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April 24, 2019

Fetal Alcohol Spectrum Disorder

Reuel S. Amdur

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While not readily in the public eye, the rate of fetal alcohol spectrum disorder (FASD) is far higher than that of the raft of other serious disorders. That includes Down syndrome, cerebral palsy, spina bifida, cystic fibrosis, and muscular dystrophy. Dr. Svetlana Popova, Senior Scientist at Toronto's Centre for Addiction and Mental Health, noted this unfortunate situation, pointing out that FASD can damage any organ of the body and can have serious mental health consequences. She was part of a panel presenting in Ottawa on January 24 at a session sponsored by the Fetal Alcohol Spectrum Disorder Group of Ottawa and Adopt 4 Life.

Popova addressed the prevalence of FASD worldwide.  Because the frequency of the condition is strongly related to female alcohol consumption, the rate of alcohol use by women of childbearing age (15 to 49) is an important marker.  In Europe, New Zealand, and Australia, around two-thirds of women drink.  The rate is somewhat lower in the Americas.  On the other hand, the rate is close to zero in the Arab world because of the Islamic prohibition on drink.  She cautioned, however, that the rate of women who drink is increasing, meaning that the rate of FASD will be rising.

Emeritus Professor in the Department of Paediatrics and Child Health at the University of Manitoba, Albert Chudley reported that the FASD rate for Aboriginals in Canada is 25 times higher than for Canadians in general.  For those in prison, the figure is 30 times higher, and for those of low socioeconomic status 24 times.

Adopted children are also more likely to have FASD.  Popova spoke of Sweden having a relatively high rate, which she concluded arises from adoption by Swedes of children from Eastern Europe. 

Chudley spoke of the importance and the difficulty of diagnosis.  A good diagnosis requires a team of specialists, as “most effects of FASD are invisible.”  Furthermore, the ways in which the condition presents vary widely.  Yet, diagnosis is important because “without diagnosis there are no services.”  He said that early diagnosis is associated with improved outcomes.  One aim is to prevent secondary effects.  A person who is afflicted may benefit from a circle of support. 

Because there is a limited number of professionals providing diagnosis of FASD, wait times can be excessive.  And as to development of programs and clinics, the alcohol industry has been an adversary.  Chudley said that the lifetime cost to the community of a single person with FASD is $1.8 million.

Dr. Valery Temple, a psychologist with Surrey Place in Toronto, works with adults with FASD.  She listed some of the areas of difficulty for her patients:  executive functioning, memory (short term), daily living, “academics”, affect, and language.

Executive functioning involves ability to manage time, initiate action, control impulses, planning and problem-solving, mental functioning, and working memory.  Difficulties in executive functioning include missing appointments, difficulty in planning for the future, etc.  Impulse control is often weak, leading to risky behavior.  Affect regulation is a problem biological in nature.  Thus, outbursts or anger should not be seen as willful.  How can we help adults with problems in executive functioning?  We can modify their environment, she said.

Daily living involves such things as meal planning and preparation, doing the laundry and cleaning the home.  When Temple speaks of working memory, she has in mind the ability to make immediate use of bits of information, the ability to follow instructions, and make good decisions.  Her use of the term “academics” refers to reading and arithmetic abilities. Language refers to speaking and receiving.  A person may be quite capable of speaking but have difficulty understanding what is said, which may be very confusing to other people. 

She observed that people with FASD often have additional diagnoses, such as mood disorder (anxiety and depression) and attention deficit hyperactive disorder (ADHD). 

Some women feel that proscribing alcohol while pregnant is an attack on females.  Unfortunately, Mother Nature is not an equal opportunity employer.  However, Dr. Chudley did say that there is some thinking now that fathers’ drinking may also be implicated, though the evidence is not clear at this point and will require much further study.

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