Citation: Burd, L, Cotsonas-Hassler, T.M., Martsolf, J.T., & Kerbeshian, J. (2003). Recognition and management of fetal alcohol syndrome. Neurotoxicology and Teratology, 25, 681-688.
Report Type: Review
Conclusion: The magnitude of the cost of persons prenatally exposed to alcohol calls for the establishment of state-wide systems of prevention, diagnosis, and management of this disability, coordinated by a FAS task force. Such a system would include: developmental assessment clinics; community treatment programs for women at-risk; early intervention for affected children; and service delivery systems for affected adults. The prevention of just few cases of FAS would more than outweigh the costs associated with establishing such a system.
Summary: The authors review the current knowledge-base on FASD, providing information on: prevalence and costs; the impact of ethanol on the developing fetus; maternal risk factors and screening/diagnostic tools; management/intervention of persons with FAS; and approaches to prevention. Tables provide overviews of: secondary disabilities; protective factors; treatment program components; developmental management models based on age; and neuropsychological areas of impairment. The financial cost of FAS is emphasized, and serves as a justification for establishing statewide systems to address assessment, treatment, and prevention incorporating a long-term system of care. Because a relatively small number of women may be responsible for the majority of children affected by prenatal alcohol exposure, efforts should include: identification of those women most at-risk; education; increasing accessibility of substance abuse treatment programs; and providing support to women at-risk in their daily living environments. A possible FAS Screening tool is provided.
Implications: The costs associated with taking a long-term system of care approach to prenatal alcohol exposure can be more than justified based on the human and financial costs of this disability. Identifying women at highest risk and addressing their needs offers the best potential for reducing the incidence of FAS.
Email Address: laburd@medicine.nodak.edu
II. B.: Recognition – Screening, Assessment, and Diagnosis
Citation: Jones, K.L. & Smith, D.W. (1973). Recognition of the fetal alcohol syndrome in early infancy. The Lancet, Nov 3;2(7836), 999-1001.
Article Type: Case Report
Conclusion: Growth deficiency, facial, and other physical features of children born to women categorized as chronic alcoholics are consistent with prior observations. Postmortem autopsy of one child’s brain confirmed damage that could account for the outward deficits. Further studies are recommended to gather more information on the correlation between prenatal alcohol exposure and physical/neurological manifestations.
Purpose: The authors present case reports of three infants born to mothers reported to be “chronic” or “severe” alcoholics, comparing their growth and feature abnormalities with those identified in eight children previously studied, as well as with historical accounts of children born to women who drank alcohol.
Findings: Features and growth patterns of the three infants reported are consistent with those previously identified as well as with historical accounts. These features include: pre- and post-natal growth deficiency; distinct facial features; joint abnormalities; and cardiac (heart) anomaly. An autopsy of one of the subjects uncovered functional and structural brain abnormalities that could account for the developmental delay and dysfunction. The authors use the term, “fetal alcohol syndrome,” to describe this pattern, and recommend additional studies to determine its incidence.
Implications: This article was where it all started, and one in which “fetal alcohol syndrome” was first coined. The signs of FAS as presented in this paper (growth deficiency, characteristic facial features) remain as diagnostic criteria as published by the Instituteof Medicine. Since then, however, requisite alcohol consumption has been broadened to include mothers who may not be chronic alcoholics, but who do consume alcohol while pregnant.
Web Address: http://depts.washington.edu/fadu/II. B.: Recognition – Screening, Assessment, and Diagnosis
Citation: Sampson, P.D., Streissguth, A.P., Bookstein, F.L., & Barr, H.M. (2000). On categorizations in analyses of alcohol teratogenesis. Environmental Health Perspectives, 108 Sup 3, 421-428.
Article Type: Statistical Analysis
Conclusion: There is a wide variation in cognitive and behavioral performance among persons categorized as FAS, FAE, and ARND. As a result, and with the advent of tools to measure and calibrate brain development and function, it is inappropriate to use the degree of facial dysmorphology as representative of the degree of brain damage. In addition, determination of a dose-response threshold is unclear; it is important to identify a dose measure that appropriately reflects the specific mechanism by which alcohol works on the brain of the developing fetus.
Purpose: This article tackled the issue of categorization in prenatal alcohol exposure, focusing on both the effects of diagnostic labeling (FAS vs. FAE vs. ARND) as well as dose-response threshold determination. The authors analyzed both cognitive and behavioral data collected from persons categorized as FAS, FAE, and ARND to determine if there were substantial differences in performance among these categories, to discern whether “the face of FAS” was a valid diagnostic criterion in assessing brain damage. In addition, these data were used to evaluate if there was a discernable threshold of prenatal alcohol exposure that could be used to predict the degree of adverse effect.
Findings: Statistical analysis of a battery of IQ and behavioral tests showed a wide variation in performance by persons categorized as both FAS and FAE, with intermingling between these two groups and at the same time, discrimination from persons with no or low prenatal alcohol exposure. The data also show no evidence of any dose threshold as it related to performance response, as well as the variability of this outcome to the dose measure being used.
Implications: The field of fetal alcohol research has made much progress in the last thirty years. During that time, our understanding of the impact of prenatal alcohol exposure on the developing fetus has become more sophisticated, and tools have been developed to assess its impact at the structural and functional levels. It is important to incorporate these enhancements into our assessment protocols, as a focus on “the face of FAS” is only serving to focus attention on a small segment of the population that has been prenatally exposed to alcohol, and leaving behind those for whom services could be of substantial benefit.
Email Address: pds@state.washington.edu