From her work in community health, forensic psychiatry, and private practice, Dr.
References Introduction Maternal alcohol use during pregnancy contributes to a range of effects in exposed children, including hyperactivity and attention problems, learning and memory deficits, and problems with social and emotional development. Fetal Alcohol Syndrome The most serious consequence of maternal drinking during pregnancy is fetal alcohol syndrome FAS.
FAS was first described in the United States by Jones and Smithwho identified a distinctive set of facial anomalies—short eyelid openings palpebral fissuresflat midface, thin upper lip, and a flat or smooth groove between nose and upper lip philtrum —in children whose mothers drank very heavily during pregnancy.
In contrast with Down syndrome patients, who exhibit Prenatal alcohol exposure in virtually all aspects of intellectual function, FAS patients often perform relatively well on language tests e.
The most consistent deficits are in arithmetic Streissguth et al. In one such study, FAS children had reading scores similar to those of IQ—matched control subjects, but they performed significantly less well on arithmetic and certain aspects of attention e.
In an attempt to increase precision in diagnosis, an Institute of Medicine panel has recommended distinguishing among three forms of FAE Stratton et al.
Although reduced IQ scores are not usually found Goldschmidt et al. That is, the most consistent deficits are in arithmetic Goldschmidt et al.
The following sections examine in more detail the cognitive and behavioral effects of prenatal exposure to alcohol. Although hyperactivity has been reported in several studies of clinic patients Steinhausen et al.
These authors suggest that studies drawing participants from medical and psychiatric referrals, in contrast with longitudinal samples such as their own, may be more likely to include patients living in unstable family situations. As a result, the hyperactivity reported in studies of clinic—referred patients may have been caused by social and environmental factors, such as co—occurring attachment disorders, anxiety, and post—traumatic stress disorder.
Clinic—referred samples may also be affected by selection bias. For example, FAS children who are also hyperactive are more likely to be referred for treatment because their behavior is disruptive in family and school settings.
Sustained attention, which refers to the ability to remain alert and focused over time, is usually assessed by timed vigilance or continuous performance tests. In these tests, a series of letters is displayed on a computer screen and the child presses a button whenever a predesignated target stimulus appears.
For example, Carmichael Olson and colleagues found poorer performance with increased prenatal alcohol exposure on a serial reaction time task, which requires remembering motor patterns of keystrokes on a computer, and on a timed reading comprehension test.
As another example, Nanson and Hiscock found more errors among alcohol—exposed children than control subjects on a delayed reaction time test. These results demonstrate deficits primarily on sustained attention tasks that also require active recall of information or response inhibition, suggesting impairment in executive function rather than sustained attention per se.
Thus, the focused attention deficit associated with prenatal alcohol exposure appears to be less severe than in ADHD. Cognitive flexibility refers to the ability to attend to multiple criteria simultaneously and to shift attention during a task.
FAS has been linked to poor cognitive flexibility on tests of verbal fluency in which the child is asked to list as many words as possible from a given category Kodituwakku et al. Reduced cognitive flexibility has also been found among FAS children on a design fluency test Schonfeld et al.
After the child utilizes the correct criterion for 10 successive trials, the criterion is changed. Poorer executive function has also been found in studies that tested children exposed to alcohol primarily at levels associated with ARND.
These studies used the Stepping Stone Maze Streissguth et al. Kerns and colleagues reported that, although nonretarded adults with FAS found it difficult to memorize word lists on the California Verbal Learning Test CVLTthey had little apparent difficulty in retaining what they learned.
Some of the words on the second list come from the first list; others do not. Although both the alcohol—exposed and Down syndrome children performed more poorly than control subjects when asked to recall a list of words they had seen without any prompting or priming, the alcohol—exposed children performed as well as the control children in recognizing those words when presented in a multiple—choice format and when given the clues provided in the priming task.
Thus, the learning and memory impairment associated with prenatal alcohol exposure is apparently more circumscribed than that associated with Down syndrome.
Retention and recognition memory are relatively intact, as is the capacity to benefit from priming. Thus, their procedural memory was apparently not affected. Memory deficits have also been reported in children exposed at levels associated with ARND.
Among 7—year—olds, greater prenatal alcohol exposure was associated with poorer memory for designs Streissguth et al. However, greater prenatal alcohol exposure was associated with slower, less efficient information processing at 6.
Socioemotional Function Prenatal alcohol exposure is associated with increased levels of irritability during infancy Coles et al.
The Vineland scores of the alcohol—exposed children were significantly lower than those of the IQ—matched control subjects, especially in the interpersonal skills domain, providing additional evidence that the social judgment and relationship problems exhibited by these children are not simply consequences of their intellectual limitations.Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy.
Fetal alcohol syndrome causes brain damage and growth problems.
The problems caused by fetal alcohol syndrome vary from child to child, but defects caused by fetal alcohol syndrome are not reversible.
Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is a newly proposed mental health diagnosis associated with the teratogenic effects of in utero exposure to alcohol.
The regions of the brain that are most seriously affected by prenatal alcohol exposure in terms of ability to function are: Frontal Lobes - this area controls impulses and judgment.
The most noteworthy damage to the brain probably occurs in the prefrontal cortex, which controls what are called the Executive Functions. no exposure to alcohol prenatal exposure to alcohol Photo courtesy of Sterling Clarren, MD Alcohol is a teratogen (substance that is toxic to the baby's developing brain).
Prenatal alcohol exposure can also affect the brain, causing developmental delays and behavioral problems. Delays may express themselves as learning disabilities, attention deficit/hyperactivity disorder, problems with language and memory, or mental retardation.
Prenatal alcohol exposure: Confirmed or Unknown prenatal alcohol exposure; Fetal alcohol syndrome (FAS) is the first diagnosable condition of FASD that was discovered.
FAS is the only expression of FASD that has garnered consensus among experts to become an official ICD-9 and ICD diagnosis.