Running head: Fetal Alcohol Syndrome 1

Fetal Alcohol Syndrome

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Fetal Alcohol Syndrome 2

Executive Summary
Fetal Alcohol Syndrome (FETAL ALCOHOL SYNDROME) is a syndrome that has
been associated with a series of physical abnormalities, cognitive and behavioral problems
experienced by children born of mothers who used to drink alcohol during pregnancy. This
report examines the history of Fetal Alcohol Syndrome and how it was discovered. This being a
syndrome, it has several characteristic features which are associated to it. The signs and
symptoms of the syndrome will also be identified. After identification of a series of the
symptoms, we will look into the diagnosis process of the syndrome whereby we will be able to
discuss the various categories used by Institute of Medicine (IoM) to identify the Fetal Alcohol
Syndrome. The categories will be observed whereby each category will be evaluated on its
extent of diagnosing Fetal Alcohol Syndrome.
Additionally, the Fetal Alcohol Effects will be evaluated whereby each effect will be discussed
in detail by using viable examples which led to the proof that indeed the children suffering from
Fetal Alcohol Syndrome are truly affected. The importance of the tests will be evaluated and the
major problems listed so as to identify the extent of the effect. Additionally, each effect will be
accompanied by a tangible test which is used to evaluate the extent of the syndrome to the
individual child. Ways of preventing Fetal Alcohol Syndrome will also be examined whereby the
reasons behind each prevention method will be explained. Lastly, the future of the Fetal Alcohol
Syndrome will be evaluated whereby we will be able to define whether the cases are projected to
reduce or to increase in future.


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Introduction
Fetal Alcohol Syndrome is defined as a collection of physical abnormalities, cognitive
and behavioral problems which are evident to children born to mothers who had an habit of
heavy drinking during their pregnancy. One of the physical abnormalities experienced by the
newborn babies include reduced size of the newborn and facial features. However, much
attention has been paid to behavioral and cognitive problems. Costs of Fetal Alcohol Syndrome
and conditions related to it are very expensive for the child, family and society. Due to the high
rates of FETAL ALCOHOL SYNDROME cases in most countries especially in United States,
several researchers have taken an initiative to get the correct data of cases experienced each year
in United States. It has also been established that out of the many cases of FETAL ALCOHOL
SYNDROME reported each year, 80 percent of them indicate that the children also suffer from
abnormalities related to behavior and microcephaly. Similarly, 50 percent of the children suffer
from hypotonia, reduced adipose tissue, Attention Deficit Hyper-activity Disorder, facial
anomalies that include cleft palate, micrognathia, and maxillary hypoplasia, and poor
coordination. Similarly, eye or ear abnormalities, hemangiomas and defects in the cardiac are
also very common (Substance Abuse and Committee on Children With Disabilities, 2013). In
this paper, I am going to discuss the Fetal Alcohol Syndrome in terms of their effects to the
child's psychological development, the child's family, social problems, and ways of reducing its
increasing cases.
Background
In 1876, documentation of the effects of fetal alcohol exposure on the newborn was done on
medical prose. However, the current research which led to the understanding and continued
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study of the effects of alcohol date back in the late 1960s. This was a time when Dr. Lemoine
from Nantes, France published a report indicating same physical and growth characteristics of
127 children born of alcoholic mothers. At the same time, Dr. Christy Ulleland from United
States was studying children with retarded growth. Ulleland stated that all the children that she
had had contact with indicated a similar history of alcoholism. In 1973, Dr. Jones came up with
the term Fetal Alcohol Syndrome after going through the findings of the previous researchers
(Hoyme,2013 ).
Diagnosis and Clinical Evaluation of Fetal Alcohol Syndrome
In order for the US congress to come out with a valid report of how serious Fetal Alcohol
Syndrome was, the Institute of Medicine (IoM) was instructed to carry out a study on the
syndrome and its related defects during birth. Diagnosis is an important step which serves
several functions including; to facilitate communication between clinicians and between
clinicians and patients, to help during the study of etiology and pathophysiology, as well as to
direct the correct treatment for the patients. However, during diagnosis, the patient is subjected
to both benefits and disadvantages. Firstly, when the patient is being diagnosed of Fetal Alcohol
Syndrome, the patient's disability is known thus appropriate medication will be facilitated
leading to social benefits. Nevertheless, people may use diagnosis to stigmatize the Fetal Alcohol
Syndrome patients by creating misconceptions about the patient's fate. These can be
discouraging to both the patient and his or her family (Institute of Medicine (U.S.) et al. 1995).
Fetal Alcohol Syndrome is a syndrome and not a disease thus it has additional features
which include maxillary hypoplasia. These features are purported to change as one advances in
age and development. For instance, the syndrome is easier to detect before a child reaches
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puberty because after puberty, some of the features such as facial features become difficult to
detect. However, the key features used to determine Fetal Alcohol Syndrome are constant
throughout all ages (Hoyme, 2013)
Before making any conclusions, the committee studied the previous criteria used for
diagnosis and came out with finding which stated that the confusing issues to clinical and
research communities could be corrected using changes in the overall table drawn to indicate the
diagnostic extent for Fetal Alcohol Syndrome. The first category diagnosed Fetal Alcohol
Syndrome patients having history of alcohol exposure to the mothers. The second category used
Fetal Alcohol Syndrome patients without maternal history in alcohol exposure. The third
category used partial Fetal Alcohol Syndrome patients with maternal history of alcohol exposure.
The committee found out that the third category would be challenging and decided to include
people with signs and symptoms related to considerable prenatal exposure of alcohol and those
who needed medical attention, social services and other support. Through this, the committee
came up with two other categories for diagnosis. The fourth category was the Alcohol-Related
Birth Defects (ARBD) whereas category five used Alcohol-Related Neurodevelopment Disorder
(ARND). The two categories were to include clinical conditions associated to observable
outcomes related to maternal alcohol intake. These two were also intended to come up with
uncertainty which needed to be proven on whether prenatal alcohol exposure were the real cause
to the effects observed on an individual or whether there were other factors which facilitated this
case. However, all these were to be significant if they were accompanied by described problems
which could be experienced by the patient at the time of diagnosis (ARMSTRONG, & ABEL,
1999).

