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FASD The Course
4-Digit Diagnostic Code
The 4-Digit Diagnostic Code was developed by the Fetal Alcohol Syndrome (FAS) Diagnostic and Prevention Network at the University of Washington in response to the need to standardize criteria for the diagnosis of fetal alcohol spectrum disorders. The four digits of the diagnostic system consider the extent to which the individual presents with the four key diagnostic features of FAS or related disorders: growth retardation, facial features, brain dysfunction, and prenatal alcohol exposure. An individual receives a rank on each of these scales and a diagnostic code based on the pattern of the four rankings. Twelve different 4-digit diagnostic code patterns may indicate an FAS diagnosis. Various other patterns may indicate atypical FAS, static encephalopathy, neurobehavioral disorder, or no detected cognitive or physical findings. The 4-Digit Diagnostic Code has shown excellent consistency and reliability.
Abstinence means not drinking any alcoholic beverage, including beer, wine, and hard liquor. It is recommended that all pregnant women abstain from alcohol to avoid fetal damage.
Abstract thinking, often thought to develop around the age of 11 in normal children, includes a sense of space (microscopic space and cosmic space) and time (historical time and future time). Many individuals with a variety of disabilities have difficulty with abstract thinking. These difficulties appear to be common in those with an FASD.
Adaptive Behavior Composite Score
The Adaptive Behavior Composite Score is a measure of the person's ability to express and comprehend language, behave appropriately in interpersonal situations, understand and use social behaviors, protect him/herself, and care for him/herself, in terms of personal hygiene and domestic independence. It is measured with instruments such as the Vineland Adaptive Behavior Scales, which measure adaptive behavior in four major domains, Communication, Daily Living Skills, Socialization, and Gross Motor Skills.
Adaptive functioning refers to the ability to adjust to a situation or an environment (e.g., sitting quietly in a classroom, taking the bus) and to complete the tasks necessary in various life domains such as daily living, socialization, and communication. Individuals with an FASD often have deficits in adaptive functioning.
Addiction is a state of dependence caused by habitual use of drugs, alcohol, or other substances. It is characterized by uncontrolled craving, tolerance, and symptoms of withdrawal when access is denied. Habitual use produces changes in body chemistry, and treatment must be geared to a gradual reduction in dosage.
Services that help with the transition from a treatment facility to community living, such as housing and job support.
Affect is the subjective aspect of an emotion considered apart from bodily changes. The term is often used as a name for feeling, emotion, or mood.
Alcohol is a drink containing the substance ethanol.
Alcohol abuse is a DSM-IV diagnosis of a maladaptive pattern of substance use as shown by one or more of the following criteria, when criteria for alcohol dependence for this class of substance have never been met:
Recurrent alcohol use leading to failure to fulfill major role obligations at work, school, or home
Recurrent substance use that puts the individual in physical danger
Legal problems related to use
Adverse social and interpersonal consequences
Pregnant women meeting the criteria for alcohol abuse may be at risk of delivering a child with an FASD.
Alcohol dependence is a DSM-IV diagnosis of a maladaptive pattern of substance use as shown by three of the following criteria, noted in a 12-month period:
Withdrawal or use of alcohol to avoid withdrawal
Use in larger amounts or for longer than intended
Unsuccessful efforts to decrease or discontinue use or a persistent desire to do so
Alcohol use as a major focus of time and life
Abandonment of social, occupational, or recreational activities
Continued use despite recognized psychological or physical consequences.
Pregnant women who are alcohol dependent are at risk of delivering a child with an FASD.
Alcohol metabolism refers to the body’s process of converting ingested alcohol to other compounds. Metabolism results in some substances becoming more or less toxic than those originally ingested. Metabolism involves a number of processes, one of which is oxidation. Through oxidation, alcohol is detoxified and removed from the blood, preventing the alcohol from accumulating and destroying cells and organs. A minute amount of alcohol escapes metabolism and is excreted unchanged in the breath and in urine. Until all the alcohol consumed has been metabolized, it is distributed throughout the body, affecting the brain and other tissues. Women who have problems metabolizing alcohol may be more likely to deliver infants with an FASD.
Alcoholic Beverage Labeling Act
In 1988, the Alcoholic Beverages Labeling Act required that a federally mandated warning label be placed on all alcoholic beverages. The warning includes the following language: “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of a risk of birth defects.”
