Unlike Whiskey and Water, Some Things Just Don’t Mix: The Neurocognitive Effects of Maternal Prenatal Alcohol Consumption on the
Fetus and Postnatal Developing Child
Presented by Paulette D. Pitt, Ph.D.
February 10th, 2016
Unlike Whiskey and Water, Some Things Just Don’t Mix: The Neurocognitive Effects of Maternal Prenatal Alcohol Consumption on the
Fetus and Postnatal Developing Child
Presented by Paulette D. Pitt, Ph.D.
February 10th, 2016
Thomas Durham, PhD
Director of Training
NAADAC, the Association for Addiction Professionals
www.naadac.org
Produced By
NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars
www.naadac.org/webinars
www.naadac.org/prenatalalcoholconsumption
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
To obtain a CE Certificate for the time you spent
watching this webinar:
1. Watch this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/prenatalalcoholconsumption
3. If applicable, submit payment for CE certificate
or join NAADAC.
4. A CE certificate will be emailed to you within 21
days of submitting the quiz.
CE Certificate
Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone preferred)
Polling Questions
Paulette D. Pitt, Ph.D.
Clinical Assistant Professor
Section of Adolescent Medicine
Department of Pediatrics
Today’s Presenter
University of Oklahoma
Health Sciences Center
Webinar Learning Objectives
Participants will be able to educate clients and
families on the cognitive and functional
outcomes associated with alcohol consumption
during pregnancy.
• Prenatal cognitive effects of maternal
alcohol consumption
• Residual cognitive effects of maternal
alcohol consumption
1 3
Webinar Learning Objectives
Learners will identify major neurocognitive
changes associated with prenatal alcohol
consumption and name neurocognitive and
functional assessment measures that
accurately evaluate residual neurocognitive
and functional deficits.
• Various localization implications
• Functional Deficits
• Assessment Measures
• Developmental implications
2
Webinar Learning Objectives
Attendees will be able to recognize appropriate
interventions to implement both at home and in
other environments based upon residual
neurocognitive and functional difficulties for
those prenatally exposed to alcohol.
• Interventions relevant to strengthening
deficit functioning
• Interventions utilized for skill
replacement
3
• Lower Socioeconomic Status
• Fewer educational accomplishments
• Less spiritual involvement
• Surrounded by others who drink heavily
• Number of previous pregnancies
• Tobacco use
• Advanced maternal age
• Poor education regarding use during pregnancy
Maternal Risk Factors for Use
Amount utilized by mother
At what time in the pregnancy the mother drinks
Earlier exposure is more likely to cause major morphological
abnormalities
Later exposure is likely to affect growth
Central Nervous System damage is likely to be observed with use at
any point throughout the pregnancy
Pattern of alcohol use during pregnancy
Relationship between duration of exposure and impairment
Postnatal environment may mediate outcomes for individuals exposed to prenatal
alcohol consumption
Biological predisposition versus placental health
Risk Factors to Child
Fetal Alcohol Facts
• “Almost all drugs are known to cross the placenta and have
some effect on the fetus”. (Behnke, M., Smith, V.C., 2013)
• The effects of alcohol have been studied for approximately 45
years. Fetal Alcohol Syndrome was first described in 1973 by the
American Academy of Pediatrics
• Alcohol related diagnoses on the Fetal Alcohol Spectrum
Disorders (FASDs) include Fetal Alcohol Syndrome, partial Fetal
Alcohol Syndrome, Alcohol-Related Birth Defects, Alcohol-
Related Neurobehavioral Disorder (ARND) (Davis, 2011)
• Prenatal alcohol exposure is the most common, preventable cause of non-genetic intellectual disability
• According to The National Survey on Drug Use and Health, alcohol use among pregnant women was approximately 10.8% (Behnke, M., Smith, V.C., 2013).
