Cognition and Behavior
Notes from Presentation by Ann Streissguth. Ph.D
Elements of Success: Helping Individuals with FASD and Co-occurring Disorders
Dumas Bay Retreat Center – FAS*FRI Conference
September 25, 2007
*****Need to read Seattle Prospective Study on psychiatric disorders with FASD over 25 years (Am J
Psychiatry)
“The brain is the most vulnerable organ affected by prenatal alcohol exposure.”
Riley and Driscoll’s study in 1990 showed that the behaviors that we see in children with a history of prenatal
exposure to alcohol are the same as those seen in animals exposed to prenatal alcohol, so we know these effects
are caused by alcohol independent of environmental factors. There are reports that show evidence of alcohol
effects in monkeys and fruit flies. Someone stated that a study with spiders exposed to different substances,
where alcohol had the most adverse effects of all.
“FASDs are birth defects of the brain.” We set up diagnostic clinics, but we are getting the children too late,
they are missing out on the early intervention services that can make a big difference in outcome later.
Countries like Sweden that have health care for all do not have a big problem with FASD because it is dealt with
in prenatal care. In the U.S. we have more problems with FASD and we have a very high death rate for babies.
Testing: WISC, WAIS, WRAT may not show the severity of deficits in FASD. When doing the VABS on
individuals with FASD, the score is 2 standard deviations below the person’s own IQ, and even more so when
compared to general population. IE, IQ of person with FAS might be 80, and the Vineland score would be 60.
The Fetal Alcohol Behavior Scales (FABS) designed by Streissguth is based on behaviors observed in those
with a diagnosis.
Behavioral Phenotypes:

Poor Habituation (difficulty modulating incoming stimuli)
1. Becomes over stimulated in social situations
2. Over-reacts to situations with strong emotional response
3. Has mood swings set off by small things
4. Has poor attention span
5. Has trouble completing tasks

Poor cause and effect reasoning in social situations
1. Unaware of consequences of own behavior
2. Poor judgment about whom to trust
3. Interrupts with poor timing
4. Cannot take a hint
5. Wants to be the center of attention
In persons who have a diagnosis of an FASD but have a normal IQ, scores are below normal in certain attention
tests: COWAT (shifting sets), RUFF (perseveration), CVLT (free recall intrusions, adds to stories). In some
attention tests, they do well while there are no distractions, but when distractions were added, they scored 1-2
standard deviations below normal.
FASD does not fit the MR model, but it fits better with the model for Traumatic Brain Injury.
In persons with FASD, problems with Executive Functions are much worse than those with similar IQ.
Clinical Implications for Adolescents and Adults with FASD
Difficulties they have
What this means for them:
Poor judgment
Easily victimized (and then becomes victimizer)
Attention deficits
Easily distracted
Poor math skills
Cannot manage money
Memory deficits
Difficulty learning from experience
Difficulty abstracting
Cannot figure out the consequences
Disoriented in time and space
Misses social cues
Frustration tolerance
Quick to become angry
Longitudinal Study of Individuals with Prenatal Exposure to Alcohol:
Infancy outcomes show poor suck, latency in beginning to such (delayed response to nipple), poor reflexes.
Leading indicator is poor habituation to light, which is related to later learning disorders.
Bayley scales on babies at 18 months did not detect effects. This is NOT the time to test.
At 4 years of age, we can detect difficulties in areas of attention, arithmetic, processing time, latency to correct
errors, poor balance, perseverance, verbal interruptions, hypertonic (some can be hypotonic).
From age 4 to 14, behavioral differences are seen in laboratory (blind tests) in these areas: distractible,
uncooperative, rigid, seeks reassurance, disorganized, impulsive (14).
Teacher rating shows problems with cooperation, impulsivity, memory, attention, unpredictable behavior. The
same results were observed at 21 years of age.
We have failed in identification of FASD in time for early intervention to prevent secondary disabilities. We
have failed in getting relevant help when they are in the institutions and facilities when they are most vulnerable
(schools, mental health, criminal justice system). And we have failed to provide adequate services and supports
for the families caring for then.
Recommendations:
Funding for Public Health Model to initiate Neonatal Health Study to look at the corpus callosum of newborn
through fontanel ultrasound ($150, nonintrusive, mother can observe and be informed immediately to access
early intervention services). Pilot study shows ability to accurately detect FASD in half of newborns prenatally
exposed to alcohol.
States need to initiate the following:
 Residential program and transitional resources for affected individuals
 Training in Behavioral Health System
 Screening programs to identify FASD in persons getting mental health services and measure outcomes
 Screen newborns with fontanel ultrasound (described above)
 Provide services and supports to families caring for children and adults with FASD