Fetal alcohol syndrome or FAS is a disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy. It is unknown whether amount, frequency or timing of alcohol consumption during pregnancy causes a difference in amount of damage done to the fetus. Thus, the current recommendation is not to drink at all during pregnancy. Alcohol crosses the placental barrier and can stunt fetal growth or weight, create distinctive facial stigmata, damage neurons and brain structures, and cause other physical, mental, or behavioral problems.^[1][2][3] Image File history File links FASbaby. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // Q00-Q99 - Congenital malformations, deformations and chromosomal abnormalities (Q00-Q07) Congenital malformations of the nervous system (Q00) Anencephaly and similar malformations (Q01) Encephalocele (Q02) Microcephaly (Q03) Congenital hydrocephalus (Q04) Other congenital malformations of brain (Q05) Spina bifida (Q06) Other congenital malformations of spinal cord (Q07) Other congenital malformations of nervous... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... Considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol[1] indicates the NIAAA.[2] 3. ... The subject of alcohol and heart attacks is important because the major cause of death in many countries is heart disease. ... Alcohol and weight is a subject relevant to millions of people who like to drink alcoholic beverages and who also either want to maintain or to lose body weight. ... Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinkers normal personal, family, social, or work life, and may lead to physical or mental harm. ... The effects of alcohol on the human body can take several forms. ... A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... This article does not cite any references or sources. ... The placenta is an ephemeral (temporary) organ present only in female placental mammals during gestation (pregnancy). ... This article is about prenatal development in humans. ... Baby weighed as AGA Birth weight is the weight of a baby at its birth. ... Drawing by Santiago Ramón y Cajal of neurons in the pigeon cerebellum. ... // medulla oblongata medullary pyramids pons paramedian pontine reticular formation fourth ventricle cerebellum cerebellar vermis cerebellar hemispheres anterior lobe posterior lobe flocculonodular lobe cerebellar nuclei fastigial nucleus globose nucleus emboliform nucleus dentate nucleus tectum inferior colliculi superior colliculi mesencephalic duct (cerebral aqueduct, Aqueduct of Sylvius) cerebral peduncle midbrain tegmentum ventral tegmental...

The main effect of FAS is permanent and nonsubsequinciel central nervous system damage, especially the brain. Developing brain cells and structures are underdeveloped or malformed by prenatal alcohol exposure, often creating an array of primary cognitive and functional disabilities (including poor memory, attention deficits, impulsive behavior, and poor cause-effect reasoning) as well as secondary disabilities (for example, trouble with the law, mental health problems, and drug addiction).^[3][4] The risk of brain damage exists during each trimester, since the fetal brain develops throughout the entire pregnancy.^[5] Brain damage or brain injury is the destruction or degeneration of brain cells. ... In animals, the brain or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for behaviour. ... Cognitive The scientific study of how people obtain, retrieve, store and manipulate information. ... In psychology, memory is an organisms ability to store, retain, and subsequently retrieve information. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... A mental illness or mental disorder refers to one of many mental health conditions characterized by distress, impaired cognitive functioning, atypical behavior, emotional dysregulation, and/or maladaptive behavior. ... For other uses, see addicted. ... The human gestation period of approximately 40 weeks between the time of the last menstrual cycle and delivery is traditionally divided into three periods of three months, or trimesters. ...

Fetal alcohol exposure is the leading known cause of mental retardation in the Western world.^[6] In the United States alone, the FAS prevalence rate is estimated to be between 0.2 and 2.0 cases per 1,000 live births, comparable to or higher than other developmental disabilities such as Down syndrome or Spina Bifida.^[7] The lifetime medical and social costs of each child with FAS are estimated to be as high as US$800,000.^[8] While prenatal alcohol exposure does not automatically result in FAS, the U.S. Surgeon General advises pregnant women to abstain from alcohol use due to the risk of FAS.^[9] Mental retardation is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ... Mental retardation (abbreviated as MR), is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal intellectual capacity as an adult. ... Social cost, in economics, is the total of all the costs associated with an economic activity. ... The Surgeon General of the United States is the leading spokesman on matters of public health in the Government of the United States. ...

History

Historical references

Anecdotal accounts of prohibitions against maternal alcohol use from biblical, ancient Greek, and ancient Roman sources imply a historical awareness of links between maternal alcohol use and negative child outcomes.^[10] This assertion has been repeated in articles and books, but a more recent review of the original source material does not support such ancient knowledge.^[11] This Gutenberg Bible is displayed by the United States Library. ... Ancient Greece is a period in Greek history that lasted for around nine hundred years. ... Ancient Rome was a civilization that grew from a small agricultural community founded on the Italian Peninsula circa the 9th century BC to a massive empire straddling the Mediterranean Sea. ...

The earliest known observation of possible links between maternal alcohol use and fetal damage was made in 1899 by Dr. William Sullivan, a Liverpool prison physician who noted higher rates of stillbirth for 120 alcoholic female prisoners than their sober female relatives; he suggested the causal agent to be alcohol use.^[12] This contradicted the predominating belief at the time that heredity caused mental retardation, poverty, and criminal behavior, which contemporary studies on the subjects usually concluded.^[3] A case study by Henry H. Goddard of the Kallikak family — popular in the early 1900s — represents this earlier perspective,^[13] though later researchers have suggested that the Kallikaks almost certainly had FAS.^[14] General studies and discussions on alcoholism throughout the mid-1900s were typically based on a heredity argument.^[15] For other uses, see Liverpool (disambiguation). ... This article or section is in need of attention from an expert on the subject. ... Henry Herbert Goddard (1866 – 1957) was a prominent American psychologist and eugenicist in the early 20th century. ... The Kallikak Family: A Study in the Heredity of Feeble-Mindedness was a 1912 book by the American psychologist and eugenicist Henry H. Goddard. ...

Prior to fetal alcohol syndrome being specifically identified and named in 1973, a few studies had noted differences between the children of mothers who used alcohol during pregnancy or breast-feeding and those who did not, but identified alcohol use as a possible contributing factor rather than heredity.^[3] A pregnant woman near the end of her term Pregnancy is the carrying of one or more offspring in an embryonal or fetal stage of development by female mammals, including humans, inside their bodies, between the stages of conception and birth. ... A breastfeeding infant Breastfeeding is the practice of a woman feeding an infant (or sometimes a toddler or a young child) with milk produced from her mammary glands, usually directly from the nipples. ...

Recognition as a syndrome

Fetal Alcohol Syndrome was named in 1973 by two dysmorphologists, Drs. Kenneth Lyons Jones and David W. Smith of the University of Washington Medical School in Seattle, United States. They identified a pattern of "craniofacial, limb, and cardiovascular defects associated with prenatal onset growth deficiency and developmental delay" in eight unrelated children of three ethnic groups, all born to mothers who were alcoholics.^[16] The pattern of malformations indicated that the damage was prenatal. News of the discovery shocked some, while others were skeptical of the findings.^[17] Dysmorphology is the study of congenital malformations or birth defects. ... The University of Washington, founded in 1861, is a public research university in Seattle, Washington. ... City nickname Emerald City City bird Great Blue Heron City flower Dahlia City mottos The City of Flowers The City of Goodwill City song Seattle, the Peerless City Mayor Greg Nickels County King County Area   - Total   - Land   - Water   - % water 369. ... This article or section should be merged with ethnic group Ethnicity is the cultural characteristics that connect a particular group or groups of people to each other. ... King Alcohol and his Prime Minister circa 1820 Alcoholism is the consumption of or preoccupation with alcoholic beverages to the extent that this behavior interferes with the alcoholics normal personal, family, social, or work life. ...

