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June 2012 cjp

Fetal Alcohol Spectrum Disorders (FASD) Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (APS HCQU). June 2012 cjp. Disclaimer.

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June 2012 cjp

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  1. Fetal Alcohol Spectrum Disorders(FASD)Presented by: APS HealthcareSouthwestern PA Health Care Quality Unit(APS HCQU) June 2012 cjp

  2. Disclaimer Information or education provided by the HCQU is not intended to replace advice from the consumer’s personal care physician or replace any existing facility policy. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

  3. Objectives • State the cause of fetal alcohol spectrum disorders • List teaching interventions for and methods of supporting individuals with FASD • Recognize two medications used to treat FASD

  4. Defining Fetal Alcohol Spectrum Disorders (FASD) • Caused by alcohol consumption during pregnancy • Defects in physical, neurological, and organ formation • 100% Preventable

  5. Affects of Alcohol on a Fetus • Alcohol crosses the placenta • Includes all types of alcoholic beverages • Beer, wine, or spirits • Alcohol kills nerve cells in the developing brain • Could be a one time exposure • During the entire pregnancy

  6. 1st Trimester Growth and Damage • Period when facial features are formed • Effects alcohol may have on the fetus: • Changes the configuration of how cells grow and arrange themselves as they multiply • Causes a decrease in brain cells growing within the brain • Stunted growth and low birth weight in those with FASD

  7. 2nd Trimester Damage • Alcohol can cause • Increased risk of miscarriages • Periods of fetal distress that is due to binge drinking

  8. 3rd Trimester Growth and Damage • Greatest period of brain development • Central nervous system is at risk for damage.

  9. Alcohol Use During Pregnancy • A national survey found that 58.8% of women age 15-44 drank while pregnant • 65.8 % used alcohol during the 1st trimester, 56.6% in their 2nd trimester, and 53.9% in the 3rd trimester • These stats are for the women who acknowledged that they had drank during their pregnancy Substance Abuse and Mental Health Statistics Source Book 1998

  10. Conditions Associated with Prenatal Alcohol Exposure • FAS • Fetal Alcohol Syndrome • FAE • Fetal Alcohol Effects • ARND • Alcohol related neurodevelopmental disorder • ARBD • Alcohol related birth defects

  11. Defining and Diagnosing FAS • Must have evidence of abnormalities in three specific areas • Facial characteristics • Growth deficits • Central Nervous System (CNS) abnormalities

  12. Fetal Alcohol Effects (FAE) • FAE has been broken into 2 new categories with recent research and the new terms are • ARND (Alcohol related neurodevelopmental disorder) • ARBD (Alcohol related birth defects) • Neurological effects just as severe as FAS

  13. Characteristics of ARND • Functional or mental problems • Behavioral and/or cognitive deficits • Learning difficulties • Poor school performance • Poor impulse control • Poor math skills • Memory problems • Attention deficits • Poor judgment

  14. Characteristics of ARBD • Problems in the following area(s) • Heart • Kidneys • Bones • Hearing

  15. Statistics • FAS occurs 1 out of 750 live births • FAE occurs 10-12 out of 1000 live births • FASD is the leading known cause of intellectual disability Source: The ARC

  16. FASD Central Nervous System Symptoms • Intellectual disability • Alcohol withdrawal at birth • Poor sucking response • Sleep disturbances • Restlessness and irritability • Developmental Delays • Short attention spans • Learning disabilities • Low birth weight • Below average in physical growth as compared to age • Below average in mental development throughout life

  17. Neurological Symptoms • Most serious and often labeled the “invisible symptoms” • Attention deficits • Memory deficits • Hyperactivity • Difficulty with abstract concepts • Poor problem solving skills • Difficulty learning from consequences • Poor judgment • Immature behavior • Poor impulse control

  18. Secondary Disabilities • Can lead to other difficulties • High risk for psychiatric problems • Criminal behavior • Incomplete education • Unemployment • Drug and/or alcohol abuse

  19. Developmental Delays • Most have some delays • A few have lower than normal IQ • The severity of the physiological characteristics usually correspond with the developmental delays

  20. Developmental Problems • May include some of the following • Cerebral Palsy • Learning disabilities • Intellectual disability • Attention deficits • Pervasive Development Disorders • Autism

  21. Problems in the Following Areas • Input of information • Short-term memory • Applying information • Abstract reasoning • Socialization • Everyday living skills • Cause and effect reasoning • Generalizations • Time • Memory

  22. Input of Information • Cannot understand the information that is relayed • Example: Put the mail in the box. • The person may not be able to find the correct box.

  23. Short Term Memory • A person may need constant reminders about what needs done • May constantly brush their teeth because they did not remember that it was already done • Behavior may resemble OCD • May need constant guidance and support • May need to incorporate a check list and mark off items that the person has already completed for the day • Helps to eliminate stress and frustration

  24. Put Information to Use • A person is able to tell you the denominations of the money in their possession. • When at the store though, the person is unable to pay the cashier the correct amount.

