Fetal Alcohol Syndrome

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Introduction to the Disorder

Alcohol is well recognized as a teratogenic drug, which provokes stillbirth, miscarriage, growth deficiency, malformation, and dysfunction of central nervous system. Fetal Alcohol Syndrome (FAS) is a disorder of a newborn baby caused by extreme consumption of alcohol during pregnancy by woman. Any alcohol consumption during the period of pregnancy is a danger of physical and mental complication or disorder through out the child’s life. There are some exceptions, when intake of alcohol does not result into FAS, but it should be noted that any amount of alcohol ingested during pregnancy has a potential risk to the unborn baby (Kids Health).

The incidence of FAS shows how regularly this problem takes place per annum, while prevalence illustrates all new and existing causes per 1000 people.

Only in the United States, it is estimated that among 750 children one is born with retardation of mental development and physical growth better known as FAS, while about 40,000 children are born with fetal alcohol effects (FAE) every year. Most of these infants have symptoms such as memory lapse, attention deficits, coordination problems, distractibility, impulsiveness, hyperactivity, neurological, emotional instability, speech and hearing impairment. All these defects cause the child to have serious social problems in the future.

The Surgeon General of the United States strongly recommends pregnant women not to use alcohol, but, in fact, about 30% of women sometime drink spirits during their pregnancy.

Studies in the USA as well as in other countries have established incidences of FAS that have been greater than autism or Down’s syndrome in prevalence. The rate of FAS between 1976 and 1982 was set at a number of 6/1,000 live births. Some studies based on population have relied on medical registers with diagnostic criteria and indeterminate auditors for incidence estimation. The CDC Birth Defects Monitoring Program has stated the incidence of FAS at the level of 67/1,000 live births that has been growing during the last years.

In North America, some populations of American Indians stand at an extra risk, because of attitudes and customs about alcohol abuse. That is why their prevalence of FAS has been come to 10.3/1,000 that signifies the amount of people in the population with the problem in time.

Studies in Europe have found similar, though a little lower incidences that depend on the risk pattern of the target population and diagnostic criteria.

Nevertheless, it is difficult to estimate the prevalence or incidence of alcohol-related neurodevelopmental disorder (ARND) or alcohol-related birth defects (ARBD). Some diagnosticians have projected that the relative ratio of FAS to ARND had been arisen from the amounts of referrals. On the other hand, such studies depend on incidence and referral patterns.  The incidence of FAS is rather assessed by empirical methods with traditional criteria, and the prevalence of ARND is explained by maternal self reported alcohol use according to the reports of Institute of Medicine (IOM) rather than by clinical referral.

The Fetal Alcohol Study Group of the Research Society on Alcoholism standardized criteria for defining FAS in 1980, and later its modifications were suggested. The proposed criteria take in prenatal and/or postnatal retardation, face characteristics, and central nervous system (CNS) involvement. CNS dysfunction disturbs chiefly attention and activity, memory and learning, intelligence, motor and language abilities that become apparent in developmental delays, neurological abnormalities, intellectual impairment, behavioral dysfunction, and brain or skull malformations.

The incidence requires two kinds of information: stated criteria, which defines the condition, and a well-defined population over a given period. There are difficulties in estimating incidence as well as in defining the appropriate outcome state when the condition is FAS. ARND include CNS neurodevelopmental abnormalities and a complex pattern of behavior or cognitive abnormalities.

Thus, FAS diagnosis is based on prenatal or postnatal retardation after birth, craniofacial abnormalities, and CNS disorders. CNS effects to the fatal is the major cause of neurodevelopmental disorders, which include learning problems, mental retardation, poor reasoning, sensory processing disorders, and motor effect problems. Hyperactivity, aggressive behaviors, poor impulses, and poor socialization are also defects caused by CNS effects. Language deficits and speech delay such as problems in naming ability, word comprehension, receptive and expressive language skills, and articulation are also characteristic for FAS.

