Fetal Alcohol Spectrum Disorder Presentation to: Pennsylvania - - PowerPoint PPT Presentation

Fetal Alcohol Spectrum Disorder

Presentation to:

Pennsylvania Association of County Administrators of Mental Health and Developmental Services April 24, 2015

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• It is likely that every county has children (and

adults) that could be identified as having FASD.

• This includes children in the mental health,

intellectual disability, juvenile justice, adoptive or foster care systems, as well as children in the general and the special education system.

• Researchers have found that, for a child with

identified FASD, incurred health costs were nine times higher than for children without an FASD. Why Learn about FASD?

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Definitions

Fetal Alcohol Spectrum Disorder (FASD):

• This is the umbrella term that describes the range
• f effects that may occur in an individual whose

mother consumed alcohol during the pregnancy.

• These effects may include behavioral, physical,

mental, and learning disabilities with possible lifelong implications.

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FASD is in itself not a diagnostic term

• The diagnostic terms that fall under FASD include the

following:

• Fetal Alcohol Syndrome (FAS)- “the leading known

preventable cause of mental retardation and birth defects.” Sometimes identifiable through facial

• features. (National Organization on Fetal Alcohol Syndrome, NOFAS)
• Partial Fetal Alcohol Syndrome (pFAS)
• Alcohol Related Neuro-developmental Disorder

(ARND),

• Alcohol Related Birth Defects (ARBD)

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.Variation

• Although prenatal alcohol exposure is cited as the leading

preventable cause of intellectual disability, not all children exposed prenatally will have intellectual disabilities.

• In a Canadian study the range of IQ of a person with FAS

was between 20-120; the IQ of someone with ARND fell in the range of 42-142.

• It is believed that about ten percent of those with an FASD

will have an IQ under 70.

• This generally means that 90 percent will have normal to

higher than average IQ.

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But there are Behavioral Indicators:

• Easily distracted, hyperactive, inattentive,

impulsive

• Consistently displays extreme behavior

(aggression, emotional instability)

• Has trouble remembering rules
• Makes the same mistakes repeatedly
• Low self-esteem

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Prevalence

The generally cited combined prevalence of all FASDs, including FAS, Partial FAS, ARND, and ARBD – has been 1 percent of all births.

But studies are starting to show much higher estimates!

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Emerging View of Prevalence

• Paper published in Pediatrics in 2014 reported that

using one method of prevalence estimation, they found that 2.86% had FASD.

• Using a second method of prevalence estimation

calculated from cases of FASD, they found an FASD rate of 8.2%.

• A third study in an urban neighborhood identified 49%
• f the adults and youth had neurodevelopmental

disorders with 39% having clinical profiles consistent with neurobehavioral disorders associated with prenatal alcohol exposure.

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Other Findings

Child Welfare

• Another 2014 paper, also in Pediatrics, found the rates
• f FASD in foster care and adopted youth were

estimated to be higher than previously understood:

• 28.5% of these youth had FASD,
• 86.5% of these youth had never been diagnosed or

were misdiagnosed, and

• 26.4% of these youth were misdiagnosed as having

ADHD.

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Growing Awareness

• Initially, only heavy drinking was thought to be

dangerous to the developing fetus, but over time there was increasing awareness of the risk posed by all alcohol consumption during pregnancy.

• There has been a gradual progression, over more

than 35 years, from denial that alcohol during pregnancy is dangerous to the fetus, to some level

• f recognition and concern, to a much greater level
• f concern, to current questioning of all previous

assumptions about prevalence.

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Public Health Message

• In 1981 in the United States, the Surgeon General’s

“Advisory on Alcohol and Pregnancy” urged women for the first time to avoid all alcohol during pregnancy.

• In 1997, it was definitively stated that “alcohol causes

FAS” and that “drinking during pregnancy is linked with disaster” (Streissguth & O’Malley, 1997).

• But the message is not completely being heard.

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• U. S. Department of Health and Human Services

Ongoing problem

• According to the U.S. Department of Health and

Human Services, approximately 12 percent of pregnant women still drink alcohol, which means that

• ne out of eight unborn babies are exposed to

alcohol and are at risk for an FASD (2009).

• SAMHSA website says: If you are pregnant, or may

become pregnant, don't drink alcohol.

• There is no known safe amount or type of alcohol to

drink during pregnancy.

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Recommendations from OMHSAS Paper

• Pennsylvania should increase awareness and knowledge

related to FASD, including FASD prevention, identification, and intervention.

• All child-serving systems should develop a coordinated FASD

awareness and training plan.

• Screening should be pursued in all child-serving systems.
• Specialized assessment processes, including the use of

neuropsychological testing when indicated, should be supported by public and private insurance companies.

• Behavioral health providers should ensure that information

about the possible use of alcohol and other substances during pregnancy are obtained and documented as part of the treatment protocol.

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OMHSAS and DDAP

Collaboration with Department of Drugs and Alcohol Programs

• Priority: Develop and implement a statewide plan to

increase awareness regarding FASD;

• The Department has reconvened the FASD Task

Force to update the FASD State Plan for Pennsylvania; and

• The Department will continue to require SCAs to

provide two community activities related to FASD prevention during the state fiscal year.

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Growing Understanding about Intervention

Suggestions for Counties:

• The first priority will be prevention;
• The next step would be screening to identify children,

youth, and adults;

• The third step is management and treatment – and we

are rapidly learning that we need to consider something other than traditional mental health approaches, which have not been developed to address the permanency of FASD effects.

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