Fetal Alcohol Syndrome

tnfetalposterby Anuppa Caleekal B.A. M.Sc.

The pre-natal world of the fetus while cradled in the mother’s womb is sustained in a well-protected environment, although not immune to the influences of its external environment. Fetal Alcohol Syndrome which was first observed by Lemoine et. al (1968) #1 and was later coined by Jones and Smith (1973) #2 in Seattle as the “fetal alcohol syndromeâ€? (FAS). In a broad sense FAS may be viewed as a repercussion of an external environmental influence on the internal physiological environment of the developing fetus. Alcohol acts as a teratogen (derived from the Greek word tera, meaning monster), an agent, which when prenatally exposed can cause serious risks to pre and post natal human development.

Fetal Alcohol Syndrome

(FAS) lies at the extreme end of the continuum of alcohol effects on the fetus with heavy persistent maternal alcohol consumption during pregnancy contributing most significantly to the full blown syndrome. Clinically, three areas are affected:
(1) prenatal and/or postnatal growth retardation (e.g. infants shorter in length and less in weight);
(2) Central Nervous System (CNS) damage such as permanent and irreversible brain damage, learning and behavioral disorders, deficits in memory and attention, hyperactivity, speech and language delays, poor coordination;
(3) head and facial abnormalities (e.g. small head circumference and abnormally small eyes). #3

Fetal Alcohol Effects

(FAE) diagnosed children have deficits in some or one of the above three areas of FAS and their mothers were found to drink smaller daily amounts of alcohol than mothers who had FAS offspring. #4 FAS were previously estimated, as the third most frequent cause of mental retardation after Down’s syndrome and certain neural tube defects. Current prevalence estimates FAS may be the leading most common, preventable cause of mental retardation in North America and Europe. In France, Sweden and North America, prevalence of FAS is 1 per 750 live births per year. #5 It is expected that FAS children will have some degree of mental impairment, ranging from minimal brain dysfunction to severe mental retardation. For every child identified with FAS, there are several others who are affected by alcohol exposure but who lack the full set of characteristics of FAS. FAE is more common than FAS and is estimated to be 3-10 times that of those diagnosed with full FAS. #6 Low birth is an example of FAE. It must be noted that although many other factors can also cause low birth weight, alcohol is said to account for 2% of the decreased birth weight associated with prenatal alcohol exposure. #7 Another example of FAE might be a case where there is some CNS damage, with signs of speech problems or attention deficit disorder, but no apparent facial and head abnormalities. The lack of specific criteria for FAE makes estimation of incidence statistics and diagnosis difficult.

Prenatal Alcohol Exposure

The terms FAS and FAE are not restricted to the fetal stage as the names denote. The fetal stage begins around days 46-48 when the first true bone cells replace cartillage. #8 The period beginning around the 8th week after conception to birth may be viewed as the fetal stage. The embryonic stage is the early period between weeks 2-8 after conception. This stage is marked by cell development or the structural stage in human development. These cells later differentiate to produce tissues and organs, which in turn serve bodily functions, marking the commencement of the fetal stage. After conception, between weeks 4-8, a transitory period from the embryonic to the fetal stage is important as that is a time of great vulnerability to the toxic effects of alcohol. Many of the clinical symptoms of FAS are structural (e.g. facial irregularities which occur in the embryonic stage). Alcohol also affects the pre-embryonic or blastocyst stage resulting in delayed implantation and structural changes. #9 Functional deficits such as damage to the CNS are usually produced at levels of alcohol exposure lower than those which would cause structural changes. Therefore although FAS is found at the adverse end of the continuum of alcohol effects, the progression of its symptoms can begin at any point in the course of prenatal development. Its effects linger postnatally and are for the most part, irreversible. #10

Alcohol and Women: Understanding the Risk

Women Tend to Metabolize Ethanol Faster than Men

Alcohol is soluble in both water and fat, thus it can penetrate all cell membranes and move throughout all body tissues. #11, #12 Passage of ethanol from mother to fetus occurs via the placenta to a point where fetal alcohol concentration is almost equal to maternal concentration. FAS/FAE is then not necessarily the result of only full-blown alcoholism but rather it can result from drinking any amount of alcohol in excess of the level to detoxify it thus placing the fetus at risk. This pattern of high-risk drinking behaviour is usually reflected among those who are considered heavy drinkers, but also may be seen among moderate drinkers who resort to binge-style drinking.

Women generally weigh less and have less body water than men making the volume of distribution of alcohol lower. Consequently blood alcohol levels can be higher in women than men when both have consumed equal amounts of alcohol. Because they frequently experience the same effects as men with less alcohol, women need to be informed of the potential hazards of achieving drinking parity with male drinking companions. Women tend to metabolize ethanol faster than men. #13 Recently it was found that women become intoxicated at a faster rate than men do because their stomachs have less of the “protective stomach enzyme� which is said to breakdown much of the alcohol in the stomach. Because of this lower amount of protective enzyme, more of what they drink enters the bloodstream in the form of pure alcohol. It is said about 30% more alcohol is absorbed into the bloodstream than in men as a consequent of having less of this enzyme known as, alcohol dehydrogenase. Therefore, even when low doses of alcohol are ingested in men and women, due to this decreased stomach metabolism, there is more alcohol availability in women. Over time women are exposed to higher blood alcohol concentrations than men are even though similar quantities of alcohol were ingested. This difference is greater than that explained by body weight and fat content alone. #14

