Assessing FASD

by Dr. Lorin Bradbury

Question: How do you determine if a child has Fetal Alcohol Syndrome or Fetal Alcohol Effect?
The relationship between maternal consumption of alcohol during pregnancy and permanent birth defects (Fetal Alcohol Syndrome) was first described in the 1970s. Fetal Alcohol Syndrome (FAS) is the leading cause of mental retardation in the Western World. Literature from the University of Washington estimates the prevalence of FAS to range from 1 to 3 per 1000 live births in the general population. But in high-risk populations, FAS has been found to be as high as 10 to 15 per 100 live births. Western Alaska is one of those high-risk populations.
Any amount of alcohol is too much when a woman is pregnant. Many women are willing to stop using alcohol once they know they are pregnant, but by the time pregnancy is confirmed, damage to the developing fetus has already occurred. No one knows for sure how much damage will be done if a woman drinks at some time during a pregnancy. It seems to be a roll of the dice. There are many factors involved, such as what was developing the day the alcohol was consumed, how much alcohol was consumed, and/or how much alcohol crossed the placental barrier. When alcohol crosses the placental barrier, it can stunt the growth and weight of the developing fetus, create distinctive facial features, and/or damage neurons and brain structures, which can result in psychological or behavioral problems.
Some have come to believe prenatal alcohol exposure is most detrimental during the first trimester. During the first trimester of pregnancy, alcohol interferes with the migration and organization of brain cells, which can create structural deformities or deficits within the brain. However, during the third trimester, damage can be caused to areas of the brain that play a role in memory, learning, emotion, and encoding visual and auditory information, all of which can impact the function of the brain and central nervous system.
In fact, damage to the central nervous system can occur at any time during a pregnancy when the fetus is exposed to alcohol. As a result of the likelihood of damage to the developing child, the U. S. Surgeon General issued recommendations in 1981 and again in 2005 that women abstain from alcohol use while pregnant or while planning a pregnancy.
Attempts have been made to move away from the use of the term Fetal Alcohol Effect, or FAE because it has been used broadly and has been poorly defined. Instead of using the term FAE, the effects of prenatal exposure to alcohol are now defined as existing as a spectrum—Fetal Alcohol Spectrum Disorder (FASD), with Fetal Alcohol Syndrome (FAS) on one end of the spectrum.
The Bethel FASD Diagnostic Team uses the University of Washington Diagnostic System, which measures four key diagnostic features of FASD. The magnitude of the key diagnostic feature is rated on a four-point scale. The four key areas assessed are Growth Deficiency, Facial Features, Central Nervous System Damage, and Prenatal Alcohol Exposure. The degree of the existence of each of these key features is rated on a scale of 1 to 4—thus a spectrum. A pediatrician utilizing objective criteria determines growth deficiencies and facial features. A psychologist using objective norm-referenced tests assesses central nervous system damage, and information on use of alcohol during pregnancy is obtained by an interview with the mother, interviews with close relatives, or a review of birth records.
The diagnostic team analyzes the information obtained and an overall score is assigned, resulting in a diagnosis. Since we are assessing a syndrome, it is not the same as identifying a presence or absence of a particular virus or specific kind of bacteria. Instead, it is an estimate of the presence of a complex of variables and the magnitude to which they exist.
Estimates of the cost of FAS to society vary. However, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that the lifetime cost for each child with FAS is $2 million or more, depending on the costs included. There are reputable institutions that estimate that the lifetime costs go as high as $4 million per child with FAS. Further, it is impossible to measure in dollars the cost to a child who will suffer through life with the debilitating effects of FAS. If you know someone who is planning to get pregnant, or is pregnant, please do everything in your power to convince her not to use alcohol.
Lorin L. Bradbury, Ph.D. is a licensed psychologist in private practice in Bethel. For appointments, he can be reached at 543-3266. If you have questions that you would like Dr. Bradbury to answer in the Delta Discovery, please send them to The Delta Discovery, P.O. Box 1028, Bethel, AK 99559, or e-mail them to [email protected].