  25. Abstract Reasoning • “I have $ 45 in my pocket. If I spend $22 at the store, how much money would I have left?” • “It is cold outside, so I should wear long pants and a coat.”

  26. Socialization • Good impulse control • If I am speaking to someone, I need to wait until they finish speaking before I answer the question. • Poor impulse control • If someone has something I want, I can go up and take it • May need reminded of socially appropriate behaviors and actions

  27. Everyday Living Skills • May need constant supervision for safety purposes • May be able to cook but may not remember that the food is on the stove • May have problems with dressing

  28. Lack of Cause and Effect Reasoning • The person with FASD is unable to understand the effects of their actions for given situations. • “If I do not pay bills, I may not have anyplace to live.” • “If I go to the store and take what I want without paying, I could go to jail.” • “If I do not take my medications, I may have more problems.”

  29. Generalizations • “If I drink milk out of a blue glass, I will always be given a blue glass for milk.” • “I take a yellow pill in the morning, I will not take the green pill in the morning tomorrow.” • “If I cross a street and nothing is coming, the next time I cross the same street, nothing will be coming.”

  30. Time • May have problems grasping the concept of time • May not understand why they have to eat breakfast in the morning instead of before bed • “Meet me at 1:00.” The person may never show up or show up at the wrong time

  31. Memory • May need reminded that socks are put on before shoes • May forget to get dressed in the morning • Can forget a task that had been previously learned • Causes frustration for individual and staff

  32. Teaching Interventions • Structure • Cues • Role Models • Environment • Attitude of others • Medication • Supervision

  33. Structure • A person with FASD may require structure in different situations. • In activities of daily living (ADLs) • Work settings • At all times • In social relationships and activities

  34. Cues • Post-it notes for reminders • Activity binder with tasks specific to the individual’s needs • May need to be simple and include pictures • May involve multiple tasks at one time • Individual specific

  35. Role Models • May model someone known or unknown to them • Parent • Caregiver • Housemate • Sibling • Movie Star • Stranger that they passed on the street

  36. Environment • May require a simplified environment • Decreased stimulation in the home

  37. Attitudes of Others • Positive • Supportive • Understanding • Works with the other staff for uniformity of care

  38. Medication • Stimulant • ADD • ADHD • Selective serotonin reuptake inhibitor- SSRI • Clonidine • For people who have problems with sleep, anxiety, aggression in addition to hyperactivity

  39. Medical Treatment • Birth defects – permanent • Physical problems (surgery may correct) • Medications • Therapies

  40. Prevention • If sexually active, use a form of birth control • Do not consume alcohol if planning on becoming pregnant • Once pregnant, quit drinking and seek proper prenatal care

  41. A Final Thought "Of all the substances of abuse, including heroin, cocaine, and marijuana, alcohol produces by far the most serious neurobehavioral effects in the fetus.“ -Institute of Medicine 1996 Report to Congress

  42. References Research, Information, Supports & Communications, FASlink Fetal Alcohol Society. Retrieved December 10, 2011, from http://www.faslink.org/index.htm Facts About Underage Drinking, National Council on Alcoholism and Drug Dependence. Retrieved January 11, 2012, from http://www.ncadd.org/ Szalavitz, M., (29 April 2005 [Updated, August 2010], Fetal Alcohol Syndrome. Retrieved January 5, 2012, from http://alcoholnews.org/FAS.html Streissguth, A. P., Prevent Fetal Alcohol Syndrome. Retrieved January 3, 2012, from http://come-over.to/FAS/StreissguthPreventFAS.htm

  43. References Centers for Disease Control and Prevention. Facts about FASDs. Retrieved January 3, 2012, from http://www.cdc.gov/ncbddd/fasd/facts.html Kellerman, T. (2000) [Updated 2010] Prenatal Alcohol Exposure and the Brain. Retrieved January 3, 2012, from http://www.come-over.to/FAS/FASbrain.htm Centers for Disease Control and Prevention. Fetal Alcohol Spectrum Disorders. Retrieved January 4, 2012, from http://www.cdc.gov/Features/FASD/ Brown University Health Education, Alcohol and Your Body. Retrieved January 11, 2012, from http://brown.edu/Student_Services/Health_Services/Health_Educat ion/alcohol,_tobacco,_&_other_drugs/alcohol/alcohol_&_your_bod y.php

  44. References Bertrand J., Floyd R.L., Weber M.K., O’Connor M., Riley E.P., Johnson K.A., Cohen D. E., National Task Force on FAS/FAE. Fetal Alcohol Syndrome: Guidelines for Referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention; 2004. Kellerman, T., Secondary Disabilities in FASD retrieved on February 1, 2012, from http://www.comeover.to/FAS/fasconf.htm

  45. To register for future trainings,orfor more information on this or any other physical or behavioral health topic, please visit our website at www.hcqu.apshealthcare.com

  46. EvaluationPlease take a few moments to complete the evaluation form found in the back of your packets.Thank You!

  47. Test ReviewThere will be a test review after all tests have beencompleted and turned in to the Instructor.

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