Fetal Alcohol Spectrum Disorder (FASD) and ADHD Treatment PPT

Fetal Alcohol Spectrum Disorder (FASD)

  • Definition: FASD is an umbrella term used to describe all the fetal effects from ETOH exposure in utero; FAS falls under this term

    • Fetal Alcohol Syndrome (FAS): A triad of characteristics (facial features, growth restriction, and neurodevelopmental deficits) with a confirmed hx of maternal ETOH ingestion, these infants usually weight less than other babies

      • ETOH ingestion during pregnancy has both short-term and long-term effects on the fetus

      • Infants born to heavy drinkers are twice as likely to have cnogenital abnormalities

      • Infants can suffer ETOH withdraw if exposed near the time of delivery → S/S: jitteriness, increased tone and reflex responses, irritability, and seizures

  • Fetal Alcohol Spectrum Disorder:

    • Alcohol in mother’s blood passes through umbilical cord to the fetus “when a woman drinks alcohol so does her baby”

    • No safe time to drink alcohol during pregnancy or safe amount

    • FASD lasts a lifetime, no cure

  • Factors that help reduce effects of FASDs:

    • Diagnosis before 6 years of age

    • A loving, nurturing and stbale home environment

    • Absence of violence

    • Involvement in special education and social service

    • Mom must be honest

Key Characteristics of Fetal Alcohol Syndrome (FAS)

FASDs Behavioral and Intellectual Disabilities:

  • Difficulty with learning or memory

  • ☆Higher than normal level of activity (hyperactivity)

  • Difficulty with attention (ADHD)

  • Speech and language delays

  • Intellectual disability or low IQ

  • Poor reasoning and judgement skills

  • Learning disabilities

Additional Clinical Manifestations:

  • Low body weight

  • Poor coordination

  • Vision or hearing problems

  • Shorter than average height

  • Sleep and sucking problems as a baby (nutrition & growth)

  • Problems with heart, kidneys, or bones (a murmur may be present at birth)

  • Small sized head (microcephaly)

Facial Features:

  • Microcephaly

  • ☆Smooth philtrum (the groove between the nose and upper lip)

  • Thin vermilion border (upper lip)

  • Low nasal bridge

  • Small palpebral fissures (narrow eye openings)

  • Epicanthal folds

  • Upturned nose

  • Underdeveloped jaw (micrognathia)

  • "Railroad track" ears

  • Flat midface

  • Craniofacial Features: microcephaly, small eyes, think upper lip, flat midface, indistinct philtrum, hypoplastic maxilla, micrognathia

ADHD

  • “Attention-deficit hyperactivity disorder to developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity”

  • 3 Types of ADHD: Inattentive, hyperactivity-impulsive, combined

  • May have low levels of norepinephrine (associated with attention and arousal) or dopamine (associated with reward, taking a risk and being impulsive)

  • Other symptoms: inattention to detail in class, poor listening skills, fidgety behavior, seems to be busy at all times, does not engage in quiet play, communicates poorly with excessive talking, physical complaints associated with decreased appetite and insomnia

  • ADHD affects self-esteem, social status, written and adaptive skills

  • Children exhibit immaturity relative to chronological age, selevtive attention, distractibility

  • ☆Does NOT correlate with low IQ

Causes:

  • Genetic Factors: not one specific gene responsible for ADHD, if sibling has ADHD increases risk for other sibling

  • Environmental: associated with an abusive home, a chaotic home, hx of parental substance abuse, depression, antisocial behavior

  • According to the National Institute of Mental Health diagnosis may be r/t:

    • Exposure to artificial food coloring substances and food dye additives (red dye)

    • Very low birth weight

    • Complications associated with ischemic-hypoxic episodes during the birthing process

    • Drinking, smoking, exposure to drugs during pregnancy

Treatment:

  • Behavioral therapy (teaching time management and organizational skills), family counseling, medications, and proper classroom placement

  • Medications: Stimulants increase neurotransmitters (balance them out)

    • Methylphenidate hydrochloride (long acting or immediate release)

    • Dextroamphetamine sulfate

    • Dextroamphetamine and amphetamine or Amphetamine mixture

    • Lisdexamfetamine

    • With these meds closely monitor weight and suicidal ideation

    • Children taking stimulants should be monitored for tics during initial treatment, avoid in children with hx of Tourette syndrome

  • Dextroamphetamine offer a slow release of dopamine

  • Methamphetamines offer a fast release which is associated with euphoria

    • ☆Highly addictive

    • Med checks

    • Only one month supply bc addictive

  • Non-stimulants: added to stimulants to increase effectiveness or used alone if unable to tolerate stimulants

    • Atomoxetine

    • Guanfacine

    • Clonidine

  • Antidepressants:

    • Tricyclic

      • Monitor weight and frequent checks

Complications:

  • ADHD doesn’t cause other problems, however children with ADHD are more likely to suffer from:

    • Depression

    • Tourette syndrome

    • Oppositional defiant disorder (ODD)

    • Bipolar disorder

    • Conduct disorder

    • Anxiety disorder

    • Dyslexia