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Fetal Alcohol Syndrome
(FAS) is the name given to a group of physical and mental defects
caused by fetal exposure to alcohol in the womb. This condition
is caused by alcohol use during pregnancy—when a pregnant
woman drinks alcohol, it passes through the placenta* and is
absorbed by the unborn baby. The alcohol can harm the embryo**
and fetus even if the mother feels no effects.1
*The placenta is a disk-shaped
organ formed at the onset of pregnancy. It is attached to the
wall of the uterus and is connected to the fetus by the umbilical
cord where nourishment passes to the baby. However, toxins and
other substances such as alcohol can pass through the membrane
to become ingested by the developing baby as well.
**The embryo is the developing
organism from the moment of conception to the end of the second
month of pregnancy.
The Guidelines of Care for Children
with Special Health Care Needs, Minnesota Department of Health
(at website http://www.mofas.org/guidelines/whatFAS.htm)
describes FAS as a condition affecting a mother’s offspring
in the following ways:
 Physical, mental and behavioral abnormalities
Most children with FAS will have different
facial features
Most will have problems with growth
Permanent brain injury frequently occurs
FAS affects each child differently
as the Minnesota Department of Health Guidelines further describe
the characteristics as follows:
“Not all children with
FAS are alike. The effects of alcohol use during pregnancy will
vary. Some children are more severely affected than others. Some
show more of the reasoning and behavioral problems than the physical
features. Some have a normal IQ while others do not. Many will
have learning disabilities. Each child will have his or her special
needs, problems and potential.” 2
Fetal Alcohol Effects:
Some children affected by alcohol in the womb are diagnosed with
Fetal Alcohol Effects (FAE) because they do not have all the
features of FAS. For example, they may have the following characteristics:
Normal growth and a more normal appearance
More likely to have a normal IQ than
a child with FAS
Similar to an FAS-affected child, can
have mild to severe problems with reasoning, behavior and learning
Although it has been known for centuries that exposing a fetus
to alcohol can adversely affect its physical and mental development,
the term FAS was officially introduced to the world in 1973 by
a group of doctors in Seattle, Washington. These doctors noted
a pattern of malformations in newly born offspring of mothers
known to have consumed alcohol during pregnancy. The major difference
between FAS and other syndromes, such as Down’s Syndrome,
is that it is 100 per cent preventable – if a fetus is not
exposed to alcohol in the womb, there is no risk of acquiring
this condition.
FAS is the most common cause of defective cerebral (pertaining
to the brain) development in industrialized nations. Research
suggests that psychosocial factors such as stress, anxiety, social
interactions, and maternal attitude towards pregnancy may also
affect reproductive
outcomes.3 According to Health Canada, the estimated
rate of FAS in industrialized countries is 3 out of every 1,000
live births. On the other hand, studies in Native communities
are limited and show alarmingly high rates of incidence.4
A study published by the Canadian Medical Journal states that
one Aboriginal community reported an FAS rate of 1 out of every
10 births!5 Note that this figure does not necessarily
present a picture of the incidence of FAS in all Native communities
in Canada. It is believed that each community is unique and that
there are pockets of high incidence within the Aboriginal population
in Canada.
Characteristics:
Dr. Nora Setton, a specialist in Pediatrics and Neonatology (care
for the newborn), explains the signs and symptoms related to
this exposure:
“In newborns and children, we note anomalies (abnormalities)
that affect pre-and post-natal growth (in and out of the womb),
such as the development of characteristic facial features and
long-term neurological (entire system of nerve tissue in the
body that includes the brain, brainstem, spinal cord, and nerves)
development.”
Dr. Setton further explains that such babies are born with growth
retardation in the womb, often weighing less than 2.5 kg (approximately
5 lbs.) and this growth retardation carries on into childhood
and adult life. The following describes the general characteristics
of FAS/E, keeping in mind that these appear in different degrees
in affected individuals. It appears that the amount of alcohol
consumed, patterns of drinking (e.g. moderate to heavy; binge
drinking), and the point at which alcohol was consumed during
fetal growth all become factors in the degree that a person is
affected.
General Characteristics:
Facial abnormalities are slight but clearly associated with
alcohol consumption. These include narrower slits between the
eyelids, drooping eyelids, poorly developed eyelashes, small
upturned nose, absence of vermilion (red pigment) lip border,
as well as a very thin upper lip. In addition, other physical
abnormalities may include cardiac, ear, and/or eye malformations.
Neurological abnormalities are related to the nervous system and
may include an abnormally small head in newborns, minor cerebral
(portion of the brain where thought and higher function reside)
deformities, and weak muscle tone. They have difficulties with
coordination and concentration and may suffer from hyperactivity.
FAS is one of the most frequent causes of mental retardation
(after Down’s Syndrome).
Cognitive disorders, which are disturbances in the mental
processes related to thinking, reasoning and judgment, affect
many intellectual activities. These include difficulty with cause
and effect, comprehension, and not having a concept of time and
space.
Characteristics by Age Group:
There are a great variety of characteristics found in children
affected by FAS/E. It must be stressed that the developmental
problems associated with this condition can be helped by early
and supportive intervention.
The following lists are characteristics of FAS and other alcohol-related
effects in different age groups. These lists have been obtained
from the Ministry of Children and Family Development, Government
of British Columbia at the Web address:
http://www.mcf.gov.bc.ca/child_protection/fas/fas2c.htm).
