FOETAL ALCOHOL SPECTRUM DISORDERS (FASD)

EUROPEAN PARLIAMENTSTRASBOURGH,TUESDAY SEPTEMBER 4TH 2007

Dr. Kieran D. O’ Malley MB,BAO,BCH, DABPNConsultant in Adolescent Psychiatry,Belfast Trust,UK (Previously ran FAS Clinic in Edmonton,Canada & Academic Faculty,FADU, University.of Washington,Seattle,USA)

Incidence of FASIncidence of FAS

Cleveland 4.6

Roubaix, France 1.3 – 4.8

Seattle 2.8

Cleveland 4.6

Roubaix, France 1.3 – 4.8

Seattle 2.8

per 1,000 birthsper 1,000 births

Sampson, Streissguth, et al., Teratology, 1997Sampson, Streissguth, et al., Teratology, 1997

Prevalence of ARND & FASPrevalence of ARND & FAS

Seattle 9.1Seattle 9.1

THE EFFECT OF ALCOHOL AS A TERATOGEN DEPENDS ON- THE DOSE,- TIMING (TRIMESTER),- HOST (MATERNAL HEALTH)

THERE IS`NO SAFE AMOUNT OF ALCOHOL CONSUMPTION DURING PREGNANCY ALCOHOL IS A TERATOGEN THROUGHOUT THE WHOLE OF PREGNANCY

THIS INCLUDES THE CHRONICITY OF MOTHER’S ALCOHOL ABUSE, NUTRITIONAL FACTORS, SPECIFIC GENETIC FACTORS

PRENATAL ALCOHOL EXPOSURECAUSES CHRONIC DEVELOPMENTAL AND NEUROPSYCHIATIC DISORDERS CALLEDFOETAL ALCOHOL SPECTRUM DISORDERS (FASD)

1.FOETAL ALCOHOL SYNDROME (FAS), 15-20%,FACIAL DYSMORPHOLOGY

2.ALCOHOL RELATED NEURODEVELOPMENTAL DISORDER (ARND), 80-85%, NO FACIAL DYSMORPHOLOGY

PRENATAL ALCOHOL CAN CAUSE A CHRONIC DEVELOPMENTAL & NEUROPSYCHIATRIC DIS.(Dual Diagnosis) FROM INFANCY TO ADULTHOOD

i.e. REGULATORY DISORDER (Infancy) ADHD (Childhood) . DEPRESSION WITH IMPULSIVE SUICIDE RISK or MIXED `PERSONALITY DISORDER (Adulthood)

S

PRENATAL ALCOHOL IS THE COMMONEST ‘ACQUIRED’ CAUSE OF MENTAL RETARDATION

BUT

70 TO 75% of People with FASD ( FAS, OR FAE, now called ARND)Do NOT HAVE Mental Retardation BUT Do HAVE a Developmental Disability

IT is the ‘Functional Disability’ coupled with the co-morbid Neuropsychiatric Disorder that becomes the management problem

PRIMARY PREVENTION-Labels on alcohol bottles,coupled with general population health education awareness projects-Parent/Child Assistance Programme with substance-abusing pregnant mothers (PCAP)-Alcohol counselling programmes for teenager girls-School education programmes on pregnancy, including safe sex,and the risks of alcohol, smoking & drugs -Medical /Nursing/Social Work University Education on the teratogenic causes of developmental disability and neuropsychiatric disorder, especially prenatal alcohol,

SECONDARY PREVENTION-Identification of ‘At Risk’ Pregnancies-Identification of ‘ At Risk’ or alcohol-affected infants-Use of neuroprotective agents during pregnancy-Specialized early intervention multi-disciplinary clinics-Educated use of psychotropic medication

Swayze II et al., (1997). Pediatrics. 99:232-240

Agenesis of the Corpus Callosum