Dr. Paul Lemoine of Nantes, France had already published a study in a French medical journal in 1968 about children with distinctive features whose mothers were alcoholics,^[2] and in the U.S., Christy Ulleland and colleagues at the University of Washington Medical School^[1] had conducted an 18-month study in 1968-1969 documenting the risk of maternal alcohol consumption among the offspring of 11 alcoholic mothers. The Washington and Nantes findings were confirmed by a research group in Gothenburg, Sweden in 1979.^[18] Researchers in France, Sweden, and the United States were struck by how similar these children looked, though they were not related, and how they behaved in the same unfocused and hyperactive manner.^[18] Traditional city flag City coat of arms Motto: Favet Neptunus eunti (Latin: Shall Neptune favour the traveller) Location Coordinates Time Zone CET (GMT +1) Administration Country Region Pays de la Loire Department Loire-Atlantique (44) Mayor Jean-Marc Ayrault  (PS) (since 1989) City Statistics Land area¹ 65. ... Location of Gothenburg in northern Europe Coordinates: Country Sweden County Västra Götaland County Province Västergötland Charter 1621 Government  - Mayor Göran Johansson Area  - City 450 km²  (174 sq mi)  - Water 14. ... Hyperactivity can be described as a state in which a person is abnormally easily excitable and exuberant. ...

Within four years of the Washington discovery, animal studies, including non-human primate studies carried out at the University of Washington Primate Center by Dr. Sterling Clarren, had confirmed that alcohol was a teratogen. By 1978, 245 cases of FAS had been reported by medical researchers, and the syndrome began to be described as the most frequent known cause of mental retardation. Families 15, See classification A primate is any member of the biological order Primates, the group that contains all the species commonly related to the lemurs, monkeys, and apes, with the latter category including humans. ... Dr. Sterling Clarren Sterling K. Clarren is one of the worlds leading researchers into fetal alcohol spectrum disorder (FASD), an umbrella term emcompassing fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). ... // Teratogenesis is a medical term from the Greek, literally meaning monster-birth, which derives from teratology, the study of the frequency, causation, and development of congenital malformations—misleadingly called birth defects. ... Mental retardation is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ...

While many syndromes are eponymous, i.e. named after the physician first reporting the association of symptoms, Dr. Smith named FAS the causal agent of the symptoms.^[19] He reasoned that doing so would encourage prevention, believing that if people knew maternal alcohol consumption caused the syndrome, then abstinence during pregnancy would follow from patient education and public awareness.^[19] Nobody was aware of the full range of possible birth defects from FAS or its prevalence rate at that time,^[19] but admission of alcohol use during pregnancy can feel stigmatizing to birth mothers and complicate diagnostic efforts^[7] of a syndrome with its preventable cause in the name. In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ... An eponym is the name of a person, whether real or fictitious, who has (or is thought to have) given rise to the name of a particular place, tribe, discovery, or other item. ... Health education is defined as the process by which individuals and groups of people learn to behave in a manner conducive to the promotion, maintenance or restoration of health. ...

Over time, as subsequent research and clinical experience suggested that a range of effects (including physical, behavioral, and cognitive) could arise from prenatal alcohol exposure, the term Fetal Alcohol Spectrum Disorder (FASD) was developed to include FAS as well as other conditions resulting from prenatal alcohol exposure.^[19] Currently, FAS^[16][20][21] is the only expression of prenatal alcohol exposure defined by the International Statistical Classification of Diseases and Related Health Problems and assigned ICD-9 and ICD-10 diagnoses. This baby has FASD. Fetal alcohol spectrum disorder (FASD) describes a spectrum of permanent and often devastating birth-defect syndromes caused by maternal consumption of alcohol during pregnancy. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ...

Diagnosis

Several diagnostic systems have been developed in North America:

• The Institute of Medicine's guidelines for FAS, the first system to standardize diagnoses of individuals with prenatal alcohol exposure,^[21]
• The University of Washington's "The 4-Digit Diagnostic Code," which ranks the four key features of FASD on a Likert scale of one to four and yields 256 descriptive codes that can be categorized into 22 distinct clinical categories, ranging from FAS to no findings,).^[22]
• The Centers for Disease Control's "Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis," which established general consensus on the diagnosis FAS in the U.S. but deferred addressing other FASD conditions,^[7] and
• Canadian guidelines for FASD diagnosis, which established criteria for diagnosing FASD in Canada and harmonized most differences between the IOM and University of Washington's systems.^[23]

Fetal alcohol syndrome is the only expression of FASD that has garnered consensus among experts to become an official ICD-9 and ICD-10 diagnosis. To make this diagnosis (or determine any FASD condition), a multi-disciplinary evaluation is necessary to assess each of the four key features for assessment. Generally, a trained physician will determine growth deficiency and FAS facial features. While a qualified physician may also assess central nervous system structural abnormalities and/or neurological problems, usually central nervous system damage is determined through psychological, speech-language, and occupational therapy assessments. Prenatal alcohol exposure risk may be assessed by a qualified physician, psychologist, social worker, or chemical health counselor. These professionals work together as a team to assess and interpret data of each key feature for assessment and develop an integrative, multi-disciplinary report to diagnose FAS (or other FASD conditions) in an individual. The Institute of Medicine, a part of the National Academy of Sciences, is an American organization whose purpose is to provide national advice on issues relating to biomedical science, medicine, and health (National Academy of Sciences, n. ... The University of Washington, founded in 1861, is a public research university in Seattle, Washington. ... A Likert scale (pronounced lick-urt) is a type of psychometric response scale often used in questionnaires, and is the most widely used scale in survey research. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) is a detailed description of known diseases and injuries. ... Interdisciplinarity is the act of drawing from two or more academic disciplines and integrating their insights to work together in pursuit of a common goal. ... The Doctor by Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ... Psychological testing or psychological assessment is a field characterized by the use of samples of behavior in order to infer generalizations about a given individual. ... It has been suggested that Speech-Language Pathology, Speech therapy, Phoniatrics be merged into this article or section. ... Occupational therapy refers to the use of meaningful occupations to assist people who have difficulty in achieving occupationally balanced lives. ... A psychologist is a scientist or clinician who studies psychology, the systematic investigation of the human mind, including behavior and cognition. ... Professional social workers are concerned with social problems, their causes, their solutions and their human impacts. ...

The following criteria must be fully met for an FAS diagnosis:^{[22][21][7][23]}

1. Growth deficiency — Prenatal or postnatal height or weight (or both) at or below the 10th percentile^[24]
2. FAS facial features — All three FAS facial features present^[25]
3. Central nervous system damage — Clinically significant structural, neurological, or functional impairment
4. Prenatal alcohol exposure — Confirmed or Unknown prenatal alcohol exposure

Differential diagnosis

The CDC reviewed nine syndromes that have overlapping features with FAS; however, none of these syndromes include all three FAS facial features, and none are the result of prenatal alcohol exposure:^[7] In medicine, the term syndrome is the association of several clinically recognizable features, signs, symptoms, phenomena or characteristics which often occur together, so that the presence of one feature alerts the physician to the presence of the others. ...

• Aarskog syndrome
• Williams syndrome
• Noonan's syndrome
• Dubowitz syndrome
• Brachman-DeLange syndrome
• Toluene syndrome
• Fetal hydantoin syndrome
• Fetal valproate syndrome
• Maternal PKU fetal effects

Aarskog syndrome is an inherited disease characterized by short stature, facial abnormalities, musculoskeletal, and genital anomalies. ... Williams syndrome (also Williams-Beuren syndrome) is a rare genetic disorder, occurring in fewer than 1 in 7,500 live births. ... Noonan Syndrome (NS) is a relatively common congenital genetic condition which affects both males and females. ... Cornelia de Lange Syndrome aka CdLS is a rare genetic disorder that leads to severe developmental anomalies. ... // Metabolism in Humans While a significant amount of toluene, 25%-40%, is exhaled unchanged via the lungs, a greater proportion is metabolised and excreted via other pathways. ... Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. ... The neural tube is the embryonal structure that gives rise to the brain and spinal cord. ... Phenylketonuria fee-nil-kee-ton-yur-ee-aah+ (PKU) is a human genetic disorder that occurs in about 1 in 15,000 births, but the incidence varies widely in different human populations from 1 in 4,500 births among the Irish to fewer than one in 100,000 births among...