Alcoholism is a chronic, progressive, and potentially fatal disorder caused by both genetic and environmental factors. It is characterized by tolerance and physical dependence, manifested by the inability to control drinking behavior. It is often accompanied by diverse personality changes and social consequences.
Alcohol-related birth defects (ARBD)
ARBD , a term coined by the Institute of Medicine in 1996, is used to describe individuals with confirmed maternal alcohol use and one or more congenital defects, including heart, bone, kidney, vision, or hearing abnormalities.
Alcohol-related neurodevelopmental disorder (ARND)
ARND , a term coined by the Institute of Medicine in 1996, is used to describe individuals with confirmed maternal alcohol use, neurodevelopmental abnormalities, and a complex pattern of behavioral or cognitive abnormalities inconsistent with developmental level and not explained by genetic background or environment. Problems may include learning disabilities, school performance deficits, inadequate impulse control, social perceptual problems, language dysfunction, abstraction difficulties, mathematics deficiencies, and judgment, memory, and attention problems.
Attention-deficit/hyperactivity disorder (ADHD)
The essential features of ADHD are a persistent pattern of inattention or hyperactivity/impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development. Children and adolescents with an FASD often meet the diagnostic criteria for ADHD. However, they may have co-occurring ADHD, or they may exhibit symptoms that look like ADHD but are due to other difficulties, including FASD.
A behavior problem involves unusual or age-inappropriate behavior that affects the child’s social and academic functioning (e.g., unusually high or low activity, impulsivity, distractibility, aggression, poor frustration tolerance, self-regulation difficulties, social and emotional problems).
High probability of a behavior being seen in persons with a particular condition
Binge drinking generally refers to the consumption of four or more drinks in about 2 hours. Binge drinking during pregnancy can result in FASD.
Bipolar disorder, formerly known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. Bipolar disorder can cause dramatic mood swings—from overly “high” or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. It can also occur in individuals who do not have those dramatic mood swings, but rather may have some highs or lows with some alternate periods of leveling off. Severe changes in energy and behavior go along with these mood changes. The periods of highs and lows are called episodes of mania and depression. In adolescents, mania may be demonstrated by antisocial behavior rather than the euphoria often seen in adults.
A birth defect is a physical or biochemical defect (e.g., Down syndrome, FAS, cleft palate) that is present at birth and may be inherited or environmentally induced.
Blood alcohol concentration (BAC)
BAC is the amount of alcohol present in a person’s bloodstream at a given time after alcohol use. There is no known safe level of alcohol for the developing fetus.
Also called nursing, breastfeeding is the provision of breast milk to an infant directly from the breast. Some mothers choose to express breast milk into a bottle. Regardless of the method of delivery, breast milk can transmit alcohol to an infant if the mother drinks. This can affect brain development, which continues after birth.
Brief interventions are approximately one to four therapy sessions delivered to individuals with problem drinking and other problematic behaviors. The intervention may include advice to abstain from alcohol use or decrease alcohol consumption to below risk drinking levels, brief counseling, goal setting, and development of action plans.
CNS structural abnormalities
CNS structural abnormalities involve damage to the brain itself as determined through physical examination/manifestations or a brain scanning technique. They include small head size (microcephaly), seizures, or small or missing brain structures.
Individuals with an FASD often have structural brain abnormalities, particularly microcephaly, fewer basal ganglia (associated with motor activity), and small or absent corpus callosum (which carry bundles of nerve fibers that connect the right and left brain hemispheres).
In the field of substance abuse treatment, cognitive-behavioral strategies are a group of procedures that include self-management and relapse prevention strategies. They are designed to help individuals stop or reduce alcohol consumption by observing their drinking behavior, setting behavioral objectives, or training in skills to handle conflicts or stress without resorting to drinking.
The essential feature of conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms or rules are violated. These behaviors may involve aggressive conduct that causes or threatens physical harm to other people or animals, the deliberate destruction of property, deceitfulness or theft, and serious violations of rules. Some individuals with an FASD may be diagnosed with conduct disorder. This could be a co-occurring disorder for some. Others may demonstrate what looks like conduct disorder but may actually be a result of having difficulty understanding rules and requests. They may be misdiagnosed with conduct disorder.
Contraception is any means of preventing pregnancy. It is advocated for use by women who cannot or do not choose to stop consuming alcohol while pregnant in order to prevent FASD.
