Fetal Alcohol
Spectrum Disorders
Fetal Alcohol Syndrome
Fetal Alcohol Effects
Alcohol-Related Neurodevelopmental Disorder
Alcohol-Related Birth Defects
Fetal Alcohol Spectrum
Disorders
“ (FASD) is an umbrella term describing the
range of effects that can occur in an individual
whose mother drank alcohol during pregnancy.
These effects may include physical, mental,
behavioral, and/or learning disabilities with
possible lifelong implications.”
National Organization on Fetal Alcohol Syndrome terminology, 2004
FASD History
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Thoughts and concerns regarding alcohol consumption’s
effects on procreation or pregnancy are not new (centuries
old), though reportedly different1,2
First ‘official’ documentation in 1899
Breakthrough in 1960’s and 1970’s:
In 1968 Dr. Paul Lemoine studied 127 children with
features and symptoms related to prenatal alcohol
exposure
 In 1970’s further study in Seattle termed the condition
“fetal alcohol syndrome”

\Source: Clarren, Sterling K. Recognition of Fetal Alcohol Syndrome. JAMA. 1981;245(23):2436-2439. doi: 10.1001/jama.1981.03310480052033
2Abel, Ernest L.. "Was the Fetal Alcohol Syndrome Recognized by the Greeks and Romans?." Alcohol and Alcoholism 34.6 (1999): 868-872. Was the Fetal
Alcohol Syndrome Recognized by the Greeks and Romans?. Web. 20 Feb. 2014.
FASD Prevalence

Approximated

Among United States births:
<
10 in 100,000 born with HIV
 1 in 700 born with Down Syndrome
 6 in 1000 born with Fetal Alcohol Spectrum
Disorder
 Morgan Fawcett (YouTube,
Source: Centers for Disease Control
0-1:55)
Fetal Alcohol Syndrome (FAS)
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Affects .2-1.5 babies per 1000 (CDC)
FAS is the leading cause of intellectual delay
FAS is the leading cause of birth defects
Caused by a mother’s heavy drinking during pregnancy

Central nervous system (brain, spinal cord) damage
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
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Environmental issues complicate the condition
Many FAS-affected children in foster care

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Untreated, this primary disability can lead to secondary disabilities
Prevalence: 60 out of 1000*
FAS is irreversible
*Lange, Shannon, Kevin Shield, Jurgen Rehm, and Svetlana Popova. "Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Settings: A Metaanalysis." Pediatrics 142.4 (2013): e980-e995. Pediatrics.org. Web. 7 Nov. 2013.
Four Fetal Alcohol Syndrome
Criteria
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Growth problems
Specific facial features
Central nervous system damage or dysfunction
Prenatal alcohol exposure
4-Digit Diagnostic Code (WA State Diagnostic &
Prevention Network)
Growth Problems
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Growth retardation
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Bone growth - prenatally and postnatally
Height
Weight
Head circumference
Heart malformations
Low Birth Weight
Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrumdisorders/slideshow/585/#4
FAS Physical Characteristics
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Facial characteristics
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Small head
Small eyes
Large cheeks
Thin upper lip
Flat nose
Clinical presentation (AAFP, 2005)
Vision Issues
Source: Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcohol-spectrumdisorders/slideshow/585/#2
Fetal Alcohol Syndrome (FAS) Cognitive
Characteristics
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Learning differences

Visual-spatial learning

Objects on table (remembered, not placed correctly)
Slower reaction times (eye movements - geometric patterns)
 Difficulty planning, organizing


Difficulty letting go of problem-solving strategies, even when they do not
work
 Memory deficits
 Early stages, rather than recall (different from Down’s Syndrome)
• Attention deficits
May be misdiagnosed ADHD
 May focus and maintain attention well, but shift attention poorly

Source: NIAAA, Alcohol Alert, December 2000
Brain Size
Source: The Clinical Advisor. Fetal Alcohol Spectrum Disorders. http://www.clinicaladvisor.com/fetal-alcoholspectrum-disorders/slideshow/585/#1
Fetal Alcohol
Syndrome
Vignettes
(Fetal Alcohol Syndrome, National Academies Press:1996. Page 54)
http://books.nap.edu/books/0309052920/html/54.html#pagetop
Fetal Alcohol Effects (FAE)
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Those affected with prenatal alcohol exposure
Those without all the symptoms of FAS
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Growth deficiencies
Behavior problems
Substance abuse
Cognitive deficits
Some facial features
FAE now known as two diagnoses: Alcohol-Related
Neurodevelopmental Disorder, Alcohol-Related Birth
Defects
Alcohol-Related
Neurodevelopmental Disorder

Issues related to nervous system:
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Communication problems
Memory problems
Learning differences
Visual & spatial skill problems
Problems with motor skills
Alcohol-Related Birth Defects
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Defects in major organ systems:


Abnormal development
Underdevelopment
Heart
 Kidneys
 Eyes, ears
 Skeleton

Is Any Amount of Alcohol
Considered Safe?


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There is no “safe” amount of alcohol consumption (Chart: MN
Department of Health)
Most physicians will recommend pregnant women abstain from
alcohol consumption
According to American Pregnancy Association:
2-4 drinks, frequently, can lead to FAE
 5-6 drinks, frequently, can lead to FAS


According to Fetal Alcohol Syndrome (Institute of Medicine;
National Academies Press: 1996, p. 68)
Effects of mild alcohol intake are controversial
 Existing research suggests alcohol bingeing related to
FAS


Experiment in Alaska bars (NBC, 2014)
Protective Factors
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Early diagnosis
Special education
Social services
Nurturing environment
Absence of violence
(National Center on Birth Defects and
Developmental Disabilities)
Early Intervention
Common Issues Among FAS Babies
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Sleep disturbances
Poor sucking response
Crying
Underdevelopment
Toilet training challenges
Distractibility, difficulty following directions
Disobedience
Source: Teresa Kellerman, Coordinator, FAS Resource Center
Screening


In September 2012, American Academy of
Pediatrics recommended all children be screened
for Fetal Alcohol Syndrome
At Emory University, Experts Try New Approach
to Treating Fetal Alcohol Syndrome (CBS
Atlanta, September 2012)
Affected Individuals
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Randy (ARND)
Matt (FAS)
Stefanie (FAS)
Sinja (FAS; English child living in Germany)
The Story of Iyal (YouTube, 3:49)
FAS: Real People
Fetal Alcohol Syndrome: A
Biological Basis (Youtube.com)
Resources
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Fetal Alcohol Syndrome Diagnostic and
Prevention Network (UW), 206-598-0555
National Organization on Fetal Alcohol
Syndrome Washington State (Mill Creek), 206940-2832
Fetal Alcohol Drug Unit (UW), 206-543-7155