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FASD: Co morbid psychiatric conditions and psychopharmacology
Dr. Terri Erwin Assistant Professor of Psychiatry
Division of Child and Adolescent PsychiatryAssociate’s in Pediatrics
Weisskopf Child Evaluation CenterUniversity of Louisville
Louisville , KY
Central Nervous System Abnormalities
1. StructuralCerebral cortex: microcephaly, hypo plastic gyri and sulci
Cerebellum, cerebellar cortex, and hippocampus: malformations
Corpus Callosum: alterations in structure
2. Neurotrophic effects, Effects on Neurotransmitter receptors, and Effect on Signal Transduction
Central Nervous System Abnormalities/Functional
Global Cognitive or intellectual deficits representing multiple domains,(2 SD from mean), Or
Functional deficits: (1 SD from mean in 3 areas)Cognitive or developmental deficits
Executive Function deficits
Motor functioning delays
Problems with attention or hyperactivity
Poor Social Skills
Sensory or Pragmatic language problems, memory deficits
Fetal Alcohol Exposure Effects on Neurobehavior
Cognitive: FAS IQ’s often borderline range
Psychiatric/BehavioralMemory and learning impairments are common features in FAS and FASD
Verbal Learning: variety of problems with language and memory
Visual-Spatial Learning: perform poorly on tasks involving learning spatial relationships among objects
Psychiatric/Behavioral
Attention: (hallmark of prenatal alcohol exposure), Able to focus and maintain attention, but difficulty shifting attention from one task to another
Reaction time: slower less efficient information processing
Executive Function: easily distracted and impulsive; difficulty abandoning ineffective strategies when approaching problem solving tasks; respond poorly when asked to switch back and forth from identifying objects
Secondary Disabilities
These behaviors may be expressed through secondary disabilities, 6 have been recognized and assessed:
mental health issues- more than 90%
disrupted school experiences - > 60%
trouble with the law, (juvenile justice)-60%
confinement or incarceration-40%
inappropriate sexual behavior
Streissguth,A. (1997), Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Brookes Publishing. ISBN 1-55766-283-5
Psychopharmacological Considerations1. Stimulants
2. Alpha-2 adrenergic agonists
3. Antidepressants
4. Neuroleptics
5. Anti-anxiety drugs
Psychopharm - reviews
“Research based interventions for children and youth with FASD.” Child: Care, health, and development. July 2007
Literature review with 2 reviewers assessing eligibility and quality of studies, resulting in 10 studies and unable to obtain 3 studies.
Unable to use meta-analysis since studies examined different interventions and outcomes.
Studies included stimulants (Methylphenidate, Dextroamphetamine, and Pemoline) and Cognitive Control Therapy.
Studies had small samples and/or weak design and no conclusive findings.
Psychopharm“Survey med responses in children and adolescents with FAS.” Mental Health Aspects Developmental Disability. October – December 2001.
FAS, PFAS, ARND ages 3.5 to 17 years with confirmed in utero exposure.
Chart review in child development unit over prior 7 years. 22 patients with 66 med trials
Groups of meds:
1. Stimulants 63% responded well
2. Mood stabilizers 88%
3. SSRI’s 82%
4. Antipsychotics 83%
Psychopharm: ADHD and FASD
Psychopharm in Neuropsychiatric Diagnosis and Treatment. 2010.
ADHD dx 94% individuals with heavy prenatal alcohol exposure.
Some evidence ADHD in FASD is clinical subtype
Weak evidence Dextroamphetamine may be more effective than Methylphenidate.
Limited scientific evidence on effective interventions for children with FASD and ADHD.
Psychopharm: ADHD and FASD
Canadian Journal of Psychiatry. May 2002
Animal and human research
FASD + ADHD: Earlier onset of ADHDInattentive sub-type
Co morbid psychiatric, medical, and developmental
May be differential response to stimulants.
Psychopharm: FAS and ADHD
Streissguth 1997 Univ. of Washington
6 – 16 yr old with FAS + ADHD
Predicted Stimulants would improve ADHD symtoms
Mixed results
Psychopharm: Executive FunctionJournal of Canadian Academy of Child and
Adolescent psychiatry. Review of EF deficits and pharmacological management in Children and adolesents.
Executive System uses Dopamine as main neurotransmitter
Dopamine agonists (stimulants) and antagonists (neuroleptics) commonly used to tx EF
SSRI’s not very helpful
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