1.
TOPIC DISCUSSION
Presenter
Tejas Shah
Chair
Dr. Dweep Chand Singh
FETAL ALCOHOL SYNDROME
ALCOHOL AS A TERATOGEN

2.
FETAL ALCOHOL SPECTURM
DISORDERS
1PART

3.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
FETAL ALCOHOL SPECTURM DISORDERS
 FETAL ALCOHOL SPECTRUM DISORDERS (FASDS)
are a group of conditions that can occur in a person
whose mother drank alcohol during pregnancy.
 FASD is the umbrella term for a range of disorders.
 These disorders can be mild or severe and can
cause physical and mental birth defects.

4.
FAS
ARBDs
Full-blown fetal alcohol
syndrome (FAS) represents
only the “tip of the iceberg”
relative to alcohol-related
birth defects (ARBDs).

5.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
FETAL ALCOHOL SPECTURM DISORDERS
TYPES OF FASD INCLUDE
 Alcohol-Related Birth Defects (ARBD)
 Alcohol-Related Neurodevelopment Disorder (ARND)
 Neurobehavioral Disorder Associated with Prenatal Alcohol
Exposure
 Fetal Alcohol Effects (FAE)
 Fetal Alcohol Syndrome (FAS)

6.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
FETAL ALCOHOL SPECTURM DISORDERS
ALCOHOL-RELATED BIRTH DEFECTS (ARBD):
People with ARBD might have problems with the heart, kidneys, or
bones or with hearing. They might have a mix of these.
ALCOHOL-RELATED NEURODEVELOPMENTAL DISORDER (ARND):
People with ARND might have intellectual disabilities and
problems with behavior and learning. They might do poorly in
school and have difficulties with math, memory, attention,
judgment, and poor impulse control.

7.
FETAL ALCOHOL SYNDROME
2PART

8.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
FETAL ALCOHOL SYNDROME (FAS)
 FAS can be defined as non-genetic congenital disease,
abnormality or condition.
 FAS represents the severe end of the FASD.
 Fetal death is the most extreme outcome from drinking alcohol
during pregnancy.
 People with FAS might have abnormal facial features, growth
problems, and central nervous system (CNS) problems.
 People with FAS can have problems with learning, memory,
attention span, communication, vision, or hearing.
 This is one of the major causes for mental retardation.

9.
EPIDEMIOLOGY
3PART

10.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
EPIDEMIOLOGY
 Estimated 1-2 cases per 1000 live births in the United States
 Ranges from 1 in 1000 to less than 1 in 10,000 live births
internationally
 Occurs in all race and ethnicity

11.
MECHANISM
4PART

12.
 Mothers who drink alcohol expose fetus
to alcohol in utero.
 Alcohol in a pregnant woman's
bloodstream circulates to the fetus by
crossing the placenta.
 The alcohol inhibits intrauterine growth
and postnatal development.
 There, the alcohol crosses the blood-
brain barrier and interferes with the
ability of the fetus to receive sufficient
oxygen and nourishment for normal cell
development in the brain, heart and
other body organs.

13.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
PREGNANCY TRIMESTERS
ALCOHOL EXPOSURE DURING THE PREGNANCY TRIMESTERS
 First: During the first trimester, alcohol interferes with the migration and
organization of brain cells and the formation of the CNS.
 Second: Heavy drinking during the second trimester, particularly from the
10th to 20th week after conception, seems to cause more clinical features
of FAS than at other times during pregnancy.
 Third: During the third trimester, the hippocampus is greatly affected,
which leads to problems with encoding visual and auditory information
(reading and math) and the inability to form or retain new memories.

14.
MIDLINE STRUCTURES OF THE FACE AND BRAIN ARE DEFICIENT IN ALCOHOL-
EXPOSED MOUSE EMBRYOS AND IN INDIVIDUALS WITH FAS
THE FACE OF A CHILD
WITH FULL-BLOWN FAS
HAS FEATURES THAT
CAN BE CAUSED BY
DAMAGE TO MIDLINE
STUCTURES.
EYE EYE
A C
B D
MOUTH
MOUTH
NOSTRILS
NOSTRILS

15.
EFFECTS OF FETAL ALCOHOL
SYNDROME
5PART

16.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
EFFECTS OF FETAL ALCOHOL SYNDROME
BIRTH DEFECTS
 Leading cause of mental retardation
 Multiple Organ Dysfunction
 Intra and postnatal grow defects
 Lower Intelligence
 Dysfunction in central nervous system which can lead to learning
disability
 Cranial and Facial Dysmorphology
(Eustace et. al., 2003)

17.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
EFFECTS OF FETAL ALCOHOL SYNDROME
 Inattention
 Inability to foresee
consequences
 Inability to learn from
previous experience
 Inappropriate Behaviour
 Lack of Organization
 Learning Difficulties
 Poor Abstract Thinking
 Poor Adaptability
 Poor Impulse Control
 Poor Judgment
 Speech Problems
 Hyperactivity
COMMON COGNITIVE AND BEHAVIORAL PROBLEMS
(Eustace et. al., 2003)

