Prenatal Alcohol Use and Fetal Alcohol Spectrum Disorders: Diagnosis, Assessment and New Directions in Research and Multimodal Treatment

Fetal Alcohol Syndrome (FAS) is a permanent birth defect syndrome caused by maternal consumption of alcohol during pregnancy. Almost four decades have passed since the term FAS was first coined. The condition is now recognized as a spectrum of disorders: Fetal Alcohol Spectrum Disorders (FASD). Substantial progress has been made in developing specific criteria for delineating diagnoses under the umbrella of FASD. In the 14 years since the publication of the seminal report on FAS by the Institute of Medicine in 1996, clear consensus has been reached on two fundamental issues: 1) an FASD diagnostic evaluation is best conducted by a team of professionals from multiple disciplines (medicine, psychology, speech-language, occupational therapy) and 2) the team should use rigorously case-defined and validated FASD diagnostic guidelines. This chapter will provide a brief overview of the discovery of FASD, diagnostic challenges, how diagnostic guidelines and clinical models have evolved over time to address these challenges, and how new technology may influence the future of FASD diagnosis.

Fetal Alcohol Spectrum Disorders (FASD) constitutes a serious worldwide health problem that persists, despite prevention efforts. This chapter examines preclinical research on methods to reduce the severity of FASD, either during the period of prenatal alcohol exposure or during postnatal development. Some prenatal treatments focus on directly blocking or minimizing alcohol's mechanisms of teratogenic action. The possibility that nutritional supplements during prenatal alcohol exposure may reduce the severity of FASD is also explored. Finally, treatments that may be effective even after the alcohol insult, during postnatal development are examined, including nutritional, pharmacological, and environmental/behavioral interventions. Many exciting and effective treatments for FASD have been identified and the challenge is now to translate these findings to clinical populations.

For approximately 40 years, Fetal Alcohol Spectrum Disorders (FASD) has been defined consistently in terms of three diagnostic features in the presence of prenatal alcohol exposure: two physical criteria (i.e., dysmorphic face and growth deficits) and central nervous system dysfunction (structural, neurological, and/or functional). Despite this relatively long and intact diagnostic history, identifying FASD has been difficult historically due to the complexity of presenting symptoms, varied handling by different diagnostic schemes, need for multidisciplinary assessment, and the masking of neurodevelopmental symptoms behind psychiatric diagnoses (“co-occurring disorders”). The objectives of this chapter are threefold: (1) to summarize diagnostic schema and characteristics of children and adults with FASD; (2) to increase awareness of some of the diagnostic challenges that currently exist in FASD assessment, particularly in terms of co-occurring disorders; and (3) to recommend a model standard of multidisciplinary assessment and multimodal treatment that may be useful to professionals in the clinical setting.

Early intervention is vital for children born affected by prenatal alcohol exposure, and may take advantage of ‘ plasticity’ in the developing brain. Early diagnosis is associated with more positive life outcomes among those with FASD. Early intervention leads to better child and family outcomes in populations with similar challenges and, in initial research, to improved outcomes among those with prenatal alcohol exposure. This chapter begins with a ‘ neurodevelopmental viewpoint,’ central to thinking about early intervention with this population. This viewpoint emphasizes ‘ brain-based difficulties’ arising from alcohol's teratogenic effects, and the need to reduce risks and increase protective factors. Current research on child and family strengths and deficits, and the necessary step of early identification, are reviewed. Treatment recommendations from expert professional opinion and the collective family wisdom, and findings from the few studies of early intervention in this population, are provided. To spark research progress in the field, a variety of promising existing early interventions are discussed, including ideas for needed adaptations. Links are provided to websites, parent support information, training topics for early intervention providers, and new data on behavior regulation in young children with FASD. Early intervention is an exciting research direction for the field of FASD.

Fetal Alcohol Spectrum Disorders (FASD) has been estimated to affect as many as one in 100 children. Children with prenatal alcohol exposure may exhibit physical alterations and compromised cognitive functioning. The neurodevelopmental deficits associated with FASD range from global intellectual impairments to specific processing deficits, and learning disabilities that can hinder academic performance and adaptive functioning. The purpose of this chapter is to provide an overview of the impact of FASD on children's education, and to present a brief summary of the evidence-based programs and other interventions that may support better educational and behavioral outcomes for alcohol-affected children.

Fetal Alcohol Spectrum Disorders (FASD) are life long and do not disappear with maturity. As children who have been exposed prenatally reach pubescence, they will experience the typical physical and emotional issues associated with adolescence. Navigating the rocky waters of adolescence is particularly challenging to individuals whose developmental abilities are significantly less than what is expected of them according to their chronological age. In many instances, physical, psychological, behavioral and social problems become more serious and continue on into adulthood for those with FASD. Lifespan issues considered in this chapter are: routine health care; safety; sleep; oral and dental care; nutrition and fitness; sexuality; sexual abuse; work; and co-occurring disorders. Practical considerations are also suggested.

Legal standards and legal institutions have a great impact on the lives of individuals with Fetal Alcohol Spectrum Disorders (FASD). Most individuals with FASD need and are eligible for a range of special services and programs. Frequently, however, it is difficult to obtain that assistance because the application processes are complex and because program officials are not familiar with FASD. The programs and services of particular importance include an appropriate education, Social Security benefits, and state programs for individuals with developmental disabilities. Approximately 60 ' of individuals with FASD get in trouble with the law. Officials in the criminal justice system rarely recognize or understand FASD, and the system often treats defendants with this disability in a manner that is ineffective. Parents of and advocates for individuals with FASD need to better understand how to deal with the criminal justice system, and officials in that system need to be trained about FASD and about more appropriate corrective and other legal responses.

This chapter contains a series of unedited stories from family members and people affected by prenatal alcohol exposure. There is an entire spectrum of family needs, just as there is a spectrum of effects. All families share the grief of lost dreams for their children and the shocking transition to a whole new journey in parenting. All families are stretched beyond expectation emotionally, mentally, spiritually, and financially. Health, marital, and safety challenges are common. The chapter includes contributions from both adoptive and birth families, mothers and a father, affected people and siblings, with and without alcoholism in the family.

Basic research into Fetal Alcohol Spectrum Disorders (FASD) is contributing much important information to our understanding of the dynamics of how alcohol affects developing neurological and physiological systems in unborn children. Clinical research is beginning to offer guidelines for intervention, treatment and services for women who may abuse alcohol and to children who are affected by prenatal exposures. It is equally important that, when the findings of research reach the point of utility, they be put into practice as standards of care. While the types and availability of services vary among states, most jurisdictions do support systems that can provide services and treatment to these populations. The purpose of this chapter is fourfold: 1. Provide an overview of the work that has been undertaken by federal agencies and associated task forces to develop innovative interventions and to encourage and reinforce the implementation of services on the state level; 2. Describe the service components that are generally available in each state; 3. Provide a description of service models that have been established or are evolving on the state level; and 4. Describe the role of voluntary agencies in the non-profit sector in establishing service systems for persons with FASD.