Alcohol Related Neurodevelopmental Disorder

I attended the Research-to-Practice Seminar on the topic on Foetal Alcohol Spectrum Disorder a few days ago. Professor Elizabeth Elliott AM, Professor Paediatrics & Child Health, Children’s Hospital Westmead gave a wonderful overview of the research on this disorder.

                                                                     Elizabeth Elliott and Jack Dikian 2013

Given the level of alcohol related problems reported in the media in recent years Prof Elliott fittingly discussed aspects of FASD framed against a broader societal issues involving alcohol consumption.

Concerns have surrounded the consumption of alcohol during pregnancy since biblical times. However research and academic interest in the teratogenic effects of alcohol on the developing embryo is relatively recent. Since Jones first described Fetal Alcohol Syndrome (FAS) in the 1970s considerable interest and conflicting evidence have emerged in the areas of FAS and its less severe form, Fetal Alcohol Effects (FAE) or Alcohol Related Neurodevelopmental Disorder (ARND).

The diagnosis of Fetal Alcohol Syndrome is based on a set of criteria comprised of abnormalities in three main categories: growth retardation, characteristic facial features, and central nervous system anomalies (including intellectual impairment). The intellectual impairment associated with FAS is permanent and FAS is now regarded as the leading, preventable cause of non- genetic intellectual handicap.

Fetal Alcohol Syndrome A Literature Review - Prepared for the National Expert Advisory Committee on Alcohol By Colleen O’Leary can be found below:

http://www.health.gov.au/internet/alcohol/publishing.nsf/Content/746BAD892492B586CA2572610010C29A/$File/fetalcsyn.pdf

Insult to the brain caused by alcohol

I attended the Research-to-Practice Seminar on the topic on Foetal Alcohol Spectrum Disorder (FASD) a few days ago. Professor Elizabeth Elliott AM, Professor Paediatrics & Child Health, Children’s Hospital Westmead gave a great overview of the topic and research on this disorder.

Given the level of alcohol related problems reported in the media in recent years Prof Elliott fittingly discussed aspects of FASD framed in part against broader societal issues involving alcohol consumption.

We know risks associated with the consumption of alcohol during pregnancy are not insignificant. Kenneth Lyon Jones and David W. Smith in 1973 first described facies and facial features (including microcephaly small palpebral fissures, a flat nasal bridge, a smooth or indistinct philtrum, a thinned upper lip, and flattening of the midface).

Insult to the brain caused by alcohol can also include epi-canthal folds, as well as low-set or mildly malformed ears. Fetal alcohol syndrome more generally reflects the way in which alcohol affects central nervous system development, as well as the growth of the heart, eyes, legs, arms, teeth, ears, palate, and external genitalia.

Kids and school-age children may have problems with learning, low tolerance for frustration, inadequate social boundaries and difficulty reading. Teenagers can have continuous learning problems, depression, anxiety and inappropriate sexual behaviour.

At the same time I've been pondering over whether we as a society consume more alcohol now than say 10 years ago? And does this corelate with harm?

In Sydney, a day hardly goes by if we don't hear reports about another alcohol-related incident (often violent) – does it follow that if a population drinks more, then there are more heavy drinkers and therefore there is more harm from alcohol. Similarly if a population drinks less, is there less harm?

An assumption has been the overarching link between levels of alcohol consumption in a population and rates of harm - something that has been demonstrated repeatedly. So when per-capita alcohol consumption goes up, rates of alcohol problems go up with them.

Recently, however, these trends have begun to diverge in a number of places. In Sweden, per-capita consumption of alcohol has fallen in the last five years; while harm rates have remained fairly stable. In England, harm rates have increased sharply since 2004 despite a steady decline in per-capita consumption levels. 

And a similar pattern is emerging in Australia. Over the last decade or so, data from the Australian Bureau of Statistics have shown almost no change in the amount of alcohol consumed per person in Australia. In 2000/01, it was 10.15 litres of pure alcohol, while in 2010/11 it was 9.99 litres. In contrast, rates of alcohol-related harm are increasing.

Recent studies in Victoria of both adults and young people have found sharp increases in a range of problems from alcohol. This includes rates of alcohol-related hospitalisations, presentations at emergency departments due to intoxication, late-night assaults, domestic violence involving alcohol and alcohol treatment.

And a national study of alcohol-related harm between 1995 and 2006 found increases in alcohol-related hospitalisations in all states.

Perhaps changes to population level alcohol availability particularly impact risky or marginalised drinkers, those likely to experience harm from their drinking. Studies also show heavy drinkers respond to price changes and that increasing alcohol taxes reduces death and injury.

So it may be that population-level policy solutions still make the most sense, even as population-level consumption and harm rates drift apart. There are still a lot of questions we need research to address: whose drinking is shifting and why? Are particular policy changes likely to improve or exacerbate the recent harm increases? Are there particular demographic or sub-cultural groups of the population that research and policy should be targeting?

3rd Space - The difference between happiness and pleasure

The difference between happiness and pleasure

For the last six years Dr Adam Fraser has been researching how people flourish while fulfilling some of the hardest jobs in society. This ranged from special forces soldiers, palliative care nurses, leaders, working mothers and elite athletes. His research showed the common characteristic they shared was what they did in the transitional space (the third space) between the different roles, environments and tasks that they move between.

Most of us habitually carry our mindset and emotional state from one of these activities to the next - and all too often this has negative, occasionally disastrous consequences.

For years we've been told it's getting the 'big' stuff right that gives us balance and makes us happy: the holidays, the audacious goals, the pay rises. But in our hearts we know it's really the small stuff: a great result at work, our welcome home, an absorbing conversation, a game with the kids.

The Third Space is a book about getting the small stuff right - not 'sweating' it, but making it much more rewarding, much more often. It's about using the 'Third Space' (that moment of transition between a first activity and the second that follows it), to mentally 'show up' right for whatever comes next. 

According to Fraser, the average employee is interrupted every three minutes. Twenty-eight per cent of our day is spent recovering from distractions. The challenge we face is the way we transition between tasks, roles and environments for maximized performance. Fraser refers to these roles, environments and different tasks as 'spaces'.

"We spend our day transitioning between different spaces..."

• The First Space is the role/environment/task you are in right now; namely reading this article.

• The Second Space is the role/environment/task you are transitioning into, for example, you might be about to go into a meeting, or have your professional development reviewed.

• The Third Space is the transitional space in between the First and Second - and what we do in this transitional space will determine our level of success in the Second space.