Metabolism and Susceptibility

Studies indicate differential susceptibility to FAS occurring on both a racial and genetic basis. We do not know whether certain ethnic groups have a genetic susceptibility to FAS even though we do know that there are ethnic differences in the metabolism of alcohol. We also know that there is genetic control over the inter – individual variability in the rate of alcohol metabolism. In comparison to Caucasians, the Chinese, Native Americans and Japanese have a higher rate of alcohol metabolism. #15 Animal studies have shown certain strains of mice achieve higher blood alcohol levels (BAL) even though they consume the same amount of alcohol. There is also evidence of racial differences in acute reactions to ethanol in terms of alcohol sensitivity symptoms such as dizziness and hangovers. These were found to be greater among Orientals of Mongoloid heritage and American Indians than in Caucasian subjects when exposed to a mild dose. #15

In this respect it is possible, that fetal susceptibility to alcohol may also be dependent upon maternal racial and genetic compositions interacting with consumption patterns. The basis of these differences remains to be determined.

Consumption and Risk

Occasional drinking patterns, which are not on a daily or continuous basis during pregnancy, is not likely to increase the risk of FAS in offspring. However caution is advised for daily, light to heavy drinkers, as a safe level of alcohol consumption during pregnancy has not yet been established. Research indicates that increases in the amount of alcohol consumed by a pregnant woman increased the severity of alcohol’s effects in the offspring.

Heavily drinking during pregnancy (5 drinks or more daily; average of 3oz. Of pure alcohol per day) places the fetus at high risk for FAS. Risk for cranofacial anomalies, a reliable indicator of FAS, was found to increase with an average intake of 3 drinks daily during the period following conception and before pregnancy is confirmed. #16

Occasional drinking during this period did not increase risk.

Consumption risk factors associated with full FAS include increased number of drinking days, increased daily intake, and positive MAST scores (Michigan Alcohol Screening Test, one of the earliest instruments to detect alcoholism) reflecting an abusive drinking history. In terms of levels of consumption and risk of FAS offspring, the literature indicates that risk for FAS increases as consumption increases over 1oz. absolute alcohol per day.

Increased postnatal risk of clinical abnormality in the child at 4 years of age occurs at an intake of about 2oz. or more of absolute alcohol daily during pregnancy. #17 Neurobehavioral deficits may occur later and may result from lower levels of maternal drinking, and they appear to be more damaging in the long run. Binge drinking (more than 5 drinks on any occasion) and drinking during the first two months of pregnancy is considered to be the two strongest maternal predictors of postnatal neurobehavioral deficits. #16 Deficits include hyperactivity, distractability, speech and language problems.

Alcohol Consumption during Stages of Pregnancy & Severity of Effects

The Trimesters: Blood Alcohol Concentration (BAC), Duration of Exposure and Dose Level

Each trimester of pregnancy marks a stage of fetal development and our understanding of FAS risk needs to be discussed in light of how the timing of fetal development interacts with dosage, duration of alcohol exposure and BAC. In the embryonic stage: the third postconception week of human pregnancy is considered the critical period for teratogenic actions of alcohol to produce the most severe and characteristic features of FAS. Drinking an average of 3 drinks/daily during the period following conception and just before pregnancy is confirmed, increases the risk of having a FAS child. Occasional drinking during this period did not increase risk.

The nervous system develops in the first 8 weeks, making the most damaging effects result in this period. Although damage to the brain may occur in the last trimester as well, vulnerability to brain damage is highest at 15-25 days. #18 There are also two periods of rapid brain growth in the 3rd month and from the 6th month to after birth. The CNS, heart, eyes, legs, arms, teeth, ears, palate, external genitalia are vulnerable to alcohol in the first trimester.

Malformations common to these areas suggest that structural damage commence early.

Research indicates that among heavy drinkers who continued drinking throughout pregnancy had offspring with higher incidence of birth defects than those who reduced or abstained in the 3rd trimester. #19 Women who drink moderately throughout pregnancy have also been found delivering offspring with adverse outcomes such as an increase in neurobehavioral problems even in absence of physical facial anomalies of FAS. #20 Those who drank at moderate levels and discontinued alcohol use at mid pregnancy fared better than continuous drinkers. Research findings indicate the peak BAC increases likelihood of aberrant brain growth. A key factor in determining severity of FAS effects may be peak BAC during the third trimester when it is a critical period for brain development. Peak BAC can significantly affect the minimum dose necessary for producing FAE. #21 Conditions such as binge drinking which affect peak BAC should be curtailed during pregnancy. Clarren’s data on animal studies indicate binge type alcohol exposure can alter brain function without physical malformations and this occurs early in gestation. #9

Peak BAC and Breast Feeding

Reaching peak BAC has implications also for breast-feeding. Although the amount of alcohol ingested by infants through breast milk is low even when a mother consumes as many as 4 drinks daily, it is sufficient to cause slight motor delay. No effect on mental development of fetus was found at this dosage. Drinking regularly while breast feeding increases the child’s risk of impaired motor development. #22 Alcohol use during breast-feeding also inhibits prolactin hormone necessary to maintain lactation. Alcohol use during pregnancy at moderate levels may impair child’s sucking reflex at birth. Blood alcohol level threshold slightly below the legal human intoxication level in the mother results in problems in maintaining lactation. #23 These problems in feeding inevitably affect the growth of the infant.

Implications for Alcohol Education

The importance of understanding the metabolism of alcohol in women and how it differs in men, ethnic groups poses implications on what direction preventive alcohol education should take.