• Incident rates approximately .5 – 7.0 per 1,000 live births (Davis, 2011; CDC, 2009)
• Physicians lack confidence in diagnosing FASDs
Fetal Alcohol Facts Continued
Understood there is a dose dependent relationship between alcohol exposure and alcohol
effects though poorly understood
There is no “safe” level of prenatal alcohol exposure
Substances have serious teratogenic effects early in gestation
More subtle effects occur during the fetal period
Abnormal growth/maturation
Alterations in neurotransmitters/receptors
Alterations in brain organization
Congenital anomalies
Methods of indirect effects include altered nutritional status including placental insufficiency
Poor nutrition
Decreased access/compliance with health care
Effects of Alcohol Use
Effects of Alcohol Use Continued– Increased exposure to violence
– Increased risk of mental illness
– infection
• Ethanol crosses the placenta into the fetus with identification in amniotic fluid and fetal blood
• Effects of alcohol
– Embryonic stage
– Fetal stage
– Effects on placenta
– Altered prostaglandin and protein synthesis
– Hormonal alterations
– Nutritional effects
– Altered Neurotransmitter levels in brain
– Altered brain morphology and neuronal development
– Hypoxia (decreased placental blood flow/decreased vascular tone)
Polling Question #1
Prenatal alcohol consumption results in a spectrum of developmental
disabilities. True or False?
• Includes the various presentations attributed to alcohol exposure
• Characterized by the following:
• Wide range of deficiencies
• Cognitive and learning difficulties
• Behavior problems
• Attention-Deficit/Hyperactivity Disorder
Fetal Alcohol Spectrum Disorders (FASD)
FASD Continued
Reduced intelligence quotient
Fetal Alcohol Syndrome
• Diagnostic criteria– Confirmed history of maternal alcohol consumption– Characteristic pattern of minor facial abnormalities– Prenatal/postnatal growth retardation– Deficient brain growth/abnormal morphogenesis– For every child with FAS, three children are born
without the physical manifestations
• Applies to children prenatally exposed to alcohol
• Exhibit facial dysmorphology
• Display neurodevelopmental deficits
• BUT have normal growth (height, weight)
Partial Fetal Alcohol Syndrome (pFAS)
• Children having confirmed prenatal alcohol exposure
• Exhibit neurodevelopmental deficits
• BUT do not meet physical criteria for FAS or pFAS
Alcohol-Related Neurobehavioral Disorder
(ARND)
Alcohol Effects on Fetal Growth
• Growth restriction
• Required to make diagnosis of Fetal Alcohol
Syndrome
• Can be associated with even moderate alcohol
consumption amounts
• Physical outcomes
• Low birth weight
• Small head circumference
• Shorter stature
• Volumetric reductions
– Global
– Lobes
• Gray matter versus white matter
• Cortical thickness
Neurocognitive Effects
Gray vs. White Matter
Frontal Lobe
Attention, working memory, executive functions
Increased cortical thickness
Overall volume reduction
Parietal Lobe
Visuospatial functioning, attention
Increased cortical thickness
Overall volume reduction
Temporal Lobe
Memory, auditory processing, language comprehension
Increased cortical thickness
Overall volume reduction
Neurocognitive Effects Continued
Neuroanatomical Implications• Subcortical structures
– Basal Ganglia
• Motor control, learning
• Decreased volume
– Caudate Nucleus
• Learning, mental flexibility, behavioral inhibition
• Decreased volume
– Thalamus and hypothalamus
– Reduced volume
• Corpus Callosum
– Midline brain abnormality
– Absence
– Reduced volume
• Cerebellum
– Attention, executive functions, complex tasks, movement
– Reduced volume
– Displacement of vermis
– Functional deficits
Polling Question #2
Prenatal alcohol consumption has various effects upon the
developing brain including which of the following:
a. Overall volume reductions
b. Decreased presence of white matter
c. Cortical thinness
d. Only A and B
• Cognitive Functioning Difficulties
– Executive functioning deficits
• Deficient planning skills
• Poor problem solving
• Poor conceptual set shifting
• Processing speed
• Response inhibition
• Working memory
Cognitive Effects
– Attention
• Sustained Attention impairments
– Visual more impaired than auditory
• Impairments found in those with low to moderate exposures as well as heavily exposed individuals
– Memory and Learning
• Difficulty learning new information
• Unclear as to exact nature of memory deficits regarding verbal versus nonverbal information
• Verbal memory intact but verbal learning problematic
Cognitive Effects Continued
Cognitive Effects Continued
– Language functioning
• Interferes with language development and use of language
– Deficits in both expressive and receptive abilities
– Mild speech errors to problems with intelligibility
– Deficits relative to I.Q.
