1.+What+is+FASD?

Prenatal alcohol exposure can lead to fetal alcohol spectrum disorders (FASD), which are significant neurodevelopmental disabilities. According to the Public Health Agency of Canada (2011) FASD is the leading cause of developmental disability in Canada. FASD is an umbrella term used to describe the range of disabilities caused by prenatal alcohol exposure. This includes fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS) and alcohol-related neurodevelopmental disorder (ARND) (Hutchinson, 2010). According to Hutchinson (2010), a Quebec study, completed in April of 2005, states that the combining of all studies makes it possible to estimate that FAS is affects between 1 and 4 children out of 2000 in North American, while the prevalence of FASD (including FAS) is estimated at 9 in 1000.
 * Description of FASD and prevalence in North America **

** Characteristics of Children with FASD ** Children with FASD often exhibit common facial characteristics, which include short palpebral fissures (distance across the eye slit), smooth philtrum (two ridges that run between the nose and the upper lip), thin upper lip, and flattened nose bridge. However, a child with FASD maylook like a typical child, but exhibit other common characteristics.

Facial Characteristics common to children with FASD (used by Carol Christie-Beach, School Counselor, Regina Public School Board) Photo from http://fasdforever.com/?p=140

Children with FASD may go undiagnosed because they are often talkative and charming, which may initially hide their unique learning and behavioural needs. They often possess poor memory, impaired rates of learning, and difficulty generalizing. They usually have difficulty understanding cause and effect, display short attention spans, and struggle with recognizing and understanding patterns, staying focused, and mastering reading and mathematics (Hutchinson, 2010). According to Carol Christie-Beach, School Counselor for the Regina Public School Board, children with FASD are often tactile learners, colourblind, have difficulty understanding abstract concepts such as time and money, and cannot feel pain (Christie-Beach, 2011). Hutchinson (2010) highlights how parents of children with FASD describe examples of absence of social judgment, fearlessness, and lack of internalization of modeled behaviour. Hutchinson (2010) and Christie-Beach (2011) agree that a particularly common characteristic of children with FASD is difficulty understanding cause and effect. Consistency between home and school related on behaviour management is an important strategy for helping these children. In addition, children with FASD do not have habituation, which is the ability to tune out other stimulus. In other words, the central nervous system cannot tune out irrelevant stimulus (such as buzzing lights and the crinkling of plastic bags). In fact, these sounds are often amplified for them and can cause irritation and frustration (Johnson, 2006). According to Christie-Beach (2011), prenatal drug exposure causes the same effects of prenatal alcohol exposure, except there are no facial features that resemble those of children with FASD.

** Diagnosing FASD: The Teacher’s Role ** According to Linda Whittle, Learning Resource Teacher, Regina Public School Board, if a classroom teacher suspects that a student may have FASD he or she should adhere to the following procedures: 1. Read cumulative file of the student, with particular attention to registration form(s) 2. Document observations (physical as well as behavioural, emotional, intellectual, and social) 3. Share observations and concerns with the LRT and principal (include photographs, both past and present) 4. Share observations and concerns with the Professional Learning Community (PLC), which includes the school’s principal and teachers 5. Create a plan of action with your team, which may include your PLC, principal, psychologist, counsellor, SLP, LRT, occupational therapist, school nurse, and/or school social worker.

** Canadian Guidelines for Diagnosis of FASD ** According to CMAJ (2005) the diagnostic process for fetal alcohol spectrum disorders includes screening and referral, the physical examination and differential diagnosis, the neurobehavioural assessment, and treatment and follow-up. A multidisciplinary team is necessary for a correct diagnosis and treatment recommendations because of the complexity and range of characteristics related to prenatal alcohol exposure. The diagnostic team may vary depending on individual circumstances, but preferably consists of a coordinator for case management (such as a nurse or social worker), a physician trained in FASD diagnosis, a psychologist, and an occupational therapist, and a speech-language pathologist. Additional team members may include addiction counsellors, childcare workers, cultural interpreters, mental health workers, parents or caregivers, probation officers, psychiatrists, teachers, vocational counsellors, nurses, geneticists or dysmorphologists, neuropsychologists, family therapists (Canadian Medical Association, 2005).

** Criteria for Diagnosis of Fetal Alcohol Spectrum Disorders **

Central nervous system damage: evidence of functional or structural brain impairment Reliable evidence of confirmed prenatal alcohol exposure (not required if the cluster of facial anomalies is present) || Growth deficiency: height or weight in lower 10th percentile Central nervous system damage: evidence of functional or structural brain impairment Reliable evidence of confirmed prenatal alcohol exposure || Reliable evidence of confirmed prenatal alcohol exposure ||
 * ** Disorder ** || ** Diagnostic Features ** ||
 * Fetal Alcohol Syndrome (FAS) || Cluster of minor facial anomalies: short palpebral fissures (distance across the eye slit), smooth philtrum (two ridges that run between the nose and the upper lip), thin upper lip
 * Partial FAS (PFAS) || Some of the characteristic minor facial anomalies
 * Alcohol-related neurodevelopmental disorder (ARND) || Central nervous system damage: evidence of functional or structural brain impairment

According to Christie-Beach (2011), if a child has all criteria to be diagnosed with FAS except the facial characteristics, it is likely that he or she will be diagnosed with ADHD.

** Alcohol and the Fetus ** According to Hutchinson (2010), it was once believed that only substantial prenatal alcohol exposure could cause FASD. However, new research reports that even occasional exposure to alcohol during pregnancy can cause FASD. Johnson (2006) explains that when a pregnant woman drinks alcohol the fetus will have the same blood-alcohol level in minutes. They types of fetal damage that occurs depends on the when the mother drinks alcohol during the pregnancy. During the first trimester (first three months of pregnancy) the fetus is developing physically. If a pregnant woman drinks alcohol during this time her child will likely exhibit physical effects of the alcohol. There is an increased risk of miscarriage during the second trimester. If a pregnant woman drinks alcohol during the final trimester, the baby will often incur a small, underweight body size. However, a fetus’ brain develops during the entire duration of the pregnancy and therefore, alcohol exposure during any time of the pregnancy can affect the fetus’ brain development. According to Streissguth, PhD, a critical period for fetal development is during the first three weeks of pregnancy: “One of the most serious times for affecting the baby is even before a woman knows that she’s pregnant” (Johnson, 2006). This is especially concerning because over 1 in 8 women, aged 18 to 44, who are sexually active and do not use effective contraception frequently drink alcohol or binge drink (Johnson, 2006). Sources Christie-Beach, C. (2011). //FASD: Professional development workshop//. Regina Public School Board.

Chudley, A.E., Conry, J., Cook, J.L., Loock, C., Rosales, T., & LeBlanc, N. (2005). Fetal alcohol specrum disorder: Canadian guidelines for diagnosis. //Canadian Medical Association Journal//, 172, 1-21.

Hutchinson, N.L. (2010). //Inclusion of exceptional learners in Canadian schools: A practical handbook for teachers// (3rd ed.)//.// Toronto: Pearson Canada.

Johnson, B. (Producer/Writer/Editor). (2006). //Fetal alcohol exposure: Changing the future// [Motion Picture]. Princeton, New Jersey: Films for the Humanities & Sciences.

Whittle, L. (2011). Learning Resource Teacher, Regina Public School Board.