Alcohol education targeted to women needs to explain primary differences between female and male metabolic processes of alcohol consumption and its consequences on individual personal health. The next task in alcohol education is to disseminate to women of childbearing age, the potential of alcohol as a teratogen to the embryo and that FAS and FAE are preventable. As a safe level of alcohol consumption during pregnancy has not yet been established, abstinence from drinking while pregnant remains to be the best precaution, yet not an adequate one, especially for those women who do not know they are pregnant until weeks later. This ultimately asks for looking for common denominators in alcohol education when designing programs for women of the childbearing age.

Guidelines are needed to address sex and drinking as one variable when they occur as a combination of two variables acting as one independent variable in a social act or exchange between individuals similar to the act of drinking and driving. The trend towards increased consumption and early sexual activity and teenage pregnancies places teenage girls at a high-risk group for delivering offspring with FAS. The inclusion in alcohol education programs of the potential important role contraception plays in the prevention of FAS/FAE is central to targeting women of the child bearing age. As a depressant, alcohol can do away with inhibition, which can in turn be conducive to sexual activity without the use of contraceptives. A Scottish study which examined contraceptive use and drinking among teenage men and women, found a decline in contraceptive use when intercourse was preceded by alcohol consumption. #24

There is then the need to address possible outcomes: planned and unplanned pregnancies in the realm of preventing the risk of having FAS/FAE offspring, along with the importance of contraceptive use especially since research findings have not yet determined a safe level of alcohol consumption during preconception and pregnancy.

Among alcoholic women prevalence of FAS has been estimated at 21 to 29 per 1000 births. A woman who has had a FAS child may have a recurrence risk as high as 25% more than the normal population. This risk increases as she continues to reproduce, being 85 times more frequent in older siblings of FAS children (170 per 1000) and 350 times (771 per 1000) more frequent in younger siblings of FAS children than in the general population. #5

Alcohol drinking patterns and its interaction with socialization and sexual experimentation usually gets formalized in the teen years and progresses into the college and university settings. The inclusion of FAS in alcohol education programs at the high school and university/college level would be vital preventative education for both male and females. Although much attention in the research has been placed on maternal exposure to alcohol, there is some speculation that the vulnerability of faulty cell development in FAS may extend to the sperm and not just the female germ cells. #9 We know that semen of alcoholics have shown to have aberrant sperm forms resulting in low birthweight as it occurs in a significantly greater number of offspring of “regular drinking fathers�. #25, #26

The preventive goal of alcohol education with the inclusion of topics on FAS and FAE would best be served if integrated into relevant disciplines in the school and university curricula. Life skills learned in planning a family and in producing offspring integral to a nation’s development of qualitative future human resources would also enable individuals to take responsibility of their own well-being and of others.

copyright Anuppa Caleekal


1. Lemoine, P. et al Les enfants des Parents Alcoliques: Anomalites Observees�, Quest Med, 25; 476- 482, 1968 cited in Warner, R.W., and Rosett, H.L., The Effects of Drinking on Offspring: An historical survey of the American and British Literature�, Journal of Studies on Alcohol, 36; 1395-1420, 1975.

2. Jones, K.L. and Smith, D.W., Recognition of the Fetal Alcohol Syndrome in early Infancy�, Lancet, 2: 999 – 1001, 1973.

3. Ashley, M., “Drinking by Mothers to be: A Discussion for Public Health Professionals�. Information Review, ARF, Toronto, 1979

4. Clarren, S.K. “FAS: Diagnosis, Treatment and Mechanisms of Teratogenesis�, Transplacental Disorders: Perinatal Detection, Treatment and Management, Alan R. Liss Inc., 1990

5. Burd, L. and Martsolf, J.T. “ Fetal Alcohol Syndrome; Diagnosis and Syndromal Variability�, Physiology and Behaviour, 46: 39-43, 1989.

6. Smith, I.E. et al, “Identifying high Risk Pregnant Drinkers; Biological and Behavioural Correlates of Continuous Heavy Drinking During Pregnancy�, in Journal of Studies on Alcohol, 48; 4, p.304, 1987.

7. Abel, E.l. and Sokol, R.J. “ A Revised Conservative Estimate of the Incidence of FAS and its Economic Impact. “Alcoholism: Clinical and Experimental Research, Vol. 15, no.3.” May/June 1991, 514 – 524.

8. Tittmar, H.G. ed. Advanced Concepts in Alcoholism, Pergamon Press, P.6. N.Y., 1982

9. Cervantes, L. “ Not for women Only FAS�. Alcoholism, Nov/dec., 1984.

10. Nutrition Today Teaching Aid, “ The Fetal Alcohol Syndrome�, U.S.A.

11. Abel, E.L., “ Fetal Alcohol Syndrome and Fetal Alcohol Effects’. New York Plenum Press, p.37, 1984.

12. Marsland D., Principles of Modern Biology, Holt, Rinehart & Winston Publishers, N.Y., 1964.

13. Harding, S.C. and Wilson, J.R., “Ethanol Metabolism in Men and Women�, Journal of Studies in Alcohol, 48; 4, 1987.

14. ISI Press Digest, “ Alcohol in Men and Women Understanding the Difference�, 11: March 11, 1990. p.8,9.

15. Agarwal, D.P. and Goedde, H.W. “Ethanol Oxidation: Ethnic Variations in Metabolism and Response�. Ethnic Differences in Reactions to Drugs and Xenobiotics, Alan R. Liss. Inc, 1986, p.99-112.

16. Haase, T.B. ed., Alcohol, Tobacco, and other drugs may harm the Unborn. U.S. Dept. of Health and Human Services, 1990.

