|Sponsored by the HealthcareTrainingInstitute.org providing Quality Education since 1979|
Committee on Substance Abuse and Committee on Children With Disabilities
The term fetal alcohol syndrome (FAS) refers to a constellation of physical, behavioral, and cognitive abnormalities. In addition to the classic dysmorphic facial features, prenatal and postnatal growth abnormalities, and mental retardation that define the condition, approximately 80% of children with FAS have microcephaly and behavioral abnormalities. As many as 50% of affected children also exhibit poor coordination, hypotonia, attention-deficit hyperactivity disorder, decreased adipose tissue, and identifiable facial anomalies, such as maxillary hypoplasia, cleft palate, and micrognathia. Cardiac defects, hemangiomas, and eye or ear abnormalities are also common.
The term fetal alcohol effects was developed originally to describe abnormalities observed in animal studies, but it was adopted quickly by clinicians to describe children with a variety of problems, including growth deficiency, behavioral mannerisms, and delays in motor and speech performance, who lacked the full complement of FAS diagnostic criteria. The lack of specificity and absence of definitive diagnostic criteria have made research and classification difficult, and a 1980 report from the Research Society on Alcohol suggested that fetal alcohol effects encompassed "any condition thought to be secondary to alcohol exposure in utero."6 Clearly, such a definition was cumbersome and allowed for wide divergence in intepretation. The Institute of Medicine in 1996 issued a report proposing the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) to describe conditions in which there is a history of maternal alcohol exposure (defined as substantial regular intake or heavy episodic drinking) and an outcome validated by clinical or animal research to be associated with that exposure. This new terminology uses a pathophysiologic basis for the diagnostic categories to describe conditions resulting from prenatal alcohol exposure.
Children with FAS, ARND, and ARBD may manifest cognitive, behavioral, and psychosocial problems that cause lifelong disabilities, although the resulting manifestations may vary with age and circumstances. Streissguth et al traced the natural history of alcohol-affected children into adulthood and demonstrated the profound, pervasive, and persistent nature of the disorder. Abnormal cognitive functioning manifested itself in many domains, including specific mathematical deficiency, difficulty with abstraction (eg, time and space, cause-and-effect), and problems with generalizing from one situation to another. The affected persons also demonstrated poor attention and concentration skills, memory deficits, and impaired judgment, comprehension, and abstract reasoning. Behavioral issues, such as hyperactivity and impulsivity, and conduct problems, such as lying, stealing, stubbornness, and oppositional behavior, were common and were quantitatively and qualitatively different from those found in other forms of mental retardation.
None of the persons in the aforementioned study had achieved age-appropriate socialization or communication skills. Maladaptive social functioning was evidenced by their failure to consider consequences for their actions, lack of response to appropriate social cues, lack of reciprocal friendships, social withdrawal, sullenness, mood lability, teasing and bullying behavior, and periods of high anxiety and excessive unhappiness. Secondary disabilities, such as mental health problems, chemical dependency, failure to develop appropriate sexual behavior, and consequent legal problems, were also common in adults diagnosed with FAS. Current evidence suggests that while IQ scores <70 in this population increase the likelihood of such outcomes, early diagnosis and intervention may reduce the occurrence of secondary disabilities.
As one of the most commonly identifiable causes of mental retardation, FAS is estimated to occur at the rate of 5.2/10 000 live births in the United States. Higher rates are reported among selected subgroups (eg, 30/10 000 among Native Americans). There seems to be a number of factors that determine the outcome of a pregnancy during which the mother consumes alcohol. Mills et al prospectively studied approximately 31 000 pregnancies in an attempt to determine how much alcohol pregnant women can consume safely. The consumption of 1 or more drinks (a drink is defined as 1.5 oz distilled spirits, 5 oz of wine, or 12 oz of beer) per day was associated with increased risk of giving birth to an infant with growth retardation. Although maternal age, parity, and health as well as specific fetal susceptibility may contribute to the infant's outcome, the potential for harm to the fetus is much stronger with large amounts of maternal alcohol consumption than with smaller amounts. Nevertheless, current data do not support the concept of a "safe level" of alcohol consumption by pregnant women below which no damage to a fetus will occur.
The economic effects of FAS, ARND, and ARBD based on the medical, surgical, behavioral, custodial, and judicial services required takes its toll on the individual, the family, and society. Annual cost estimates for the United States range from $75 million to $9.7 billion. The total lifetime cost of caring for a typical child with FAS may be as high as $1.4 million. The mental retardation related to FAS has by itself been estimated to account for as much as 11% of the annual cost of caring for all mentally retarded institutionalized residents of the United States and may account for up to 5% of all congenital anomalies. The nonfiscal costs to families and affected children in terms of emotional and social effects are enormous.
-Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorders; Pediatrics; Aug2000; Vol. 106, Issue 2The article above contains foundational information. Articles below contain optional updates.
Reflection Exercise #9
Online Continuing Education QUESTION 16
Others who bought this Addictions/Substance Abuse Course
Booklet for this course | Addictions
Forward to Section 17
Back to Section 15
Table of Contents
Karon Elijah Peoples pleaded guilty in Baltimore to the distribution of heroin and conspiracy charges this week after drugs he helped distribute were linked to 27 overdoses. Nine of those 27 overdoses were fatal. Police connected the overdoses, deaths, and Peoples by records of messages to and from his large collection of cell phones. According ...
The post Baltimore man behind 27 heroin overdoses, pleads guilty appeared first on Addictions.
It’s the job of people at the U.S. Centers for Disease Control and Prevention to fight opioid addiction and abuse, but for the agency’s director, the battle is deeply personal. Robert Redfield, the director of the CDC since March, who turned 66 earlier this month, said in a speech at an event last week that ...
The post CDC Director Robert Redfield says son nearly killed by opioids appeared first on Addictions.
Pennsylvania’s governor, Tom Wolf, said July 16 that his state has issued new guidelines about how and when opioid drugs should be prescribed to people with workers’ compensation claims. The state’s health secretary, Rachel Levine, said these new regulations will aid healthcare providers in choosing the right drugs, but they won’t take the place of ...
The post Pennsylvania updates opioid prescribing policies appeared first on Addictions.
A 7-year-old girl was killed by a car in Detroit while trying to cross the highway to get help after her father, who was drunk, crashed his car early Sunday morning. Dessandra Mariah Thomas, police said, was trying to cross the median of Interstate 94 near the Detroit Metro Airport. Her father, driving drunk on ...
The post 7-year-old Detroit girl killed while seeking help after father’s DUI crash appeared first on Addictions.
The New York State Department of Health will allow people who might otherwise qualify for opioid painkillers to use medical marijuana as replacement therapy and to use pot as a treatment for opioid addiction. This move by the Empire State is an attempt to cut down on the number of opioid painkiller prescriptions and thereby ...
The post New York offers medical marijuana as a substitute for opioids appeared first on Addictions.
CEU Continuing Education for
Psychology CEUs, Counselor CEUs, Social Worker CEUs, MFT CEUs