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Substance Abuse and
Substance Abuse and
Child Welfare
Child Welfare
Making decisions in the best
Making decisions in the best
interest of the child…
interest of the child…
Mark W. Weston, MA, LPC
Mark W. Weston, MA, LPC

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Research Triangle, 2
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Fetal
Fetal
Alcohol
Alcohol
Syndrome
Syndrome

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Research Triangle, 2
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Fetal Alcohol Syndrome
Fetal Alcohol Syndrome
“
“
The offspring of alcoholics have been found
The offspring of alcoholics have been found
defective not because of alcoholism of the

defective not because of alcoholism of the
parents but because the parents themselves
parents but because the parents themselves
came from a defective stock.” (Journal
came from a defective stock.” (Journal
American Medical Association, 132:419, 1946).
American Medical Association, 132:419, 1946).

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Research Triangle, 2
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Fetal Alcohol Syndrome
Fetal Alcohol Syndrome

Low birth weight
Low birth weight

Central nervous system effects
Central nervous system effects

Facial dysmorphology
Facial dysmorphology

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Research Triangle, 2
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Fetal Alcohol Syndrome:
Fetal Alcohol Syndrome:
The Older Child
The Older Child


Poor growth, weight gain
Poor growth, weight gain

Central nervous system effects
Central nervous system effects

Facial dysmorphology
Facial dysmorphology

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Diagnostic Criteria
Diagnostic Criteria
I.
I.
Growth retardation
Growth retardation
II.
II.
Facial malformations (>1): short palpebral fissures, thin
Facial malformations (>1): short palpebral fissures, thin
upper lip, flat elongated philtrum, hypoplastic midface
upper lip, flat elongated philtrum, hypoplastic midface
III.
III.
Neurodevelopmental disorder
Neurodevelopmental disorder
FAS

FAS
Confirmed
Confirmed
or
or
unconfirmed
unconfirmed
history of prenatal alcohol exposure
history of prenatal alcohol exposure
Meets criteria in all three categories: I, II, III
Meets criteria in all three categories: I, II, III
ARND
ARND
Confirmed
Confirmed
history of prenatal alcohol exposure
history of prenatal alcohol exposure
Meets criteria in III
Meets criteria in III
NIAAA
NIAAA

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FASD
FASD
Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders

“
“
an umbrella term describing the range of effects that can
an umbrella term describing the range of effects that can
occur in an individual whose mother drank during
occur in an individual whose mother drank during
pregnancy. These effects may include physical,
pregnancy. These effects may include physical,
mental, behavioral, and/or learning disabilities with
mental, behavioral, and/or learning disabilities with
possible lifelong implications.”
possible lifelong implications.”
Bertrand et al, 2004
Bertrand et al, 2004

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Research Triangle, 2
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Epicanthal foldsfolds
Flat nasal bridge
Low set ears
Flat philtrum
Receding jawThin upper lip
Short, upturned nose
Flattened midface
Short palpebral
fissures
Microcephaly

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Risk Factors
Risk Factors

Dose of alcohol
Dose of alcohol

Pattern of exposure - binge vs chronic
Pattern of exposure - binge vs chronic

Developmental timing of exposure
Developmental timing of exposure

Genetic variation
Genetic variation

Maternal characteristics
Maternal characteristics

Interaction with nutritional variables
Interaction with nutritional variables

Synergistic reactions with other drugs
Synergistic reactions with other drugs

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Research Triangle, 2
006