17. Streissguth, A.P., “ Psychological and Behavioural effects in Children Prenatally Exposed to Alcohol�, in Alcohol Health and Research World, Fall, 10: 1, 1985

18. Santrock, J.W., Life Span Development, Brown Publishers, 1986.

19. Royal College of Physicians: The Working Party on Alcohol (1987) cited in Oppenheimer, E., “ Alcohol and Drug Misuse Among Women: An Overview”, British Journal of Psychology, 158 (Suppl.10), 36-44, 1991.

20. Coles, C.D. et al “ Neonatal Neurobehavioural Characteristics as Correlates of Maternal Alcohol Use During Gestation”, Alcoholism Clinical Experimental Research 9: 454 – 460, 1985.

21. Pierce, D.R., West, J.R., “ Blood Alcohol Concentration. A Critical factor for Producing FAE’, Alcohol, 3: 269 – 272,1986.

22. Little, R.E., Anderson, K.W., “ Maternal Alcohol Use during Breast Feeding and Infant Mental and Motor development at One Year�, New England Journal of Medicine, 321; 425-430, Aug. 17, 1989.

23. Subramanian, M.G. et al “ Alcohol Inhibition of Suckling – Induced Prolactin Release in Lactating Rats: threshold evaluation�, Alcohol, 8: 203-206, 1991.

24. Robertson, J.A. and Plant, M.A., “ Alcohol, Sex and Risks of HIV Infection�, Drug and Alcohol Dependence, 22,p.75-78, 1988.

25. Gallant, D.M., “ Cytological Abnormalities in Sperm of Alcoholics�, in Alcoholism: Clinical and Experimental Research, 16: 5, Sept./Oct.1986.

26. Little, R.E., Sing, C.F., “ Association of Fathers Drinking and Infants birthweight�, Lancet, 1: 1644-1645, 1986.

Other Publications by Anuppa Caleekal

Other Research Publications and Reports in Alcohol Education by Anuppa Caleekal

1. Caleekal, Anuppa. 1991. Working Paper on Alcohol and Pregnancy : A Literature Review and Operational Guidelines for High School Teachers Teaching Aid “, Health Promotions Branch, Homewood Health Services, Canada.

2. Caleekal-John, Anuppa and Pletsch, D.H. 1984. ” An Interdisciplanary Cognitive Approach to Alcohol Education in The University Curriculum, Journal of Alcohol and Drug Education, Volume 30, No. 1

3. Goodstadt, M.S. and Caleekal-John, Anuppa. 1984.” Alcohol Education programs for University Students. A Review of their Effectiveness. International Journal of the Addictions, November, Volume 19 (7)

4. Caleekal-John, Anuppa and Goodstadt, M.S. 1982. ” Alcohol Use and Its Consequences Among Canadian University Students. Canadian Journal of Higher Education, Volume X11. No 2.

5. Caleekal-John, Anuppa. 1982. “Perceived Needs Regarding Alcohol Problems and Alcohol Education Programs on Ontario University Campuses”. Addiction Research Foundation Substudy, Education Research Section, Toronto.

6. Caleekal-John, Anuppa. 1982. An Approach to Alcohol Education in Universities. M.Sc Thesis, University of Guelph, Canada. (Supervisor Dr. D.H. Pletsch, Chairman, Department of Rural Extension Studies, University of Guelph, Canada


And The Beat Goes On

by Teresa Kellerman

My 18-year-old son John plays the drums. He has his own set of drums in his room and he plays every day – for hours. Now, if you are imagining me with my hands over my ears and my face wrinkled up in a migraine frown, think again. John is pretty good on the drums, and I actually enjoy listening to him as he plays along to the radio or a favorite tape. Part of my pleasure can be attributed to his taste in music, which pretty much matches mine. He likes the Eagles and Yanni, and even plays a tape of Scotish pipers occasionally when he needs to soothe himself with something relaxing.

John enjoys playing the drums – with a passion. In fact, it is one of the few pleasures he enjoys in life. John doesn’t have a car, in fact he doesn’t even drive. He doesn’t have an easy time in school. He doesn’t have any close friends, except for his doggy. You see, John has Fetal Alcohol Syndrome (FAS), a disorder caused by prenatal exposure to alcohol that has sentenced John to a life-long hangover. His birth mother’s drinking during pregnancy caused John’s mild retardation, small stature, unusual facial features, and damage to his central nervous system. Because of FAS, John is not as bright, not as tall, not as good-looking as other teens his age. He has a hard time learning the rules of life, and when he learns them, he has a hard time remembering them. His behavior and mannerisms seem inappropriate to most people, and while he desires to be close to people and has a friendly and out-going personality, others are put off and maybe even repulsed, and they shy away from him. John needs reminders about how to behave normally around people. I give him verbal cues for everything from getting ready for school in the morning, to taking care of his dog, to how to behave in public, to how to interact with company,and so on and so on, day after day. His brain just doesn’t function like yours and mine. He seems smarter than he is, he can “talk the talk” but he can’t “walk the walk.” He has a hard time carrying through from knowing what to do to actually doing it. So John needs to be reminded, consistently and continuously, in order to get through each day. One rule that John has finally learned is to ASK first before playing his drums. So every day, when John comes home from school, he ASKS me, “Mom, can I play my drums?” And most of the time, I say, “Sure,I’d LOVE to hear you play!” And I do love to hear him play. Because I know his drums give him one of the only pleasures he has in life.

