Fetal Alcohol Syndrome and Intellectual Disability

Essay Support and Timetable Discussion

Gemma and the lecturer offer essay support. Students are encouraged to create essay plans and submit them on Moodle or discuss them in person for 10 minutes. Essay plan support begins mid-February.

Timetable and Scheduling

Timetable planning considers external modules, which complicates scheduling.
The lecturer is trying to find the best possible times for the two sessions, considering that many students have busy schedules, especially on Tuesdays.
Possible Session Times:
- Wednesday: 1 PM to 2 PM might be a possibility, acknowledging that many students might be working during Wednesday afternoons.
- Thursday: Initially considered but might not be ideal due to potential independent study days and students being off-campus; efforts are being made to move year group meetings to avoid conflicts.
- Friday: Considered as a potentially good day as it's not too busy for most students.

Scheduling Decisions

Friday is considered a potentially good day for most.
The lecturer will try to get the session on the timetable; otherwise, students should note it in their diaries.
The lecturer considers running both sessions one after the other on Fridays or splitting them across different weeks. The preference is to have them sooner rather than later.

Confirmed Dates and Sessions

Essay support is tentatively scheduled for February 16th (Valentine's week). Time and room are yet to be determined based on availability.
Students should pencil in February 16th for essay support sessions.

Additional Essay Support Sessions

An essay writing recap session (PS116 recap) will be organized by Gemma and the lecturer based on feedback from finalists.
A session on how to write essays for exams is scheduled for week nine, given the increase in essay-type exams.
Luke and Hester will also be present to provide assistance during these sessions.

Academic Skills Mentor

The psychology guide on the current student page provides details for the academic skills mentor drop-in sessions available on Wednesdays.
The mentor is available even if psychology is not the student's primary department.

Essay Writing Resources

Essay writing documents have been co-created with Olivia Gunn (a study abroad student) and are available on the student portal.

Guide Dog Visit

There are six spaces left for the guide dog visit, split into two dates: February 14th and 21st.
A waitlist will be created for those who want to attend; if there’s enough interest, another session will be added.
Touching the dogs is not allowed as they need to focus on their training, but a guide dog and owner will be present.
Students unable to attend should inform the organizers, as each space costs £10 for the department and a coach has been paid for.
Students who live in Leamington and can drive themselves to the Guide Dog Centre should also inform the organizers.

Essay Question 3: MENCAP Resource

MENCAP (a charity for individuals with learning disabilities) has asked for a resource to help clinical psychologists understand the high risk of inequality (health, criminal justice, social inclusion) faced by young adults with intellectual disabilities.
Students are to use concepts from the module to evaluate key factors for the resource.
Approach:
- Treat this task as writing a classic essay rather than creating a pamphlet.
- Focus on one area—criminal justice, social inclusion, or health—instead of trying to cover all.

Essay Question Examples

Criminal Justice:
- Why are people with intellectual disabilities more likely to be victims or perpetrators of crime?
Social Inclusion:
- Focus on inclusion within the community, friendships, and loneliness.
Health:
- Use information from lectures on Down syndrome or Gemma's lecture.

Guide Dog Centre and Essay Planning

The Guide Dog Centre visit will provide more information on this topic.
Those unable to attend the Guide Dog Centre visit can still answer the question but are encouraged to submit an essay plan.

LKG Inclusion

LKG will be discussed in two weeks' time (February 16th, if the date is confirmed).
It should be included on the tabular and on the other sheet. The date is March 18.

Guide Dog Centre Location and Parking

The Guide Dog Centre is located in Bishop’s Tachbrook, about ten minutes outside of Leamington.
Parking is plentiful.

Environmental Causes of Intellectual Disability: Fetal Alcohol Syndrome (FAS)

Fetal Alcohol Syndrome (FAS) is the leading cause of intellectual disability in the Western world and is completely preventable.

