
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Specific High Risk Populations
Juvenile Justice
1% FAS
22.3% FAE (old term)
Fast et al., 1999
Screened 287 youth remanded for forensic psychiatric evaluation (in system >1 year)
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Specific High Risk Populations, cont.
Children in Foster Care10-15 per 1,000 children
10-15x greater than general population (their assertion)Astley et al., 2002
Adult women in AODA Treatment Programs
22 outreach clinics conducted over 5 years76 referrals of adult women at risk34% diagnosed with one of FASDs
Wisconsin FASD Treatment Outreach Project
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Cautions
Methodology varies across studies
Populations are highly selected/screened
Criteria for FASDs may vary
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Review of Brain Structures/Functions
http://www.headwaywearside.org.uk/about.html23
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Implications of PAE
Sensory or regulatory effects
Developmental delays
Deficits in neurocognitive functioningAcross all domains
• Visual/spatial abilities• Math skills• Visual-motor integration
Drawing/writing
Hyperactivity/Distractibility
Memory deficits
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Implications of PAE, cont.
• ADHD/Impulsivity
• Difficulty with executive functioning/abstracting abilities
• Poor comprehension of social rules, expectations, boundaries
• Easily influenced by others
• Difficulty predicting or understanding consequences of behavior
• Concrete thinkers
• Mental health issues
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Also consider…
Genetics of biological parents
• Including mental health disorders
Environment
• Second-hand exposures
• Trauma
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Implications for Treatment and Recovery
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FASD & Other Cognitive Disabilities in Treatment Settings
Disabilities are common in the U.S.
“Hidden” conditions may affect up to 40% of clients in treatment programs
Individuals with disabilities are less likely to complete treatment
Helwig & Holicky, 1994
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Think in terms of hidden disabilities when discussing routine subjects:
Example: Incorporate follow-up questions when discussing medical history, success in school, participation in other social service programs
• Did you ever have special classes or tutoring in school?
• Have you ever had problems…?Concentrating? Getting your point across?
FASD & Other Cognitive Disabilities in Treatment Settings
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Functional limitations can interfere with treatment progress
Don’t assume:
• Lack of progress = lack of motivation
• Not following directions = noncompliant
• Lack of concentration = ambivalence
• Inability to recognize negative consequences = denial
Sometimes the biggest barrier is our attitude…
FASD & Other Cognitive Disabilities in Treatment Settings
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Recommendations
• Screen women for FASD during intake
• Conduct adaptive functioning assessment
• If warranted, refer for diagnostic assessment
• Modify treatment plan based on individual characteristics
Meet a woman where she’s at!
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Screening
• Use (or develop) screening tool for consistent use
• Use collateral information as needed
• Consider family history in screening
Do parents have cognitive/mental health concerns?
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Screening for FASDs
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Conduct Adaptive Functioning Assessment
Consider:• Vineland Adaptive Behavior Scales-II
• Good evidence base with FASD
Adaptive functioning data provides:
• How women navigate their environment can bring challenges to light
• Starting point for treatment planning
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Collect Additional Information
Medical records
School records
Observation
Formalized assessment of:
• Executive function
• Intellectual capacity
• Sensory processing function
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Refer for Diagnostic Assessment
Screening does not mean diagnosing
• Suspicions do not equal a diagnosis
Refer to experts for assessment, diagnosis
National Resource Directory: www.nofas.org
Few physicians are comfortable/trained to diagnose FASDs in adults!
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What Conditions should be Considered?
Fetal Alcohol Spectrum DisordersHistory may be more important than physical features
Learning Disabilities/Mental RetardationBacked up by school/psych records
Traumatic Brain InjuryAccident/violence-induced
Korsakoff’s SyndromeWatch for sudden onset of memory problems
Co-Occurring Mental Health Issues
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References to review:
• Treatment Improvement Protocol (TIP) #58
• Grant et al., 2013: The Impact of Prenatal Alcohol Exposure on Addiction Treatment (J Addict Med, Vol 7, No 2)
Addressing the Needs of Clients with FASDs
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Strategies for Working with Women in Treatment
• Environmental
• Counseling/Therapy
• Educational
• Physical Health/Medical
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Environmental
• Structure
• Predictability
• Monitored level of stimulation
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Counseling/Therapy, cont.
Modify counseling to accommodate cognitive disability:
• Individual vs. group counseling
• Plan session times• Time of day
• Length of session
• Number of sessions per week
• Consider insight of client vs. actual behavior
• Concrete vs. insight-oriented counseling
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Educational
• Accommodate information processing, comprehension and retention deficits
• Multi-modality instruction
• Use concrete, practical language
• Appropriate reinforcement techniques
• Repetition
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Physical Health/Medical
Behavior may be related to (or exacerbated by) other health issues.