Co-occurring refers to the simultaneous existence of a disorder (e.g., FAS) interacting with one or more independent disorders (e.g., schizophrenia) or disabilities. The disorder/disability is of a type and severity that exacerbates the other conditions, complicates treatment, or interferes with functioning in age-appropriate social roles. In substance abuse, it is typically used to describe persons who have both mental illness and a substance abuse/dependence disorder.
Developmental disabilities are a diverse group of physical, cognitive, psychological, sensory, and speech impairments that begin any time during development up to 18 years of age.
Diagnosis is the process of determining disease status through the study of symptom patterns and the factors responsible for producing them.
Diagnostic and Statistical Manual of Mental Disorders
Published by the American Psychiatric Association in 1994, the DSM-IV is the main diagnostic reference of mental health professionals in the United States. FASD is not yet a diagnostic category in the DSM.
Dysmorphology is a term coined by the late Dr. David W. Smith for the study of human congenital malformations.
Ethnicity refers to racial, national, tribal, religious, linguistic, or cultural origin or background. Rates of FASD vary among ethnic groups. For example, some Native American populations have higher rates of FASD than the general population.
Executive function is the process or processes that enable an individual to set and reach goals by organizing, strategizing, sequencing, and sustaining behavior to achieve those goals. It helps a person to connect and apply past experience to present action.
Failure to thrive
Failure to thrive is a term used to describe children early in life who do not receive or are unable to take in or retain adequate nutrition to gain weight and grow as expected. Often, children with FAS are initially diagnosed with failure to thrive.
Fetal alcohol effects (FAE)
FAE is a term used to describe individuals exposed prenatally to alcohol who have some, but not all, of the features of FAS. These features may include developmental delay, cognitive impairments, and/or behavioral abnormalities. These individuals often have similar patterns of behavior to those with FAS but lack the characteristic facial features of FAS. FAE is a descriptive term and is not meant to be used as a diagnostic term.
Fetal alcohol spectrum disorders (FASD)
FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.
Fetal alcohol syndrome (FAS)
FAS is the term coined in the United States in 1973 by Dr. Kenneth Jones and Dr. David Smith at the University of Washington to describe individuals with documented prenatal exposure to alcohol and (1) prenatal and postnatal growth retardation, (2) characteristic facial features, and (3) central nervous system problems.
Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis
These guidelines were published in 2004 by the Centers for Disease Control and Prevention, in collaboration with the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect. They are intended to assist physicians and allied health professionals in the timely identification, referral, and diagnosis of persons with FAS. The guidelines include specific diagnostic criteria in the areas of facial dysmorphia, growth problems, central nervous system abnormalities, and maternal alcohol exposure.
Fetal hypoxia refers to low levels of oxygen during fetal development, which can cause brain damage. Prenatal alcohol exposure may cause fetal hypoxia.
A fetus is a developing being, usually from 3 months after conception until birth for humans. Prior to that time, the developing being is typically referred to as an embryo.
Frontal lobe defects
The frontal lobes of the brain are responsible for higher cognitive thought processes. These include self-control, maturity, judgment, tactfulness, and reasoning. Persons with an FASD may have frontal lobe defects that impair these abilities.
Gender-specific substance abuse treatment
A gender-specific substance abuse treatment program has specific services for one gender or is only open to a single gender (e.g., women’s residential treatment). Women with substance abuse problems generally do better in gender-specific programs.
Genetic disorders are caused by a disturbance of one gene or several genes or chromosomes. They may be inherited or caused by environmental factors. Genetic disorders may cause various diseases and disorders, such as hemophilia and mental retardation (e.g., Down syndrome).
NIAAA defines heavy drinking as four or more drinks in a day (for women) at least occasionally.
An impulse is a sudden spontaneous inclination or incitement to some usually unpremeditated action. It is a force that often produces sudden motion, which sometimes is inhibited. For example, an individual might swing at another person who bumps into him or her by accident or a child may have an impulse to run away and may run away or resist the impulse and not run away.
Impulsivity involves the failure to resist an impulse, drive, or temptation to perform an act (e.g., an angry outburst, inappropriate touching) in a situation that may be damaging to the person or others. Impulsivity can result from a number of causes.
The incidence rate is the rate at which new events occur in a population.