FAS: Key Aspects to Cover

Etiology: What happens during each trimester.
Prevalence: Actual occurrence might exceed reported figures.
Brain Structures: Understanding affected structures helps explain behaviors.
Cognitive Aspects: Focus on neuropsychological profile rather than classic IQ scores.
Factors: How cognition affects behavioral development.
Canadian Study: Individuals with FAS are 20 times more likely to be in prison.

Reading Material

Chapters 1, 11, and 12 are provided as reading resources (with hyperlinks).
Most individuals with FAS have a normal IQ range, despite executive functioning issues.

Historical Context

Aristotle (Problemata): Observed correlations between "foolish, drunken" mothers and children with similar traits, reflecting early perceptions of intellectual disability.
Liverpool Physician (1899): Noted high stillbirth rates among children of alcoholic mothers compared to sober relatives, establishing a causal link between alcohol and developmental issues. Further research revealed high rates of stillbirth, epilepsy, intellectual disability signs, and physical abnormalities among children born to subsequent generations.
1968 in France: FAS was defined as a disorder, with longitudinal studies showing heavy drinking mothers displaying physical and cognitive deficits in children.

Underestimation of Alcohol Use During Pregnancy

Worldwide, approximately $9.8$ % of women drink during pregnancy.
Europe: $25$ % of pregnant women drink.
Western Pacific region: $8.6$ %.
Southeast Asia: $1.8$ %.
Rate of FAS diagnosis correlates with drinking culture and drinking rates during pregnancy. For example, Europe has higher rates of both.
Approximately 7,000 babies annually are born with fetal alcohol syndrome.

Reasons for Underestimation

Mothers are reluctant to admit drinking during pregnancy.
Misdiagnosis with other conditions like ADHD or attributing symptoms to malnutrition.
Co-occurring conditions complicate the diagnosis.
Early pregnancy may be unrecognized.

Controversial Nature of FAS

Controversy stems from its impact on individuals and society, variations in drinking cultures, and misdiagnosis.
Wider effects (FASD) involve approximately 21,000.
Co-occurring mental health issues are common.
Worldwide, 3 million children annually are thought to be born with fetal alcohol syndrome.
In the UK, 75% of children with FAS are adopted due to growing up in environments of neglect; mothers often suffer from alcoholism, viewed in the DSM as a disease or addiction.

Variations in Symptomology

Variations in symptomology of FAS are broad; alcohol's impact on the developing embryo varies.
Exposure level and timing, as well as genetics of the mother, influence outcomes.
Alcohol is a tetrogen (poison); embryos cannot break it down. Tetrogens affect the central nervous system most between 4-16 weeks.
Impact to the Heart and Limbs happens during a shorter period, and during the third trimester growth size occurs.
The CNS develops throughout pregnancy, explaining executive function issues.

Diagnostic Criteria

WHO's ICD-11 is preferred as the diagnostic criteria for FAS, which encompass children with slight cognitive impacts without physical abnormalities.
ICD-10 variations include full syndrome, partial syndrome, and behavioral effects.
DSM does not have a specific FAS diagnosis, terming it neurobehavioral disorder associated with prenatal alcohol exposure due to lack of diagnostic consensus.

Central Nervous System Effects

Smaller head size and potential walking problems are frequent.
Softer signs include executive functioning issues.
Visible facial features are typical, particularly around the eyes, nose, and jaw.
DSM calls it neurobehavioural disorder associated with prenatal alcohol exposure (ND-PAE). Diagnoses requires alcohol exposure and cognitive deficits like executive functioning, memory deficits, and self-regulation issues.

MenCap Video

Video presents diverse FAS cases, with impacts ranging in severity; some need lifelong support, while others need support at certain points.
Individuals with neurological development of the brain, speech communication deficit delays, and problems with understanding and processing your normal developmental milestones.

Ethical Dilemmas

The article discusses legal and ethical dilemmas regarding societal views on alcoholism, addiction, and implications for children with learning disabilities; controversial topic.
The article presents questions such as whether alcoholism should be seen as a disease or choice, and how families and the ecosystem should be treated.
During prosecution in court, cases focus on addiction (often from extreme trauma), and preventative measures need to be taken.
No benefit to prosecuting someone; reinvest funds put into prosecution to rehabilitation.
Is there more benefit to causing this sort of harm to your own baby should be considered an independently issue outside of the two of them.

