Fetal alcohol syndrome and fetal alcohol effects (see Appendix 15) are the leading causes of mental retardation in the country. At least 762,000 children are born each year exposed to alcohol during pregnancy.  Once ingested and absorbed into the maternal bloodstream, alcohol readily crosses the placenta and enters the fetal circulation. 

It is found in the amniotic fluid, even after ingestion of a moderate dose. Alcohol is eliminated from the amniotic fluid at one-half the rate at which it is eliminated from the maternal blood; therefore, it remains in the fetal circulation after it is no longer in the mother’s bloodstream. It is estimated that approximately one of every three to four mothers exposes her fetus to the potentially harmful effects of alcohol. Fetal alcohol syndrome is the leading preventable cause of mental retardation and neurobehavioral defects in North America (Pagliaro & Pagliaro, 2002).

The signs and symptoms of fetal alcohol syndrome have been established by the Fetal Alcohol Study Group of the Research Society on Alcoholism and incorporate the following criteria (Pagliaro & Pagliaro, 2002):

•  Prenatal and/or postnatal growth retardation.
•  Central nervous system involvement (including neurologic abnormality, developmental delay, behavioral dysfunction, intellectual impairment, and/or structural abnormalities such as microcephaly).
•  A characteristic face described as including short palpebral fissures and elongated mid-face,  a long and flattened philtrum,  thin upper lip, and flattened maxilla.

Many patients have a less severe form of alcohol-induced brain damage called fetal alcohol effects. The behavioral and neurological problems associated with prenatal exposure to alcohol in the absence of the symptoms of full-blown fetal alcohol syndrome are termed alcohol-related neurodevelopmental disorder or fetal alcohol effects. Patients with fetal alcohol effects don’t have the full syndrome,  but they have neurological and behavior problems due to alcohol-related brain damage. Children with fetal alcohol problems often have short attention spans and are described as hyperactive or impulsive. Maladaptive behaviors are common and include poor judgment, failure to consider consequences of their actions, and difficulty perceiving social cues (Gordis, 2003; Streissguth, 1998).

The Fetal Alcohol Behavior Scale (see Appendix 15) is helpful in uncovering fetal alcohol syndrome and fetal alcohol effects in your patients. You must make sure that you have evidence of maternal drinking before you can diagnose this problem. Many of your patients will have a mild to moderate form of this brain damage and will need more structure in recovery.

Alcohol has poisoned their brain,  and they will need an advocate in the community to buffer problems with society (Streissguth, Bookstein, Barr, Press, & Sampson, 1998).

If you don’t think alcohol is a poison, take an egg and drop it into Everclear, which is 95%  pure alcohol.  The egg will instantly turn white as it cooks. This is a good demonstration for your patients. It allows them to see the poisonous effect of their drug of choice. People with fetal alcohol effects may have normal intelligence, but they have defects in their brain and behavior. They can do some things some days but are unable to do the same things the next day.

They have difficulty generalizing. A rule they learn in one situation may not transfer to other situations.  They have difficulty learning from past experiences, and they have difficulty learning how the past affects the future. They tend to be very nice, people-oriented patients, but they keep relapsing. Does this sound like anyone you know? There are probably patients you are seeing now who have this disorder,  and many will be incapable of working a self-directed program of recovery. These patients will need a mentor or a structured facility for the rest of their lives.

The mentor is usually someone in the family or community who can act as an advocate for the patient in recovery. These patients are very frustrating to work with until you figure out what the problem is and change the treatment plan to incorporate this condition (Streissguth, 1998).

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Robert R. Perkinson,  PHD
Helping Your Clients Find the Road to Recovery

Alcoholism - Treatment.  I.  Title.
RC565.P375 - 2004
616.86’10651- dc22