Fetal Alcohol Spectrum Disorder
Fetal alcohol spectrum disorders (FASD) are a group of conditions that can occur in a person whose mother consumed alcohol during pregnancy. FASD is the most common cause of brain damage before birth (called congenital neurological deficits) and is related to alcohol intake by the mother during pregnancy. Alcohol intake during pregnancy causes a wide range of damage to an unborn child and results in many different disorders. The degree of damage varies according to the amount of alcohol consumed and the particular time during the pregnancy that the alcohol was consumed. Other factors such as maternal nutrition also contribute to the variation in the effects on the baby. A pattern of binge drinking is considered the most damaging (large amounts of alcohol consumed rapidly). In the first trimester of pregnancy, alcohol interferes with the organization of brain cells. Weeks 3-8 of fetal development are considered to be an especially critical period for brain damage from alcohol exposure. Exposure to heavy drinking between the 10th and 20th week is most likely to cause the physical features. In the third trimester the baby's hippocampus (a small, curved formation in the brain that plays an important role in the limbic system) is affected. The limbic system is associated with a number of functions including the sense of smell, behavior, learning, long-term memory, emotions, and drives. When the limbic system is affected, it can lead to learning problems, such as difficulties with reading and math. Comprehension, money and time concepts, emotional maturity and social skills are the areas where development is typically most affected. Children are easily influenced by others and can be vulnerable to victimization. However, they are typically very verbal, and may have good long-term visual memory. Their positive characteristics need to be identified and used to build programs for their long-term skill development and behavior management.
Mild damage is described as fetal alcohol effect (FAE). Mild damage will include decreased intellectual function, visual problems, and high pain tolerance. Most children will be shorter and lighter than average for their ages.
About 85% of children with fetal alcohol spectrum disorder have characteristic facial features (wide-set eyes, thin upper lip, flat nasal philtrum, small head size called microcephaly). The degree of facial involvement does not correlate with the degree of brain dysfunction for the child, making the hidden effects of alcohol exposure the most damaging to the child, long-term. About 20-50% of alcohol-exposed children will have other physical conditions such as cleft lip and palate, heart defects, immune problems, epilepsy, cerebral palsy, renal damage or heart failure. Other children do not have characteristic facial features but have significant brain damage affecting their intellectual function and judgment. Most children with prenatal alcohol exposure will have limited life skills regarding relationships and decision-making. Mental illness is common, including depression, withdrawal, isolation and unpredictable behavior.
Some researchers divide the physical features of fetal alcohol spectrum disorder into three categories: 1) Fetal Alcohol Syndrome (FAS) where children have all the facial characteristics of prenatal alcohol exposure; 2) Partial Fetal Alcohol Syndrome (PFAS) with only partial facial characteristics; and, 3) Alcohol-Related Neurodevelopmental Disorder (ARND) with little facial deformity. Regardless of the terminology, fetal exposure to alcohol has a very serious effect on the developing brain, and its effects continue throughout life.
Some preliminary research shows that the father's alcohol use may also affect the unborn child's intellectual and social development.
Prevalence of alcohol-related conditions is very hard to estimate, though some statistics indicate that up to 20% of children have been exposed to alcohol prenatally. In some countries that rate of exposure may be much higher (in Russia, for example). Because not all children demonstrate the facial features, it is under-diagnosed. Perhaps 60% of individuals in penitentiaries were exposed to alcohol before birth, according to some studies. Epidemiologic studies in the US estimate an overall incidence of 1 in 500 live births, occurring in 2-6 births per 1000 Caucasians, 6 per 1000 African-Americans, and up to 20 per 1000 American Indians.
There is no treatment for fetal alcohol syndrome effects, but intervention during the early childhood years is crucial to assist the child in as many ways as possible to develop social, life and educational skills. Drawing on the child's strengths and setting small achievable goals will be a good starting point in parenting and teaching children who have had alcohol exposure. Assessment by an interdisciplinary team experienced in caring for children with the disorder will be very helpful, and referral to home-based programs sponsored by school districts is indicated. Social workers, psychologists and speech/language therapists can collaborate with teachers and parents to design an Individual Education Plan (IEP). Working together to find out what motivates the child, setting achievable goals and consistently rewarding good behavior can be effective.
Resources for reliable information and support for parents are available online:
- Proof Alliance (formerly MOFAS)
- Fetal Alcohol Syndrome Consultation, Education and Training Services (FASCETS)
- CDC: Fetal Alcohol Spectrum Disorders (FASDs)