Speech and Language Characteristics of the Disorder

Children with FAS typically have delayed language development or some degree of language disability that result in significant problems with academic learning and social communication. Speech and language effects of the disorder are connected with deflects in higher level receptive and expressive language, learning difficulties, poor capacity for abstraction or metacognition.

The language skills are developed at a slower degree than in children without FAS. The young ones can not use the grammatically and vocabulary complex language structures that are foreseen for their age. They may not remember the word even knowing its meaning or use the wrong term from the same category.  Instances of immature syntax are inappropriate plurals, wrong verb or pronoun form, omittance of prepositions, and other grammar mistakes.

Articulation and pronouncement of sounds such as “th”, “s” or “r” can make a difficulty for children with FAS, too. The speech problem can be even broader that creates difficulty with the development of social skills, because of unintelligible language. Articulation complications often become clear before school, while language expression may be not identified until the challenges made in the classroom. The consultation of the speech/language pathologist can be a necessity for determination of the student’s further studying. Language and speech therapy is vital for resolution of such problems.

The pragmatics of language denotes the use of language for social communication. There may be a difficulty of starting a dialogue or making appropriate respond in it. It shows problems with the language’s understanding and listening. Some children are very talkative, but it does not mean that there is no communication problem. Speech can be fluent, but empty by its content. Receptive and expressive language delays exist in 86% of patients with FAS. It is essential to give such students response about their expressive language skills in order to help them.

During the test of language development, children with FAS had shown quantitative language differences in the memory, semantic, and syntactic abilities. They did not demonstrate syntactic and morphological forms for picture identification, comprehension of verbal commands. Instead, there were shown less complete and grammatically correct sentences in their conversations.

The children had poorer ability of storage linguistic elements in the short-term memory comparatively to the earlier subjects. Comprehension of single word vocabulary also was not illustrated. The FAS group had more simple impairments in their pronunciation of sounds according to their nonverbal cognitive ability. There was mentioned a change of both oral-peripheral mechanism’s function and structure. The variations were mainly seen in the function of the larynx and tongue and the dentition (Becker, Warr-Leeper, & Leeper, 1990).

Therefore, disorders of speech production consist of lack of intonation, deflects in fluency, poor articulation, slurred speech, and voice dysfunctions as well as memory and verbal learning deflects, involuntarily imitating words and phrases. Language comprehension and acquisition are affected by cognitive and hearing functions. At least four kinds of hearing disorders originate from FAS: sensorineural hearing loss, central hearing loss, delayed maturation of the auditory system, and conductive hearing loss secondary according to regular serous otitis media.

Children with FAS are described as those, who have poor syntactic, semantic and memory abilities, delays in receptive and expressive language, language acquisition, speech pathologies, and hearing disorders, because of CNS, structural, oral-motor, and hearing deficits. That is why it is very important to improve basic language skills for the development of interpersonal communication, behavior, and social skills in persons with FAS.

Evaluation Tools and Methods

Assessing the health of a pregnant woman with drinking problems is one of the best ways for determining the risk of diseases later in the child. It is an inexpensive and simple method, but highly effective one during implementation. Risk experts say that it is the accurate method of assessing condition of the fetus. Healthcare professional can use this information to determine risk of the child developing certain illnesses or conditions later in life.

From this time, the affected woman can take precautionary measures in preventing such disease. These precautions include desistance from drinking and taking of medicine to improve the condition of the fetus.  The pregnant woman must be responsible for her lifestyle and behavior in order to reduce the risk of being faced by the fetus. Family health graphic representations are vital tools, which may also be used in evaluating genetic issues related to drinking (McCreight, 1997). Information obtained from family health history is important in assessing the probability of disease risk later in the child. 

Evidence-based practice recommends use of screening tools. Verbal screening tools provide adequately valid estimate of the quantity of ethanol ingested in the critical period for FAS. Beneath some starting point, FAS does not take place, and clinical exanimation by skilled auditors does not outcome in false positives.

