Fetal Alcohol Spectrum Disorder: Advances in Research and Practice

Preface to the Series
Preface
Contents
Contributors
Chapter 1: The Fetal Alcohol Spectrum Disorders: Recognition, Reaction, and Resurgence
	1 Recognition of the Fetal Alcohol Syndrome
	2 Reactions to Recognition of Fetal Alcohol Syndrome
	3 Resurgence
		3.1 Educational System
		3.2 Juvenile Justice System
	References
Chapter 2: FASD: A Clinician´s Perspective: Key Questions and Answers with Commentary
	1 Introduction
	2 Methods
		2.1 Background
	3 Notes
		3.1 What Is the Evidence That Alcohol Causes FASD?
		3.2 What Level of Alcohol Exposure Can Result in FASD or Other Alterations in Development?
		3.3 Can Paternal Drinking Cause FASD?
		3.4 Who Is at Risk, and What Are the Risk Factors That Contribute to FASD?
		3.5 How Is FASD Diagnosed?
		3.6 How Common Is FASD?
		3.7 What Is the Differential Diagnosis of FASD?
		3.8 What Breakthroughs Do We Need to Achieve Risk Reduction in FASD?
	References
Chapter 3: Teleost Fish as Model Animals to Understand Alcohol Teratology
	1 Introduction
		1.1 Animal Models and Fish Models
		1.2 Mechanisms of Actions of Alcohol-Induced Teratogenicity
		1.3 Central Nervous System
		1.4 Heart
		1.5 Pigments
		1.6 Defects of Craniofacial Development
		1.7 Cleft Lip and/or Palate
		1.8 Defects of the Facial Phenotype
		1.9 Lower Jaw and Teeth
	2 Concluding Remarks
	References
Chapter 4: Fetal Alcohol Spectrum Disorder as a Retinoic Acid Deficiency Syndrome
	1 Models for FASD Induction
		1.1 Alcohol Induction of Cell Death
		1.2 Increased Oxidative Stress
		1.3 Disruption of Cell Adhesion
		1.4 Alcohol Induces Abnormal Epigenetic Signatures
		1.5 Ethanol Interferes with Growth Factor Function
		1.6 Ethanol Competes with the Biosynthesis of Retinoic  Acid
	2 Xenopus Embryos to Study FASD
		2.1 Experimental Models to Study  FASD
		2.2 The Xenopus Experimental FASD Model
	3 Insights on the Etiology of FASD from Xenopus Embryos
		3.1 The Developmental Sensitivity Window for EAE Induction
		3.2 The Embryonic Organizer as a Site of Early RA Signaling in the Embryo
	4 The Involvement of Retinoic Acid in the Etiology of  FASD
		4.1 Spemann-Mangold Organizer Anomalies and Gastrulation Defects
		4.2 Anterior-Posterior Patterning and Size Defects
		4.3 Craniofacial Malformations
		4.4 Molecular Anomalies
	5 The Biochemical Competition Between Acetaldehyde and Retinaldehyde Oxidation
		5.1 Rescuing EAE by Manipulation of RA Precursors
		5.2 The RA Network During Embryogenesis
		5.3 Acetaldehyde Reduces RA Production
	6 Conclusions
		6.1 RA Reduction and Other FASD Models
		6.2 Human Diseases Attributed to Reduced RA Signaling and Resembling  FASD
	References
Chapter 5: Genetics of FASD: Confounding Rare Craniofacial and Neurodevelopmental Disorders May Identify Ethanol-Sensitizing G...
	Abbreviations
	1 Introduction
	2 Genetics of FASD
		2.1 Genes and Cell Signaling Pathways Involved in FASD
		2.2 SHH Mutations and Signaling Pathway Impairments in FASD
		2.3 WNT Mutations and Signaling Pathway Impairments in FASD
		2.4 Retinoic Acid Deficiency and Signaling Pathway Impairments in FASD
		2.5 Cholesterol Deficiency and Signaling Pathway Impairments in FASD
		2.6 Clinical Genetic Assessment of FASD
	3 Genetics of Confounding Craniofacial and Neurodevelopmental Disorders
		3.1 CHARGE Syndrome (CHD7)
		3.2 Aarskog Syndrome (FGD1)
		3.3 Smith-Lemli-Optiz Syndrome (DHCR7)
		3.4 Opitz-Kaveggia Syndrome (MED12)
		3.5 Campomelic Dysplasia (SOX9)
		3.6 Noonan Syndrome (PTPN11/SOS1, RAF1, RIT1, KRAS)
		3.7 Cornelia de Lange Syndrome (NIPBL, RAD21, SMC3, BRD4)
		3.8 22q11.2 Deletion Syndrome
	4 Genetic and Epigenetic Commonalities Among Craniofacial and Neurodevelopmental Disorders and FASD
		4.1 22q11.2DS Shares Genetic Etiologies with FASD and Other Developmental Disorders
			4.1.1 22q11.2DS Genes Are Involved in Other Rare Developmental Disorders and FASD
			4.1.2 22q11.2DS Genes Are Implicated in PAE Pathways: WNT/Ca2+, SHH, RA, and Cholesterol
		4.2 Dysregulation of RAS/MAPK Genes Is Found Among Rare Developmental Disorders and FASD
		4.3 How the Epigenetics of FASD and Rare Developmental Disorders Converge
	References
Chapter 6: Comparative Analysis of Physical Traits of Children with Fetal Alcohol Spectrum Disorders in South Africa and the U...
