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Section 9
The Impact of FASD on Mental Function

Question 9 | Answer Booklet | Table of Contents

Fetal Alcohol Syndrome (FASD) is a set of specific birth defects caused by maternal alcohol consumption during pregnancy. Scientists first identified the syndrome in France in 1968 (Lemoine et al. 1968) and in the United States in 1973 (Jones et al. 1973). Today, FASD is considered the most common nonhereditary cause of mental retardation. Estimates of FASD prevalence vary from 0.5 to 3.0 per 1,000 live births in most populations, with much higher rates occurring in some communities (Stratton et al. 1996).

At birth, children with FASD are recognizable by their apparent growth deficiency and characteristic minor facial anomalies (i.e., craniofacial abnormalities) that tend to become less noticeable and adopt a more normal appearance as the child matures. Less evident at birth--but far more devastating to FASD children and their families--are the lifelong effects of alcohol-induced damage to the developing brain. In addition to deficits in general intellectual functioning, persons with FASD often demonstrate difficulties with learning, memory, problem-solving, and attention as well as difficulties with mental health and social interactions.

However, the diagnosis of FASD identifies only a relatively small proportion of children affected by alcohol exposure before birth. Many children with significant prenatal alcohol exposure lack the characteristic facial defects and growth deficiency of FASD but still have serious alcohol-induced mental impairments. This condition is referred to as "alcohol-related neurodevelopmental disorder" (ARND). In addition, some prenatally exposed children without FASD facial features exhibit other alcohol-related physical abnormalities of the skeleton and certain organ systems; these anomalies are referred to as alcohol-related birth defects (ARBD).

Effects on Mental Health and Psychosocial Behavior
Both the psychosocial and psychiatric effects of prenatal alcohol exposure also profoundly influence the lives of alcohol-exposed children and their families. Impaired social functioning disturbed behaviors, and psychiatric disorders are common in people with FASD. These problems, which can occur with or without mental retardation and persist into adulthood, often disrupt daily life and magnify other FASD-related problems.

Mental Health
In a large study of secondary disabilities in persons of various ages with FASD or FAE, 94 percent of the participants had a history of mental health problems (Streissguth et al. 1996). Attention deficits were the most frequent problems in children and adolescents and occurred in 61 percent of the subjects. Among adults, depression was the most frequently reported problem (52 percent). Other studies found that preschool and school-aged children prenatally exposed to alcohol showed behaviors characteristic of people with autism, such as impairments in social interaction and communication.

Psychosocial Behavior
Other studies have indicated additional impairments in social abilities and psychological functioning in alcohol-exposed children. For example, compared with control children, children prenatally exposed to alcohol had greater problems with respect to anxiety, social skills, and academic achievement; significantly higher scores on scales measuring behavioral problems, such as anxiety, depression, and attention problems; and more deficits in social skills, such as manners and interactions with others. The differences in social skills were greater at older ages, indicating that social skills developed more slowly in the FASD children.

Issues in FASD Prevention
Unlike most other birth defects, FASD has the potential to be entirely preventable, because its direct cause--maternal drinking--is presumed to be a controllable behavior. Although many strategies to prevent FASD have been developed and implemented in recent years, an intensifying need exists for effective prevention strategies. One study found that although alcohol use among pregnant women decreased between 1988 and 1992 (from 22.5 to 9.5 percent), by 1995 it had increased to 15.3 percent (Ebrahim et al. 1998). Moreover, binge drinking (defined in the study as five or more drinks per occasion) among pregnant women, a particularly hazardous drinking pattern in terms of FASD risk, increased significantly between 1991 and 1995 (from 0.7 to 2.9 percent of pregnant women) (Ebrahim et al. 1999). In addition, little is known about the patterns of drinking by pregnant women; the social and psychological risk factors associated with drinking during pregnancy and the birth of FASD children; or the processes by which drinking, particularly heavy drinking, by pregnant women can be prevented. Consequently, the generation of a solid research base to guide prevention program developers is critical.
- Prenatal Exposure to Alcohol; Alcohol Research & Health; 2000; Vol. 24, Issue 1

Personal Reflection Exercise #2
The preceding section contained information regarding the impact of FASD on mental functioning.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 9
What are four psychosocial components that are significantly impacted by prenatal alcohol exposure? To select and enter your answer go to Answer Booklet.


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