Fetal Alcohol Syndrome Health Article

Diagnosis

FAS is a clinical diagnosis, which means that there is no blood, x ray or psychological test that can be performed to confirm the suspected diagnosis. The diagnosis is made based on the history of maternal alcohol use, and detailed physical examination for the characteristic major and minor birth defects and characteristic facial features. It is often helpful to examine siblings and parents of an individual suspected of having FAS, either in person or by photographs, to determine whether findings on the examination might be familial, of if other siblings may also be affected. Sometimes, genetic tests are performed to rule out other conditions that may present with developmental delay or birth defects. Individuals with developmental delay, birth defects or other unusual features are often referred to a clinical geneticist, developmental pediatrician, or neurologist for evaluation and diagnosis of FAS. Psychoeducational testing to determine IQ and/or the presence of learning disabilities may also be part of the evaluation process.

Treatment

There is no treatment for FAS that will reverse or change the physical features or brain damage associated with maternal alcohol use during the pregnancy. Most of the birth defects associated with prenatal alcohol exposure are correctable with surgery. Children should have psychoeducational evaluation to help plan appropriate educational interventions. Common associated diagnoses such as attention deficit-hyperactivity disorder, depression, or anxiety should be recognized and treated appropriately. The disabilities that present during childhood persist into adult life. However, some of the secondary disabilities mentioned above may be avoided or lessened by early and correct diagnosis, better understanding of the life-long complications of FAS, and intervention. Streissguth has describe a model in which an individual affected by FAS has one or more advocates to help provide guidance, structure and support as the individual seeks to become independent, successful in school or employment, and develop satisfying social relationships.

Prognosis

The prognosis for FAS depends on the severity of birth defects and the brain damage present at birth. Mis-carriage, stillbirth or death in the first few weeks of life may be outcomes in very severe cases. Major birth defects associated with FAS are usually treatable with surgery. Some of the factors that have been found to reduce the risk of secondary disabilities in FAS individuals include diagnosis before the age of six years, stable and nurturing home environments, never having experienced personal violence, and referral and eligibility for disability services. The long-term data helps in understanding the difficulties that individuals with FAS encounter throughout their lifetime and can help families, caregivers and professionals provide the care, supervision, education and treatment geared toward their special needs.

Prevention of FAS is the key. Prevention efforts must include public education efforts aimed at the entire population, not just women of child bearing age, appropriate treatment for women with high-risk drinking habits, and increased recognition and knowledge about FAS by professionals, parents, and caregivers.

BOOKS

Jones, Kenneth Lyons. Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia: W.B. Saunders Company, 1997.

Streissguth, Ann. Fetal Alcohol Syndrome: A Guide for Families and Communities. Baltimore: Paul H. Brookes Publishing Company, 1997.

PERIODICALS

Committee of Substance Abuse and Committee on Children with Disabilities. "Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorders." Pediatrics 106 (Aug. 2000): 358-361.

Cramer, C., and F. Davidhizar. "FAS/FAE: Impact on Children." Journal of Child Health Care 3 (Autumn 1999): 31-34.

Gladstone, J., et al. "Reproductive Risks of Binge Drinking During Pregnancy." Reproductive Toxicology 10 (Jan./Feb.1996): 3-13.

Hannigan, J. H., and D. R. Armant. "Alcohol in Pregnancy and Neonatal Outcome." Seminars in Neonatology 5 (Aug.2000): 243-54.

Olson, Heather Carmichael, et al. "Association of Prenatal Alcohol Exposure with Behavioral and Learning Problems in Early Adolescence." Journal of the American Academy of Child and Adolescent Psychiatry 36 (Sept.1997): 1187-1194.

"Prenatal Exposure to Alcohol." Alcohol Research and Health 24 (2000): 32-41.

Sampson, Paul D., et al. "Incidence of Fetal Alcohol Syndrome and Prevalence of Alcohol-Related Neurodevelopmental Disorder." Teratology 56 (Nov. 1997): 317-326.

Streissguth, Ann Pytkowicz, et al. "Fetal Alcohol Syndrome in Adolescents and Adults." JAMA 265 (Apr. 1991): 1961-1967.

ORGANIZATIONS

Arc's Fetal Alcohol Syndrome Resource Guide. The Arc's Publication Desk, 3300 Pleasant Valley Lane, Suite C, Arlington, TX 76015. (888) 368-8009. <http://www.thearc.org/misc/faslist.html>.

Fetal Alcohol Syndrome Family Resource Institute. PO Box 2525, Lynnwood, WA 98036. (800) 999-3429. <http://www.fetalalcoholsyndrome.org>.

Institute of Medicine. National Academy Press, Washington, DC. <http://www.come-over.to/FAS/IOMsummary.htm>.

March of Dimes Birth Defects Foundation. 1275 Mamaroneck Ave., White Plains, NY 10605. (888) 663-4637. <resourcecenter@modimes.org>. <http://www.modimes.org>.

Nofas. 216 G St. NE, Washington, DC 20002. (202) 785-4585. <http://www.nofas.org>.

Laurie Heron Seaver