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Welcome!

ATTC Center of Excellence on Behavioral Health for Pregnant and Postpartum Women and Their Families

ATTC Regional Center Partners: Great Lakes ATTC Mid-America ATTC New England ATTC Southeast 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.

Understanding Fetal Alcohol Spectrum Disorders (FASD): Implications for Women’s Treatment

Georgiana Wilton, PhD

University of Wisconsin-Madison School of Medicine and Public Health Department of Family Medicine and Community Health CoE PPW Webinette 1 January 12, 2016

Webinette Overview

• Fetal Alcohol Spectrum Disorders

(FASD) in a Nutshell

• Implications for Women’s Treatment

Programs

Alcohol’s Potential Effect

• n Pregnancy

Prenatal Development Flickr.com/2013

Severity of Effects

Severity of effects depends on:

• dose
• pattern
• timing

What is Fetal Alcohol Syndrome (FAS)?

Fetal Alcohol Syndrome

A specific, yet variable, combination of abnormalities seen in some individuals who were exposed to high levels of alcohol during gestation.

Major signs leading to a diagnosis of FAS

• Central Nervous System effects
• Small size and weight
• Specific facial features

Fetal Alcohol Spectrum Disorders (FASD)

• An umbrella term used to describe the range
• f 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

Diagnoses under the Umbrella

• Fetal Alcohol Syndrome (FAS)
• Partial FAS (pFAS)
• Alcohol-related neurodevelopmental disorder

(ARND)

• Alcohol-related birth defects (ARBD)

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)

Podcast: The Clinical Exam

https://www.youtube.com/watch?v=044Zxy3_0u8

Podcast: Foundations of FASD

https://www.youtube.com/watch?v=ARPgT26dg24

Fetal Alcohol Syndrome

.2-1.5 per 1,000 live births

May & Gossage, 2001 Review of data from multiple surveillance studies

6 to 9 per 1,000 first graders

May et al., 2014 Screened 70.5% of all first graders with <25% height/weight/head circumference

Fetal Alcohol Spectrum Disorders

24 to 48 per 1,000 children

2.4-4.8%

May et al., 2014

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)

Specific High Risk Populations, cont.

Children in Foster Care

10-15 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 years 76 referrals of adult women at risk 34% diagnosed with one of FASDs

Wisconsin FASD Treatment Outreach Project

Cautions

Methodology varies across studies Populations are highly selected/screened Criteria for FASDs may vary

Review of Brain Structures/Functions

http://www.headwaywearside.org.uk/about.html

23

Implications of PAE

Sensory or regulatory effects Developmental delays Deficits in neurocognitive functioning

Across all domains

• Visual/spatial abilities
• Math skills
• Visual-motor integration
• Drawing/writing

Hyperactivity/Distractibility Memory deficits

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

Also consider…

Genetics of biological parents

• Including mental health disorders

Environment

• Second-hand exposures
• Trauma

Implications for Treatment and Recovery

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

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

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

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!

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?

Screening for FASDs

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

Collect Additional Information

Medical records School records Observation Formalized assessment of:

• Executive function
• Intellectual capacity
• Sensory processing function

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!

What Conditions should be Considered?

Fetal Alcohol Spectrum Disorders

History may be more important than physical features

Learning Disabilities/Mental Retardation

Backed up by school/psych records

Traumatic Brain Injury

Accident/violence-induced

Korsakoff’s Syndrome

Watch for sudden onset of memory problems

Co-Occurring Mental Health Issues

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

Strategies for Working with Women in Treatment

• Environmental
• Counseling/Therapy
• Educational
• Physical Health/Medical

Environmental

• Structure
• Predictability
• Monitored level of stimulation

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

Educational

• Accommodate information processing,

comprehension and retention deficits

• Multi-modality instruction
• Use concrete, practical language
• Appropriate reinforcement techniques
• Repetition

Physical Health/Medical

Behavior may be related to (or exacerbated by)

• ther health issues.

Consider:

• Sleep disorders
• Sensory processing disorders
• Exercise
• Diet
• Medication

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

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

Georgiana.Wilton@fammed.wisc.edu

References

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