Signs and symptoms

Growth deficiency

Newborn infant with FAS.

Growth deficiency is defined as significantly below average height, weight or both due to prenatal alcohol exposure, and can be assessed at any point in the lifespan. Growth measurements must be adjusted for parental height, gestational age (for a premature infant), and other postnatal insults (e.g., poor nutrition), although birth height and weight are the preferred measurements.^[22] Deficiencies are documented when height or weight falls at or below the 10th percentile of standardized growth charts appropriate to the patient's population.^[24] Image File history File links NewbornFAS.jpg Newborn baby with FAS from the clinic of Dr. Jon Aase, specialist in FASD, taken from [1] Dr. Aase has been e-mailed to request a free licence. ... Image File history File links NewbornFAS.jpg Newborn baby with FAS from the clinic of Dr. Jon Aase, specialist in FASD, taken from [1] Dr. Aase has been e-mailed to request a free licence. ... Growth can mean increase in spatial number or complexity for concrete entities in time or increase in some other dimension for abstract or hard-to-measure entities. ... Stature redirects here. ... Weight, in the context of human body weight measurements in the medical sciences and in sports is a measurement of mass, and is thus expressed in units of mass, such as kilograms (kg), or units of force such as pounds (lb). ... Maximum life span is a measure of the maximum number of years a member of a group has been observed to survive. ... Gestational age is age of a fetus (or newborn infant) from presumed conception. ... In most systems of human pregnancy, the condition, premature birth (also known as a preterm birth), occurs when the baby is born within sooner than 36 weeks of completed gestation. ... Postnatal (Latin for after birth) is the period beginning immediately after the birth of a child and extending for about six weeks. ... Many diseases in humans are thought to be directly or indirectly related to nutrition, These include, but are not limited to, deficiency diseases, caused by a lack of essential nutrients. ...

The CDC and Canadian guidelines use the 10th percentile as a cut-off to determine growth deficiency.^[7][23] The "4-Digit Diagnostic Code" allows for mid-range gradations in growth deficiency (between the 3rd and 10th percentiles) and severe growth deficiency at or below the 3rd percentile.^[22] Growth deficiency (at severe, moderate, or mild levels) contributes to diagnoses of FAS and PFAS (Partial Fetal Alcohol Syndrome), but not ARND (Alcohol-Related Neurodevelopmental Disorder) or static encephalopathy.

Growth deficiency is ranked as follows by the "4-Digit Diagnostic Code:"^[22]

• Severe — Height and weight at or below the 3rd percentile.
• Moderate — Either height or weight at or below the 3rd percentile, but not both.
• Mild — Either height or weight or both between the 3rd and 10th percentiles.
• None — Height and weight both above the 10th percentile.

Facial features

A thin upper lip and smooth philtrum are diagnostic of FAS.

Several characteristic craniofacial abnormalities are visible in individuals with FAS.^[26] The presence of FAS facial features indicates brain damage, though brain damage may also exist in their absence. FAS facial features (and most other visible, but non-diagnostic, deformities) are believed to be caused mainly during the 10th and 20th week of gestation.^[27] This work is copyrighted. ... This work is copyrighted. ... The philtrum (Greek philtron, from philein, to love; to kiss) is the vertical groove in the upper lip, formed where the nasomedial and maxillary processes meet during embryonic development. ... Craniofacial (cranio- combining form meaning head or skull + -facial combining form referring to the facial structures grossly) may be used to describe cratain congenital malformations, injuries, surgeons who subspecialize in this area, multi-disiplinary medical-surgical teams that treat and do research on disorders affecting this region, and organizations with... Brain damage or brain injury is the destruction or degeneration of brain cells. ...

Refinements in diagnostic criteria since 1975 have yielded three distinctive and diagnostically significant facial features known to result from prenatal alcohol exposure and distinguishes FAS from other disorders with partially overlapping characteristics.^[28][29] The three FAS facial features are:

• A smooth philtrum — The divot or groove between the nose and upper lip flattens with increased prenatal alcohol exposure (see photo at right).
• Thin vermilion — The upper lip thins with increased prenatal alcohol exposure (see photo at right).
• Small palpebral fissures — Eye width shortens with increased prenatal alcohol exposure.

Measurement of FAS facial features uses criteria developed by the University of Washington. The lip and philtrum are measured by a trained physician with the Lip-Philtrum Guide,^[30] a 5-point Likert Scale with representative photographs of lip and philtrum combinations ranging from normal (ranked 1) to severe (ranked 5). Palpebral fissure length (PFL) is measured in millimeters with either calipers or a clear ruler and then compared to a PFL growth chart, also developed by the University of Washington.^[25] The philtrum (Greek philtron, from philein, to love; to kiss) is the vertical groove in the upper lip, formed where the nasomedial and maxillary processes meet during embryonic development. ... Lips (upper and lower) are the red (or pink or brown) and soft edges covering the human mouth. ... Palpebral fissure is the anatomic name for the separation between the upper and lower eyelids. ... For other uses, see Eye (disambiguation). ...

Ranking FAS facial features is complicated because the three separate facial features can be affected independently by prenatal alcohol. A summary of the criteria follows:^[22][31]

• Severe — All three facial features ranked independently as severe (lip ranked at 4 or 5, philtrum ranked at 4 or 5, and PFL less than or equal to two standard deviations below average).
• Moderate — Two facial features ranked as severe and one feature ranked as moderate (lip or philtrum ranked at 3, or PFL between one and two standard deviations below average).
• Mild — A mild ranking of FAS facial features covers a broad range of facial feature combinations:
  • Two facial features ranked severe and one ranked within normal limits,
  • One facial feature ranked severe and two ranked moderate, or
  • One facial feature ranked severe, one ranked moderate and one ranked within normal limits.
• None — All three facial features ranked within normal limits.

These distinctive facial features in a patient does strongly correlate to brain damage. Sterling Clarren of the University of Washington's Fetal Alcohol and Drug Unit told a conference in 2002: Dr. Sterling Clarren Sterling K. Clarren is one of the worlds leading researchers into fetal alcohol spectrum disorder (FASD), an umbrella term emcompassing fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). ...

I have never seen anybody with this whole face who doesn't have some brain damage. In fact in studies, as the face is more FAS-like, the brain is more likely to be abnormal. The only face that you would want to counsel people or predict the future about is the full FAS face. But the risk of brain damage increases as the eyes get smaller, as the philtrum gets flatter, and the lip gets thinner. The risk goes up but not the diagnosis. Brain damage or brain injury is the destruction or degeneration of brain cells. ... In animals, the brain or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for behaviour. ... The philtrum (Greek philtron, from philein, to love; to kiss) is the vertical groove in the upper lip, formed where the nasomedial and maxillary processes meet during embryonic development. ...

At one-month gestation, the top end of your body is a brain, and at the very front end of that early brain, there is tissue that has been brain tissue. It stops being brain and gets ready to be your face ... Your eyeball is also brain tissue. It's an extension of the second part of the brain. It started as brain and "popped out." So if you are going to look at parts of the brain from alcohol damage, or any kind of damage during pregnancy, eye malformations and midline facial malformations are going to be very actively related to the brain across syndromes ... and they certainly are with FAS.^[32] Gestation is the carrying of an embryo or fetus inside a female viviparous animal. ... Wikipedia does not yet have an article with this exact name. ...

Central nervous system damage

The image shows the brains of two six-week-old infants. The left brain is confirmed no alcohol exposure, while the right brain is of an infant with FAS. [1]

Central nervous system (CNS) damage is the primary feature of any FASD diagnosis. Prenatal alcohol exposure, a teratogen, can damage the brain across a continuum of gross to subtle impairments, depending on the amount, timing, and frequency of the exposure as well as genetic predispositions of the fetus and mother.^[21][33] While functional abnormalities are the behavioral and cognitive expressions of the FAS disability, CNS damage can be assessed in three areas: structural, neurological, and functional impairments. Image File history File links FASbrains2. ... Image File history File links FASbrains2. ... A diagram showing the CNS: 1. ...

