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... s affected by prenatal alcohol exposure. The last number from South Africa is from recent work done by Phil May and colleagues. References England G, Perham-Hester KA, Gessner BD, Ingle D, Berner JE, Middaugh JP. Fetal Alcohol Syndrome in Alaska, 1977 through 1992: An administrative prevalence derived from multiple data sources. American Journal of Public Health. 1998. 88 (5): 781 - 786.
Aberdeen IHS Area (1995) MMWR. vol 44 (#): 253 - 261. BDMP (1995): MMWR Vol. 44 (13): 249 - 253. Atlanta, Ga. (1997) MMWR Vol. 46 (47): 1118 - 1120. Sampson, P.
D. , Streissguth, A. P. , Bookstein, F. L. , Little, R. E. , Clarren, S. K. , Dehaene, P. , Hanson, J. W. , & Graham, J.
M. , Jr. (1997). Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology, 56 (5), 317 - 326. Stratton, K. , Howe, C. , & Battaglia, F. (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, and treatment.
Washington, DC: National Academy Press. Institute of Medicine: 1996 Clinic-based (page 89), American Indian/Alaskan Native (page 88) May, P. , Viljoen, D. , Gossage, J. , Brooke, L. , Croxford, J. (1999). An epidemiological analysis of data from children with fetal alcohol syndrome and controls in Wellington, South Africa. Alcoholism: Clinical and Experimental Research, 23 (5), 110 A. May, P. , Viljoen, D. , Gossage, J. , Brooke, L. , Croxford, J (1999). An update on the maternal risk factors associated with the prevalence of fetal alcohol syndrome in Wellington, South Africa.
Alcoholism: Clinical and Experimental Research, 23 (5), 91 A Background It must be stressed that the facial characteristics basically define FAS. Without these facial features, one cannot be diagnosed with FAS. In particular, the discriminating features are short palpebral fissures (the length of the eye opening), a flat mid face, an indistinct or flat philtres (the ridge under the nose), and a thin upper vermillion (lip). While each of these can occur in a variety of disorders, the combination of these features appears to be consistent with heavy prenatal alcohol exposure. Children with FAS can also have other facial features, such as epicanthus folds (tiny folds of tissues along the eye opening), a low nasal bridge, an underdeveloped jaw and minor ear anomalies. These individuals can also have a variety of associated features.
Heart defects, skeletal anomalies, altered palmar creases (those creases on your hands), and urogenital anomalies are among the anomalies found more frequently in FAS. Reference Streissguth, A. P. (1994). A long-term perspective of FAS, Alcohol Health & Research World (Vol. 18, pp. 74 - 81).
image Facies in fetal alcohol syndrome Background The brain on the left was obtained from a 5 -day-old child with FAS while the brain on the right is a control. The effects are obvious. The brain on the left suffers from microcephaly (small brain) and migration anomalies (neural and glia cells did not migrate to their proper location in the brain, but instead many of them simply migrated to the top of the cortex). Although it cannot be seen here, there is also agenesis of the corpus callosum and the ventricles are dilated. The corpus callosum is the major fiber tract connecting the two hemispheres of the brain (more on this later). Major findings of other autopsies of children with FAS have found microcephaly, hydrocephalus, cerebral dys genesis, neuroglia l heterotopia's, corpus callosum anomalies, ventricle anomalies, and cerebellar anomalies.
It must be pointed out, however, that these autopsies have typically been conducted only on the most severe cases, since these children often have enough problems that they do not survive. The interested reader on the pathological changes that occur in FAS is referred to the following articles. References Clarren, S. K. (1986). Neuropathology in fetal alcohol syndrome. In J.
R. West (Ed. ), Alcohol and Brain Development (pp. 158 - 166). New York: Oxford University Press. Roebuck, T. M. , Mattson, S. N. , and Riley, E.
P. (1998). A review of the neuro anatomical findings in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research, 22 (2), 339 - 344. Image brain damage resulting from prenatal alcohol Background The image on the left is a normal midsaggital MRI scan of the human brain with the cerebrum and cerebellum pointed out. The data on the right show the reduction in size of the these two areas in children with FAS and PEA. PEA stands for Prenatal Exposure to Alcohol, and includes children with known histories of heavy prenatal alcohol exposure, but who lack the features necessary for a diagnosis of FAS.
As can be seen, the extent of reduction in the volume of both the cerebrum and cerebellum is significant. While the PEA group shows a reduction in volume, with these sample sizes, this is not a significant difference. Other brain imaging studies indicate disproportionate size reductions in the basal ganglia, cerebellum, and corpus callosum. The data are presented as percent of normal matched controls.
References Mattson, S. N. , Jernigan, T. L. , & Riley, E. P. (1994 a).
