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Fetal alcohol spectrum disorders (FASD) is an umbrella term used to refer to the range of negative outcomes associated with prenatal ethyl-alcohol exposure (PAE). Although the impact of maternal drinking on the pre and postnatal development of children was examined as early as the late 19th century (Sullivan 1899), the teratogenic effects of PAE were not widely recognized until 1973, when Jones and Smith discussed PAE. The fetal alcohol syndrome (FAS) they described is now recognized internationally as a permanent birth defect syndrome resulting from PAE. Fetal alcohol syndrome is characterized by growth deficiency, a unique cluster of three minor facial anomalies, and evidence of central nervous system (CNS) abnormalities. At an estimated prevalence of one to three cases per 1,000 live births, FAS is the leading known preventable cause of developmental and intellectual disabilities (Bailey and Sokol 2008). Because the distinctive FAS facial phenotype provides a specific diagnostic marker of PAE (Astley 2006), FAS is the most readily recognized of the FASD. Fetal alcohol spectrum disorders that lack the tell-tale facial phenotype of FAS are more difficult to diagnose, but share a similar range and severity of CNS impairments and social costs. Other FASDs are many times more prevalent than FAS (Bailey and Sokol 2008) and may occur in as many as 1% of all children. Along with CNS, craniofacial, and growth impairments, FASD may also include ophthalmologic, cardiac, renal, and orthopedic abnormalities. Although heavier PAE, particularly binge drinking, leads to increased risk of FASD, no safe exposure level has been established. It is apparent that risk is substantially increased if the mother is older, has a history of alcoholism, has a family history of FASD, or is living in poverty. However, no clear set of risk or protective factors has been determined for any FASD that would allow for evidence-based advice to a particular mother on the relative risk that a particular level of drinking might have on her child’s development (Bailey and Sokol 2008; Jacobson et al. 2004; Maier and West 2001; Nulman et al. 2004; see also Disney et al. 2008).

This chapter discusses fetal alcohol syndrome, including biochemical abnormalities, factors to be considered in nutritional and other evaluations, dietary and other management, prevention of fetal alcohol syndrome or fetal alcohol effects, and follow-up care.

In 1996, when I was working with Channi as a psychiatry trainee, we were both struck by how often we were seeing women with psychotic disorders in the outpatient clinic who were seeking advice on whether or not they should try to conceive and have a family. Although there was a small amount of literature on the parenting difficulties some of these women would experience, there was a very limited evidence base on their risk of adverse obstetric outcomes. We felt we needed to know more about the outcome of pregnancy for women with pre-existing psychotic disorders, and this led to my PhD, funded by a Wellcome Trust Clinical Training Fellowship, with Channi as my primary supervisor. Channi became too ill to continue working on this project, but our work together led to my perinatal mental health research programme, for which I will always be in his debt. This chapter describes this early PhD research, and the research it has led on to, over the subsequent years. We initially thought about collecting detailed clinical outcome data from the women we were seeing locally, who came from a large catchment area. However, to obtain a large enough sample size would take many years and it became clear we needed large epidemiological datasets in order to optimize statistical power and minimize bias. We therefore started to look for such data, with the first dataset available coming from colleagues at the Institute of Psychiatry—the PriSM psychosis study (Thornicroft et al. 1998). The PRiSM psychosis study research team conducted the complete ascertainment of all prevalent cases of psychosis in the two study catchment areas in the index year (1991–1992) providing us with a representative population of mothers with psychotic disorders. We found that 63% of women with psychotic disorders (n = 155) were mothers, and that these women were more likely to be older and live in unsupported accommodation than women who had not had children, although they had similar levels of disability and health and social care needs (Howard et al. 2001).

Syndromes are a group of symptoms that occur together and characterize a particular disorder. Similar to other disorders and disabilities, syndromes can have a range of severity and effect people differently. Tourette syndrome may be present in occasional music students. A number of other syndromes can also occur in college students. Each syndrome is a bit different and strategies for inclusion of the student will vary. For example, students with Tourette Syndrome experience increased tics when under stress, however, being musical is often a release from tics due to feeling more relaxed.

This chapter describes the development of the fetus in the third month of pregnancy. As the author faces the inevitable lifestyle changes that come with being pregnant, she discusses the dangers of various teratogens (i.e., toxins) for the developing fetus. Specifically, she discusses the effects of over-the-counter drugs, alcohol, smoking, maternal stress, anxiety, and depression on a fetus. Relatedly, the timing of how these toxins might affect a fetus is discussed, stressing the importance of development in the first trimester, when most of the important anatomy is forming, using the classic examples of spina bifida and the harmful effects of thalidomide.

The assessment and diagnosis phase of autism spectrum disorder (ASD) is a very difficult time for the parent. You will likely feel completely bewildered. You will be filled with many mixed emotions such as love for your child and fear for your child’s future. You may feel like your heart is breaking. But I can tell you, you are going to make it through this—just like I have. You will likely have to overcome significant denial to even discuss the unusual signs or symptoms that you have noticed in your young child. You may be afraid to hear the term “autism” come from your pediatrician’s mouth. However, you are about to start a very important journey with your child. You have to be strong in order to obtain for your child vital treatments and therapies that can dramatically improve your child’s life and future. Theoretically, ASD is not difficult to recognize and diagnose. However, in practice, it can be challenging. The full spectrum of symptoms included in ASD is quite wide. One child may appear quite typical with only minor eccentricities while another has significant intellectual disability, social impairment, self-injurious behavior, and aggression. No two individuals with ASD are exactly alike. In fact, individuals with autism are often more different than similar. We cannot easily pigeonhole or stereotype our children. Further complicating diagnosis, professionals often have little training in ASD, even in fields that have autism within their scope of practice. Furthermore, children with more subtle ASD symptoms or those who are “high-functioning” (more verbal and with more capabilities in general) do not always have symptoms that are evident at a very young age. At times, autism symptoms may not be identifiable until social problems become more significant as the child grows older. Primary care physicians are not typically able to spend long enough with your child during visits to pick up on the sometimes subtle signs needed to alert them to a possible ASD diagnosis.