My 15-year-old son, who is “normal,” plays the guitar, and although his taste in music runs more toward the hard rock and alternative rock that many kids his age like, I still think he’s pretty good. Recently his friend, who plays the bass guitar, came over to practice their music, and the two younger-but-bigger boys asked John if he would like to play along with them. John was thrilled. They set up their instruments, and tried a few songs that all three knew. It didn’t go as well as they had expected. John is such a good drummer, so they didn’t understand why he had such a hard time accompanying them. He would lose the beat in the middle of the song, and by the time he got back on the beat, the song had fallen apart and they would have to start all over. I realized that John could keep the beat only while playing along with a tape or the radio. He couldn’t keep a beat on his own.

I guess that’s how life is for John. He will always need someone else there to “play along” with him and keep the beat for him. On his own, he will surely fall out of step from the rest of the world. It is so easy for him to become lost in the music of life. I’m happy to be here for John, to help him catch the beat again when he loses it, to accompany him through a life that can bring him joy and success that he might not realize by playing solo.

But what about the other 5,000 children born each year with FAS? What about the 50,000 others born each year with alcohol related birth defects? They are the ones who may appear to be normal physically and intellectually, but who nevertheless have suffered from prenatal exposure to alcohol with similar dysfunction of the central nervous system. These are the kids who are hyperactive, have attention deficit disorder, don’t learn from the consequences of their actions, who are too impulsive to think before they act, who are just as frustrated with their inability to control their behavior as everyone else around them. Who is going to help them find the beat? Who is going to provide them with the accompaniment they need to get through life?

It feels good to help guide John through the challenges he faces in life. But somehow, that’s not enough. After all, FAS is preventable – 100% preventable. And it’s the leading cause of mental retardation in our country. Something is wrong here. Research has shown that there is no safe level of alcohol consumption during pregnancy. The only sure way to prevent damage is to abstain from alcohol during pregnancy. In the spirit of solidarity, I have chosen not to drink, to support others who have chosen not to drink, to make it easier for others,maybe a pregnant woman, to choose not to drink. In the spirit of education, I have chosen to speak out about FAS and alcohol related birth defects, in the hope that an increase in awareness today might promote an increase in the wellness of our community tomorrow. After all, I believe that all children deserve to have a chance at a happy and healthy life.

copyright Teresa Kellerman

Primary And Secondary Greatness

by Teresa Kellerman

Phoenix airport – 9/6/96, 5:15 p.m.
As I sit on the runway, awaiting delayed departure on this the last leg of my journey home from the conference on the secondary disabilities of Fetal Alcohol Syndrome, I finish the final pages of a best-seller that I brought for my quiet time on the trip. The book was a welcome respite at the end of each day of the conference, when I returned to my room from another session, my head filled with thoughts of primary and secondary disabilities, diagnoses, treatment plans, behavior scales, and the many stories told of beloved children who suffer from prenatal exposure to alcohol. After so many hours of inundation with data and statistics, bringing new hope and new fears, I welcome the respite of fiction that takes me far away from the dilemmas of FAS. Soon I will be home again, ready to face the challenges of FAS head-on when greeted by my son, John.

I think about him and life with him these past 19 years. He was only two and a half pounds when he was born, and just four pounds when I brought him home from the hospital. I think about the sleepless nights that long first year. I remember the cuteness attributed to his silly antics, and how the cuteness wore off as he got older and the same silly behavior became labeled as “inappropriate social interactions.” I think about how hard I have worked to make life a little easier for John as he struggles to control his impulses, as he searches for the right social response, as he apologizes, again, for some mistake he has made, some rule he has forgotten. I think how fortunate he is to have escaped from the effects of the secondary disabilities, such as expulsion from school, alcohol or drug abuse, or trouble with the law.

Oh, but my mind is tired of all this. And I return to the novel, and soon come to the end of the book. Then I remember the book in my bag, the one I bought as a gift for a friend back home. It’s not a novel, but a best-seller nonetheless, one I had not yet read. So I take it out, open it to the first chapter, and escape once again into a book.

In the first few pages, I read an account of a father’s concern for a son who struggles with difficulties in school, unable to follow directions, socially immature, who displays embarrassing behavior, who is small, skinny and uncoordinated. No, this boy does not have FAS, but the author has caught my attention with a discription that sounds so familiar, and I continue reading. The author states that no matter what the parents did, or how hard they tried, nothing changed with their boy. They had inadvertently given their son the message that he could not succeed. They realized that if they wanted to change their child’s situation, they would need to change themselves first.

The author stated that in order to change ourselves effectively, we first have to change our perceptions. Now I’ve heard this before many times, and I heard it again at the conference. I didn’t pay much attention, because I believed I already have a healthy attitude in that respect. As I read on,and turn the page, I am struck by these words in bold print as they jump out at me: “Primary and Secondary Greatness.” Of course ! In my concern about my son’s disabilities, I had forgotten about his greatness.

Then I remember the words of conference speaker Carolyn Hartness, a wonderful Washington woman whose message serves to remind us to be aware of not only the physical and emotional aspects of our children and their disabilities, but also the spirit of each as well, which is primarily whole and healthy. She reminds us that our children are sent to us as teachers, filled with wisdom beyond their years, beyond their IQ’s. She reminds us of the many gifts of the spirit that they share with us: humor, generosity, kindness, musical ability. These I see are the gifts of “Primary Greatness.” Someone else at the conference had shared that children with FAS are very sensitive emotionally. What some may see as a detriment, I see as a gift, this ability to sense and feel at a deep, intuitive level, a gift possessed by each child with FAS.

