Fetal Alcohol Spectrum Disorders: Understanding the Effects of Prenatal Alcohol Exposure and Supporting Students
Green, Jennifer H., Journal of School Health
Maternal alcohol consumption during pregnancy is known to adversely affect the developing fetus, resulting in a broad range of negative, lifelong developmental outcomes. (1-4) Fetal alcohol spectrum disorders (FASD) is a term referring the range of outcomes and disabilities that can occur when an individual is exposed to alcohol prenatally. (5) Given that FASD affect a large number of children in this country, 9.1 per 1000 live births, (6) it is imperative that education, health, and all professionals in schools understand the disabilities associated with prenatal alcohol exposure and are aware of strategies to support students in meeting academic, social, emotional, and behavioral goals of school. This article addresses the diagnosis of fetal alcohol syndrome (FAS) and other alcohol-related conditions, describes the cognitive, social, emotional, and behavioral characteristics of individuals with FASD, and introduces intervention strategies that are helpful in supporting individuals with FASD in schools.
The negative impact of alcohol on the developing fetus was recognized over 30 years ago. (7) Early observations and documentation of the characteristics of children exposed prenatally to alcohol are quite consistent with how the full syndrome of FAS is defined today. The diagnostic criteria for the full syndrome of FAS are relatively straightforward and have been recently clarified and updated by a diverse group of professionals, clinicians, and scientists. (8) Diagnostic criteria include facial dysmorphia, growth deficiency, and central nervous system (CNS) abnormalities, which may include small head circumference, neurological problems, cognitive/developmental deficits, and behavioral/emotional problems. (8) Facial dysmorphia refers to a characteristic pattern of facial features that include a smooth philtrum, thin upper lip, and small eyes. The philtrum is the vertical ridge between the nose and upper lip. Alcohol exposure during prenatal development affects the natural development of the philtrum, eyes, and lip as well as negatively affects brain development. (8) The CNS abnormalities or brain damage can range from severe structural abnormalities in the corpus callosum or basal ganglia (9) to mild cognitive deficits. (10) As described below, neurocognitive deficits, academic challenges, and emotional and behavioral concerns are commonly associated with FAS. (10-13) May and Gossage (14) estimate the prevalence rates for FAS from .5 to 2.0 cases per 1000 births.
While the diagnostic criteria for FAS are relatively straightforward, the diagnosis or identification of other FASD conditions is more complicated. Because not all individuals exposed prenatally to alcohol display the characteristic pattern of facial features, many do not meet the full criteria for FAS. However, they often demonstrate the cognitive, social, emotional, and behavioral difficulties associated with the teratogenic effects of alcohol on the brain. That is, the cognitive and behavioral effects of prenatal exposure can occur independently of the characteristic facial features. The term fetal alcohol spectrum disorders was coined to encompass the range of disabilities associated with prenatal alcohol exposure. (5) This umbrella term includes medical diagnoses such as fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder (ARND) as well as older terms such as fetal alcohol effects and newer terms (eg, neurobehavioral disorder, alcohol exposed). For example, multiple diagnoses such as partial FAS with confirmed maternal alcohol exposure and ARND were identified within the Institute of Medicine's (IOM) diagnostic framework, which was published in 1996. According to the IOM criteria, (15) the diagnosis of partial FAS can be made when there is confirmation of substantial exposure to alcohol prenatally, some evidence of facial features, and at least one of the following: growth deficiency, CNS neurodevelopmental abnormalities, or a complex pattern of behavioral and cognitive abnormalities. …