|
Answer:
Dear Shannon:
Thank you for your thoughtful questions about the relationship between
FAS and ADHD. FAS is not an educational diagnosis however, I will address
those questions related to education. I'm referring questions related
to medicine to Dr. Kay Browne, behavioral pediatrician.
Understanding the diagnosis of FAS is critical to understanding the
relationship between FAS and ADHD. First of all, unlike ADHD, FAS is
not a mental health diagnosis described in the Diagnostic and Statistical
Manual of Mental Disorders IV (DSM-IV). Fetal Alcohol Syndrome is a
physical, mental and neurobehavioral birth defect resulting from maternal
use of alcohol during pregnancy. A child can also be affected by paternal
alcohol consumption, though only maternal consumption can cause FAS.
The father's drinking can lower testosterone levels, decrease healthy
sperm, and increase the risk of disorders, particularly behavior problems,
in offspring. Preliminary animal studies indicate that alcohol can damage
the DNA in male sperm.
FAS is a lifelong birth defect characterized by abnormal facial features
and growth and central nervous system problems. People with FAS suffer
from difficulties with learning, memory, attention and judgment. FAS
is also a leading cause of mental retardation (NIAAA, Eighth Special
Report NIH Publication No. 94-3699), but only 15% of people with FAS
have IQ's under 70.
Many terms have been used to describe the effects of prenatal alcohol
exposure. I'm assuming that your abbreviation "FASE" stands
for the term "fetal alcohol effects" or FAE, at one time considered
to be a milder form of Fetal Alcohol Syndrome. You are not the only
one confused by the terminology! In April 2004, a summit conference
was held by the medical community to determine appropriate descriptors.
Most recently, physicians have come to describe both FAS and FAE under
the umbrella term Fetal Alcohol Spectrum Disorder (FASD). The term FAE
has been replaced by the terms ARND and ARBD.
- Fetal Alcohol
Syndrome (FAS) is the term used to describe children with all
the characteristics of Fetal Alcohol Spectrum. Differences in
facial features are a hallmark of FAS.
- Alcohol-Related
Neurodevelopmental Disorder (ARND) Those with ARND may have
functional or mental problems linked to prenatal alcohol exposure
but not facial abnormalities. Their difficulties include behavioral
and/or cognitive deficits such as learning difficulties, poor
school performance and poor impulse control. They may have difficulties
with mathematical skills, memory, attention, and/or judgment.
- Alcohol-Related
Birth Defects (ARBD) Children with ARBD may have problems with
the heart, kidneys, bones, and/or hearing but the behavioral
and cognitive deficits may be mild and facial differences may
not be visible.
|
Children with FAS often
have a smaller than normal head. Facial characteristics of FAS include
short eye slits, elongated mid-face, long and flattened nose and upper
lip, thin upper lip and flattened facial bone structure. The illustration
below is borrowed from the FASlink website http://www.acbr.com/fas
The most serious effects
of FASD, and those most affecting school performance are:
- Attention
deficits*
- Memory
deficits*
- Hyperactivity*
- Difficulty
with abstract concepts
- Inability
to manage money
- Poor problem
solving skills*
|
- Difficulty
learning from consequences*
- Immature
social behavior*
- Poor emotional
control*
- Overly
friendly toward strangers
- Poor impulse
control*
- Poor judgment*
|
I have starred those characteristics
commonly demonstrated by children with either disorder. A child or teen
with ADHD might also demonstrate poor money skills, but this is not
a most common characteristic. Some children and teens with ADHD are
well able to think abstractly. However, they may have difficulty producing
work that demonstrates this.
As you can see, the two disorders have much in common, particularly
when facial abnormalities are not present. Children with FASD have ADHD
as part of their diagnosis. In absence of facial abnormality, FASD may
not be apparent to school personnel who might be the first to refer
a child. Also, unless the parent is willing to disclose a history of
alcohol consumption during pregnancy, ARND may be missed. Denial is
one of the psychological effects of alcohol addiction. Facial characteristics
of FAS are most apparent between the ages of 2 and 10 years. They are
often not as obvious immediately following birth, during adolescence
or in adulthood. This transient appearance compounds diagnosis.
Children with FASD and ADHD have many of the same behavioral characteristics
and needs. However, although children with FASD often demonstrate a
wide range of behaviors from mild to severe, FASD often involves more
severe and intractable behaviors and these children often have more
difficulty linking cause and effect. In addition, because 15% of children
with FASD have mental retardation, more concrete methods may need to
be applied. Many experts feel that modifying the environment is easier
than modifying the behavior of the child with FASD. The Ministry of
Education in British Columbia has published a handbook on teaching children
with FAS. It is available at: http://www.acbr.com/fas
However, according to the National Center on Birth Defects and Developmental
Disabilities, behavioral interventions for children with FASD are currently
"often non-specific, unsystematic, and/or lack scientific evaluation
or validation." Several university settings are involved in research
on educational and behavioral strategies. These include:
- Marcus
Institute- Atlanta
- Georgia
University of Washington - Seattle
- Washington
University of Oklahoma Health Sciences Center - Oklahoma City, Oklahoma
- Children's
Research Triangle - Chicago, Illinois
For more information about FASD, the
relationship of FASD to ADHD, and school interventions, refer to the
following websites:
American Academy of Pediatrics
www.aap.org
FAS Community Resource Center
www.come-over.to/FASCRC
National Organization on Fetal Alcohol Syndrome
http://www.nofas.org/main/index2.htm
National Center on Birth Defects and Developmental Disabilities (NCBDDD)
http://www.cdc.gov/ncbddd/fas/fasask.htm
An informational CD the includes psycho-educational profiles of students
with FASD can be purchased at:
FASlink
http://www.acbr.com/faslinkcd.htm
|
Discussion Home Page