Brain Abnormalities

Autopsies, though rare, show smaller brain sizes (microcephaly), agenesis of the corpus callosum, and underdeveloped sulci.
Alcohol's impact is global, affecting the hippocampus, amygdala, cerebellum, primitive brain (coordination, posture), and motor dexterity (writing, picking up objects).
Damage impacts memory (confabulations) and motor coordination, so there are misdiagnosis.

Corpus Callosum

Deficits are strong indicators of FAS, showing mild impairment to agenesis. Shown is the control corpus callosum (A), a 12 year old's corpus callosum thinning, and a 14 year old's corpus callosum that is not there.
Cerebellum: Smaller, impacts posture, balance, attention; causes motor deficits and awkward gait. The full syndrome has stronger changes in brain size than the partial.

Other Physical Effects

The basal ganglia is important for memory, verbal learning, awareness, and spatial learning and has been associated with hyperactivity and what is called preservative behaviors. It has been associated with Wisconsin Card test where there are repetitive actions.

Emotional and Behavioral Effects

Emotional Regulation issues may be due to Limibic system deficiencies.

Cognitive Performance

The lecturer has planned to discuss this further as the research has found that this session may be less interactive.
Children with FAS often score just above the cutoff on IQ tests ( $70$ for intellectual disability).

What is Missing?

Clinicians may rely sorely on IQ, which means diagnosis is based upon fine-grained approach and detailed neuropsychological profiles.

Executive Functioning

Executive Dysfunction/Impairments make us human. There are difficulties to many factors:
- Focus: Ability to give focus to a task.
- Effort: Getting up, getting ready, having a shower requires effort.
- Emotions: Struggling to manage frustrations and emotions.
- Memory: Working memory (retaining something), accessing memory (recall).
- Monitoring and self regulating actions: Internal Buffer, if I am getting in trouble.

Fine-Grained Approach

Digit, Block design are subscales that make up IQ.
Lots of tests can be done to see working memory and point to signals and give a response, as some people can have additional issues.

Problem Behaviors

Some scale problems children with FAS may have: Social, Depression, Anxiety.
There are non verbal memory impairments that can cause issues: Executive functioning, poor judgment, consequences.
Remember, Attention issues is the cardinal feature.

Tower of Hanoi Test

Inhibition is tapped during the Tower of Hanoi Test: Stopping yourself from doing what you want to do, and planning involved
rule violation increases, showing more errors and not adding to rules compared to control group.

Implication and Recall

Memory impairments causes issues with why people get trouble from law.
Spatial tests are conducted to help, and individuals with FAS show issues with this.

Wisconsin Card Sorting Test

Used to see cognitive flexibility between rules.
Change what they have learned and it helps tap the ability to problem solve.

Range of Deficits

There are many factors of deficits: visuospatial, Learning, Memory, non verbal and Executive functioning.

Impact of Neurobiology

Environmental aspects can change people as well, if others treat you differently and there are changes to the corpus callosum.
Help to maintain an independent life and is twofold, including neurocognitive challenges and non optimal environments with foster care and adoption.
High rates of offending due to neurological difficulties and non optimal environments.
Adaptive behaviors must be considered.

Adapting Behaviors

FAS has massive impacts, and Emotional issues and delays can occur.
Model used to help understand: genetic factors, exposure, temperament, and cognitive deficits

ADHA and FAS

High rate co-diagnosed together, and brain regions affected by alcohol are similar to ADHD.

Neuropsychological Testing

Can be sensitive for diagnostic overlapping and assumptions.
This testing will show performances is different amongst patients.
There are some differences in the response to medication.
There is a high co occurrence of mental health with FAS with psychiatric disorders. Can it be the environment of the Nuero.

Tanner Case

Tanner was wrongfully convinced, but what caused this, was it neurological? There was suggestibility because he was there and the way interviewing works.
So there are professionals with very little experience is this and a lot of other risk factors.