Fetal Alcohol Spectrum Disorders
“The largest cause of brain injury in children is prenatal exposure to alcohol. Often the neurological damage goes undiagnosed, but not unpunished.”
Fetal alcohol syndrome (FAS) is characterized by brain dysfunction, a specified set of minor facial features and growth deficiency, which occur as a consequence of alcohol exposure in gestation.
While FAS is believed to occur in approximately 1-3 per 1000 live births in North America, gestational alcohol exposure produces birth defects, and a wider range of abnormalities than those seen in FAS alone. This larger group, which includes several diagnostic subgroups, is collectively referred to as the fetal alcohol spectrum disorder (FASD). It is estimated that FASD occurs as frequently as one in every 100 live births with the costs for care estimated at $2M per year, making it a public health problem of epidemic proportions.
The brain is the principal target organ for alcohol teratogenesis; this is by far the most common and serious effect of FASD. Animal experimentation has demonstrated that alcohol most commonly produces small neurochemical and structural changes throughout the brain, rather than gross malformations. In humans, these changes frequently go undetected until the child reaches an age when normal functions should be maturing, but appear impaired. The consequences of alcohol exposure manifest in a wide variety of mild to moderate brain dysfunctions in processes, such as memory, executive function, social communication, attention span, irregular patterns in intelligence test sub skills, and motor and sensory differences. Childhood depression, anxiety, and other mental health conditions are also common: these could be a result of either primary brain alterations or may be secondary to the neurobehavioral / neurobiological alterations that occur. The combination of these functional deficits leads to severe adaptive problems at home, at school or work, and in society.
“In order to prevent brain damage, it is essential to be able to detect that the brain is being threatened before the damage becomes permanent.”
Cerebral palsy (CP) is the most common physical impairment encountered in pediatrics, occurring at a frequency of approximately 2-2.5 per 1000 live births in developed countries. Despite advances in preventing and treating certain causes of CP, the percentage of babies who develop the condition has remained the same over the past 30 years (6). Recent estimates suggest the increased cost per case of CP is roughly $1.5 million Canadian over a lifetime. This estimate does not take into account the considerable personal, familial, and societal burdens attached to a diagnosis of CP.
CP is an extremely complex disorder: in addition to its essential core of early onset objective neuromotor impairment, it frequently features various additional co-morbidities such as epilepsy, cognitive limitations, sensory (auditory, visual, tactile) impairments, behavioral disorders, feeding difficulties, and musculo-skeletal complications (such as scoliosis). Thus, individuals with CP often require access to multidisciplinary specialized medical care, as well as educational and social support services.
Autism Spectrum Disorders
“Research costs less than a ‘band-aid’ therapy and will save and improve lives. ASC (Autism Society Canada) estimates that lifetime assistance costs can be cut by 50% with: early diagnosis; effective early treatment; adequate family supports.”
Autism is the prototypic form of what is more broadly referred to as the ‘autism spectrum disorders’ (ASD): a group of disorders that share common characteristics, such as impairments in socialization and communication, and repetitive interests and behaviours. These disorders differ in developmental course, symptom pattern, and cognitive and language abilities. ASD subtypes include Asperger Syndrome (AS), which is characterized by less severe cognitive and language handicaps; and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS), which is characterized by sub-threshold symptoms and/or later onset. Collectively, ASD is among the most common developmental disorders, with a prevalence of about one in 150 . There has been a several-fold increase in the estimated prevalence of ASD over the past 20 years, from less than one in 1000 to 3-4 in 1000. When all ASD subtypes are included, estimated prevalence increases to 6-11 in 1000 . Consequently, over 52,000 Canadian children and youth under the age of 20, as well as many older adults, are affected by ASD. The frequency and burden of suffering (including extraordinary levels of family stress), and cumulative societal costs, associated with ASD argue for concerted efforts aimed at improving outcomes for these individuals and their families.
ASD profoundly affects all aspects of daily life. Difficulties with communication and coping with novel situations and minor changes in routine lead to extreme distress and behavioural dysregulation. These behaviours negatively influence the child’s social and learning opportunities, and create extraordinary challenges for parents, who often find themselves increasingly isolated and unable to participate in community activities as a family. Not surprisingly, autism is associated with extreme levels of family stress, considerably higher than for other disabilities, such as Down syndrome , non-specific mental retardation, and chronic physical disorders such as epilepsy. Along with mental stress, raising a child with ASD is associated with a very high economic costs, including special education, social services, and lost employment, half of which are borne directly by parents. One study in the UK found that the lifetime costs associated with a person diagnosed with ASD “exceeded £2.4 million”, or 4.4 million CAD.
References from original document not included.