18.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
EFFECTS OF FETAL ALCOHOL SYNDROME
 Mental Health Problems 90%
 Dependent Living 80%
 Employment Problems 80%
 Disruptive School Experience 60%
 Trouble with the Law 60%
 Confinement 50%
 Inappropriate Sexual Behavior 50%
 Alcohol or Drug Problems 30%
SECONDARY DISABILITIES
(Koren et al., 2003)

19.
SYMPTOMS AND FEATURES
6PART

20.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
SYMPTOMS AND FEATURES
GROWTH RETARDATION
 Delayed development of gross motor skills like rolling over,
sitting up, crawling and walking
 Impaired language development
 Delayed in development of fine motor skills such as grasping
objects with the thumb and index fingers and transfer objects
from one hand to the other

21.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
SYMPTOMS AND FEATURES
FACIAL FEATURES
 Eyes: small, slant downward, drooping
eyelid, wide-set
 Ears: large, low set (below eyes),
posterior rotation (toward back of
head), poorly formed concha (hollow
of external ear)
 Nose: upturned, shortened, hypoplasia
of nasal bridge
 Mouth: wide, thin upper lip, cleft
palate, cleft lip, poorly formed teeth
(Abel, 1984)

22.
FACIAL FEATURES
NORMAL FEATURES ABNORMAL FEATURES

23.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
SYMPTOMS AND FEATURES
OTHER SIGNS
 Cardiac
 Heart murmur; usually disappears by one year of age
 Ventricular Septal Defect (VSD)
 Atrial Septal Defect (ASD)
 Skeletal: Joint abnormalities, altered palmer crease pattern,
small distal phalanges and small fifth fingernail.
 Renal: Horseshoe, aplastic, dysplastic or hypoplastic kidney.
 Ocular: Strabismus, optic nerve hypoplasia
 Low birth weight

24.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
SYMPTOMS AND FEATURES
ABNORMAL ORGAN DEVELOPMENT
People diagnosed with FAS may have
abnormal organ development in the….
Heart, kidneys, genitals, respiratory
system, liver, limb/joint and muscular
abnormalities
(Abel, 1984)

25.
FETAL ALCOHOL SYNDROME
DIAGNOSIS CRITERIA
7PART

26.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
DIAGNOSIS CRITERIA
Q86 Congenital malformation syndromes due to known exogenous causes,
not elsewhere classified  Q86.0 Fetal alcohol syndrome (dysmorphic)
MUST MEET 3 CRITERIA TO BE DIAGNOSED WITH FAS
1) Prenatal or postnatal growth retardation (body weight,
length, or head circumference)
2) Characteristic facial anomalies (at least 2 or 3)
 a. Microcephaly (below 3rd percentile)
 b. Microphthalmia or short palpebral fissures
 c. Underdeveloped philtrum, thin upper lip, and maxillary hypoplasia
3) Central nervous system dysfunction (neurological abnormality, mental
deficiency, developmental delay.
(Abel 1984)

27.
TREATMENT OPTIONS
8PART

28.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
TREATMENT OPTIONS
 There's no cure or specific treatment
 The physical defects and mental deficiencies typically
persist for a lifetime
 Heart abnormalities may require surgery
 Learning problems may be helped by special services in school
 Parents often benefit from counselling to help the family with a
child's behavioural problem

29.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
TREATMENT OPTIONS
 FAS Children do learn, but all learn differently,
“find what works best and stick to it!”
 Create a friendly and structured home environment that is
familiar. . .
 Creating routines/schedules serves as anchors overtime for
children with FAS/FAE
 Limit changes in their routine/schedules “less is better!” To avoid
overwhelming
REMEMBER, “STRATEGIES NOT SOLLUTIONS!”

30.
SUMMARY
9PART

31.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT)
SUMMARY
 When a pregnant person drinks alcohol, some of that alcohol
easily passes across the placenta to the fetus.
 People with this condition may have problems with their vision,
hearing, memory, attention span, and abilities to learn and
communicate.
 You can prevent fetal alcohol syndrome by avoiding alcohol
during pregnancy.

32.
THANK YOU FOR LISTENING

33.
REFERENCES
 Emory University (n.d.). Maternal Substance Abuse and Child Development.
Retrieved December 28, 2016 from http://www.psychiatry.emory.edu/
PROGRAMS/GADrug/fasqa.htm#does
 Graefe, Sara. (2004). (Ed.). Living with FASD: A Guide For Parents.
 British Columbia: Special Needs Adoptive Parents. Groundwork Press.
Retrieved December 28, 2016 from website:
http://www.faslink.org/strategies_not_solutions.pdf
 Kellerman, Teresa (2005). Symptoms of Fetal Alcohol Spectrum Disorders.
Retrieved December 28, 2016 from http://www.come-over.to/FAS/faschar.htm
 Kellerman, Teresa (2008). Prenatal Alcohol Exposure and the Brain.
Retrieved December 28, 2016 from http://www.come-over.to/FAS/FASbrain.htm
 Kock, Gregory C. &Kupesky, Regina H. (2002).
 Parenting the Hurt Child: Helping Adoptive Families Heal and Grow. Pinon Press.
Retrieved December 28, 2016 from website:
http://www.faslink.org/strategies_not_solutions.pdf