Take note that this inventory is not exhaustive, but there are
many places for parents to go to for more information. For example,
The FAS Support Network of British Columbia has prepared booklets
(called the FASNET Assessment Tools) that contain detailed listings
of the range of problems that may affect those with FAS.
Infants:
Small size and slow development
Sleeping difficulties
Feeding difficulties
Easily over-stimulated, sensitive to
noise and light
Birth defects such as heart problems,
kidney problems, tumors
and skeletal anomalies
Susceptibility to infections
Pre-school Aged Children:
Small physique
Delays in development of speech, poor
articulation, slow development of vocabulary and sentence patterns
Poor judgment – difficulty in recognizing
danger
Difficulty following directions
Destructive behavior and tantrums
Distractibility, hyperactivity
Over-friendliness – lack of fear
of strangers
Poor coordination, poor motor skills,
clumsiness
Lack of impulse control and emotional
over-reaction
Overly tactile (likes to touch persons
and things)
Elementary School Aged Children:
Small physique
Intellectual impairment and learning
disability (but many have normal
intelligence)
Delayed language and speech
development
School problems – particularly
difficulties
in reading, math, spelling, problem
solving and comprehension
Memory difficulties – both in registering
and retrieving information
Impaired reasoning from cause to effect
Difficulty predicting and understanding
consequences
Difficulty separating fact from fantasy
Temper tantrums, lying, stealing and
defiance
Poor motor coordination
Attention deficit and hyperactivity
Adaptive and social behavior difficulties
– over-friendliness, need for physical
contact, easily influenced, immaturity,
problems with changes in routines,
difficulty with choices and life skills,
appearing capable but not having the
actual abilities
Adolescents and Young Adults:
Some catch up in growth
Intellectual impairment and low level
of academic achievement
More pronounced difficulties with impulsiveness
Poor ability to generalize (e.g. taking
a situation and applying it to
something else)
Poor ability to anticipate and respond
to consequences
Difficulty in organizational skills and
logic
Poor motivation, passivity (does not
respond assertively)
Tendency to lie, cheat and steal
Difficulty in setting and recognizing
boundaries (e.g. that can lead to inappropriate sexual behavior)
Easily misled
Difficulty in understanding and responding
to others’ feelings or needs
Low self-esteem and depression
Susceptibility to suicide, drug and alcohol
misuse, unplanned parenthood, physical and sexual abuse, legal
problems
Difficulty in independent living and
in getting and keeping a job
Secondary disabilities:
Secondary disabilities are those that a person with FAS or FAE
is not born with and that could probably be improved through
better understanding and practical help.1
According to the State of Alaska FAS Website, “These disabilities
arise when needs go unmet for children with alcohol-related birth
defects.”2
In 1996, Dr. Anne Streissguth, a leading researcher and expert
on FAS/E, studied such ‘secondary disabilities’ in
415 patients between the ages of 6 and 51 years old. She identified
the following impacts that FAS/E had on these patients’
lives:
Mental health problems
Disrupted school experience (e.g. suspension,
expulsion or drop-out for those 12 years and older)
Trouble with the law (12 and older)
Confinement (in-patient treatment or
imprisonment by those 12 and older)
Inappropriate sexual behavior (12 and
older)
Alcohol and drug use problems (12 and
older)
Needing dependent living situations (21
and older)
Problems with employment (21 and older)
Universal Protective Factors:
Can anything be done to lessen these problems?
Dr. Streissguth’s study reports that yes, these issues can
be minimized if they are addressed early on and in a consistent
manner. In fact, the study identified the following eight helpful
actions, referring to them as ‘universal protective factors’:
Living in a stable, nurturing home for
over
72 per cent of life
Being diagnosed before the age of 6
Never having experienced violence against
oneself
Staying in each living situation for
an
average of more than 2.8 years
Experiencing a good quality home from
age
6 to 12
Having applied for and been found eligible
for governmental disability services/benefits
Having a diagnosis of FAS rather than
FAE
Having basic needs met for at least
13 per cent of
life
Bibliography
1 What is FAS/FAE? Guidelines, Minnesota
Department of Health 1999: http://www.mofas.org/guidelines/whatFAS.htm
(25 September 2001).
2 What is FAS/FAE? Guidelines of Care
for Children with Special Health Care Needs: http://www.mofas.org/guidelines/whatFAS.htm
(24 September 2001).
3 Conference Proceedings: Interdisciplinary
Approach to the Management of FAS and FAE. Red Deer, AB, November
1 & 2, 1994; http://www.ccsa.ca/fasresrc.htm#F1
(13 September 2001).
4 It Takes a Community: A Resource Manual
for Community-based Prevention of Fetal Alcohol Syndrome and
Fetal Alcohol Effects, Health Canada, 1997.
5 CMAJ, Fetal Alcohol Syndrome Epidemic
on Manitoba Reserve, July 1, 1997, http://www.cma.ca/cmaj/vol-157/issue-1/0059.htm
(13 September 2001).
6 Streissguth, Ann, Helen Barr, Julia
Kogan, and Fred Bookstein. Understanding the Occurrence of Secondary
Disabilities in Clients with FAS and FAE. University of Washington
School of Medicine, Dept. of Psychiatry and Behavioral Sciences.
7 State of Alaska: Dept of Health &
Social Services FAS Website. http://health.hss.state.ak/us/fas/disabil.html
(22 September 2001). |
