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9 FASD Foetal Alcohol Spectrum Disorder The simple fact - there is no known safe level of alcohol consumption during pregnancy! Babies born with Foetal Alcohol Spectrum Disorder (FASD) don t sleep well, are sensitive to touch, light and noise. Some babies may have heart problems. They suffer with poor attention. They suffer with short-term memory problems. Hyperactive. They do not understand maths, time and money. Cannot solve problems. They do not understand cause and effect. They present childish behaviour. They do not think before taking action. Alcohol is like a poison that changes the way an unborn baby grows in the womb. A child s brain is growing all the way through pregnancy and alcohol can affect this at any time. Changes happen but they can appear after the child is born as he or she grows. Alcohol causes more damage to the developing foetus than any other substance, including marijuana, heroin, and cocaine. (Institute of Medicine 1996) Think before you drink the damage lasts a lifetime. WCTU Australia PO Box 7612 Dandenong Vic 3199

10 PREVENT FETAL ALCOHOL SYNDROME There is no safe time or amount to drink during pregnancy! Alcohol is an agent that causes birth defects (a teratogen). Teratogens have four effects: Death (including stillbirth, spontaneous abortion, miscarriage, and death shortly after birth) because the baby is malformed internally Sever malformation such as heart defects, clef- lip and palate, hip displacement, club foot (some of these malformations are treatable) Growth deficiency (born smaller and abnormal development) Functional deficits caused by brain disruption, which is the main source of the damage, and one that cannot be corrected Ways alcohol causes damage in the developing foetus: Excessive cell death normally cells grow and die in the developing brain, but alcohol causes an excessive amount of cell death Impaired cell proliferation alcohol interferes with normal cell development, which includes growth and division Disruption of cell migrational pattern alcohol causes errors to occur in brain development so that a cell that has a particular place to go in the brain may migrate to the wrong location Inhibited nerve growth alcohol disrupts the neurotransmitters so messages are unable to get from one area to another There are times when the foetus is not as susceptible as others. Some women seem not to be as sensitive to alcohol and some foetuses are resistant to the alcohol s effects. But since none of these factors are predictable, the only safe course for the pregnant woman is to refrain from drinking. Since the central nervous system which includes the brain is developing throughout the entire pregnancy, this underlines the fact that there is no safe time or amount to drink during pregnancy. In the first 3 months of foetal development alcohol causes physical damage In the 2nd trimester alcohol increases the risk of spontaneous abortion And in the last trimester alcohol can cause growth deficiency

11 PREVENT FETAL ALCOHOL SYNDROME Studies of FAS children have shown the following results: Poor sucking skills; poor sleep and wake patterns; crying and trembling; neurotransmission delayed; arithmetic is their hardest subject; these children need help with daily living skills socialization, adaptive behaviour and communication. Alcohol produces dysfunctional families; adults have no goal in life; they have difficulty holding a job; teens experience disruptive school experiences; adults are suicidal; more than 90% FAS individuals have mental health problems. WHAT IS THE COMMUNITY SOLUTION? IPIP Intervention, Prevention, Intervention, Prevention Each community needs to intervene with high- risk mothers to prevent more alcohol- affected babies. Further, the community needs to intervene with high- risk babies to prevent secondary disabilities. To solve the problem of alcohol- affected babies women must either be motivated not to drink during pregnancy or, if they can t stop drinking, to avoid pregnancy. The five P s of prevention are: 1. Public Awareness 2. Professional education 3. Provide service from birth to age 3 4. Public policy (everyone can become involved) 5. Parent Power (support groups are important) We need communities totally committed to not having any more FAS babies! Continual awareness is required through public service announcements, posted signs about the danger of drinking during pregnancy, and other educational endeavours. This is the message. FAS is only a small part of alcohol- related disabilities. FAS lasts a lifetime, BUT FAS is preventable. This is a condensed version of the WCTU Signal Press brochure with title of the same name written by Ann P. Streissguth, PH.D.

12 Alcohol and Pregnancy Cause for Concern? In Australia and around the world there are increasing rates of: women drinking at high risk binge drinking amongst teens & indigenous women unplanned pregnancies alcohol use in pregnancy FAS diagnoses What is FASD? An umbrella term for a range of disabilities and effects from prenatal alcohol exposure Foetal Alcohol Syndrome (FAS) - the tip of the iceberg Alcohol-related birth defects Alcohol-related neuro-developmental disorders Stillbirth, prematurity, miscarriage the most common preventable cause of birth defects and brain damage in children a lifelong condition that causes physical and mental disabilities can result in secondary disabilities. All drugs affect the unborn child. The 3 legal drugs are known to cause the most harm to the foetus because of their widespread use tobacco caffeine alcohol Alcohol is a Teratogen an agent that causes a structural abnormality following foetal exposure during pregnancy. One standard drink contains about 10% alcohol and gives a blood alcohol content level of between 0.02 and 0.05 depending on the body size, genetics etc. (Laboratory studies show that BAC can effect a foetus: ¼ - ½ of a standard drink) Alcohol passes through the placenta Foetus has same BAC as the mother Baby s liver unable to metabolise alcohol Uterus alcohol cycle trap longer exposure to alcohol than the mother No safe level no safe time