All four diagnostic systems allow for assessment of CNS damage in these areas, but criteria vary. The IOM system requires structural or neurological impairment for a diagnosis of FAS.^[21] The "4-Digit Diagnostic Code" and CDC guidelines state that functional anomalies must measure at two standard deviations or worse in three or more functional domains for a diagnoses of FAS.^[22][7] The "4-Digit Diagnostic Code" further elaborates the degree of CNS damage according to four ranks:

• Definite — Structural impairments or neurological impairments for FAS or static encephalopathy.
• Probable — Significant dysfunction of two standard deviations or worse in three or more functional domains.
• Possible — Mild to moderate dysfunction of two standard deviations or worse in one or two functional domains or by judgment of the clinical evaluation team that CNS damage cannot be dismissed.
• Unlikely — No evidence of CNS damage.

Structural

Structural abnormalities of the brain are observable, physical damage to the brain or brain structures caused by prenatal alcohol exposure. Structural impairments may include microcephaly (small head size) of two or more standard deviations below the average, or other abnormalities in brain structure (e.g., agenesis of the corpus callosum, cerebellar hypoplasia).^[21] Agenesis is the medical term for the failure of an organ to develop during embrionic growth and development. ... The corpus callosum is a structure of the mammalian brain in the longitudal fissure that connects the left and right cerebral hemispheres. ... Cerebellar hypoplasia is a disorder found in cats and dogs in which the cerebellum is not completely mature at birth. ...

Microcephaly is determined by comparing head circumference (often called occipitofrontal circumference, or OFC) to appropriate OFC growth charts.^[24] Other structural impairments must be observed through medical imaging techniques by a trained physician. Because imaging procedures are expensive and relatively inaccessible to most patients, diagnosis of FAS is not frequently made via structural impairments, except for microcephaly. The orbitofrontal cortex (OFC) is a region of association cortex of the human brain involved in cognitive processes such as decision making. ... Medical imaging designates the ensemble of techniques and processes used to create images of the human body (or parts thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and function). ...

Evidence of a CNS structural impairment due to prenatal alcohol exposure will result in a diagnosis of FAS, and neurological and functional impairments are highly likely.^{[21][22][7][23]}

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.^[34] During the third trimester, damage can be caused to the hippocampus, which plays a role in memory, learning, emotion, and encoding visual and auditory information, all of which can create neurological and functional CNS impairments as well.^[35] Brain cells incude mostly neurons and glial cells. ... The hippocampus is structurally located inside the medial temporal lobe of the brain. ...

As of 2002, there were 25 reports of autopsies on infants known to have FAS. The first was in 1973, on an infant who died shortly after birth.^[10] The examination revealed extensive brain damage, including microcephaly, migration anomalies, callosal dysgenesis, and a massive neuroglial, leptomeningeal heterotopia covering the left hemisphere.^[36] Post-mortem, postmortem and post mortem redirect here. ... This article or section does not adequately cite its references or sources. ... The meninges (singular meninx) are the system of membranes that contain the brain. ... In medicine, heterotopia refers to the displacement of an organ or part of an organ from its normal position, often specifically gray matter heterotopia, the displacement of gray matter into the cerebral white matter or ventricles. ...

In 1977, Dr. Clarren described a second infant whose mother was a binge drinker. The infant died ten days after birth. The autopsy showed severe hydrocephalus, abnormal neuronal migration, and a small corpus callosum (which connects the two brain hemispheres) and cerebellum.^[36] FAS has also been linked to brainstem and cerebellar changes, agenesis of the corpus callosum and anterior commissure, neuronal migration errors, absent olfactory bulbs, meningomyelocele, and porencephaly.^[36] The corpus callosum is a structure of the mammalian brain in the longitudal fissure that connects the left and right cerebral hemispheres. ... The human brain as viewed from above, showing the cerebral hemispheres. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ... The brain stem is the stalk of the brain below the cerebral hemispheres. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ... The corpus callosum is a structure of the mammalian brain in the longitudal fissure that connects the left and right cerebral hemispheres. ... The Anterior Commissure (precommissure) is a bundle of white fibers, connecting the two cerebral hemispheres across the middle line, and placed in front of the columns of the fornix. ... The olfactory bulb is a structure of the vertebrate forebrain involved in olfaction, the perception of odors. ... ... Cephalic disorders are congenital conditions that stem from damage to, or abnormal development of, the budding nervous system. ...

Neurological

When structural impairments are not observable or do not exist, neurological impairments are assessed. In the context of FAS, neurological impairments are caused by prenatal alcohol exposure which causes general neurological damage to the central nervous system (CNS), the peripheral nervous system, or the autonomic nervous system. A determination of a neurological problem must be made by a trained physician, and must not be due to a postnatal insult, such as a high fever, concussion, traumatic brain injury, etc. Neurology is a branch of medicine dealing with disorders of the nervous system. ... A diagram showing the CNS: 1. ... The Peripheral nervous system resides or extends outside the CNS central nervous system (the brain and spinal cord) to serve the limbs and organs. ... This article or section is in need of attention from an expert on the subject. ... This article needs additional references or sources for verification. ... Concussion, or mild traumatic brain injury (MTBI), is the most common and least serious type of traumatic brain injury. ... Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. ...

All four diagnostic systems show virtual agreement on their criteria for CNS damage at the neurological level, and evidence of a CNS neurological impairment due to prenatal alcohol exposure will result in a diagnosis of FAS, and functional impairments are highly likely.^{[21][22][7][23]}

Neurological problems are expressed as either hard signs, or diagnosable disorders, such as epilepsy or other seizure disorders, or soft signs. Soft signs are broader, nonspecific neurological impairments, or symptoms, such as impaired fine motor skills, neurosensory hearing loss, poor gait, clumsiness, poor eye-hand coordination, or sensory integration dysfunction. Many soft signs have norm-referenced criteria, while others are determined through clinical judgment. Epilepsy (often referred to as a seizure disorder) is a chronic neurological condition characterized by recurrent unprovoked seizures. ... A motor skill is a skill required for proper usage of skeletal muscles. ... Hearing impairment or deafness is decreased or absent ability to perceive auditory information. ... A gait can refer to: a particular way or manner of moving on foot: walking and running are the two basic human gaits; see also gait analysis and Gait (human). ... It has been suggested that this article or section be merged with Apraxia. ... It has been suggested that Sensory processing disorder be merged into this article or section. ... A test is said to be norm-referenced when the translated score tells where the person stands in some population of persons who have taken the test. ...

Functional

When structural or neurological impairments are not observed, all four diagnostic systems allow CNS damage due to prenatal alcohol exposure to be assessed in terms of functional impairments.^{[21][22][7][23]} Functional impairments are deficits, problems, delays, or abnormalities due to prenatal alcohol exposure (rather than hereditary causes or postnatal insults) in observable and measurable domains related to daily functioning, often referred to as developmental disabilities. There is no consensus on a specific pattern of functional impairments due to prenatal alcohol exposure^[21] and only CDC guidelines label developmental delays as such,^[7] so criteria vary somewhat across diagnostic systems. Mental retardation (abbreviated as MR), is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal intellectual capacity as an adult. ...