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Table Showing the criteria used for Diagnosis of Fetal Alcohol Syndrome.




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How Fetal Alcohol Syndrome and Fetal Alcohol Effects are determined.
According to Adubato and Cohen (2011), Fetal Alcohol Effects is a term which is used to
the children whose mothers used to drink alcohol during pregnancy. They are known to display
some of the characteristics of Fetal Alcohol Syndrome. The intelligent quotient (IQ) ratios for
the children suffering from FAE are higher as compared to those suffering from Fetal Alcohol
Syndrome. During diagnosis, 'partial Fetal Alcohol Syndrome' is used for children who have
already been confirmed of heavy prenatal alcohol exposure, physical growth, and some
constituents of the typical alcohol-related facial dymorsphology. Alcohol-Related Birth Defects
(ARBD) is used to the patients who have been confirmed of heavy prenatal alcohol exposure and
one or more of the abnormalities related to congenital including; skeletal, renal, auditory, ocular,
or cardiac.
Findings on Psychological effects experienced by Fetal Alcohol Syndrome patients
In several reports, the results that relate Fetal Alcohol Syndrome to hyperactivity have
been proved to be inconsistent. For the patients who visited various clinics, it was found out that
they were hyperactive. However, this problem has been given less weight in since the parents to
the children suffering from Fetal Alcohol Syndrome say that the problem is not so severe to the
children. According to the research carried out by Coles and et al. (1997), there were little
evidence in relation to hyperactivity in a sample of children having Fetal Alcohol Syndrome. The
authors found out that the hyperactivity cases reported by the mothers who sought prenatal care
could be attributed to social and environmental factors such as anxiety and post-traumatic stress
disorder.
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Additionally, the Fetal Alcohol Syndrome children were found not to have sustained
focus on activities. This was assessed using continued tests of performance whereby several
letters were displayed on a computer screen and the child was directed to press the button of the
number appearing on the screen. It was found out that there was slower reactions among the
Fetal Alcohol Syndrome/Fetal Alcohol Effects children but the errors made by the children could
not be used to draw a concrete conclusion. It was then concluded that the Fetal Alcohol
Syndrome/ Fetal Alcohol Effects could only display attention deficiency if they were given a
task that required them to be actively involved in processing information. Poorer performance
was noted with increased prenatal alcohol exposure on a task that required remembering patterns
of numbers on the computer and on a timed reading passage test (Jacobson, & Jacobson, 2014).
Focused attention is the ability of a person to maintain attention to something in the
presence of distraction. According to Ollendick and Schroeder (2003), focused attention was
deemed to be more poor to the Fetal Alcohol Syndrome/ Fetal Alcohol Effects children who
experienced prenatal alcohol exposure.
In termers of cognitive flexibility, Fetal Alcohol Syndrome was found to be poor on verbal tests
that included fluency tests whereby the child was asked to list as many words as possible from a
given subject. Cognitive flexibility is the capacity of a person to attend to several things
simultaneously as well as being able to shift his or her attention during the task. Schonfeld et al.
(2001) indicates that Fetal Alcohol Syndrome children display decreased cognitive flexibility
when undergoing fluency test. Winconsin card sorting test is one of the tests which are used to
test cognitive flexibility of the Fetal Alcohol Syndrome children. The child is supposed to sort
cards in terms of color, shape or number of items on the card. After carrying out ten successive
trials, the criterion is changed. If the child fails to recognize what he or she should do after the
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criterion changes, then he or she has failed in flexibility thus lack cognitive flexibility. Similarly,
FAE/Fetal Alcohol Syndrome children have been found to have poor response inhibition when
doing California Stroop test which tests one's speed in reading the different names of colors
(Ollendick & Schroeder 2003).
In terms of planning, Fetal Alcohol Syndrome children have shown poor performance in tests
Raven's Progressive Matrix. This tests tries to ascertain the child's ability to determine which
among the six patterns is appropriate to insert a blank space cut from a larger design. The test is
designed to assess the ability of the child to analyze a problem, come up with a strategy of
dealing with the problem, analyze the performance of the strategy, and modify one's strategy as
he or she continues to solve the problem.
Fetal Alcohol Syndrome patients have been noted to be impaired when it comes to learning and
memorizing certain aspects. The learning and memorizing however, varies from one patient to
the other. Fetal Alcohol Syndrome/FAE children who underwent California Verbal Learning
Test had more difficulty when asked to memorize information which they had not dealt with
before as compared to retention and remembering the concepts they had been previously taught.
MATTSON, SCHOENFELD, and RILEY (1999) found out that recognition memory of Fetal
Alcohol Syndrome/FAE children was unaffected to the children who had not been affected by
prenatal alcohol exposure. However, for the babies aged 6.5 to 12 months who had been