13 Alcohol and Pregnancy Dr Margaret Clarke found that in Canada 96% of mothers with alcohol-affected children are social drinkers, and only 4% are alcohol dependent. Effects on the Infant: Preterm delivery Low birth weight Birth defects Small head or unusual face Irritable, sleep disturbance, feeding difficulty Poor muscle tone Hearing and visual impairment Growth and development problems Effects on the Developing Neural Tube and Brain Alcohol interferes with the development of the cell itself, migration of the cells and also with the growth and multiplication of the cells. As the brain develops, intricate cell communication networks are being formed with over 10,000 connections. Alcohol at this stage of development affects executive control as this is dependent on the communications networks being created. It also affects the cell adhesive molecules which allow the cells to move out to make these networks. Cells may commit apoptosis (cell suicide) as they recognise that they are impaired - causes cell shrinkage in the brain. Effects on Brain Function Corpus Callosum poor executive function Hippocampus learning and memory Cortex - Average FAS IQ is 70 (mild ID) but can range from Alcohol Related Neurological Disorders (ARND): 70-75% have normal IQ s but are affected by some learning problems. Speech & language Poor school performance: reading numeracy (telling time & money) writing (fine motor dysfunction) Difficulty with memory, abstract thought, sequencing, generalising & cause and effect reasoning Frontal lobe judgement, conscience

14 Alcohol and Pregnancy Hypothalamus emotions Poor social skills, judgement Problems relating: overly physical, friendly, inappropriate sexuality Difficulty making friends Poorly organized, often late Repeat the same mistakes Hyperactive behaviour (ADD/ADHD) Inattention, overactivity, impulsivity Conduct disorder - aggression Anxious, depressed, low self-esteem We just assumed that the kids with FAS had ADHD and gave them Ritalin. Claire Coles, Ph.D., associate professor at Emory Effects on Education and Social Life: Difficulty storing and retrieving information, Inconsistent performance days Impulsivity, distractibility, disorganization, Ability to repeat instructions, but inability to put them into action. Difficulty with abstractions, such as math, money management, time concepts. Cognitive processing deficits Slow auditory pace Developmental lags Inability to predict outcomes or understand Secondary Effects of FASD - Not born with these. Disrupted education (60%) Unemployment (80%) Mental health problems (90%) Trouble with the law and imprisonment (60%) Alcohol and drug abuse (30%) Vulnerable, inappropriate sexuality (50%) 10% >21 years live, work independently Homelessness Suicide Streissguth, 1997 (n = 415)

15 Alcohol and Pregnancy Challenges: Most children with foetal alcohol spectrum disorder face more stress, more obstacles, more loneliness, more failure, and less success in a single day than most non-affected people face in a far longer time. These children are not exceptional because they have the condition; they become exceptional through trying to survive despite all odds. The tragedy lies not in the reality that some people have FAS. The tragedy lies in the reality that they are denied their basic human rights to have an appropriate education, to be raised in a supportive environment, and to grow up to be adults who participate in life in a productive and satisfying manner. (McCreight 1997). Traditional learning based theory requires the brain to: Understand and process information quickly Understand ideas and concepts Make links and form associations Interpret, store and remember information Take what is learnt in one situation and apply it in another A person with FASD will not be able to function in this context, but individuals with FASD CAN learn!! But we must : Understand that the brain is the source of all behaviour Individuals with FASD have a brain difference Brain difference = different behaviour = normal for them Accept them as individuals who can t do rather than won t do We also know that people with FASD may be very good at many things. They may: be loving & affectionate be friendly & outgoing be artistic & musical work well with animals and plants be very loyal show a great determination to succeed in life! What Can be Done? Early Diagnosis brings understanding encourage health department to increase knowledge for doctors and society and to increase number of diagnostic clinics.

16 Alcohol and Pregnancy Involvement in Special Education and Social Services individualized educational programs respite care stress and behavioural management training Children who receive special education geared towards their specific needs and learning style are more likely to achieve their developmental and educational potential. Children with FAS show a wide range of behaviours and severity of symptoms. Special education allows for individualized educational programs. In addition, families of children with FAS who receive social services, such as respite care or stress and behavioural management training, have more positive outcomes than families who do not receive such services. Provide Loving, Nurturing, & Stable Care FASD people are particularly sensitive to: disruptions transient lifestyles harmful relationships Reduce Exposure to Violence anger or frustration management training. What can we do personally? Choose to say No to alcohol. Don t blame or judge others - recognise that alcoholism is a disease & some people do not know. Be informed and share with others encourage them to be drug-free. Encourage governments to warn and legislate to protect the community. Be supportive of those affected individuals, carers, teachers FASD is a lifelong disability! Help to prevent it! Stay alcohol free! Where can we get more information?