The four diagnostic systems list various CNS domains that can qualify for functional impairment that can determine an FAS diagnosis:

• Evidence of a complex pattern of behavior or cognitive abnormalities inconsistent with developmental level in the following CNS domains — sufficient for an PFAS or ARND diagnosis using IOM guidelines^[21]
  • Learning disabilities, academic achievement, impulse control, social perception, communication, abstraction, math skills, memory, attention, judgment
• Performance at two or more standard deviations on standardized testing in three or more of the following CNS domains — sufficient for an FAS, PFAS or static encephalopathy diagnosis using 4-Digit Diagnostic Code^[22]
  • Executive functioning, memory, cognition, social/adaptive skills, academic achievement, language, motor skills, attention, activity level
• General cognitive deficits (e.g., IQ) at or below the 3rd percentile on standardized testing — sufficient for an FAS diagnosis using CDC guidelines^[7]
• Performance at or below the 16th percentile on standardized testing in three or more of the following CNS domains — sufficient for an FAS diagnosis using CDC guidelines^[7]
  • Cognition, executive functioning, motor functioning, attention and hyperactive problems, social skills, sensory problems, social communication, memory, difficulties responding to common parenting practices
• Performance at two or more standard deviations on standardized testing in three or more of the following CNS domains — sufficient for an FAS diagnosis using Canadian guidelines
  • Cognition, communication, academic achievement, memory, executive functioning, adaptive behavior, social skills, social communication

In the United States and Canada, the term learning disability (LD) is used to refer to a range of neurological conditions that affect one or more of the ways that a person takes in, stores, or uses information. ... Deferred gratification or delayed gratification is the ability to wait in order to obtain something that one wants. ... Social learning refers to the acquisition of social competence that happens exclusively or primarily in a social group. ... Communication is a process that allows beings - in particular humans - to exchange information by several methods. ... abstraction in general. ... In psychology, memory is an organisms ability to store, retain, and subsequently retrieve information. ... It has been suggested that Neural mechanisms behind shifts of attention be merged into this article or section. ... In probability and statistics, the standard deviation of a probability distribution, random variable, or population or multiset of values is a measure of the spread of its values. ... Standardized testing is: in theory: a tool to ensure that student knowledge and aptitude in a given subject are examined with the same criteria across different schools. ... In neuropsychology and cognitive psychology, the mental capacity to control and planfully apply ones own mental skills. ... In psychology, memory is an organisms ability to store, retain, and subsequently retrieve information. ... Look up Cognition in Wiktionary, the free dictionary. ... Adaptive behavior is a type of behavior that is used to adapt to another type of behavior or situation. ... A motor skill is a small bunny that requires an organism to utilize their super powerss effectively. ... It has been suggested that Neural mechanisms behind shifts of attention be merged into this article or section. ... Cognitive The scientific study of how people obtain, retrieve, store and manipulate information. ... IQ redirects here; for other uses of that term, see IQ (disambiguation). ... Standardized testing is: in theory: a tool to ensure that student knowledge and aptitude in a given subject are examined with the same criteria across different schools. ... Standardized testing is: in theory: a tool to ensure that student knowledge and aptitude in a given subject are examined with the same criteria across different schools. ... Look up Cognition in Wiktionary, the free dictionary. ... In neuropsychology and cognitive psychology, the mental capacity to control and planfully apply ones own mental skills. ... A motor skill is a small bunny that requires an organism to utilize their super powerss effectively. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Social skills are skills a social animal uses to interact and communicate with others to assist status in the social structure and other motivations. ... It has been suggested that Sensory processing disorder be merged into this article or section. ... Communication is a process that allows beings - in particular humans - to exchange information by several methods. ... In psychology, memory is an organisms ability to store, retain, and subsequently retrieve information. ... For other uses, see Parent (disambiguation). ... In probability and statistics, the standard deviation of a probability distribution, random variable, or population or multiset of values is a measure of the spread of its values. ... Standardized testing is: in theory: a tool to ensure that student knowledge and aptitude in a given subject are examined with the same criteria across different schools. ... Look up Cognition in Wiktionary, the free dictionary. ... Communication is a process that allows beings - in particular humans - to exchange information by several methods. ... In psychology, memory is an organisms ability to store, retain, and subsequently retrieve information. ... In neuropsychology and cognitive psychology, the mental capacity to control and planfully apply ones own mental skills. ... Adaptive behavior is a type of behavior that is used to adapt to another type of behavior or situation. ... Social skills are skills a social animal uses to interact and communicate with others to assist status in the social structure and other motivations. ... Communication is a process that allows beings - in particular humans - to exchange information by several methods. ...

Prenatal alcohol exposure

Prenatal alcohol exposure is determined by interview of the biological mother or other family members knowledgeable of the mother's alcohol use during the pregnancy (if available), prenatal health records (if available), and review of available birth records, court records (if applicable), chemical dependency treatment records (if applicable), or other reliable sources. This article or section does not cite any references or sources. ...

Exposure level is assessed as Confirmed Exposure, Unknown Exposure, and Confirmed Absence of Exposure by the IOM, CDC and Canadian diagnostic systems. The "4-Digit Diagnostic Code" further distinguishes confirmed exposure as High Risk and Some Risk:

• High Risk — Confirmed use of alcohol during pregnancy known to be at high blood alcohol levels (100mg/dL or greater) delivered at least weekly in early pregnancy.
• Some Risk — Confirmed use of alcohol during pregnancy with use less than High Risk or unknown usage patterns.
• Unknown Risk — Unknown use of alcohol during pregnancy.
• No Risk — Confirmed absence of prenatal alcohol exposure, which rules out an FAS diagnosis.

Blood alcohol content (BAC) or blood alcohol concentration is the concentration of alcohol in blood. ...

Confirmed exposure

Amount, frequency, and timing of prenatal alcohol use can dramatically impact the other three key features of FAS. While consensus exists that alcohol is a teratogen, there is no clear consensus as to what level of exposure is toxic.^[21] The CDC guidelines are silent on these elements diagnostically. The IOM and Canadian guidelines explore this further, acknowledging the importance of significant alcohol exposure from regular or heavy episodic alcohol consumption in determining, but offer no standard for diagnosis. Canadian guidelines discuss this lack of clarity and parenthetically point out that "heavy alcohol use" is defined by the National Institute on Alcohol Abuse and Alcoholism as five or more drinks per episode on five or more days during a 30 day period.^[37] The National Institute on Alcohol Abuse and Alcoholism (NIAAA), as part of the U.S. National Institutes of Health, supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. ...

"The 4-Digit Diagnostic Code" ranking system distinguishes between levels of prenatal alcohol exposure as High Risk and Some Risk. It operationalizes high risk exposure as a blood alcohol concentration (BAC) greater than 100mg/dL delivered at least weekly in early pregnancy. This BAC level is typically reached by a 55kg female drinking six to eight beers in one sitting.^[22] BAC or Bac may refer to: The abbreviation BAC can refer to: BACEngine data search tool Bacterial artificial chromosome Badminton Asia Confederation, an Asian governing body for badminton Baltimore Aircoil Band-anticrossing Bank of America, N.A., under the New York Stock Exchange ticker symbol system Basic Airborne Course (United...

Unknown exposure

For many adopted or adult patients and children in foster care, records or other reliable sources may not be available for review. Reporting alcohol use during pregnancy can also be stigmatizing to birth mothers, especially if alcohol use is ongoing.^[7] In these cases, all diagnostic systems use an unknown prenatal alcohol exposure designation. A diagnosis of FAS is still possible with an unknown exposure level if other key features of FASD are present at clinical levels.

Related signs

Other conditions may commonly co-occur with FAS, stemming from prenatal alcohol exposure. However, these conditions are considered Alcohol-Related Birth Defects^[21] and not diagnostic criteria for FAS. This baby has FASD. Fetal alcohol spectrum disorder (FASD) describes a spectrum of permanent and often devastating birth-defect syndromes caused by maternal consumption of alcohol during pregnancy. ...

