The Journal of the Arkansas Medical Society Med Journal May 2020 Final 2 | Page 12

EDITORIAL PANEL: Chad T. Rodgers, MD, FAAP | Elena M. Davis, MD, MPH | Shannon Edwards, MD | William L. Mason, MD | J. Gary Wheeler, MD, MPS
Fetal Alcohol Spectrum Disorders
Advocacy in Arkansas
ELIZABETH CLEVELAND, ABD, CCC-SLP; DAVID DEERE, LCSW AND ANGELA KYZER, BA; AND SHANECA SMITH, BSB, RN, CNOR(E)
F
etal Alcohol Spectrum Dis-
orders (FASDs) are the most
common cause of preventable
developmental disabilities.
They include a range of disorders
that can occur in individuals exposed
prenatally to alcohol. FASDs affect
people of every race, religion, educa-
tion level and socioeconomic status.
Affecting about one in 20 people
nationwide, FASD is more prevalent
than autism spectrum disorder. 1
In Arkansas, the estimated annual
cost of FASD is more than $79
million; more than $4 billion for the
United States. 2 This includes costs
for medical care, special education,
substance abuse treatment and
incarceration. Individuals with
FASD often have a variety of
delays — physical, mental, behavioral
or learning disabilities — that require
assistance with daily living tasks,
social skills, mental health services
and finances. 3
The cost of failing to provide early
intervention services and support
is even higher. Many people with
FASD are eventually incarcerated or
require mental or substance abuse
services. Studies found 16.9% of
children in the child welfare system
have FASD. 4 Youths with FASD are 19
252 • The Journal of the Arkansas Medical Society
times more likely to be incarcerated
than those without FASD. 5 Early
intervention helps prevent or lessen
these secondary challenges.
Arkansas advocates are seeking
to change these statistics, including
Arkansas None for Nine, the Arkansas
Leadership Education in Neurodevel-
opmental Disabilities program and
AFMC by educating providers and
the public about FASDs.
There is no safe amount of
alcohol during pregnancy. The most
critical time to refrain from alcohol
exposure during pregnancy is week
three. Most women do not know
they are pregnant until weeks six
to eight, so exposure to alcohol
can happen without the mother
even knowing she is pregnant. The
Centers for Disease Control and
Prevention (CDC) report one in
nine women use alcohol during
pregnancy. 6 In Arkansas, about 100
pregnant women are admitted to a
state-supported treatment facility
for alcohol or drug treatment each
year, according to the Arkansas
Department of Human Services.
Experts agree that pregnant
women should abstain from alcohol
completely. Women of childbearing
age should abstain or use effective
contraception. Prevention should
begin with regular alcohol-use
screening for all women of childbear-
ing age. Valid screening tools include
the AUDIT, TWEAK or T-ACE. 7
FASDs include Fetal Alcohol
Syndrome (FAS), Neurobehavioral
Disorder Associated with Prenatal
Alcohol Exposure (ND-PAE),
Partial Fetal Alcohol Syndrome
(pFAS), Alcohol Related Birth
Defects (ARBD), and Alcohol
Related Neurodevelopmental
Disorder (ARND).
Physical diagnostic criteria for
FAS include facial dysmorphias
(thin upper lip, smaller inner/outer
eye openings, smooth upper lip),
growth deficits and central nervous
system abnormalities (small head
circumference, low cognition,
developmental delays). 8 Most
FASD patients do not present with
physical characteristics but display
functional or behavioral impairments
such as poor executive functioning,
impulsivity, hyperactivity, risky
behaviors and sensory sensitivity.
They may be diagnosed with
attention deficit hyperactivity
disorder or oppositional defiant
disorder, but these treatments may
not work for FASD.
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