	1 Introduction
		1.1 The Prevalence of Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders
		1.2 The Importance of Understanding the Characteristic Physical Traits of Children with FASD
	2 Methods
		2.1 Active Case Ascertainment Sampling in First-Grade Classes of Entire Communities
		2.2 The Examination and Diagnostic Process
		2.3 Statistical Analysis
	3 Results
		3.1 Children with FASD in the South African Studies
		3.2 Children with FASD in the US Studies
		3.3 Comparing Children with FAS from South Africa and the  USA
		3.4 Comparing Children with PFAS from South Africa and the  USA
		3.5 Comparing Children with ARND from South Africa and the  USA
		3.6 Quantity of Alcohol Consumption and Likelihood of an FASD Birth
		3.7 Trimester of Alcohol Consumption and Likelihood of an FASD Birth
	4 Discussion
		4.1 Meaningful Variables of Difference Within Each Population
		4.2 Dysmorphology Assessment Plays a Vitally Important Role in All FASD Diagnoses
		4.3 Alcohol Is the Determining Factor in Most Within- and Between-Population Diagnoses
	5 Conclusion
	References
Chapter 7: Approach to Managing Behavior in FASD
	1 Understanding Self-Regulation and Behavior
	2 Understanding Behavior Through Functional Domains
	3 Cognitive and Behavioral Challenges Across the Life Span
		3.1 Infancy
		3.2 Preschool Age
		3.3 School Age
		3.4 Adolescents and Adults
	4 Best Practice Behavioral Management for Improved Outcomes
		4.1 The Diagnostic ``Road Map´´
		4.2 Consider Caregiver Stress
	5 Understand Common Comorbid Disorders
		5.1 Common Medical Conditions
		5.2 Contributing Social Factors
	6 Behavioral Management Approaches
		6.1 Self-Regulation and ADHD
		6.2 Mood Dysregulation and Mental Health
		6.3 Cognitive, Executive Functioning, and Memory
		6.4 Social Adaptive Functioning
	7 Medication Management
	8 Additional Supports for Individuals and Caregivers
	9 Conclusions
	References
Chapter 8: Fetal Alcohol Spectrum Disorder and the Corrections System
	1 Introduction
	2 Methods
		2.1 Prevalence
		2.2 FASD Diagnostic Criteria: We Need Change
		2.3 Exposure Assessment
		2.4 Multipotentiality of Causation
		2.5 Diagnosis of FASD
		2.6 Thinking About Our Current Diagnostic Criteria
		2.7 Secondary Disabilities
		2.8 Developmental Disabilities and People in Corrections
		2.9 Costs of FASD
		2.10 Women in Corrections
		2.11 Screening
		2.12 A New Approach
	3 Conclusion
	References
Chapter 9: Development and Utility of a National Database of Individuals Exposed Prenatally to Alcohol
	1 Introduction
	2 Methods
	3 Notes
	References
Chapter 10: Nutrition Intervention as a Preventative Approach to Fetal Alcohol Spectrum Disorder
	1 Introduction
	2 Alcohol and Nutrients
		2.1 Vitamin A
		2.2 Vitamin  E
		2.3 Vitamin  C
		2.4 Thiamin
		2.5 Folate
		2.6 Choline
		2.7 Iron
		2.8 Selenium
		2.9 Zinc
		2.10 Docosahexaenoic Acid
	3 Further Considerations
	4 Conclusion
	References
Chapter 11: Alcohol Use Screening in Pregnant and Childbearing Aged Women: Practices and Implications
	1 Introduction
		1.1 Global Trends of Alcohol Use Among Women of Childbearing  Age
		1.2 Global Trends of Alcohol Use During Pregnancy
		1.3 Minimizing Disease Burden from Alcohol and Preventing Alcohol Use in Pregnancy
		1.4 Alcohol Use Screening
	2 Screening Strategies
		2.1 Level 1: Clinician-Directed Questions in Health-Care Encounters
		2.2 Level 2: Validated Alcohol Use Assessment Tools
		2.3 Level 3: Laboratory Tests to Screen for Alcohol  Use
	3 Improving Prenatal Alcohol Use Screening Practices
		3.1 Understanding Risk Factors of Prenatal Alcohol  Use
		3.2 Prenatal Care Provider Practices
		3.3 Understanding the Impacts of Stigma and Discrimination
		3.4 Screening Pregnant Women as a Pathway for Interventions
	4 Conclusions
	References
Chapter 12: Dental Signatures as a Potential Biomarker of FASD
	1 Introduction
	2 Association Between Midline Craniofacial and Neurodevelopmental Malformations in FASD
	3 Developmental Origins of Midline Craniofacial and Dental Malformations in Individuals with FASD: Assessing Developmental Pat...