MRI and prenatal alcohol exposure. Alcohol Health & Research World, 18 (1), 49 - 52. Archibald, S. L. , Fennema-Note stine, C. , Games, A. , Riley, E.
P. , Mattson, S. N. , and Jernigan, T. L. (submitted, 2000). Brain dys morphology in individuals with severe prenatal alcohol exposure. image change in brain size Background One anomaly that has been seen in FAS is agenesis of the corpus callosum. While not common, it occurs in FAS cases (~ 6 %) more frequently than in the general population (0. 1 %) or in the developmentally disabled population (2 - 3 %).
In fact it has been suggested that FAS may be the most common cause of agenesis of the corpus callosum. In the top left picture, is a control brain. The other images are from children with FAS. In the top middle the corpus callosum is present, but it is very thin at the posterior section of the brain. In the upper right the corpus callosum is essentially missing. The bottom two pictures are from a 9 year old girl with FAS.
She has agenesis of the corpus callosum and the large dark area in the back of her brain above the cerebellum is a condition known as coprocephaly. It is essentially empty space. Most children with FAS do have a corpus callosum, although it may be reduced in size. The reduction in size occurs primarily in the front and rear portions (genu and selenium). One interesting item is that this same pattern of reduction in the genu and selenium has been found in ADHD children. The behavioral problems seen in FAS frequently are similar to those seen in ADHD.
References Mattson, S. N. , Jernigan, T. L. , & Riley, E. P. (1994 a). MRI and prenatal alcohol exposure.
Alcohol Health & Research World, 18 (1), 49 - 52. Mattson, S. N. , & Riley, E. P. (1995). Prenatal exposure to alcohol: What the images reveal. Alcohol Health & Research World, 19 (4), 273 - 277.
Riley, E. P. , Mattson, S. N. , Sowell, E. R. , Jernigan, T. L. , Sobel, D.
F. , & Jones, K. L. (1995). Abnormalities of the corpus callosum in children prenatally exposed to alcohol. Alcoholism: Clinical and Experimental Research, 19 (5), 1198 - 1202. Background There have been over a dozen retrospective studies of children with FAS (total N = 269).
Overall, these studies, such as the Seattle studies or studies out of Germany, reported an overall mean IQ of 72. 26 (range of means = 47. 4 - 98. 2). The data presented here were collected in San Diego, CA as part of a project at the Center for Behavioral Teratology. The mean IQ performances of children with FAS were compared to alcohol-exposed children with few if any features of FAS. All children in this study were exposed prenatally to high amounts of alcohol, however only the FAS group displayed the craniofacial anomalies and growth deficits associated with the diagnosis. The other group was designated as having prenatal exposure to alcohol (PEA) and had documented exposure to high levels of alcohol but were not dimorphic, microcephalic, or growth-retarded. In comparison to normal controls, both groups of alcohol-exposed children displayed significant deficits in overall IQ measures as well as deficits on most of the subtest scores.
While the PEA subjects usually obtained marginally higher IQ scores than those with FAS, few significant differences were found between the two alcohol-exposed groups. These results indicate that high levels of prenatal alcohol exposure are related to an increased risk for deficits in intellectual functioning and that these deficits can occur in children without all of the physical features required for a diagnosis of FAS. Our PEA subjects may be somewhat similar to individuals identified by other groups as having FAE, however individuals with PEA display few if any of the facial features of FAS, and are not growth retarded or microcephalic. References Streissguth AP, Are JM, Clarren SK, Ranges SP, LaDue RA, Smith DF (1991). Fetal alcohol syndrome in adolescents and adults. Journal of the American Medical Association 265: 1961 - 1967.
Mattson, S. N. , Riley, E. P. , Gramling, L. , Delis, D. C. , and Jones, K.
L. (1997). Heavy prenatal alcohol exposure with or without physical features of fetal alcohol syndrome leads to IQ deficits. Journal of Pediatrics, 131 (5), 718 - 721. Mattson, S.
N. and Riley, E. P. (1998). A review of the neuro behavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research, 22 (2), 279 - 294. image general intellectual performance Background This was a study of a broad range of neuropsychological tests, such as: The Wide Range Achievement Test- which assesses academic skills, the Peabody Picture Vocabulary Test and the Boston Naming test-both assessment of basic language functioning, the California Verbal Learning Test-a list learning and memory test, the Visual-Motor Integration Test which measures basic visual-perceptual skills, the Grooved Pegboard test-a test of fine-motor speed and coordination, and the Children's Category Test-a measure of nonverbal learning.
Along the x-axis are the tests included in the battery; for comparison purposes, all scores were converted to standard scores with a mean of 100 and an SD of 15. Children with FAS or PEA showed deficits in comparison to controls and they were very similar to each other. There does seem to be some indication that the nonverbal measures (on the right of the slide) are not as impaired as the verbal and academic measures, which are on the left and center of the slide. The take home message is that children with FAS and those exposed to high amounts of alcohol, but without the characteristics required for a diagnosis of FAS, are similarly impaired.