• Cardiac — A heart murmur that frequently disappears by one year of age. Ventricular septal defect most commonly seen, followed by an atrial septal defect.
• Skeletal — Joint anomalies including abnormal position and function, altered palmar crease patterns, small distal phalanges, and small fifth fingernails.
• Renal — Horseshoe, aplastic, dysplastic, or hypoplastic kidneys.
• Ocular — Strabismus, optic nerve hypoplasia^[38] (which may cause light sensitivity, decreased visual acuity, or involuntary eye movements).
• Occasional abnormalities — Ptosis of the eyelid, microophthalmia, cleft lip with or without a cleft palate, webbed neck, short neck, Tetralogy of Fallot, coarctation of the aorta, Spina bifida, and hydrocephalus.

Murmurs are abnormal heart sounds that are produced as a result of turbulent blood flow, which is sufficient to produce audible noise. ... A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). ... Atrial septal defects (ASD) are a group of congenital heart diseases that enables communication between atria of the heart and may involve the interatrial septum. ... A joint is the location at which two or more bones make contact. ... In humans, a single transverse palmar crease is a single crease that extends across the palm of the hand, formed by the fusion of the two palmar creases that people typically have. ... The phalanges in a human hand The name Phalanges is commonly given to the bones that form fingers and toes. ... Horseshoe kidney is a congenital disorder, affecting about 1 in 500 to 1 in 600 people, in which a persons two kidneys fuse together to form a horseshoe-shape. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Strabismus (from Greek: στραβισμός strabismos, from στραβίζειν strabizein to squint, from στραβός strabos squinting, squint-eyed[1]) is a condition in which the eyes are not properly aligned with each other. ... Optic nerve hypoplasia is a medical condition that results in underdevelopment of the optic nerves. ... The sensitivity of a human, often considered with regard to a particular kind of stimulus, is the strength of the feeling it results in, in comparison with the strength of the stimulus. ... Traditional Snellen chart used for visual acuity testing. ... In ophthalmology, ptosis is an abnormally low position (drooping) of the upper eyelid which may grow more or less severe during the day. ... The tetralogy of Fallot is a congenital heart defect which classically has four anatomical components. ... Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. ...

Prognosis

Primary disabilities

The primary disabilities of FAS are the functional difficulties with which the child is born as a result of CNS damage due to prenatal alcohol exposure.^[4] Often, primary disabilities are mistaken as behavior problems, but the underlying CNS damage is the originating source of a functional difficulty^[39] (rather than a mental health condition, which is considered a secondary disability).

The exact mechanisms for functional problems of primary disabilities are not always fully understood, but animal studies have begun to shed light on some correlates between functional problems and brain structures damaged by prenatal alcohol exposure.^[3] Representative examples include: For other uses, see Animal testing (disambiguation). ...

• Learning impairments are associated with impaired dendrites of the hippocampus^[40]
• Impaired motor development and functioning are associated with reduced size of the cerebellum^[41]
• Hyperactivity is associated with decreased size of the corpus callosum^[42]

Functional difficulties may result from CNS damage in more than one domain, but common functional difficulties by domain include:^{[39][3][43][44]} (This is not an exhaustive list of difficulties.) In the United States and Canada, the term learning disability (LD) is used to refer to a range of neurological conditions that affect one or more of the ways that a person takes in, stores, or uses information. ... Dendrites (from Greek dendron, “tree”) are the branched projections of a neuron that act to conduct the electrical stimulation received from other neural cells to the cell body, or soma, of the neuron from which the dendrites project. ... The hippocampus is structurally located inside the medial temporal lobe of the brain. ... A motor skill is a small bunny that requires an organism to utilize their super powerss effectively. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ... Hyperactivity can be described as a state in which a person is abnormally easily excitable and exuberant. ... The corpus callosum is a structure of the mammalian brain in the longitudal fissure that connects the left and right cerebral hemispheres. ...

• Achievement — Learning disabilities
• Adaptive behavior — Poor impulse control, poor personal boundaries, poor anger management, stubbornness, intrusive behavior, too friendly with strangers, poor daily living skills, developmental delays
• Attention — Attention-Deficit/Hyperactivity Disorder (ADHD), poor attention or concentration, distractible
• Cognition — Mental retardation, confusion under pressure, poor abstract skills, distinguishing between fantasy and reality, slower cognitive processing
• Executive functioning — Poor judgment, Information-processing disorder, poor at perceiving patterns, poor cause and effect reasoning, inconsistent at linking words to actions, poor generalization ability
• Language — Expressive or receptive language disorders, grasp parts not whole concepts, lack understanding of metaphor, idioms, or sarcasm
• Memory — Poor short-term memory, inconsistent memory and knowledge base
• Motor skills — Poor handwriting, poor fine motor skills, poor gross motor skills, delayed motor skill development (e.g., riding a bicycle at appropriate age)
• Sensory integration and soft neurological problems — Sensory integration (SI) disorders, tactile defensiveness, under-sensitive to stimulation
• Social communication — Intrude into conversations, inability to read nonverbal or social cues, "chatty" but without substance

In the United States and Canada, the term learning disability (LD) is used to refer to a range of neurological conditions that affect one or more of the ways that a person takes in, stores, or uses information. ... Deferred gratification or delayed gratification is the ability to wait in order to obtain something that one wants. ... Anger Management is a 2003 comedy film starring Adam Sandler and Jack Nicholson which was directed by Peter Segal and written by David S Dorfman. ... Please wikify (format) this article as suggested in the Guide to layout and the Manual of Style. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Mental retardation is a term for a pattern of persistently slow learning of basic motor and language skills (milestones) during childhood, and a significantly below-normal global intellectual capacity as an adult. ... abstraction in general. ... Look up Cognition in Wiktionary, the free dictionary. ... Decision making is the cognitive process of selecting a course of action from among multiple alternatives. ... Processing Disorder A Processing Disorder refers to a problem that people with learning disabilities have attending to, decoding or recalling information needed to perform more complex cognitive tasks such as understanding what others say, reading, writing or doing math. ... For the term in the context of mathematical logic, see Generalization (logic). ... Expressive language disorder (DSM 315. ... Mixed receptive-expressive language disorder (DSM-IV 315. ... Short-term memory, sometimes referred to as primary, working, or active memory, is that part of memory which stores a limited amount of information for a few seconds. ... Fine motor skills can be defined as small muscle movements which occur in the fingers, in coordination with the eyes. ... The term gross motor skills refers to the abilities usually acquired through infancy to early childhood as part of the childs motor development. ... Sensory integration is defined as the neurological process that organizes sensation from ones own body and the environment, thus making it possible to use the body effectively within the environment. ... It has been suggested that Sensory processing disorder be merged into this article or section. ... Sensory Defensiveness is defined as having an anxious reaction to non-noxious sensory stimuli. ... This article does not cite any references or sources. ... Social learning refers to the acquisition of social competence that happens exclusively or primarily in a social group. ...

Secondary disabilities

The secondary disabilities of FAS are those that arise later in life secondary to CNS damage. These disabilities often emerge over time due to a mismatch between the primary disabilities and environmental expectations; secondary disabilities can be ameliorated with early interventions and appropriate supportive services.^[4]

Six main secondary disabilities were identified in a University of Washington research study of 473 subjects diagnosed with FAS, PFAS (partial fetal alcohol syndrome), and ARND (alcohol-related neurodevelopmental disorder):^[4][3]

• Mental health problems — Diagnosed with ADHD, Clinical Depression, or other mental illness, experienced by over 90% of the subjects
• Disrupted school experience — Suspended or expelled from school or dropped out of school, experienced by 60% of the subjects (age 12 and older)
• Trouble with the law — Charged or convicted with a crime, experienced by 60% of the subjects (age 12 and older)
• Confinement — For inpatient psychiatric care, inpatient chemical dependency care, or incarcerated for a crime, experienced by about 50% of the subjects (age 12 and older)
• Inappropriate sexual behavior — Sexual advances, sexual touching, or promiscuity, experienced by about 50% of the subjects (age 12 and older)
• Alcohol and drug problems — Abuse or dependency, experienced by 35% of the subjects (age 12 and older)

Two additional secondary disabilities exist for adult patients:^[4][3] The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Clinical depression (also called major depressive disorder, or unipolar depression when compared to bipolar disorder) is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individuals social functioning and/or activities of daily living. ... A mental illness or mental disorder refers to one of many mental health conditions characterized by distress, impaired cognitive functioning, atypical behavior, emotional dysregulation, and/or maladaptive behavior. ...

