FASD and Early Intervention
Jo Nanson, Ph. D.
What happens after screening?
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If an infant is found to be positive for
prenatal exposure to alcohol of other
drugs, what could happen next?
Assumption that all exposed infants are at
risk
Unless there is population-based
screening, this assumption is unproven
Relationship between exposure and
affectedness
 Prenatal screening is too new to have any
data yet on the relationship between
exposure and affectedness
 Until there is population-based screening
and follow up, the relationship is unknown
 Using screening in high risk situations only
gives false perspective on this relationship
Early Intervention
 Early intervention programs in general
provide for three groups of children:
 Those at known risk (e.g. Down syndrome,
FAS, etc.)
 Those at biological risk (e. g. Very low birth
weight, term asphyxia)
 Those at social risk (low income, mental
illness of the parent)
Early Intervention
 No data on early intervention in FASD
 Animal research suggests that other brain
structures and function are improved
following early intervention is alcohol
exposed animals
 In other groups, early intervention is very
effective in reducing handicapping
conditions
Early Intervention
 More is better
 Center based programs generally have
better outcome than home based programs
 More intensive programs have better
outcome
 Sleeper effects: early intervention is
powerful prevention for juvenile delinquency
 Few of the youth I see from the courts have
had early intervention
Remediation of prenatal alcohol
effects
Number of slips
Female Rat Performance on Parallel Bars
IC
5
*
*
5
RC
SC
GC
*
3
3
1
1
2
3
4
5
6
AE
2
3
4
5
6
Intrarod Distance (cm)
Klintsova AY., 1998
Early Intervention after maternal
screening
 Unless FAS is diagnosed at birth, after a
positive maternal screen, offering early
intervention assumes that the child is at
environmental risk.
 There is tendency to assume that these
children will be apprehended from the birth
mother
Guiding Principles
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Hope
Respect
Understanding
Compassion
Cooperation
Screening and Child Protection
 It is not clear that child protection authorities
would always intervene if a maternal screen
were positive
 Not clear that there are resources to cope if
every positive screen were turned over to
child protection
Screening and Child Protection
 Relationship between health care system
and child protection in dealing with positive
test results is not clear
 Should Child Protection be able to request
screening?
 Should test results be disclosed without
consent?
 Should screening occur without consent?
Screening and Child Protection
 Debates are currently under way regarding
the ethics of disclosing pap screening
results to the Cancer Clinic
 Using Health data to track school
attendance
 Implementation of new federal and
provincial legislation
Early Intervention Options
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Healthy and Home
Follows all neonatal discharges
Uses nurses and lactation consultants
See a variety of home situations
Can refer to other programs
Limited time of follow up
Early Intervention Options
 Kids First
 Only sees children from high risk areas of
the community, based on income levels
 Uses a variety of staff
 Works only with high risk families
 Can follow children for a longer time
Early Intervention Options
 Early Childhood Intervention Programs
 Long history of working with a variety of
children from all risk groups, starting with
infants
 Sees any child referred regardless of
income
 Can follow for a long time
 Has a waiting list
Early Intervention Options
 Head Start
 Available to aboriginal children on and off
reserve
 Only covers a limited number of children
 Does not start with infants
Early Intervention Options
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Parent aids
Works directly in the home
Works on variety of parenting skills
Focus on the parent not the infant
Can follow for a long time
Often seen as an adversary by high risk
parent.
Early Intervention Options
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Out of home care
Extended family is preferred to foster care
Often difficult to monitor
Goal is always to return the child home, yet
little is done to maintain the parent-child
relationship
 Foster families and biological parents often
have adversarial relationships
Early Intervention Options
 Out of home care
 Saskatchewan lacks options for fostering
families as opposed to children
 Foster families are not seen as a resource
to the biological family, or vice versa
 Saskatchewan lacks family centered
addiction treatment
Early Intervention Options
 Early intervention may provide secondary
prevention by encouraging parents to delay
or prevent future pregnancies
 May encourage parents to seek drug and
alcohol treatment
Summary
 Relationship between exposure and
affectedness is unclear
 Ethical issues remain to be resolved
 Relationship between health care and child
protection is tenuous
Summary
 Early intervention likely reduces the effects
of prenatal alcohol exposure
 May help the parent to develop a healthier
life style before the next pregnancy is
attempted
 May help parents to space or limit
pregnancies to the ones they really want
 Every child should be a wanted child !