Wed, 29 August 2007
This week, I am sending the original article on the Ten Brain Domains from the Journal of FAS International for your review. The regular audio podcast will return next week. Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com. |
Wed, 22 August 2007
The Fetal Alcohol Diagnostic Program (FADP), in Duluth, MN, spearheaded by the Executive Director, Jeanette Lang, and her crack team, has developed the Ten Brain Domains, which provides clear definitions of brain dysfunction, specifies empirical data needed for accurate diagnosis, and defines intervention considerations that address the complex nature of FASD. The Ten Brain Domains include functional skills in the following areas:
These domains are reviewed in the podcast and will be further expanded upon in future podcasts. Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com. |
Wed, 15 August 2007
Each key feature of FASD can vary widely across individuals exposed to prenatal alcohol. While consensus exists for the diagnosis of FAS across diagnostic systems (see last podcast), minor variations among the systems lead to differences in definitions and cut-off criteria for other diagnoses across the FASD continuum. The FASD conditions of Partial FAS (PFAS) and Alcohol-Related Neurodevelopmental Disorder (ARND) are reviewed today, as well as the University of Washington's 4-Digit Code designations of Static Encephalopathy and Neurobehavioral Disorder, which are essentially refinements of ARND.
Partial FAS (PFAS)This diagnosis is easiest to explain and, in all practical purposes, the same as FAS. Central nervous system damage is present at the same level as FAS, and these individuals have the same functional disabilities but "look" less like FAS. Here are the criteria:
Alcohol-Related Neurodevelopmental Disorder (ARND)This is where the diagnostics become muddy to the average layperson, so I want to keep it basic. For an ARND diagnosis, an individual must have confirmed prenatal alcohol exposure and evidence of clinically significant impairment in three or more of the following Ten Brain Domains: Achievement, Adaptive Behavior, Attention, Cognition/IQ, Communication/Language, Executive Functioning, Memory, Motor Skills, Sensory Integration/Soft Neurological Signs, and/or Social Communication. Growth deficiency and FAS facial features may be mild or nonexistent, and are irrelevant to the diagnosis.Static Encephalopathy and Neurobehavioral DisorderThe 4-Digit Code separates ARND into "Static Encephalopathy," which literally means non-progressive brain damage, and "Neurobehavioral Disorder," which requires that only two Brain Domains are clinically impaired.Additional NotesThe problem with FASD conditions is not about the facial features or growth deficiency. It is about the CNS damage that then creates functional problems in an individual's life. That is why the assessment of the Ten Brain Domains is so important and the most germain aspect to an FASD Evaluation: to find out how to help an individual function better. Don't worry about getting caught up in the specifics all the diagnoses. Just know that if an individual had moderate to severe prenatal alcohol exposure AND has functional problems, then an FASD condition (disability) may be present. This leads to another question that someone asked last week at a workshop I gave: "I had a few drinks before I knew I was pregnant, but stopped in the second month. My kid has terrific grades, but has low attention skills and poor social skills [Adaptive Behavior problems, from the Ten Brain Domains perspective]. Does this mean he has FASD?" No. While there is no recommended safe level of drinking alcohol while pregnant, this situation does not result in an automatic FASD diagnosis. The attention skills and behavior problems would have to be severe, and the most important thing is missing: A diagnostic team would need to be convinced that the problems were related to the alcohol exposure. Attention and social skills can be affected by so many factors in life (e.g., genetics, peer group, parenting style, etc.) that this are not diagnostic. I would like to caution everyone not to "over-diagnose" just as much as I want to caution everyone to be knowledgeable about the potential negative effects of prenatal alcohol exposure. Links discussed in the Show
Next week, we will review the Ten Brain Domains, which will start giving a better idea of what exactly CNS damage is. Until then.... Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com. |
Wed, 8 August 2007
Any Fetal Alcohol Spectrum Disorder (FASD) is diagnosed by assessing the four key features that were first identified in Fetal Alcohol Syndrome (FAS) in 1973. FAS requires a positive and severe finding in all four key features, but other FASD conditions may vary across a continuum of severity. FAS is the only expression of FASD that has garnered consensus among experts to become an official ICD-9 and ICD-10 diagnosis. The four key features of FASD that are assessed with any diagnostic system include:
The following criteria must be fully met for an FAS diagnosis:
Is FAS worse than other FASD conditions? No. The fact is that other FASD conditions have more secondary disabilities. Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com. |
Wed, 1 August 2007
HistoryThe earliest known observation of possible links between maternal alcohol use and fetal damage may have been made in 1899 by Dr. William Sullivan, a Liverpool prison physician who noted higher rates of stillbirth for 120 alcoholic female prisoners than their sober female relatives and suggested the causal agent to be alcohol use (Sullivan, 1899). This view contradicted the predominant theories of the day, which were that genetics caused mental retardation, poverty, and criminal behavior. A case study popular in the early 1900s by Henry H. Goddard involved the Kallikak family and shows the bias of the time period (Goddard, 1912), though later researchers conclude that the Kallikaks almost certainly had FAS (Karp, R.J., et al, 1995). Fetal Alcohol Syndrome, or FAS, was named in 1973 by two dysmorphologists, Drs. Kenneth Lyons Jones and David W. Smith of the University of Washington Medical School in Seattle. They identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children of three ethnic groups, all born to mothers who were alcoholics (Jones, K.L., et al, 1973). While many syndromes are eponymous, or named after the physician first reporting the association of symptoms, Dr. Smith named FAS after alcohol, the causal agent of the symptoms. His reasoning for doing so was to promote prevention of FAS, believing that if people knew maternal alcohol consumption caused the syndrome, then abstinence during pregnancy would follow from patient education and public awareness. Nobody was aware of the full range of possible birth defects from FASD or its prevalence rate at that time, but admitting alcohol use during pregnancy can feel stigmatizing to birth mothers and complicate diagnostic efforts of a syndrome with its preventable cause in the name. Over time, the term FASD is coming to predominate. Diagnostic SystemsSince the original syndrome of Fetal Alcohol Syndrome (FAS) was reported in 1973, four FASD diagnostic systems that diagnose FAS and other FASD conditions have been developed in North America:
Each diagnostic system requires that a complete FASD evaluation include assessment of the four key features of FASD--prenatal alcohol exposure, FAS facial features, growth deficiency, and central nervous system damage. A positive finding on all four features is required for a diagnosis of FAS, the first diagnosable condition of FASD that was discovered. However, prenatal alcohol exposure and central nervous system damage are the critical elements of the spectrum of FASD, and a positive finding in these two features is sufficient for an FASD diagnosis that is not "full-blown FAS." Diagnoses and diagnostic criteria will be described in detail in the next podcast. Feedback or comments may be sent to: Michael__at__FASDElephant__dot__com. My Podcast Alley feed! {pca-6ab64b0bda8df39635beb79ecf0e0585} |