• Dependent living — Group home, living with family or friends, or some sort of assisted living, experienced by 80% of the subjects (age 21 and older)
• Problems with employment — Required ongoing job training or coaching, could not keep a job, unemployed, experienced by 80% of the subjects (age 21 and older)

Protective factors and strengths

Eight factors were identified in the same study as universal protective factors that reduced the incidence rate of the secondary disabilities:^[4][3]

• Living in a stable and nurturant home for over 72% of life
• Being diagnosed with FAS before age six
• Never having experienced violence
• Remaining in each living situation for at least 2.8 years
• Experiencing a "good quality home" (meeting 10 or more defined qualities) from age 8 to 12 years old
• Having been found eligible for developmental disability (DD) services
• Having basic needs met for at least 13% of life
• Having a diagnosis of FAS (rather than another FASD condition)

Malbin (2002) has identified the following areas of interests and talents as strengths that often stand out for those with FASD and should be utilized, like any strength, in treatment planning:^[43]

• Music, playing instruments, composing, singing, art, spelling, reading, computers, mechanics, woodworking, skilled vocations (welding, electrician, etc.), writing, poetry

Treatment

There is no cure for FAS, because the CNS damage creates a permanent disability, but treatment is possible. Because CNS damage, symptoms, secondary disabilities, and needs vary widely by individual though, there is no one treatment type that works for everyone. Instead, comprehensive, multi-model approaches based on the needs of the patient must be used. Several treatment models have been identified, but regardless of the predominant approach, most in the current literature recommend multiple types of interventions to ameliorate the negative effects.

Medical interventions

Traditional medical interventions (i.e., psychoactive drugs) are frequently tried on those with FAS because many FAS symptoms are mistaken for or overlap with other disorders, most notably ADHD.^[45] For instance, an FAS patient who is inattentive, does not complete schoolwork, and cannot stay seated has characteristics that an untrained person could easily mistake as ADHD, especially if the patient is not yet diagnosed with FAS. A common course of action would be a medication referral to a pediatrician, who might recommend a trial of Ritalin for the symptoms. Medical model is the term (cited by psychiatrist Ronald D. Laing in his The Politics of the Family and Other Essays) for the set of procedures in which all doctors are trained. ... An assortment of psychoactive drugs A psychoactive drug or psychotropic substance is a chemical substance that acts primarily upon the central nervous system where it alters brain function, resulting in temporary changes in perception, mood, consciousness and behavior. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Methylphenidate (C14H19NO2), or MPH, is an amphetamine-like prescription stimulant commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) in children and adults. ...

Medications are often important in treating FAS, but should be used in conjunction with other intervention approaches to address the multiple disabilities that arise from FAS.

Behavioral interventions

Traditional behavioral interventions are predicated on learning theory, which is the basis for many parenting and professional strategies and interventions.^[43] Along with ordinary parenting styles, such strategies are frequently used by default for treating those with FAS, as the diagnoses Oppositional Defiance Disorder (ODD), Conduct Disorder, Reactive Attachment Disorder (RAD), etc. often overlap with FAS (along with ADHD), and these are sometimes thought to benefit from behavioral interventions. Frequently, a patient's poor academic achievement results in special education services, which also utilizes principles of learning theory, behavior modification, and outcome-based education. Behaviorism (also called learning perspective) is a philosophy of psychology based on the proposition that all things which organisms do—including acting, thinking and feeling—can and should be regarded as behaviors. ... In education and psychology, learning theories help us understand the process of learning. ... For other uses, see Parent (disambiguation). ... Psychology (from Greek: ψυχή, psukhē, spirit, soul; and λόγος, logos, knowledge) is both an academic and applied discipline involving the scientific study of mental processes and behavior. ... Parenting style is a psychological construct representing standard strategies parents use in raising their children. ... Oppositional Defiance Disorder is a supposed and largely disputed mental illness characterized by an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior. ... In psychiatry, conduct disorder is a pattern of repetitive behavior where the rights of others or the social norms are violated. ... It has been suggested that this article or section be merged with Attachment disorder. ... DISCLAIMER Please remember that Wikipedia is offered for informational use only. ... Special education is instruction that is modified or particularized for those students with special needs, such as learning differences, mental health problems, specific disabilities (physical or developmental) [1] , and giftedness [2]. // Children with special needs have always been part of society. ... Learning theory can refer to the following, although it is possible that the fields may eventually link up: In education and psychology, learning theory is a theory about the process of how humans learn. ... This article is about the behaviorist technique. ... It has been suggested that this article or section be merged with Standards-based education reform. ...

Because the "learning system" of a patient with FAS is damaged, however, behavioral interventions are not always successful, or not successful in the long run, especially because overlapping disorders frequently stem from or are exacerbated by FAS.^[43] Kohn (1999) suggests that a rewards-punishment system in general may work somewhat in the short-term but is unsuccessful in the long-term because that approach fails to consider content (i.e., things "worth" learning), community (i.e., safe, cooperative learning environments), and choice (i.e., making choices versus following directions).^[46] While these elements are important to consider when working with FAS and have some usefulness in treatment, they are not alone sufficient to promote better outcomes.^[43] Kohn's minority challenge to behavioral interventions does illustrate the importance of factors beyond learning theory when trying to promote improved outcomes for FAS, and supports a more multi-model approach that can be found in varying degrees within the advocacy model and neurobehavioral approach. Alfie Kohn is an American lecturer and author in the fields of education, psychology and parenting, residing in Belmont, Massachusetts. ... Cooperative learning was proposed in response to traditional curriculum-driven education. ... The term choice theory is closely associated with the work of Dr. William Glasser, MD, author of the book so named, and is the culmination of some 50 years of theory and practice in psychology and counseling. ...

Developmental framework

Many books and handouts on FAS recommend a developmental approach, based on developmental psychology, even though most do not specify it as such and provide little theoretical background. Optimal human development generally occurs in identifiable stages (e.g., Jean Piaget's theory of cognitive development, Erik Erikson's stages of psychosocial development, John Bowlby's attachment framework, and other developmental stage theories). FAS interferes with normal development,^[44] which may cause stages to be delayed, skipped, or immaturely developed. Over time, an unaffected child can negotiate the increasing demands of life by progressing through stages of development normally, but not so for a child with FAS.^[44] This article includes a list of works cited or a list of external links, but its sources remain unclear because it lacks in-text citations. ... Jean Piaget [] (August 9, 1896 – September 16, 1980) was a Swiss philosopher, natural scientist and developmental psychologist, well known for his work studying children, his theory of cognitive development and for his epistemologic view called genetic epistemology. He created in 1955 the International Centre for Genetic Epistemology in Geneva and... // Although there is no general theory of cognitive development, one of the most historically influential theories was developed by Jean Piaget, a Swiss psychologist (1896–1980). ... This article needs additional references or sources for verification. ... Eriksons stages of psychosocial development describe eight developmental stages through which a healthily developing human should pass from infancy to late adulthood. ... John Bowlby (1907 - 1990) was a British developmental psychologist in the psychoanalytic tradition, notable for his pioneering work in attachment theory. ... Mother and child. ... In Developmental psychology, a stage is a distinct phase in an individuals development. ...

By knowing what developmental stages and tasks children follow, treatment and interventions for FAS can be tailored to helping a patient meet developmental tasks and demands successfully.^[44] If a patient is delayed in the adaptive behavior domain, for instance, then interventions would be recommended to target specific delays through additional education and practice (e.g., practiced instruction on tying shoelaces), giving reminders, or making accommodations (e.g., using slip-on shoes) to support the desired functioning level. This approach is an advance over behavioral interventions, because it takes the patient's developmental context into account while developing interventions. Adaptive behavior is a type of behavior that is used to adapt to another type of behavior or situation. ...

