TOUGH KIDS AND SUBSTANCE ABUSE
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Fetal Alcohol Syndrome / Fetal Alcohol Effects

Although Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) have been with us for many years, it is not until recently that we, as a community, have begun to notice the effects. Previously, many alcohol affected children were often viewed as difficult and oppositional children who could not learn. Later, as adults, they struggled to live in the community. Today, we are more aware of the educational and community living needs of these children and are more committed to finding a key to unlock their potential.

Many professionals only learn of Fetal Alcohol Syndrome after they are faced with a child affected by FAS/E on their caseload. This short orientation to FAS, FAE and ARND is provided to answer some frequently asked questions about ARND related issues in the home, school and community.

What is Fetal Alcohol Syndrome (FAS) or
Fetal Alcohol Effects (FAE)?

Fetal Alcohol Syndrome Is:

a medical diagnosis used to describe a pattern of birth abnormalities found in children exposed to alcohol (and/or drugs) prenatally. To be diagnosed with full FAS, children must have a number of symptoms from each of three categories:

1. Evidence of Growth Retardation, including low birth weight, low weight to height ratio and decelerating weight over time.
2. Evidence of Facial Abnormalities, including wide set eyes, elongated philtrum and flat upper lip.
3. Evidence of Central Nervous System Damage, including small head size, impaired fine and gross motor control, poor hand/eye co-ordination, hearing loss, hyperactivity, poor impulse control, learning disabilities.

Fetal Alcohol Effects

To be diagnosed with FAE there must be maternal admission of prenatal alcohol, drug use or both. Children usually have effects in one or both of the first two diagnostic elements of FAS, that is evidence of growth retardation and facial abnormalities, but not the third which is evidence of nervous sytem damage. Generally children with FAE exhibit a pattern of behavioural and/or learning difficulties that include one or more of the following concerns:

     a. hyperactivity
     b. attention difficulties
     c. poor gross and/or fine motor control
     d. poor auditory or visual functioning
     e. learning disabilities
     f. memory problems, and
     g. difficulties with processing abstract concepts.

Until recently, most professionals believed that FAE was a lesser form of FAS. However, some studies are beginning to show that children with Fetal Alcohol Effects may actually be at higher risk than those diagnosed with Fetal Alcohol Syndrome. This may be due in part to the fact that these children are not as easily identified and therefore are often misunderstood at home and at school.

In 1996 the American Medical Association recommended that the term FAE be replaced with three new terms. These terms are now being used in many diagnostic clinics. They include:

Partial FAS (pFAS)

applied to a child who exhibits some, but not all of the physical signs of FAS, but also shows learning and behavioural issues which imply Central Nervous System Damage.

Alcohol Related Birth Defects (ARBD)

applied to a child who exhibits physical anomalies such as small stature, large joints, or gross and fine motor control issues.

Alcohol Related Neurodevelopmental Disorders (ARND)

applied to a child who shows evidence of Central Nervous System damage which includes behavioural and learning issues.

For further information please see:
Streissguth, A., Kanter, J., (1997)
The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities.
Seattle: University of Washington Press.

How Common is FAS/FAE? Is it Inherited ?

There is no firm record of the incidence of FAS or FAE. However, some Canadian studies imply that 2 of every 1,000 children are born with FAS and 8 of every 1,000 children are born with FAE. FAS/FAE is found in every economic and racial group.

FAS and FAE are unique in that the cause is directly linked to maternal drinking and substance abuse. The amount and timing of ingestion of alcohol or drugs affects the amount of damage done to the fetus. However, a mother who abstains from drinking throughout her pregnancy, even if she is alcohol affected herself, or has a past history of alcohol and drug abuse will not give birth to an child with FAS/FAE. So far, there is no evidence that paternal sunstance abuse has any direct affect on the fetus.

For further information please see;
Stratton, K., Howe, C. Barraglia (Eds.) (1996) Fetal Alcohol Syndrome: Diagnosis, Epistemology, Prevention and Treatment.
Washington:Institution of Medicine, National Academy Press.
Bibber, M. (1997)
It Takes a Community: A Resource Manual for Community-Based Prevention of Fetal Alcohol Syndrome:Fetal Alcohol Effects.
Available from the Aboriginal Nurses Association of Canada


Are all Children with FAS/FAE Cognitively Impaired?

