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Section 11
Hope for FASD Diagnosis and Treatment

Question 11 | Answer Booklet | Table of Contents

In all societies, men drink more than women; in recent decades, however, that gap has narrowed. The Institute for Alcohol Studies in Britain recently reported that 13% of female drinkers are drinking over the recommended limit of 14 units of alcohol per week, while 2% are drinking at very high levels of over 35 units per week. That 15% total compares to 8% of women who were drinking over the recommended limits in the late 1980s. At highest risk are lone parents with children, those who live in urban rather than rural areas and those who have less contact with relatives or neighbours. In North America, the greatest increase in alcohol use in the 1990s was among college-educated Caucasian women, unmarried or students, with a household income greater than $50,000 a year. The number of women who drank during pregnancy jumped from 10% in 1992 to 15.3% in 1995, according to Obstetrics and Gynecology (August 1998), despite warning labels on alcoholic beverages and public education programs.

Experts blame increased drinking for women on the fact that it is now a more socially acceptable and expected activity. The advertising industry has, in recent years, targeted the growth market of women drinkers, and has been criticized for portraying alcohol as fashionable and glamorous, used by women who are independent, fun-loving and desirable.

Horrific lifetime odds
Among children with FAE: 95% will have mental health problems 68% will have "disrupted school experience" 68% will experience trouble with the law 55% will be confined in prison, drug or alcohol treatment centres or mental institutions 52% will exhibit "inappropriate sexual behaviour" 50% of males and 70% of females will have alcohol and drug problems 82% will not be able to live independently 70% will have problems with employment.
(Children with full FASD-lower IQs and a distinctive appearance-actually tend to do better in life because they receive earlier diagnoses and can be better protected by their parents and society.)

FASD Research Points to Encouraging Possibilities
The National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, is working on promising research for preventing and diagnosing FASD. Program administrator Laurie Foutin cautions that most experimentation is still in the preliminary stages on animal models, but says it bodes well for future application to humans.

1. Pregnant rats given vitamin E along with alcohol give birth to pups which appear normal. Scientists theorize that ethanol (alcohol) may be causing the formation of free radicals at levels that damage cells in the developing brain, and the antioxidant, vitamin E, may be removing them. (Told of this discovery, Alberta's Minister of Children's Services, former RN Iris Evans, replied enthusiastically, "Perhaps we could get all the young women buying contraception to take vitamin E.")

2. As the brain develops, peptides (amino acid compounds) help cells to make proper connections so that parts of the brain can interact. Ethanol inhibits growth, while peptides stimulate further growth. Injecting two synthetic peptides into the bloodstream of a pregnant mouse restores normal growth, not only to the fetus' brain, but also to its body.

3. Since many women are reluctant to reveal heavy drinking during pregnancy, in order to determine if a baby has been exposed to alcohol, specialists can now analyze the meconium (first stool) for fatty acid ethyl esters. A positive test does not mean the child has FASD, but does act as a "biomarker for exposure," indicating the child should be followed during early development and not overlooked.

4. A special hearing test measures brain-stem response. If there are abnormalities, the baby can be referred for intensive follow-up.

5. Eyeblink conditioning-pairing a tone with a puff of air on the eye-can train a small child or animal to blink before the puff. Rats prenatally exposed to alcohol are impaired in that response.

6. Studies are examining magnetic resonance imaging to determine which regions of the brain are not affected so those can be reinforced and capitalized upon.

7. Past research has determined that steady practice in acrobatic skills involving balance and coordination like walking rope bridges and narrow beams stimulates growth of new synapses in the cerebellum, dramatically improving the ability to perform new motor tasks. Now Professor Charles Goodlett of Indiana University has found that in rats, synapses can be created in other parts of the brain, including the cerebral cortex. This governs memory, attention, and even control of behaviour-all deficits for those with FASD/FAE. He has reported at scientific meetings that there is clear evidence that the effects of prenatal exposure to alcohol are not immutable. "People are not completely condemned to a lifetime of certain behaviours, although they may be limited," he states. He recommends challenging the intellect as much as possible by providing complex new tasks like learning to play a musical instrument, increasing the complexity daily, while understanding that positive change may take months.

8. Michael Thomas, Ph.D. at the University of New Mexico recommends hide-and-seek and puzzles for young children, and for older children, games which require thinking of two concepts simultaneously, such as number games in which the child remembers three numbers, then says them backward or repeats the second or third one back. "This requires that they store what was required, as well as the string of numbers," Thomas explains. For those in Grades 1 or 2, "anything involving several different items like colours, numbers, shapes; for example, putting the right-coloured object in the right-shaped hole." It is also very important, he stresses, for parents to educate teachers in techniques they have found effective with their children.
- McLean, Candis; The Fetal Alcohol Crisis; Report/Newsmagazine (BC Edition); 2000; Vol. 27, Issue 10.

Personal Reflection Exercise #4
The preceding section contained information regarding encouraging FASD diagnosis and treatment related findings.  Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
Fetal alcohol spectrum disorder resources for health
professionals: a scoping review protocol

- Okurame, J. C., Cannon, L., Carter, E., Thomas, S., Elliott, E. J., & Rice, L. J. (2022). Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol. BMJ open, 12(9), e065327. https://doi.org/10.1136/bmjopen-2022-065327

Peer-Reviewed Journal Article References:
Acuff, S. F., Soltis, K. E., Dennhardt, A. A., Borsari, B., Martens, M. P., Witkiewitz, K., & Murphy, J. G. (2019). Temporal precedence of self-regulation over depression and alcohol problems: Support for a model of self-regulatory failure. Psychology of Addictive Behaviors, 33(7), 603–615.

Key, K. D., Ceremony, H. N., & Vaughn, A. A. (2019). Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma and Health, 4(2), 196–203.

Marceau, K., Rolan, E., Leve, L. D., Ganiban, J. M., Reiss, D., Shaw, D. S., Natsuaki, M. N., Egger, H. L., & Neiderhiser, J. M. (2019). Parenting and prenatal risk as moderators of genetic influences on conduct problems during middle childhood. Developmental Psychology, 55(6), 1164–1181.

QUESTION 11
What types of activities should older children with FASD engage in? To select and enter your answer go to Answer Booklet.