Indicated prevention efforts target high-risk individuals who have signs or symptoms of a condition or have biologic markers indicating predisposition. Targets of indicated prevention include women who abuse alcohol, such as women who binge drink while pregnant, particularly pregnant or preconceptional women who drink alcohol and have already given birth to children with an FASD. Substance abuse treatment for pregnant women is a form of indicated prevention.
Inherited disorders are genetic disorders caused by a genetic or chromosomal abnormality in a parent that is transmitted to a child (e.g., Fragile X syndrome). FASD cannot be inherited. However, people with an FASD can have children with an FASD if they drink during pregnancy.
Learning disabilities (LD) are identified difficulties with reading, writing, spelling, computing, or communication. LD affects people’s ability to either interpret what they see and hear or to link information from different parts of the brain. These limitations can show up in many ways, as specific difficulties with spoken and written language, coordination, self-control, or attention. Such difficulties extend to schoolwork and can impede learning to read, write, or do math.
According to current growth charts, low birthweight is a weight below 2,500 g at the time of birth. This standard may need to be revised to reflect variations among different racial and ethnic groups.
Major depressive disorder
Major depressive disorder is marked by a depressed mood or a loss of interest or pleasure in daily activities consistently for at least 2 weeks. This mood must represent a change from the person’s normal mood; social, occupational, educational, or other important functioning must also be negatively impaired by the change in mood. In children and adolescents, this mood may be demonstrated by irritability.
Mental retardation is a disorder characterized by a significantly below-average score on a test of intellectual ability and limitations in such areas as self-direction, school, work, leisure activities, daily living, and social and communication skills. About 27 percent of individuals with FAS and 9 percent with FAE meet intelligence quotient (IQ) criteria for mental retardation (70 or below).
Microcephaly is a congenital anomaly of the CNS where the head circumference is more than 3 standard deviations below the mean for age and sex.
Micrognathia is a relative term describing the small size of the lower jaw. In true micrognathia, the jaw is small enough to interfere with feeding of an infant and may require special nipples in order to feed adequately.
Motivational interviewing (MI)
MI is a structured brief intervention procedure for people with substance use problems. It includes clinician empathy and advice, feedback, establishment of client responsibility, determination of options, and encouragement of the client’s self-efficacy in changing behavior.
Neonatal abstinence syndrome (NAS)
NAS refers to withdrawal symptoms at birth among infants born with a substance such as cocaine, heroin, or alcohol in their bodies at high levels. Symptoms include tremors (trembling), irritability (excessive crying), sleep problems, high-pitched crying, tight muscle tone, hyperactive reflexes, seizures, yawning, stuffy nose and sneezing, poor feeding and suck, vomiting, diarrhea, dehydration, sweating, and fever or unstable temperature.
Oppositional defiant disorder (ODD)
Oppositional defiant disorder (ODD) is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), as a recurring pattern of negative, hostile, disobedient, and defiant behavior in a child or adolescent, lasting for at least six months without serious violation of the basic rights of others.
Palpebral fissures are eye openings. People with FAS have short palpebral fissures. The palpebral fissure is measured from the inner canthus (corner) of the eye to the outer canthus of the eye. Short palpebral fissures usually measure below –2 standard deviations for age.
In relation to births, parity refers to the number of viable pregnancies a woman has had to the 20th week, regardless of the outcome. Studies have shown that women with drinking problems and greater parity are more likely to produce offspring with FAS, particularly as maternal age increases.
Partial FAS (pFAS)
Partial FAS is a term used to describe a cluster of problems in individuals who are known to have faced significant prenatal exposure to alcohol and have some signs of FAS. These include some of the characteristic facial abnormalities associated with FAS and evidence of one other component of FAS: growth deficiency , neurodevelopmental abnormalities, or behavioral or cognitive abnormalities unexplained by family background or environment.
Perinatal pertains to events occurring after the 28th week of pregnancy through the 28th day after birth.
Perseveration involves doing the same thing over and over (e.g., repeating a motor movement, talking about one topic and not being able to change focus).
Pervasive developmental disorder
The primary features of pervasive developmental disorder are severe and pervasive impairment in the development of reciprocal social interaction. This is associated with impairment in either verbal or nonverbal communication skills or with the presence of stereotyped behavior, interests, and activities.
The philtrum is the vertical groove between the nose and the middle part of the upper lip. Individuals diagnosed with FAS have a flattening of the philtrum.