Studies show that IQ levels for children with FAS range from 50-115 averaging about 70. Children with FAE tend to have slightly higher IQ levels with many functioning at grade level or just slightly below and some even graduating from High School, University and Graduate School. Unlike children with typical cognitive delays, children with FAS tend to show the greatest difficulty in areas which require the use of abstract thought and auditory functioning. Further, many children with FAS/FAE show difficulties with social skills, memory and attention which affects their ability to function well in a classroom.

What about the Family Situations for these Children?

Unfortunately, children affected by prenatal alcohol and substance abuse are often born into families where addiction is a fact of life. This, coupled with the fact that children with FAS/FAE are often fussy and not easily soothed or may have ongoing medical issues creates a difficult family situation. It is therefore no surprise that by the time they begin school, up to 80% of these children have experienced violence first-hand and have been involved in the child welfare system. It is important to recognize that FAS/FAE is not simply a physiological condition. The child’s physical environment may also affect their ability to function well in school. Problems may include attachment and bonding issues, oppositional-defiant disorders and detrimental effects due to of family violence, poverty and neglect. These issues are well documented in the recent Secondary Disability Study and point to the need to provide supports for children affected by prenatal substance abuse that address both the child and the family's needs.

For further information please see:
Sparks, S. (1993) Children of Prenatal Substance Abuse: School-Age Children Series.
California:Singular Publishing Group.



What is the Connection Between FAS/FAE and
Attention Deficit Hyperactivity Disorder (ADHD)?

Many (if not most) children with FAS/FAE also show signs of hyperactivity. However, research shows that FAS/FAE and ADHD are different conditions. Although children with ADHD have difficulty focusing on activities, they are able to sort and encode information, often quickly after the fact; then change their behaviour using their new skills. Children with FAS/FAE, however, have great difficulty encoding information. Often they have no capacity to sort through information to make a reasonable choice. Instead they continue to make impulsive and poor decisions.

For further information please see:
Coles, K., Platzman, K., Raskind-Hood, C., Brown, R., Falek, A., Smith, I., (1997)
A Comparison of Children Affected by Prenatal Alcohol Exposure and Attention Deficit, Hyperactivity Disorder. Alcoholism:Clinical and Experimental Research. Volume 21/1.

How Would I Know if There Was a Child with FAS/FAE On My Caseload?

Although children with FAS/FAE show marked learning difficulties in the classroom, quite often it is their behaviour that signals problems to teachers, professionals and parents. Children with FAS/FAE often show impulsivity and hyperactivity, especially in situations when the activity level is high. Children with FAS/FAE often struggle with making choices during these periods. They also demonstrate elevated levels of stress during transition or sitting quietly in a group. They may have difficulty learning social skills and may struggle with learning social norms of play with other children. By about age eight, children affected by FAS/FAE will begin to show learning difficulties, especially with verbal and auditory processing and memory. The child will have increased difficulty at school and their problems may become more pronounced. The child must struggle to assimilate new information that is presented in increasingly abstract terms. Behavioural problems may occur more frequently as the child becomes frustrated with this inability to learn. This frustration often leads students to leave school before graduating.

Are There Good Outcomes for These Children?

Although the needs of children with FAS/FAE seem overwhelming, they can learn to function well in their school and community. However, they do require extra support at home, in the classroom and the community to function to their potential. Studies show that the best supports include diagnosis before age five, a good, strong and supported family unit, support in their school and in their community. We all play an important role in welcoming and making accomodations for children with FAS/FAE in our community. The first step is in recognizing their unique needs.

Copies of “TOUGH KIDS AND SUBSTANCE ABUSE” can be ordered from:
The William Potoroka Memorial Library, 1031 Portage Avenue, Winnipeg, Manitoba, CANADA, R3G 0R8
TEL: (204) 944-6233, FAX: (204) 772-0225