My thoughts fly around in a flurry of emotions, as I rummage through my purse for a pen to write all this down. and my hand touches a picture of John I carry with me. Oh that smile, always ready to brighten the spirit of anyone in the same room. Those arms, so willing to give a hug, not always inappropriately, often just when I need one. The hands that grasp drum sticks to beat out a rhythm on his drums, with real talent, hands always ready to share with others, to help someone in need. Those dark sparkling eyes with such readiness to love and willingness to understand my feelings. I’ve only been gone for three days, and I miss him so.

Carolyn Hartness warns us that great damage can be done when a child is beaten down by peers and teachers, even those who mean well. We need be careful how we touch the child’s spirit, she states, for this has a great impact on the child. I may not be able to undo the damage to my child of the primary disabilities of FAS, but I can nurture the primary greatness of my child’s spirit, so he can bloom and thrive in the secondary greatness of self-confidence, pride, respect, talent, self-expression and self-actualization. Carolyn reminds us that our children are not “FAS kids” – they are “children and adults with Fetal Alcohol Syndrome.” I agree when she said that words carry great power.

And so, here I sit on the runway, still waiting to take off, anxious now to get home to my Great Son and give him a warm hug and say “I love you and I appreciate you and all you are, and I am so grateful that you are in my life.” And I’m thankful for this gift of extra time, to write down these powerful words of others, so that I can read them again, to remind myself, when I become discouraged dealing daily with the primary and secondary disabilities of FAS, that there is greatness there also. I share these words with you, to remind you, next time you see a child that has been labeled as “disabled,” to look for and see, and cherish and nurture, the greatness of that child’s spirit.

copyright Teresa Kellerman

Brief Overview Of Fetal Alcohol Syndrome And Effects

tnfasheadby Dr. Cheryl Schroeder Ed. D.

“The births of all things are weak and tender, and therefore, our eyes should be intent on beginnings.” – Michel Eyquem Montaigne

What is Fetal Alcohol Syndrome?

Fetal Alcohol Syndrome (FAS) is a pattern of malformations and disabilities resulting from a pregnant woman drinking heavily during her pregnancy. FAS will not occur if the father was drinking heavily or if the pregnant woman was drinking a very small amount of alcohol on rare occasions. Heavy drinking on a consistent basis or binge drinking on an occasional basis can produce FAS. Fetal Alcohol Syndrome is currently the leading cause of mental retardation in the United States.

What is Fetal Alcohol Effects?

Fetal Alcohol Effects (FAE) is a condition where children are born with lessdramatic physical defects but with many of the same behavioral and psychosocial characteristics as those with FAS. FAE is often thought of as lower on a continuum than FAS, but this is not correct. Many individuals with FAE, while looking quite normal, have significant deficits in their intellectual, behavioral, and social abilities which prevent them from leading normal lives.

Forty-four percent of women who drink heavily during pregnancy will have a child with Fetal Alcohol Syndrome.

Of the other 56%, some will have Fetal Alcohol Effects, be Fetal Alcohol exposed, to minor learning and behavioral difficulties.

A few will be apparently normal.

A combination of factors determines whether the exposed child will be afflicted with FAS or FAE. First of all is the genetic makeup of the mother and the fetus. It has been demonstrated that many members of certain populations have similar genetic compositions. Research has suggested, for example that some individuals of Native American descent do not make enough of an enzyme necessary in the breakdown of alcohol in the liver or some are lacking that enzyme all together. Therefore these individuals would be at genetic risk of passing this trait onto the fetus.

A mother’s nutritional status and physical well-being might also play roles of varying significance in determining whether an infant is affected, and to what degree, by the prenatal exposure to alcohol. A great deal more research is necessary to determine the reason that some developing fetuses are more vulnerable to prenatal exposure to alcohol than others. The knowledge base in this arena needs to be greatly expanded.

There is a continuum of effects that can result from maternal prenatal consumption of alcohol.

The most common effects seen is an increase in spontaneous abortions, commonly known as miscarriages. Babies can also be born at low birth weight, birth length, and with a small head circumference resulting from prenatal alcohol exposure. Some of the other effects caused by maternal drinking range from an increase in the number of stillbirths, decreased apgar scores at birth, an increase in the number of birth defects, increased developmental delays, decreased I.Q. scores, to Fetal Alcohol Syndrome and an increased death rate.

Birth defects are dependent on:

Agent (alcohol, crack, heroin)

Dosage (how much is used)

Timing of Exposure (when is it used?)

Individual Factors of mother and child

Genetic Factors

Nutritional Factors

Metabolic Factors

There are variables which help determine whether a teratogen will have an effect upon the fetus. Which teratogen is used – alcohol, crack, heroin, x-rays, etc. The dosage of the exposure is very important. The more minimal exposure, usually the better off the fetus will be. When the teratogenic exposure occurs is of vital importance. Is it one short exposure time or was the exposure on a daily or hourly basis?

The individual factors of the mother and child are also vitally important and the reason why professionals cannot tell a pregnant woman how much would be safe to drink. Since these individual factors cannot be determined, the only way to prevent FAS and FAE is for a pregnant woman to abstain from the use of alcoholic beverages during her entire pregnancy.

FAS is characterized by a triad of symptoms:

1. Central Nervous System Involvement: The central nervous system is composed of the brain and spinal cord. Damage to this area must be demonstrated; i.e., mental retardation, severe learning disabilities, etc.

2. Prenatal and Postnatal Growth Retardation: The baby is born weighing less than it should. The baby does not gain as much weight as it should once it is born.

3. Characteristic Facial Patterns: There are characteristic dysmorphic features which appear due to prenatal alcohol insult or exposure.