– Deficits in phonological processing
– Visual Spatial Difficulties
• Possible deficits in detailed visual spatial processing as opposed to global processing
– Motor Functioning
• Deficits in fine and gross motor functions
• Difficulties with postural stability
• Poorer academic performance as related to intellectual ability, sometimes exceeding intellectual deficits
– Mathematics deficits
– Reading problems
Academic Problems
Polling Question #3
Academic problems experienced by children with prenatal
alcohol exposure are limited to reading difficulties only. True
or False?
• Linked to significant behavior problems
• Linked to problematic adaptive behaviors spanning from early childhood to adulthood
– Communication
– Daily living skills
– socialization
• Poor social interactions
• Aggressive behaviors
• Inappropriate sexual behaviors
Associated Behavior Problems
Associated Behavior Problems Continued
• Negative affect
• Disrupted school experiences
• Delinquent behavior
• Criminal behavior
• Substance abuse – increased risk of alcohol abuse later in life
• Increased psychiatric disorders/comorbid diagnoses
• Major Depressive Disorder
• Attention-Deficit/Hyperactivity Disorder
• Oppositional Defiant Disorder
• Conduct Disorder
• Identification is key
• Psychological/neuropsychological assessment is necessary
• Home interventions
– Parental psychoeducation regarding abilities and expectations
– Stability of home environment
– Home-based behavioral programming to manage behavioral difficulties
Interventions
• School interventions
– Child may be eligible for Special Education placement with an Individual Education Plan or may be eligible for Section 504 accommodations
– Academic supports geared toward specific deficits
– Behavioral supports addressing problematic behaviors
– Coordination between home and school regarding academics and behavior
– Adaptive skills training
Interventions Continued
Interventions Continued
• Other interventions
– Language and socialization deficits may require interventions by a Speech Language Pathologists
– Motor deficits may be remediated by an Occupational Therapist or Physical Therapist
– Social deficits may improve with direct teaching involved in social skills groups
– Individual psychotherapy to address emotional control and provide alternative coping strategies for stressful emotions.
Summary
• Prenatal alcohol consumption creates a spectrum of
developmental difficulties impacting neurological
development resulting in problematic expressed
cognitive abilities and functioning.
• Specific effects upon the brain and cognitive
functioning are known.
• Impacts upon academic functioning and adaptive
abilities are becoming increasingly clear.
• Behavioral and mental health outcomes are poorer for
individuals exposed to alcohol prenatally.
• Interventions addressing various deficits should be
utilized to maximize outcomes.
Alvik, A. Aalen, O.O., Lindemann, R. (2013). Early fetal binge alcohol exposure predicts
high behavioral symptom scores in 5.5-year-old children. Alcoholism: Clinical and
Experimental Research. Vol 37(11). P. 1954-1962.
Behnke, M., Smith, V.C., (2013). Prenatal Substance Abuse: Short-and Long-term Effects
on the Exposed Fetus. American Academy of Pediatrics 131, number 3, 1009-1024.
Blair, P., O’Connor, M.J. (2011). Behavioral Interventions for Children and Adolescents
with fetal alcohol spectrum disorders. Alcohol Research Health. 34(1) p. 64-75.
Centers for Disease Control and Prevention Alcohol use among pregnant and non-
pregnant women of childbearing age: United States, 1991 – 2005. MMWR: Morbidity and
Mortality Weekly Report. 1009a;58(19):529 – 532. [PubMed]
Chasnoff, I.J., Wells, A.M., Telford, E., Schmidt, C., Messer, G. (2010).
Neurodevelopmental functioning in children with FAS, pFAS, and ARND. Journal of
Developmental Pediatrics 31. p. 192-201.
References
Davis, A. (Eds.) (2011). Handbook of Pediatric Neuropsychology. (1st ed.). New York, NY:
Springer Publishing Company, LLC.
Doney, R., Lucas, B.R., Jones, T., Howat, P., Sauer, K., Elliott, E.J. (2014). Fine motor
skills in children with prenatal alcohol exposure or fetal alcohol spectrum disorder.
Journal of Developmental & Behavioral Pediatrics. Vol 35(9). P. 598-609.
Graham, D.M., Crocker, N., Dewesse, B.N., Roesch, S.C., Coles, C.D., Kable, J.A., May,
P.A., Philip, A., Kalberg, W.O., Sowell, E.R., Jones, K.L., Riley, E.P., Mattson, S.N.
(2012). Prenatal alcohol exposure, attention-deficit/hyperactivity disorder, and sluggish
cognitive tempo. Alcoholism: Clinical and Experimental Research Vol 37(1). P. E338-
E346.
