Fetal Alcohol Spectrum Disorders: Problems Encountered and Gaps in Service

1
Fetal Alcohol Spectrum Disorders Problems
Encountered and Gaps in Service

• Briefing to the legislature 8-17-04
• Randi Hagerman MD, FAAP
• Tsakopoulos-Vismara Professor in Pediatrics
• Medical Director M.I.N.D. Institute
• UC Davis Medical Center

2
(No Transcript)
3
(No Transcript)
4
Prevalence of Combined FAS and ARND(Sampson et
al. 1997)

• Seattle study of 581 children with EtOH exposure
  5 waves of psychometric testing (to age 7).
  Those below 7.5 on neuromotor scoring also had
  uniformly high deficit scores on all outcome
  measures persistently over time were considered
  ARND
• Combined FAS ARND prevalence is 9.1/1,000,
  which is approximately 3 times the rate of FAS
  alone
• Almost 1 per 100 rate

5
Secondary DisabilitiesStreissguth et al. (1996)

• 94- Mental health problems
• 61- Attention deficit problems
• 42- Depression in adolescents (52 in adults)
• 23- Suicide attempts in adults
• 24- Panic attacks in adolescents (34 in adults)
• 29- Psychotic symptoms in adults
• 45- Inappropriate sexual behavior
• 43- Disrupted school experience
• 42- Trouble with the law
• 32- Incarceration for a crime in adolescents
  (42 in adults)
• 42- Alcohol problems in adults
• 20- Adults confined in jail or in the hospital
  from alcohol or drug problems

6
FASD Psychiatric Diagnoses

• Famy et al. 1998 25 adults with IQ gt 70
• 44 with major depressive disorder
• 60 with alcohol or drug dependence
• 40 with psychotic spectrum disorder (including 7
  with Brief Psychotic Disorder, 1 with Schizo
  Affective Disorder, 1 with Delusional Disorder
  1 with Psychotic Disorder NOS)
• 20 with Bipolar I Disorder
• 20 with anxiety disorders
• 16 with eating disorder
• 4 with Dysthymic Disorder

7
Survey for FAS Spectrum in Criminal Justice System

• 287 Canadian youth 12 to 18 years guilty of an
  offense underwent inpatient psychiatric/medical
  evaluation (Fast et al. 1999)
• 67 or 23 had an alcohol related diagnosis (only
  3 previously diagnosed)
• 3 with full FAS (1)
• 52 with partial FAS (18)
• 12 with ARND (4)
• average age 14.8 years 54 males 13 females
• 38 Caucasian 18 Native American 7
  Caucasian/Native American 4 other ethnic origin
• IQ 55 to 129 average 87 13.8

8
Gaps we need to fill

• Regional centers wont qualify individuals with
  an FASD diagnosis unless they are mentally
  retarded with IQ less than 70.
• Seattles data show that those with a higher IQ
  ie in the borderline range have the worst
  outcome. They are smart enough to get into
  trouble but they dont qualify for services.
• These kids need a detailed medical and
  psychiatric assessment and ongoing services an
  intensive treatment program to keep them out of
  trouble and out of jail
• Mental health may not treat them because of FASD

9
Assessment and Treatment Programs

• Medical assessment to diagnose FASD and organize
  Rx plan This may include EEG, MRI, cognitive
  testing, learning assessment, behavior and
  psychiatric assessment
• Psychopharmacological intervention for many
• Ongoing behavioral support for home and school
• Individual therapies for language, motor training
• Special education support
• Vocational support including job coaching
• Advocate or therapist long term to keep out of
  jail

10
(No Transcript)
11
Prenatal EtOH Exposure Behavior at 6 to 7 years

• Sood et al. 2001 501-parent-child pairs followed
  during pregnancy and childhood
• 23 denied ETOH use
• 64 - low level use (gt0 butlt0.3 fl oz/day)
• 13 - moderate/heavy (gt 0.3fl oz/day)
• Higher ETOH exposure associated with low birth
  weight gestational age, higher lead levels,
  maternal age, exposure to cocaine smoking,
  lower maternal education SES, paternal drinking
  other drug use.
• Even low level use associated with increases in
  aggressive externalizing behavior
• Odds ratio 3.2 for scoring in clinical range for
  delinquent behavior (CBCL) with any prenatal
  exposure compared to non-exposed

12
(No Transcript)
13
FASD living circumstances

• 60 of alcoholic mothers are dead at 7 year
  followup
• Of those with FASD Streissguth et al. 1993 90
  adults gt 21 year old
• 83 living dependently most required help with
  money decision making
• 79 problems with employment
• Only 13 were classified as eligible for DD
  services
• 30 women had given birth but 40 were drinking
  during pregnancy
• 17 had a child diagnosed with FASD 13 had
  child suspected affected
• 57 of mothers no longer had children in their
  care

14
Early Intervention in the Home

• Address mothers issues with advocacy
• (Grant et al. 1996, Olson et al. 1997)
• psychological support
• rehabilitation or drug/EtOH abuse treatment
• help obtaining services, entitlements or other
  supports
• crisis intervention respite care
• guidance, feedback general encouragement
• Parent skills training
• how to read childs needs
• safety training medical follow-up
• early intervention training i.e. enhanced milieu
  therapy
• model appropriate interaction positive
  reinforcement
• structure environment for child

15
(No Transcript)