FAS can be prevented through awareness, healing, support, and education. The lack of awareness in the past made people affected by FAS isolated from the society by guilt, shame, and grief. Intervention and support are also necessary issues for persons affected by FAS that help them to live productive lives.

Worldwide prevention methods can protect entire populations through the implementation and training of public health policy. Selective programs and measures include publishing prevention messages and general screening of drinking during pregnancy. Interventions like birth control, case management, and treatment for alcohol abuse are good tools for children with the problems of FAS, ARND, and ARBD. 

The key elements of intervention are responsibility of personal control, feedback of personal risk, menu of ways to reduce or stop drinking, advice to change, self-efficacy about stopping drinking, and empathetic counseling style. It also involves constant support by nonjudgmental, supportive techniques. The most effective intervention methods focus on reduction of alcohol use without incitement of guilt and any criticism instead of volitional or moral bans.

Hence, evaluation tools and methods are found through intervention system, a compassionate style, the ability to avoid bad arguments, an optimistic attitude about change, comfort discussing of alcohol problems, and respect in addition to genuineness for clients.

A range of prevention programs can lower the prevalence of FAS significantly. Moreover, public health specialists need to continue their evidence-based studies in order to reduce medical and behavioral risk factors of prenatal alcohol damage. These researches will develop better categorical and diagnostic criteria that can be useful for more effective intervention and prevention programs than previous spectrum of approaches.

Treatment Programs or Methods

FAS can be prevented only by total avoiding of alcohol. There is no safe threshold limit of alcohol use, because even a small amount can harm the health of the unborn child. If the woman is not able to stop drinking, she must contact her doctor otherwise find a local alcohol treatment center or even local Alcoholics Anonymous. The Substance Abuse and Mental Health Services Administration has a Substance Abuse Treatment Facility locator, which supports people in alcohol treatment programs. The father’s role in FAS prevention is important, too. Other family members, social and healthcare organizations, schools, and communities are able to stop FAS through intervention and education.

There are also treatment programs that can provide child care. Parent Child Assistance Program (PCAP) is a good example of the social work intervention strategies that should be put in place to reduce the incidence of FAS. It aims at reducing substance abuse in mothers with zero to three years old. The program runs for three years and it decides if the mother will remain with the child or not by providing a paraprofessional advocate service (Malley, 2005). It runs the operations intensively in close relationship with the victims and by providing long term advocacy. Centers are opened in the USA in the Washington state.

The program also protects zero to three year old children from neglect and child abuse often accompanied with alcohol abuse. Mothers, who have Child Protective Service (CPS), may retain custody by writing contracts for care with the CPS and the advocate. Mothers, who do not have CPS, do not retain custody as their children are protected by being placed in foster or relative families. Malley (2005) also argues that infant massage and sensory integration have been used for many years and they remain useful tools.

The program also protects prenatal children by introducing neuroprotective agent of pregnant mothers. Children are screened for Post Traumatic Stress Disorder (PTSD), which can happen due to the physical or sexual abuse, and Reactive Attachment Disorder (RAD), which can occurs, because of emotional disconnection from the parents.

Specialized feeding techniques for infants are helpful in feeding children with poor suck or those with long tendency to suck because of FAS. Educational demonstrations shown in Braselton Scale Examination benefited parents by educating them of the infant’s capabilities. Parent sensitivity was increased by coaching on how they interact with their newborns.

Primary toddler assessment, enriched pre-school and home environments are beneficial to the children. Children with positive results from the screening of PDST and RAD benefited from the subsequent treatments such as play therapy and dyadic therapy for the mother and her child.

As a result, most of PCAP’s strategies like motivational interviewing and family therapy, self-report tools and questionnaires, infant massage and sensory integration, use of specialized feeding techniques, holding educational demonstrations and early toddler assessment showed positive results. PCAP’s potential has not been exploited fully, since FAS is still common disorder. That is why there should work a public policy for better implementation of the program in order to ensure better understanding for the consequences of prenatal alcohol consumption as well as for the prevalence of alcohol related damages.