Hepper, P.G., Dorman, J.C., Lynch, C (2012). Fetal brain function in response to maternal
alcohol consumption: Early evidence of damage. Alcoholism: Clinical and Experimental
Research. Vol 36(12). P. 2168.2175.
References
Koren, G., Zelner, Ir., Nash, K., Koren, G (2014). Foetal Alcohol spectrum disorder:
identifying the neurobehavioral phenotype and effective interventions.
Neurodevelopmental and Neurocognitive Disorders. Vol 27(2). P. 98-104.
Lewis, C.E., Thomas, K.E., Dodge, N.C., Molteno, C.D., Meintjes, E.M., Jacobson, J.L.,
Jacobson, S.W. (2015). Verbal learning and memory impairment in children with fetal
alcohol spectrum disorders. Alcoholism: Clinical and Experimental Research. Vol 39(4).
P. 724-732.
Marquardt, K., Sigdel, R., Caldwek, K., Brigman, J.L. (2014). Prenatal ethanol exposure
impairs executive function in mice into adulthood. Alcoholism: Clinical and Experimental
Research. Vol 38(12). p 2962-2968.
References
Nunez, S.C., Florence, R., and Sowell, E.R. (2011). Focus on: Structural and Functional
Brain Abnormalities in Fetal Alcohol Spectrum Disorders. Alcohol Research Health. Vol
34(1). P. 121-132.
Rojmahamongitkol, P., Cheema-Hasan, A., Weltzman, C. (2015). Do Pediatricians
recognize fetal alcohol spectrum disorders in children with developmental and behavioral
problems? Journal of Developmental & Behavioral Pediatrics Vol 36(3). P. 197-202.
Ware, A.L, Glass, L., Cocker, N., Deweese, B.N., Coles, C.D., Kable, J.A., May, P.A.,
Kalberg, W.O., Sowell, E.R., Jones, K.L., Riley, E.P., Mattson, S.N. (2014). Effects of
prenatal alcohol exposure and attention-deficit/hyperactivity disorder on adaptive
functioning. Alcoholism: Clinical and Experimental Research. Vol 38(5). p. 1439-1447.
References
Paulette D. Pitt, Ph.D.
Clinical Assistant Professor
Section of Adolescent Medicine
Department of Pediatrics
Thank You!
University of Oklahoma
Health Sciences Center
www.naadac.org/prenatalalcoholconsumption
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
To obtain a CE Certificate for the time you spent
watching this webinar:
1. Watch this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/prenatalalcoholconsumption
3. If applicable, submit payment for CE certificate
or join NAADAC.
4. A CE certificate will be emailed to you within 21
days of submitting the quiz.
CE Certificate
The Spirituality of Addiction
by Nina Marie Corona
February 24, 2016 March 23, 2016
March 9, 2016
E-Cigarettes: A Cessation Device or
Alternative Vice? The Good, the Bad, the
Ugly
by VJ Sleight
April 6, 2016
Upcoming Webinars
www.naadac.org/webinars
Build Your Business with the DOT/SAP
Qualification
by Wanda McMichael
Attention Deficit-Hyperactive
Disorder: Addiction’s Perfect Storm
By Beth Donnellan
www.naadac.org/webinars
Free CEs for
Members
Levels:
Professional
Associate
Student
www.naadac.org/
join
Over 75 CEs of free educational
webinars are available. Education
credits are FREE for NAADAC
members.
WEBINAR SERIES
In each issue of Advances in
Addiction & Recovery, NAADAC's
magazine, one article is eligible for
CEs.
MAGAZINE ARTICLES
NAADAC offers face-to-face
seminars of varying lengths in the
U.S. and abroad.
FACE-TO-FACE SEMINARS
Earn CEs at home and at your own
pace (includes study guide and
online examination).
INDEPENDENT STUDY
COURSES
NAADAC Annual Conference in
Minneapolis, Minnesota
October 7-11, 2016.
CONFERENCES
Demonstrate advanced education
in diverse topics with the NAADAC
Certificate Programs.
CERTIFICATE PROGRAMS
Contact Us!
NAADAC
1001 N. Fairfax Street, Suite 201
Alexandria, VA 22314
phone: 703.741.7686 / 800.548.0497
fax: 703.741.7698 / 800.377.1136
www.naadac.org
NAADACorg
Naadac
NAADAC
