What are FASD, FAS, Partial FAS and ARND?    


Fetal Alcohol Spectrum Disorders (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. An individual would not receive a diagnosis of FASD. Diagnoses like FAS, partial FAS and ARND fall under the umbrella of FASD. Each year, as many as 40,000 babies are born with FASD, costing the Nation about $4 billion.

Fetal Alcohol Syndrome (FAS) is a birth defect syndrome caused by maternal alcohol consumption during pregnancy. FAS is characterized by:

  • growth deficiency (height or weight < 10th percentile).
  • a unique cluster of minor facial anomalies (small eyes, smooth philtrum, thin upper lip).
  • central nervous system damage (structural, neurological, and/or functional impairment).
  • prenatal alcohol exposure.

The prevalence of FAS is estimated to be 1 to 3 per 1,000 live births. This is roughly equivalent to the prevalence of down syndrome. FAS is the leading known cause of mental retardation and developmental disabilities and is entirely preventable.

Partial FAS is a diagnostic classification for patients who present with:

  • most, but not all, of the growth deficiency and/or facial features of FAS.
  • central nervous system damage (structural, neurological, and/or functional impairment).
  • prenatal alcohol exposure.

Alcohol Related Neurodevelopmental Disorders (ARND) is a diagnostic classification, coined by the Institute of Medicine in 1996, for patients who present with:

  • central nervous system damage (structural, neurological, and/or functional impairment).
  • prenatal alcohol exposure.

Fetal Alcohol Effects (FAE) was a term, introduced in 1978, that was used to describe abnormalities seen in individuals that were compatible with those caused by prenatal alcohol exposure, but the pattern was not sufficiently complete to render a diagnosis of FAS. FAE was rapidly adopted as a medical diagnostic term. In 1995, Aase et. al. published a paper expressing concern about the clinical validity of the term FAE. The term implied a causal association between prenatal alcohol exposure and abnormalities observed in an individual patient that could not be confirmed. With the likely exception of the full FAS facial phenotype, no other physical anomalies or cognitive/behavioral disabilities observed in an individual with prenatal alcohol exposure are necessarily specific to (caused only by) their prenatal alcohol exposure. Features such as microcephaly, neurological abnormalities, attention deficit, mental retardation, and growth deficiency frequently occur in individuals with prenatal alcohol exposure, and frequently occur in individuals with no prenatal alcohol exposure. Aase et al (1995) wrote "We propose abandoning the clinical use of the term FAE with its implications of causation, and urge simple recording of the verifiable conclusions concerning the individual patient."

The FASD 4-Digit Diagnostic Code does not use the terms ARND and FAE because, as clearly expressed by Aase et al., (1995), they imply alcohol exposure caused the neurodevelopmental disorder or effect. The 4-Digit Code avoids this problem by using diagnostic terms that report the patient was exposed to prenatal alcohol rather than reporting the patient's outcomes are alcohol effects or alcohol-related outcomes. As recommended by Aase et al., (1995) "If prenatal alcohol exposure has taken place, but FAS cannot be substantiated, the exposure still should be indicated, and any nonspecific abnormalities or problems noted." The 4-Digit Diagnostic Code uses the following two terms in lieu of ARND or FAE.

Static encephalopathy (alcohol exposed). The term "encephalopathy" refers to "any significant abnormal condition of the structure or function of brain tissues" (Anderson, 2002). The term "static" means that the abnormality in the brain is unchanging; neither progressing nor regressing. This diagnostic classification is for patients who present with:

  • central nervous system damage (structural, neurological, and/or significant functional abnormalities).
  • prenatal alcohol exposure.

Neurobehavioral Disorder (alcohol exposed) is a diagnostic outcome classification for patients who present with:

  • central nervous system dysfunction (mild functional impairment with no evidence of structural or neurological abnormalities).
  • prenatal alcohol exposure .

 

Outcomes such as ARND, Static Encephalopathy (alcohol exposed), and Neurobehavioral Disorder (alcohol exposed) are far more prevalent than FAS or partial FAS.

In general, the central nervous system damage/dysfunction observed in individuals with ARND or Static Encephalopathy (alcohol exposed) are frequently as severe as those observed in individuals with FAS.

 

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