Overview of Fetal Alcohol Syndrome People with fetal alcohol syndrome (FAS) are born with it. FAS is a birth defect that has its primary effect on the brain. Some people with FAS are slightly affected and manifest only mildly dysfunctional behavior; others are severely affected, devastatingly disabled in their ability to cope with even simple day-to-day interactions. Each child with FAS has his or her own special needs, problems, and capabilities. FAS is a birth defect whether or not it is noticeable at birth. One does not outgrow FAS, although the manifestations may change with age. A bad environment (e.g., one in which there is abuse, neglect, or poverty) cannot cause FAS, just as a good environment (e.g., one with loving, caring parents) cannot fully undo it. A good environment and proper community supports, however, can protect the person with FAS from secondary disabilities, which can also be debilitating. FAS is caused by prenatal alcohol exposure (see Figure 1.1) and is characterized by growth deficiency, a specific pattern of facial features, and some signs of CNS dysfunction. PRENATAL ALCOHOL EXPOSURE CAN CAUSE A SPECTRUM OF EFFECTS Prenatal alcohol exposure does not always result in FAS. Depending on the dose, timing, and conditions of exposure as well as on the individual characteristics of the mother and fetus, prenatal alcohol exposure can cause a range of disabling conditions. Some children are diagnosable with the full FAS; others have only partial manifestations, usually the CNS effects without the characteristic facial features or growth deficiency. Children who have only some of the characteristics of FAS (i.e., not enough for a full diagnosis) are often said to have fetal alcohol effects (FAE) or possible fetal alcohol effects (PFAE). These terms, although useful descriptively, have no specific differentiating criteria that would warrant their own diagnoses, even though these conditions can be just as debilitating as FAS. In 1996, the term alcohol-related neurodevelopmental disorder (ARND) was introduced by the Institute of Medicine (IOM, Stratton, Howe, & Battaglia). Focusing on the CNS characteristics (rather than on the growth deficiency and characteristic face), ARND is used congruently with FAE in this book. As these CNS effects can be caused by alcohol but are not unique to alcohol, the terms FAE, PFAE, and ARND are not appropriately used in the absence of a prenatal alcohol exposure history. Research has shown that people with both FAS and those with FAE/PFAE/ARND experience many of the same kinds of problems growing up. Their families and communities also face many of the same kinds of challenges raising them. Therefore, this book frequently refers to these terms in the collective (i.e., FAS/FAE) in tacit recognition of the fact that it is the behavior problems caused by the prenatal damage from alcohol that present the primary challenge to treatment and management. People with FAS/FAE, like everyone else, have a variety of talents and capabilities. They exhibit a wide range of intellectual levels and functional disabilities that probably reflect differing sites and degrees of prenatal brain damage due to different levels, patterns, and timing of prenatal alcohol exposure and individual differences in mothers and offspring. Despite their wide array of talents and abilities, many people with FAS exhibit some of the same general behavioral characteristics. They are usually trusting (even overly trusting), loving, and naive despite their years. They can also be grumpy, irritable, and rigid. As a result of their prenatal brain damage, they may have difficulty, especially as they mature, in evaluating a situation and using their past experiences to cope with the problems at hand. They seem to need more protection, supervision, and structure for a longer period of life than usual. Individuals with both FAS and FAE also vary widely i Excerpted from Fetal Alcohol Syndrome: A Guide for Families and Communities by Ann P. Streissguth All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