The FAS children tend to be a bit worse than the PEA children, but the pattern of behavioral deific its is fairly similar over a wide range of tests. References Mattson, S. N. , Riley, E. P. , Gramling, L. , Delis, D. C. , & Jones, K.
L. (1998). Neuropsychological comparison of alcohol-exposed children with or without physical features of fetal alcohol syndrome. Neuropsychology, 12 (1), 146 - 153. image neuropsychological performance Background In addition to the abilities already discussed, a few studies have documented other specific neuropsychological deficits in individuals with FAS.
Children with prenatal alcohol exposure, with and without FAS, have demonstrated various deficits on measures of executive functioning. These measures have revealed problems in areas such as planning (tower task-shown above), cognitive flexibility (trails test), inhibition (stop test), and concept formation and reasoning (word context tests). Generally, performance on these measures is characterized by increased errors and more difficulty adhering to rules. Therefore, children are less successful overall. For example, on the tower measure shown above (Tower of California-similar to Tower of London), children with FAS and PEA passed fewer items overall and made more rule violations than controls.
The only two rules were to never place a larger piece on top of a smaller one and to move only one piece at a time. As can be seen the alcohol exposed children had many more rule violations. In addition, deficits have been found on the WCST (Wisconsin Card Sort Test), a nonverbal measure of problem solving. The WCST test requires both problem solving and cognitive flexibility and has been proposed to be sensitive to frontal system dysfunction. This test is a gold standard in the measure of executive functioning in neuropsychology.
Children with prenatal exposure to alcohol made more errors and had more difficulty with the conceptual nature of the task than controls. New data indicate that they have trouble identifying and defining concepts. Finally, tests of planning ability are also thought to be sensitive to frontal systems dysfunction although few such studies have been done in individuals with FAS. On the Progressive Planning Test which is similar to the Tower of London test children with FAS/FAE had difficulty with planning ahead and tended to perseverate on incorrect strategies. So far the results could be summarized as: 1) Heavy prenatal alcohol exposure is associated with a wide range of neuro behavioral deficits including visuospatial functioning, verbal and nonverbal learning, and executive functioning 2) Heavy prenatal alcohol exposure causes microcephaly and disproportionate reductions in the corpus callosum, basal ganglia, and cerebellum 3) Children with and without physical features of the fetal alcohol syndrome display qualitatively similar deficits References Carmichael O. H. , Feldman JJ, Streissguth AP, Gonzalez RD: Neuropsychological deficits and life adjustment in adolescents and adults with fetal alcohol syndrome.
Alcoholism: Clinical and Experimental Research 16: 380, 1992 Kodituwakku PW, Handmaker NS, Cutler SK, Weathersby EK, Handmaker SD: Specific impairments in self-regulation in children exposed to alcohol prenatally. Alcoholism: Clinical and Experimental Research 19: 1558 - 1564, 1995 Mattson, S. N. , Goodman, A. M. , Caine, C. , Delis, D. C. , & Riley, E. P. (1999).
Executive functioning in children with heavy prenatal alcohol exposure. Alcoholism, Clinical and Experimental Research, 23 (11), 1808 - 1815. Background Secondary disabilities are those disabilities that the individual is not born with, and hopefully with appropriate intervention could be ameliorated. This slide illustrates the extent of these secondary disabilities as a function of age. These are individuals with FAS and FAE.
As can be seen over 90 % of these individuals have mental health problems and about 50 % of those over the age of 12 have disrupted school experiences, trouble with the law, which is frequently severe enough to require confinement. They also engage in relatively high rates of inappropriate sexual behavior and a significant number have alcohol and drug abuse problems. Interestingly, the factors that are protective against these secondary disabilities are: Being raised in a stable, nurturing home, diagnosis before the age of 6, no sexual or physical abuse, not changing households every few years, not living in a poor quality home, and receiving Developmental Disabilities services. References Streissguth, A. P. , Barr, H. M. , Kogan, J. , & Bookstein, F.
L. (1996). Final Report: Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Seattle, WA: University of Washington Publication Services. Image secondary disabilities Background Much of what we know about FAS and the effects of prenatal alcohol exposure is the result of work on animal models. After FAS was identified it became important to demonstrate that the effects were indeed the result of alcohol exposure and not due to factors such as other drugs, maternal conditions, or nutritional variables. The development of appropriate animal models was very important in this regard.
Models were developed for assessing physical features of FAS as well as the behavioral, neuro anatomical, and neuro chemical profiles of prenatal alcohol exposure. The ideal test animal would absorb, metabolize and elicit...
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Research essay sample on Fetal Alcohol Syndrome Prenatal Alcohol Exposure