Drawn by David P. Schroeder
Copyright © 1994-99 Creative Consultants, Inc.

The eyes appear to be widely spaced; the nose is often short and upturned; the philtrum (area between the bottom of the nose and upper lip) is elongated and flat; the upper lip is thin; and the ears might be low-set and rotated to the back of the head. In addition, the teeth of individuals with FAS are often misshapen and misplaced. It is common for orthodontia to be necessary.

Remember that a diagnosis of FAS or FAE should only be made by physician who is trained in the identification of these symptoms.

FAS is only the tip of the iceberg.

In addition to those with FAS are those individuals who appear normal but who have Fetal Alcohol Effects. Further from our sight are those individuals we suspect on a clinical basis have something wrong with them or are clinically abnormal but the reason why is hidden. The largest part of the iceberg, but where it most difficult for us to see, are those individuals that are apparently normal but unable to meet their potential. Some of these individuals are in the classrooms of today. They work hard and try, but it all doesn’t come together.

What mom drinks, baby drinks.

The alcohol that the pregnant woman drinks goes directly to the developing baby at the same level of concentration. If mom’s blood alcohol level is 0.2, so is the baby’s. However, mom is much, much larger. Her mature liver acts to detoxify the alcohol. On the other hand, the fetus is incredibly smaller. Its liver is not yet mature. Therefore, while mom might stay drunk for several hours, the developing fetus can stay drunk for three to four days.

It is because of this phenomena that binge drinking, consuming two or more drinks per hour, has been found to be more detrimental to the developing infant than low level, chronic drinking. The fetal blood alcohol level becomes very high and stays that way for a long period of time.

Incidence of FAS and FAE

World-wide incidence: 1.9 per 1,000 live births Southwest Plains Indians: 9.8 per 1,000 live births

-Abel, 1988, Abel & Sokol, 1986

What causes this large difference? Genetics is the answer. The results of the latest research indicate that many more members of some populations, in this case the Southwest Plains Indians, are lacking or have a reduced amount of an enzyme necessary in the breakdown of alcohol. The amount of enzyme produced by the body is genetically coded. Therefore some populations must be even more careful in this regards just as some other populations are at a much higher risk of developing high blood pressure or having an infant with spina bifida.

The knowledge that alcohol can cause problems has been around for a very long time.

In the Bible, Judges 13:7, pregnant women were admonished to “drink no wine nor strong drink, and eat no unclean food.” Women during that time were told to eat and drink only pure substances, those that would not harm the developing baby.

Aristotle said, “Foolish, drunken, and hare-brained women most often bring forth children like unto themselves, morose and languid.” It was seen even in Aristotle’s day that women who were alcoholic had children who appeared sullen, and not full of play and joy.

In England in the mid-1700’s, physicians were extremely concerned at the high number of infants being born who were mentally retarded and even stillborn. When Parliament imposed a hefty tax on gin, the number of people who could afford to drink it was dramatically reduced. Within a year or so, the number of children born mentally retarded and the number of infants who died before their first birthday fell dramatically.

Fetal alcohol exposure has lifelong consequences.

Fetal Alcohol Syndrome and Fetal Alcohol Effects do not go away. Once the brain is damaged, it is permanent. Most of the damage that occurs in the brain is a result of the brain tissue not moving and growing where it should, resulting in areas of the brain which are not developed at all or are underdeveloped. Neuronal connections that should have been made are simply are not there. Since brain tissue does not regenerate, this damage to the brain is permanent, especially if the tissue did not form initially. It doesn’t ever get better.

FAS is costly!

Anne Striessguth, Ph.D., a leading researcher in the area of FAS and FAE from the University of Washington, estimated in 1980 that the lifetime cost of each child born with FAS was over half a million dollars. In 1989 she adjusted that figure to 1.4 million dollars. Dr. Rizwan Shah, Director of the Family Ecology Center in Des Moines, Iowa, estimated that in 1994 the lifetime cost of each child born with FAS was 2.4 million dollars.

The health care costs for individuals with FAS and FAE can be staggering. If special facilities are needed, they are extremely costly. Special education costs are very high, especially if the individual needs to be placed in a special care facility.

The emotional burden on the family and child is monumental.

The child is very much aware that something is “different” about him or her. A great deal of the time they simply think they are dumb. The overwhelming majority of these parents do an outstanding job of working with and loving their affected child. Many of these children are in adoptive or long-term foster care settings.

Physical, cognitive, and social deficits associated with FAS:

Low birth weight

Failure to thrive (eat and grow well)

An exaggerated startle response

Poor wake and sleep patterns

Hyperactivity, distractibility and attention deficits


Temper tantrums

Lying and stealing are common behaviors

Poor social skills

Poor abstracting abilities

Many of these children are in adoptive or foster care.

As a result of their mothers’ high-risk lifestyles, many FAS children have been placed in adoptive or long-term foster care settings at an early age, usually before anyone knows that the child is affected. Many of these adoptive and foster parents have been chastised for harming their child when, in fact, they are only helping the child to the very best of their ability. We must be aware and not criticize nor judge. They are doing the best they can.

The good news is that FAS is 100% preventable.

Education and awareness by everyone at all levels is necessary. Individuals in their child-bearing years, both men and women, need to know the grave harm that can be caused to an unborn child by drinking during pregnancy. Our children world-wide need to know so they will not make these irreversible decisions.

Many health care providers need to learn more about FAS and FAE. Specific “selectives” dealing with this subject are currently offered in only three medical schools in the United States. Those schools are the University of New Mexico, Georgetown University, near Washington, D.C., and Northwestern University in Chicago, Illinois.