The placenta is the organ that allows nutrients and oxygen in the mother’s blood to pass to the fetus and metabolic waste and carbon dioxide from the fetus to cross in the other direction. The two blood supplies do not mix. When a mother drinks during pregnancy, the alcohol crosses the placenta to the fetus.
Prenatal care involves medical care and monitoring received during pregnancy. Prenatal care is necessary for healthy pregnancies, particularly for women with alcohol or drug issues, poor nutrition, or medical illnesses and women who take medication.
Prenatal exposure to alcohol (PEA)
PEA refers to the exposure of a fetus to alcohol through maternal drinking during pregnancy.
The prevalence of a disorder is the number of instances of the disorder in a given population at a designated time. The prevalence of FASD is estimated to be 10 per 1,000 live births.
Prevention is the protection of health through personal and communitywide efforts. FASD is 100 percent preventable if women do not drink while pregnant.
Primary disabilities are functional deficits that reflect the CNS damage inherent in FASD (e.g., low IQ, disabilities in reading and math, problems in adaptive functioning).
An individual with problem drinking has issues concerning alcohol use and may require treatment to manage the problem. Women of childbearing age who are problem drinkers require intervention to increase the chances of abstinence during pregnancy and the birth of a healthy child.
Factors that reduce risk of an adverse outcome, such as a stable home.
A psychometric test is any standardized procedure for measuring sensitivity, memory, intelligence, aptitude, personality, etc.
Reactive attachment disorder of infancy or early childhood
The essential feature of reactive attachment disorder is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 and is associated with grossly pathologic care. Children with reactive attachment disorder may be excessively inhibited, hypervigilant, or highly ambivalent in response to caregivers or may exhibit indiscriminate sociability or a lack of selectivity in the choice of attachment figures. Children with an FASD who are adopted or in foster care may be diagnosed with reactive attachment disorder; however, whether the disturbed pattern of social relating is due to brain damage or environmental causes remains unknown.
Respite care is care for an individual by a person other than the usual caregiver as a form of rest or relief for the caregiver. Respite care is an important service for caregivers of individuals with an FASD due to their high needs.
With regard to FASD, any alcohol use during pregnancy is considered risk drinking. For nonpregnant women of childbearing age, risk drinking is consuming more than three standard drinks on one occasion or more than seven standard drinks in one week. Effective screening tools are an essential part of women’s health care to assess risk drinking. Effective screening tools look at any alcohol use, along with some problem drinking patterns. These tools are typically brief, with good specificity and sensitivity. Examples are the AUDIT, AUDIT-C, TWEAK, T-ACE, 4 P’s, and CAGE.
Risk factors are traits or habits that make a person more likely to develop disease or to engage in a potentially harmful behavior. Risk factors for drinking during pregnancy include a family history of alcohol abuse and a partner who drinks heavily.
Schizophrenia is a brain disorder usually diagnosed during the teen or early adult years. In rare cases, schizophrenia is diagnosed in children. The symptoms of schizophrenia are usually divided into two categories: positive and negative. “Positive” refers to overt symptoms that should not be there, such as delusions and hallucinations. “Negative” refers to a lack of characteristics that should be there. Negative symptoms include emotional flatness, inability to start and complete tasks, brief speech that lacks content, and lack of pleasure or interest in life. Symptoms of schizophrenia may overlap with other disorders, such as bipolar disorder. Persons whose symptoms cannot be clearly categorized are sometimes diagnosed as having a “schizoaffective disorder.”
Alcohol screening is a question-based method for identifying individuals who drink alcohol, drink at risk levels, drink heavily, or have alcoholism. Alcohol screening is extremely important for pregnant women to ensure that they receive appropriate interventions to help them stop drinking. Alcohol screening is also important for all women of childbearing age to identify those drinking at levels associated with health problems. Drinking more than seven drinks per week or four or more drinks at one time in the past 30 days is associated with health problems.
Secondary disabilities are specific problems that may arise after birth in individuals with an FASD. They may be ameliorated through better understanding of the disorder, early identification, and appropriate early interventions. Secondary disabilities associated with FASD include disrupted school experiences, trouble with the law, confinement in mental health/substance abuse treatment/criminal justice facilities, inappropriate sexual behavior, substance abuse disorders, dependent living, and problems with employment.