experienced increased prenatal alcohol exposure, they showed slower and inefficient information
processing.
During infancy, the children who had been exposed to prenatal alcohol exposure indicated high
levels of irritability. This phenomenon is known to contribute to poor maternal attachment and
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behavioral problems in childhood. The children who have been exposed to prenatal alcohol have
shown less social competence and increased aggressiveness in class. These indicated that
prenatal alcohol exposure leads to socio-emotional development effects which are independent
of the social environment in which the child was raised (MATTSON, SCHOENFELD, & RILEY,
1999).
How to reduce Fetal Alcohol Syndrome.
Since the effects of alcohol to the infant are pernicious, multiple, incurable and very costly, they
are however preventable. The federal government took a step of warning the public that alcohol
consumption was extremely insecure during pregnancy. In 2002, a section of the women carried
out a research and presented a report showing that out of 10.1 percent of the women who
engaged in alcohol, 1.9 percent engaged in heavy drinking while another 1.9 percent engaged in
binge drinking. As the alcohol consumption prevalence among the women is increasing during
pregnancy, the US Department of Health and Human Services established a goal called 'Healthy
people 2010' to target the decrease of the number of women who abstained from alcohol. In
2004, the US Preventive Services Task Forces established that screening and counseling would
be the primary care of ensuring that the cases of alcohol misuse during pregnancy reduced
(Mukherjee, Hollins, & Turk,2006) .
Similarly, due to the increased effects to the fetus, pregnant mothers were advised to abstain
from alcohol drinking. Alcohol Exposed Pregnancy (AEP) has also been employed so as to
ensure that the clinicians are able to judge the exposure effects of the pregnant mothers to
alcohol. AEP helps the clinician to know the amount of alcohol consumed at any time when the
woman was pregnant. In order to prevent AEP, it is essential for the women who are sexually
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active and fertile to abstain from alcohol intake. They are also advised to engage in effective
contraceptive methods as well as abstaining from sexual activities (Mukherjee, Hollins, &
Turk,2006).
Recommendations
After diagnosis, it is essential for the Fetal Alcohol Syndrome patients, their families and the
society to realize that the process of diagnosing of an individual should incorporate appropriate
heath care, community services and education. When the Fetal Alcohol Syndrome individuals
are diagnosed at an early age, it will be advantageous for the home and nurturing environment
of the patients.
Since the life skills and learning of those affected by prenatal exposure vary amongst various
individuals, it is essential to evaluate the current and past environment where the person lived for
proper information to be conveyed to him or her. This means that the services provided by
different families differ and thus it is significant for the clinical officers to take note of the part
of the brain affected, the age, health and functionality of families as well as the environment
where the person lives.
Interventions should include strategies that will help in stabilizing the home of the affected
persons. This means that the parents, society and the individuals should be made to understand
the disorder so that the children get special treatment while growing.
The professionals working with the affected families should ensure that they get first hand
information from the family members who live with the children so as to get a better
understanding of the different situations. They should also ensure that they give correct
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counseling to the parents that will help them deal with the day to day challenges. The clinicians
should also ensure that they help the families identify the available services that will help
towards taking care of the children, and understand how to work productively towards getting
the best services from service providers.
The infants who have been exposed to prenatal care often enter adaptive care system at a very
early age. This impairs the correct growth of a child since the service providers at prenatal care
do not have much knowledge about Fetal Alcohol Syndrome. It is hence the responsibility of the
clinicians to ensure that the prenatal care givers are presented with correct information that will
help the children grow without having negative effects after their growth.
Conclusion
Fetal Alcohol Syndrome is a syndrome which has been discussed widely and we have
been able to come up with ways of reducing the cases as well as ways of taking care of the
children. It is thus a syndrome which is inevitable and should be of a major concern to the
government as well as the health organization. It is also essential that the education system
integrate the Fetal Alcohol Syndrome effects and prevention so as to provide the necessary
information which will help the society improve in its drinking habits. It is also essential for the
pregnant mothers to get adequate information on the effects of heavy drinking while pregnant.
This will assist the mothers to realize how to prevent their children from Fetal Alcohol
Syndrome and how to help indulge in healthy eating habits as compared to alcoholism. The
mothers should also be taught on how to handle the affected children after birth so as to ensure
that the children grow in an environment that supports them to grow other than abandoning them.

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