Diagnosis

It needs to be emphasized that a definitive diagnosis of neurodevelopmental behaviors cannot be made in infants and preschoolers. Clinicians can generally make a diagnosis and distinguish causes only when medical findings exist. These can be microcephaly (abnormally small skull), seizures, or severe delays due to brain damage. In most children, the causes of observed neurodevelopmental behaviors will not be identified until the child can be given psychometric testing. Some behaviors may not be diagnosable until the child is almost ten years old. But it is very important for the child's development that alcohol related damage be identified early in life. Children identified prior to age 5 have a greatly improved chance of home and school intervention maximizing the child's potential. No treatments exist that can reverse the effects of Fetal Alcohol Syndrome.

Alcohol-Related Neurodevelopmental Disorder (ARND)

Children with ARND do not have full FAS, but may demonstrate learning and behavioral problems caused by prenatal exposure to alcohol. Alcohol related problems can manifest as changes in behavior, poor fine motor skills, difficulties with attachment, poor attention span, difficulty developing language skills, and reduced cognitive function.

Alcohol-Related Birth Defects (ARBD)

Alcohol-related birth defects can include a variety of abnormalities to the face, eyes, ears, heart, brain, kidneys, and limbs of an affected child.

• Heart -- Atrial or ventral septal defect (a hole in the heart between the atria or ventricles), truncus abnormalities (defects in the division between the ventricles), other deformities in the heart muscle
• Eyes -- Retinal vessel abnormalities, lens flaws, cornea deformities, ptosis (drooping eyelids)
• Ears -- Conductive hearing loss, low-set backward-rotated ears, auditory nerve defects
• Kidneys -- aplastic (defective function), dysplastic (abnormal growth), hypoplastic (underdeveloped)
• Skeletal -- fused bones in forearms, fingers, toes, hands

Effects

"The U.S. Public Health Service has indicated that there is no safe level of alcohol use during pregnancy. If a woman drinks while pregnant, she puts her developing fetus at risk for a wide spectrum of adverse effects including spontaneous abortion; growth retardation; physical, mental, and behavioral abnormalities; facial abnormalities; and CNS impairment, such as developmental delay, speech or language delay, lower IQ, and decreased head circumference. In the worst cases, prenatal exposure to alcohol may result in fetal death."

 Centers for Disease Control and Prevention

The exact mechanism by which alcohol damages the fetus and critical times of exposure are not known. Some studies have shown that exposure during the first trimester results in the structural defects (i.e., facial changes) characteristic of FAS. But the growth and central nervous system disturbances could occur from alcohol use during any time in pregnancy. It must also be noted that not all women who drink alcohol during pregnancy deliver a child with FAS or ARND.

While the specific mechanisms are not known, their results can be seen. Fetal brain analysis has shown that the cerebral cortex (area of the brain which coordinates sensory and motor information) in exposed children contains abnormal patterns of neuron and neurotransmitter distributions. The hippocampus (memory forming area) and cerebellum (coordinates muscles and the maintenance of bodily equilibrium) have been shown to have decreased cell numbers and altered neurochemical activity.

Studies that followed FAS children into adulthood have shown that the majority of them have difficulty leading independent lives. Many have difficulty maintaining employment and establishing stable relationships with family and friends. As the FAS children grow to adulthood, they still retain their motor skills problems, hyperactivity, and problems with learning and retention. While intervention at an early age may help the children develop coping skills and ways to work around some of their problems, there are no cures. They will always have the physical and structural damage caused by alcohol exposure while in the uterus.

>> Continue to Page 4 >>