Selective prevention targets people who are at greater risk for a particular outcome because they are members of a subgroup known to be at higher risk than the general population. Targets of selective FASD prevention include women of childbearing age who drink alcohol. Alcohol screening and brief interventions are forms of selective prevention.
The sensitivity of a screening test is the proportion of truly disordered persons in the screened population who correctly test positive.
Sensory integration is the involuntary process by which the brain assembles a picture of our environment at each moment in time using information from all of our senses. Children with learning disabilities or autism have difficulties with sensory integration.
Sensory integration (SI) dysfunction
SI dysfunction is a neurologic disorder involving the inefficient brain processing of information received through the senses. People with SI dysfunction experience problems with learning, development, and behavior.
Social perceptual problems
Problems in social perception involve the lack of awareness of the consequences of behavior, conversational deficits (e.g., interrupting, poor timing), and the inability to comprehend nonverbal communication (e.g., facial expressions and hand gestures).
Social skills training
Social skills training involves a treatment package, including modeling, behavioral rehearsal, and reinforcement used to teach individuals interpersonal competencies necessary to successfully interact with others. Social skills training is a highly promising procedure for individuals with an FASD and is being pilot tested.
Socioeconomic status (SES)
SES is an individual’s social standing or condition in society determined by both income and employment status. For example, a physician usually has a high SES.
The specificity of a screening test is the proportion of those without disease who correctly test negative.
Because alcoholic beverages vary in alcohol concentration, drinks are designated by a standard drink conversion. One standard drink is 12 ounces of beer, 4 ounces of wine, or 1 ounce of hard liquor. All have the same equivalency of 0.48 ounces of absolute alcohol.
Substance abuse treatment
Substance abuse treatment is a therapeutic program, staffed by addiction professionals, for individuals with alcohol or drug problems. It may involve inpatient or outpatient care.
Surveillance of a disorder involves ongoing monitoring of all aspects of the disorder’s occurrence and its spread pertinent to effective control. FASD surveillance through hospital discharge records, birth defect registries, studies of infants of mothers who drink, and screening of individuals at risk for an FASD in the community is used to determine the incidence and prevalence of these disorders.
Swaddling is the art of snugly wrapping a baby in a blanket for warmth and security. It can also keep babies from being disturbed by their own startle reflex, and it may help them stay warm for the first few days of life until their internal thermostat kicks in. Swaddling has been shown to calm infants and some success has been reported with infants with an FASD.
T-ACE is a screening tool for identifying pregnant women who drink alcohol or nonpregnant women that drink at risk levels. The acronym stands for:
T - Tolerance: How many drinks does it take you to feel high?
A - Annoyed: Have people annoyed you by criticizing your drinking?
C - Cut down: Have you ever felt you ought to cut down on your drinking?
E - Eye-Opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
The tolerance question is scored as 2 points if the respondent reports needing more than two drinks to get high. This threshold can be reduced to 2 or more drinks when screening pregnant women. This will increase the number of women who drink any alcohol. A positive response to A, C, or E is scored as 1 point each. A score of 2 or more indicates likely drinking during pregnancy. The T-ACE has been found to be effective in identifying pregnant women who drink alcohol.
A teratogen is any substance, such as alcohol, or condition, such as measles, that can cause damage to a fetus, resulting in deformed fetal structures. Alcohol causes birth defects and brain damage, resulting in neurobehavioral problems in exposed offspring.
TWEAK is a screening tool for identifying pregnant women with alcohol problems. The acronym stands for:
T - Tolerance: How many drinks can you hold?
W - Have close friends or relatives Worried or complained about your drinking in the past?
E - Eye-Opener: Do you sometimes take a drink in the morning?
A - Amnesia: Has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?
K(c) - Do you sometimes feel the need to Cut Down on your drinking?
On the tolerance question, 2 points are given if a woman reports that she can consume more than 5 drinks without falling asleep or passing out. A positive response to the worry question yields 2 points and positive responses to the last three questions yield 1 point each. A score of 2 signals an at-risk drinker. TWEAK has been found to be highly sensitive in identifying women who are at-risk drinkers.
Universal prevention strives to ensure that all members of society understand that a behavior, such as drinking alcohol during pregnancy, can have hazardous consequences. Mass media campaigns to the general public over radio and TV are examples of universal prevention.
Withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of an addictive substance such as alcohol after chronic or prolonged ingestion. People who have withdrawal symptoms after stopping alcohol use may have problems with alcohol dependence.
Using The Course