There is no specific treatment for children with FAS, but they can study in special schools in order to cope with language disabilities. Language and literary training (LLT) intervention are efficient for such students. This exercise emphasis on the promotion and phonological awareness of literacy skills such as the ability to manipulate phonemes and syllables, letter knowledge, semantic and reading skills. The LLT of students shows noteworthy improvements in the areas of syllable manipulation, letter knowledge, non-word spelling, non-word and word reading. These findings can be useful in enhancing of literary skills and specific language.

Evidence-based practice recommends a range of methods: functional communication training, language and speech, social communication training, and increasing imitation. Language intervention is ensured only by its development at home and in school. Peer intervention and parent training are effective methods. Programs with specific goal of linguistic and cognitive competencies are especially valuable for children. Lastly, the method of facilitating language development for children with significant delays and normally developing young ones is advanced.

Personal Reaction

It is obvious that women with a high proportion of drinking problem have higher level of FAS. Statistics shows that children, who suffer from this condition, are very likely to engage in alcohol use in their lives. Furthermore, the chance of using drugs is also very high as well as crime participation and other negative social effects.

Lack of or reversed hemispheric lateralization in the auditory mode is just one aspect of functional impairments that children with FAS experience. Depending on the amount, frequency, and timing of gestational alcohol abuse, developmental abnormalities and associated speech, language, hearing, and cognitive impairments vary substantially, but generally impose lifelong learning disabilities.

Longitudinal follow-up of children with FAS into adulthood has shown the profound, pervasive, and permanent impact of the disorder in multiple domains. For instance, multi-domain cognitive impairments including mathematical deficiencies, difficulty with abstract concepts (time and space, cause and effect, etc.), and problems with generalization from one circumstance to another identified early in life have been traced into adulthood.

Similarly, behavioral problems including hyperactivity and impulsivity, memory deficits, maladaptive social functioning, and communication skills have been shown to pose significant problems throughout life.

A study by Weinberg (1997) showed that children with FAS may present with deceptively good speech skills. However, compromised language skills often preclude adequate peer interaction, explaining at least in part the behavioral and social problems of individuals with FAS. Deficits in semantic and syntactic aspects of language use, along with poor oral-motor and articulation abilities, verbal learning, and short term memory have also been reported in early studies of American Indian FAS cohorts (Becker et al., 1990).

The above findings indicate that clinically significant deficits in both receptive and expressive language abilities may undermine language development and comprehension in children with FAS. Other factors such as mental impairment may further contribute to developmental delays in such way that children with FAS may never be able to catch up with their TD peers over time. Mental impairments may also produce secondary disabilities like mental health problems, chemical dependency, inappropriate sexual behavior, and consequent legal problems in adults. Though, recent evidence suggests that early diagnosis and intervention of FAS children, regardless of their intelligence quotients, may not only improve the chances of diminishing developmental delays, but also alleviate the occurrence of secondary disabilities.

Children with FAS are at risk for developmental hearing loss of both conductive and sensorineural origin. Moreover, involvement of the central auditory nervous system may contribute to additional problems in the areas of speech-language and auditory learning. Thus, early identification and intervention are critical for successful clinical outcomes in not only speech-language and hearing areas, but also in the overall behavioral and social rehabilitation of FAS individuals.

Knowledge about FAS creates a possibility for a speech-language pathologist to develop evaluation tools and methods, use effective treatment programs and make own plan of individual coaching to be successful and qualified expert. Thus, one will have clear understanding for the needs of students with FAS. Moreover, the speech-language pathologist can create really supportive social, physical, emotional, and intellectual environment for these children.

Experience and knowledge, encouragement and guidance are central issues to the work with children. FAS problem requires knowledge of effective communication, child’s needs and strengths, cooperation with parents and other members of the school team. Positive communication, cooperative planning and preparation are the foundation for operative speech-language practice. The speech-language pathologist should use goal-directed behavior, manage language according to behavior, and language skills learned in therapy with real-life situations.

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