Academic journal article Alcohol Health & Research World

Intervention and the Child with FAS

Academic journal article Alcohol Health & Research World

Intervention and the Child with FAS

Article excerpt

Fetal alcohol syndrome (FAS) affects children in several ways, with a considerable amount of variability in the levels of behavioral, psychological, and cognitive deficits (Rosett and Weiner 1984; Weiner and Morse 1991). Some children have only subtle problems, whereas others are so severely affected that, as they age, they cannot function in the community. People working with these children have tried to develop caretaking and teaching techniques that circumvent the disabilities. The goal of such intervention strategies is to afford all people affected by FAS every opportunity to thrive in society and to reach their maximum potential.

In the field of child development, there is a general view that early intervention and a facilitating environment can help to maximize every child's potential, no matter what the problem. However, children without learning disabilities or behavioral problems can thrive without such interventions, whereas children such as those with FAS need interventions to approach normalcy.

UNDERSTANDING THE CHALLENGES OF FAS

Before adequate interventions can be designed, the challenges of rearing and educating the diverse population of children with FAS must be understood. IQ's of children with FAS range from 45 to 110,(1) and the majority of affected children have mild to moderate behavior problems. However, the literature usually describes only the most critically affected children, who have IQ's below 50 and have severe behavior problems. As a result, negative outcomes for all children with FAS have been predicted; they are often described as mentally retarded, lacking conscience and judgment, and prone to criminal activity. Such dire predictions fail to consider the enormous heterogeneity of the affected population and the potential benefits of targeted intervention strategies.

CNS PROBLEMS OF CHILDREN WITH FAS

Abnormalities of the brain and central nervous system (CNS) in children with FAS can create problems, including diminished intelligence, learning disabilities, inappropriate or unusual behaviors, delays in speech and language development, poor eating and sleeping patterns, and delayed developmental milestones (Rosett and Weiner 1984). Many of these problems are evident even in children with FAS who have normal intelligence. Studies that examine and describe the developmental problems of children with FAS provide some understanding of the special needs of these children that can lead to intervention strategies.

Research Problems. Studies conducted to date have some methodological problems. Few large, well-controlled studies have compared the progress of children with FAS with the progress of children with other developmental problems or with no problems. Instead, most studies measure the children's intelligence, motor coordination, and attention span and compare the results with societal norms. The studies reviewed below include children who were tested only once or twice over time and who were not provided with specific or consistent interventions. Most were case studies of individual children who had been referred to research centers after receiving a diagnosis of FAS from their primary care providers, so they were unlikely to be a representative sample of children with FAS. The age at which the children were evaluated varied from infancy to adolescence. Few of these studies employed a control population.

CNS Problems. In a group of 20 children with FAS ranging in age from 9 months to 21 years, Streissguth and colleagues (1978) found that intelligence scores remained stable 1 to 4 years after the first testing, suggesting that the abilities of children with FAS do not improve over time. Similarly, Dehaene and colleagues (1977) reported that among a group of 16 children with FAS, IQ scores did not change over time for the most severely affected. In their study, Spohr and colleagues (1993) reported that psychiatric and learning problems persisted in children with FAS over time. …

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