		3.1 Shh Mutations and Signaling Pathway Impairments in FASD
		3.2 Cholesterol Deficiency and Signaling Pathway Impairments in FASD
		3.3 Retinoic Acid Deficiency and Signaling Pathway Impairments in FASD
		3.4 Wnt Mutations and Signaling Pathway Impairments in FASD
	4 Incidence of Dental Signatures in FASD
	5 Rationale to Use Dental (Oral) Signatures as a Potential Biomarker of FASD
	References
Chapter 13: Fetal Alcohol Spectrum Disorder in Australia: From Fiction to Fact and to the Future
	1 Introduction
	2 Epidemiology of FASD in Australia
	3 FASD in High-Risk Groups
	Case Study 1: The Lililwan Project: Aboriginal Communities Leading the Way
	Case Study 2: The Banksia Hill Study: Recognizing FASD in Juvenile Detention
	4 Health Professionals´ Knowledge, Attitudes, and Practice Regarding FASD
	5 Models of Care and Interventions for FASD
	Case Study 3: FASD New South Wales and the CICADA Service
	6 Prevalence of Alcohol Use in Pregnancy
	7 Harms from Prenatal Alcohol Exposure
	8 Impacts on Families
	9 Women´s Knowledge, Attitudes, and Practice Regarding Alcohol Use in Pregnancy
	10 Managing Alcohol Use in Pregnancy
	11 Alcohol Policy to Minimize Harms in Pregnancy
	12 Government Commitment to Address FASD
	Case Study 4: The FASD Hub Australia
	Case Study 5: National Awareness Campaign: Every Moment Matters
	13 Impacts of Research and Future Directions
	References
Chapter 14: Fetal Alcohol Spectrum Disorder: Challenges in Adulthood
	1 Overview of FASD Diagnosis in Adulthood
	2 Physical Health Issues and Neurocognitive Profile of FASD in Adulthood
		2.1 Physical Health Issues
		2.2 Neurocognitive Profile
	3 Affect Regulation and Mental Health in Adults with FASD
		3.1 Affect Regulation Deficits in FASD Diagnosis
		3.2 Framework for Assessment of Affect Regulation in FASD
			3.2.1 Case Study
	4 Summary and Future Directions
	References
Chapter 15: FASD in the UK: Challenges, Changes, and Opportunities
	1 Historical Background
	2 The NHS and Devolution
	3 A Neurodevelopmental Perspective
	4 Not All FASD
	5 Ruling in and Ruling Out
	6 Hub and Spoke
	7 Opportunities and Developments and Challenges
	8 NICE
	9 Service
	10 Research Collaboratives and Research Growth
	11 Treatments
	12 Future
	References
Chapter 16: FASD and Children in Care: Lessons Learned from Research and Practice in Manitoba
	1 Introduction
	2 Context
	3 Aging Out of Care: A Time of Great Risk for Youth in Care with FASD
	4 Manitoba FASD Resources and Child Welfare
		4.1 Child Welfare and FASD Services and Programs
		4.2 Indigenous Children and Families with Disabilities and the Evolving Child Welfare Practice Context
		4.3 Health, Social, and Economic Costs of CIC with FASD
		4.4 Evolving Social Structural Changes in Child Welfare Programs and Services
		4.5 Children in Care with FASD Youth Criminal Justice System
		4.6 Manitoba Resources for Assisting Children and Youth Involved with Child Welfare and the Criminal Justice Program
		4.7 Youth with FASD the Court and Youth Justice System
	5 Lessons Learned from Practice and Research Relating CIC and CJS
	6 Conclusions and General Lessons Learned from Practice and Research
	References
Chapter 17: Reflections from Manitoba: Supporting the Healing Journey
	1 Introduction
	2 Methods
	3 Periods of Evolution
		3.1 Awareness and Prevention: 1980-1996
		3.2 The Context of Women´s Lives: 1996-2007
		Lessons Learned
		3.3 Access and Quality of Service: 2007-2014
		Lessons Learned
		3.4 Supporting the Healing Journey: 2014-2020
		Lessons Learned
		Lessons Learned
		3.5 Considerations for Moving Forward: 2021 and Beyond
			3.5.1 Listening and Partnering Effectively with Those Impacted by FASD
			3.5.2 Discontinuing the Use of the Words ``FASD Prevention´´ and the Diagnostic Term ``FASD´´
			3.5.3 Alcohol Policy
	4 Conclusion
	References
Index