Consider:
• Sleep disorders
• Sensory processing disorders
• Exercise
• Diet
• Medication
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CAUTION: What to Watch For
Don’t assume if a client can repeat rules that she understands them and is capable of following them
• Information processing
• Expressive vs. Receptive language
• “Masking”
(i.e., waiting for others to go first)
• Clue gathering
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For More Information
Georgiana Wilton, PhD
University of Wisconsin School of Medicine and Public Health
Department of Family Medicine and Community Health
1100 Delaplaine Court
Madison, WI 53715
Phone: 608-261-1419
Fax: 608-263-5813
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References
• Bailey, B. A. & Sokol, R. J. (2011). Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Research & Health, 86-91.
• Bremner, J. D. (1999). The lasting effects of psychological trauma on memory and the hippocampus.
• Burd, L., Klug, M. G., Martsolf, J. T., & Kerbeshian, J. (2003). Fetal alcohol syndrome: Neuropsychiatric phenomics. Neurotoxicology and Teratology, 25, 697-705.
• Burden, M. J., Westerlund, A., Muckle, G., Dodge, N., Dewailly, E., Nelson, C. A., Jacobson, S. W., Jacobson, J. L. (2011). The effects of maternal binge drinking during pregnancy on neural correlates of response inhibition and memory in childhood. Alcoholism: Clinical and Experimental Research, 35, 69-82.
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References• CDC. (2008). The Effects of Childhood Stress on Health Across the
Lifespan. www.cdc.gov
• CDC. (2009). FASD Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice. www.cdc.gov
• Chen, W. A. & Maier, S. E. (2011). Combination drug use and risk for fetal harm. Alcohol Research & Health, 34, 27-28.
• Coles, C. (2011). Discriminating the effects of prenatal alcohol exposure from other behavioral and learning disorders. Alcohol Research & Health, 34, 42-50.
• Crocker, N., Vaurio, L., Riley, E. P., & Mattson, S. N. (2011). Comparison of verbal learning and memory in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 35, 1114-1121.
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• De-Bellis, M. D., Lefter, L., Trickett, P. K., & Putnam, F. W. (1994). Urinary catecholamine excretion in sexually abused girls. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 320-27.
• Dold, L. (1998). Substance Abuse and Treatment Needs Among Pregnant Women in Wisconsin. A report to the Wisconsin Department of Health and Family Services. Wisconsin Survey Research Laboratory, University of Wisconsin-Extension, Madison.
• Ewing, S. W., Filbey, F. M., Sabbineni, A., Chandler, L. D., & Hutchison, K. E. (2011). How psychosocial alcohol interventions work: A preliminary look at what fMRI can tell us. Alcoholism: Clinical and Experimental Research, 35, 643-651.
References
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References
• Feldman, H. S., Jones, K., L., Lindsay, S., Slymen, D., Klonoff-Cohen, H., Kao, K., Rao, S. & Chambers, C. (2011). Patterns of prenatal alcohol exposure and associated non-characteristic minor structural malformations: A prospective study. American Journal of Medical Genetics Part A, 155, 2949-2955.
• Feldman, H. S., Jones, K. L., Lindsay, S., Slymen, D., Klonoff-Cohen, H., Kao, K., Rao, S. & Chambers, C. (2012). Prenatal alcohol exposure patterns and alcohol-related birth defects and growth deficiencies: A prospective study. Alcoholism: Clinical and Experimental Research, doi:10.1111/j.1530-0277.2011.01664.x
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• Gaensbauer, T. J. (1995). Trauma in the preverbal period: Symptoms, memories, and developmental impact. Psychoanalytic Study of the Child, 50, 122-49.
• Green, J. H. (2007). Fetal alcohol spectrum disorders: Understanding the Effects of Prenatal Alcohol Exposure and Supporting Students. Journal of School Health, 77, 103-108.
• Idrus, N. M. & Thomas, J. D. (2011). Fetal alcohol spectrum disorders: Experimental treatments and strategies for intervention. Alcohol Research & Health, 34, 76-85.
• Jacobson, J. L., Dodge, N. C., Burden, M. J., Klorman, R., & Jacobson, S. W. (2011). Number processing in adolescents with prenatal alcohol exposure and ADHD: Differences in the neurobehavioral phenotype. Alcoholism: Clinical and Experimental Research, 35, 431-442.
References
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• Kully-Martens, K., Denys, K., Treit, S., Tamana, S. & Rasmussen, C. (2011). A review of social skills deficits in individuals with fetal alcohol spectrum disorders and prenatal alcohol exposure: Profiles, mechanisms, and interventions. Alcoholism: Clinical and Experimental Research, doi:10.1111/j.1530-0277.2011.01661.x
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