Advocacy model

The advocacy model takes the point of view that someone is needed to actively mediate between the environment and the person with FAS.^[3] Advocacy activities are conducted by an advocate (for example, a family member, friend, or case manager) and fall into three basic categories. An advocate for FAS: (1) interprets FAS and the disabilities that arise from it and explains it to the environment in which the patient operates, (2) engenders change or accommodation on behalf of the patient, and (3) assists the patient in developing and reaching attainable goals.^[3] Advocacy is the act of arguing on behalf of a particular issue, idea or person. ... Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health needs through communication and available resources to promote quality cost-effective outcomes. ...

The advocacy model is often recommended, for example, when developing an Individualized Education Program (IEP) for the patient's progress at school.^[45] In the USA, an Individualized Education Program, commonly referred to as an Individual Education Plan, (IEP) is a mandated requirement of the Individuals with Disabilities Education Act (IDEA). ...

An understanding of the developmental framework would presumably inform and enhance the advocacy model, but advocacy also implies interventions at a systems level as well, such as educating schools, social workers, and so forth on best practices for FAS. However, several organizations devoted to FAS also use the advocacy model at a community practice level as well.^[47] Community Practice is a branch of social work in the United States that focuses on larger social systems and social change, and is tied to the historical roots of United States social work. ...

Neurobehavioral approach

The neurobehavioral approach focuses on the neurological underpinnings from which behaviors and cognitive processes arise.^[43] It is an integrative perspective that acknowledges and encourages a multi-modal array of treatment interventions that draw from all FAS treatment approaches. The neurobehavioral approach is a serious attempt at shifting single-perspective treatment approaches into a new, coherent paradigm that addresses the complexities of problem behaviors and cognitions emanating from the CNS damage of FAS. Neurology is a branch of medicine dealing with disorders of the nervous system. ... This article does not cite any references or sources. ... Look up Cognition in Wiktionary, the free dictionary. ...

The neurobehavioral approach's main proponent is Diane Malbin, MSW, a recognized speaker and trainer in the FASD field, who first articulated the approach with respect to FASD and characterizes it as "Trying differently rather than trying harder."^[48] The idea to try differently refers to trying different perspectives and intervention options based on effects of the CNS damage and particular needs of the patient, rather than trying harder at implementing behavioral-based interventions that have consistently failed over time to produce improved outcomes for a patient. This approach also encourages more strength-based interventions, which allow a patient to develop positive outcomes by promoting success linked to the patient's strengths and interests.^[43]

Public health and policy

Treating FAS at the public health and public policy levels promotes FAS prevention and diversion of public resources to assist those with FAS.^[3] It is related to the advocacy model but promoted at a systems level (rather than with the individual or family), such as developing community education and supports, state or province level prevention efforts (e.g., screening for maternal alcohol use during OB/GYN or prenatal medical care visits), or national awareness programs. Several organizations and state agencies in the U.S. are dedicated to this type of intervention.^[47] Public health is concerned with threats to the overall health of a community based on population health analysis. ... Public policy is a course of action or inaction chosen by public authorities to address a problem. ... Public services is a term usually used to mean services provided by government to its citizens, either directly (through the public sector) or by financing private provision of services. ... Obstetrics and gynaecology (often abbreviated Ob-Gyn in the US and O&G elsewhere) form a single medical specialty and have a combined postgraduate training program. ...

Prevention

Alcohol is a teratogen, and the only certain way to prevent FAS is to avoid drinking alcohol during pregnancy.^[3] Some studies have shown that small amounts of alcohol during pregnancy might not pose a risk to the fetus, although no amount of alcohol during pregnancy can be guaranteed to be absolutely safe.^[49][50] In the United States, the Surgeon General recommended in 1981, and again in 2005, that women abstain from alcohol use while pregnant or while planning a pregnancy, the latter to avoid damage in the earliest stages of a pregnancy, as the woman may not be aware that she has conceived.^[9] In the United States, federal legislation has required that warning labels be placed on all alcoholic beverage containers since 1988 under the Alcoholic Beverage Labeling Act. // Teratogenesis is a medical term from the Greek, literally meaning monster-birth, which derives from teratology, the study of the frequency, causation, and development of congenital malformations—misleadingly called birth defects. ... Surgeon General can have several different meanings. ... A sperm cell fertilizing an ovum This article is about reproduction in organisms. ... The Alcoholic Beverage Labeling Act (or ABLA) is a United States federal law enacted in 1988. ...

See also

• Recommended maximum intake of alcoholic beverages

This article summarizes the recommended maximum intake (or safe limits) of alcohol as recommended by the health agencies of various governments. ...

References

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 101st day of the year (102nd in leap years) in the Gregorian calendar. ... is the 52nd day of the year in the Gregorian calendar. ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 101st day of the year (102nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 101st day of the year (102nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 100th day of the year (101st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 100th day of the year (101st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 100th day of the year (101st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 100th day of the year (101st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 100th day of the year (101st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 101st day of the year (102nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 101st day of the year (102nd in leap years) in the Gregorian calendar. ...

Further reading

• Astley S (2004). "Fetal alcohol syndrome prevention in Washington State: evidence of success". Paediatric and Perintal Epidemiology 18 (5): 344-51. PMID 15367321. 
• Astley S, Clarren S (2001). "Measuring the facial phenotype of individuals with prenatal alcohol exposure: correlations with brain dysfunction". Alcohol and Alcoholism 36 (2): 147-59. PMID 11259212. 
• Gideon Koren, Idan Roifman, Irena Nullman. Hypothetical Framework; FASD and criminality-causation or association? The limits of evidence based knowledge. Journal of FAS International volume=2, issue=6, year=2004 |http://www.motherisk.org/JFAS/econtent_commonDetail.jsp?econtent_id=59
• Grant T, Ernst C, Streissguth A (1996). "An intervention with high-risk mothers who abuse alcohol and drugs: the Seattle Advocacy Model". American Journal of Public Health 86 (12): 1816-7. PMID 9003147. 
• Mattson, S.N., & Riley, E.P. (2002). Neurobehavioral and Neuroanatomical Effects of Heavy Prenatal Exposure to Alcohol, in Streissguth, A.P., & Kanter, J. (Eds.) The Challenge in Fetal Alcohol Syndrome: Overcoming Secondary Disabilities. First published in 1997. ISBN 0-295-97650-0
• Olegård R, Sabel K, Aronsson M, Sandin B, Johansson P, Carlsson C, Kyllerman M, Iversen K, Hrbek A (1979). "Effects on the child of alcohol abuse during pregnancy. Retrospective and prospective studies". Acta Paediatrica Scandinavica Suppl 275: 112-21. PMID 291283. 
• Ratey, J.J. (2001). A User's Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain. New York: Vintage Books. ISBN 0-375-70107-9.
• Ulleland CN, Wennberg RP, Igo RP, Smith NJ (1970). "The offspring of alcoholic mothers". Abstract. American Pediatric Society for Pediatric Research.

Gideon Koren, MD, FACMT, FRCP(C) (born 1947) is a Canadian pediatrician, clinical pharmacologist, and toxicologist. ...

External links

• Fetal alcohol syndrome at the Open Directory Project
• Congressional Caucus on Fetal Alcohol Spectrum Disorders}
• Fetal Alcohol Syndrome Diagnostic & Prevention Network (FAS DPN)
• CDC’s National Center on Birth Defects and Developmental Disabilities
• Foetal Alcohol Syndrome Aware UK
• Iceberg—a quarterly international educational newsletter on FASD
• Fetal Alcohol Syndrome prevention campaign in South Africa
• (http://www.motherisk.org/JFAS/econtent_archives.jsp?archive_id=3)