Physicians, especially those who deal with children,need to learn how to better diagnose this condition. We can all do something to help prevent this tragedy from occurring in the future.

The Surgeon General advises women who are pregnant or considering pregnancy not to drink alcoholic beverages and to be aware of the alcoholic content of foods and drugs. Even drinking on a social basis can have effects on the unborn child.

Social drinking (1 to 2 drinks per day) can produce an increase in miscarriages, stillbirths, low birth weight, and behavior abnormalities in the baby which can persist throughout adulthood.

The only way to prevent Fetal Alcohol Syndrome is for a pregnant woman to abstain from drinking alcohol during her entire pregnancy, even before she knows she is pregnant.

This will necessitate a change in lifestyle for those in their reproductive years unless they are consistently using a very safe method of birth control. Unfortunately much damage can be done to the developing embryo before the mother realizes she is pregnant. Therefore, it is recommended that a women should not drink alcohol beverages prior to and during her pregnancy.

It is never too late to stop drinking!

No matter when a pregnant women stops drinking,the child will be better off than if she continues to drink during the entire pregnancy.

Drinking during very early pregnancy, even before a woman knows she is pregnant, increases the chance of having a baby with growth deficiency or birth defects.

If someone is drinking 0 to 1 drinks per day during very early pregnancy they, like everyone else who has no additional risk factors, have a 2% chance of having a baby with growth deficiency or a birth defect. If, however, that pregnant woman is drinking two to three drinks per day, then the risk factor goes from 2% to 11% – more than one in ten. If a pregnant woman is drinking four or more drinks per day, even before she might know she is pregnant,then that chance of having a baby with growth retardation and/or a birth defect soars to 19% – almost one in five!

Please remember the good news: FAS and FAE are completely preventable!

People need to know what drinking during pregnancy can do to a developing fetus and the lifelong impact that it can have on a child. The longer we wait, the more children who will be born with significant disabilities If we all help spread this message, this leading and preventable form of mental retardation can be greatly reduced and even obliterated.

“Many things we need can wait, the child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today.”

copyright Creative Consultants Inc.

The Effect Of Alcohol And Cigarette On The Embryo

tnboard2The Embryo Just Can’t Say No !

by Clarence Williams

published here with the permission of his mother Sandra Clarke-Williams.

I will understand structure and function in living systems.
I will understand how organisms respond to environmental stimuli.
I will understand and explain the concepts of form and function; how things change and how they stay the same; and cause and effect.
I will be able to use evidence from reliable sources to develop descriptions, explanations, and models.
I will be able to gather information from multiple sources.
I will be able to represent data in multiple ways.
I will be able to support my argument with evidence.
I will be able to communicate in a form that is appropriate for the audience and the purpose.

I have a cousin that has Fetal Alcohol Syndrome (FAS). This was the result of my aunt drinking alcohol when she was pregnant. I also see commercial on TV telling women not to drink alcohol and not to smoke cigarette when they are pregnant. They say it is harmful to the baby. Well my research is to find out if Alcohol and tobacco will hurt a plant embryo in the same way that they hurt the human embryo.

Delayed Development or Intellectual Impairment
Reduced growth before or after birth
Small Head & Eyes
Thin Upper Lips
Flat Cheekbones
Narrow, Small Eye openings
Small Jaw
Holes between the two sides of the heart
Decreased joint movement

At first I thought that if I soaked lima beans in any kind of liquid the bean would grow. I used:

15 lima beans
3 clear jar (for germinating)
20 plastic cups
½ cup of water (usual liquid use to germinate a seed)
½ cup of milk (the best drink for someone that is pregnant)
½ cup of rum
½ cup of beer
½ cup of cigarette smoke water (smoke extracted by Dr. Logan in her lab)
3 sheets of paper towel (to line the 3 jars for germinating beans)
labels (to identify what bean was soaked in which liquid)
marker or pen (to write on the label)

The experiment was tried 3 times to see if I would get the same result. I took 5 plastic cups and placed 3 lima beans in each cup. I marked each cup with one of the liquid I was using and in the marked cup I put the liquid that I wrote on it.


So, I filled 1 cup with ½ cup of water, 1 cup with ½ of milk, 1 cup with ½ of rum, 1 cup with ½ cup of beer, and 1 cup with the cigarette water. Next I left the beans soaking for 24 hours (1 day). I started at 8 O’clock in the morning so at 8 O’clock the next morning the seeds were ready to germinate.



I folded each sheet of the paper towel in 3 so that none of it hung out. Next I wet each paper towel with water. After that I put one sheet of paper towel in each jar so that it stuck to the wall. I labeled each jar with the name of the 5 liquids that I used. I took one of the lima beans from each liquid and place it between the wet paper towel and the jar next to the label that said the liquid. Each jar is checked everyday for growth and recorded on a chart.



(Bean was soaked in for 24 hrs) DID SEED GERMINATE ?
(Yes or No)

Beer No
Rum No
Water Yes (After 2 weeks)
Milk Yes (2 days to 1 week)
Cigarette Water No

I found out that first, an embryo does not have a choice as to what it eats or drinks. Just like the lima beans, someone had to feed it with what it ate. The human baby eats what the mother eats through the placenta. Secondly, I found out that alcohol (that is in the rum and the beer) and tobacco and nicotine (that is in cigarette) could hurt a plant embryo (lima bean) in the same way it hurt a human embryo (baby). As you can see, if the embryo drank any kind of alcohol and is exposed to tobacco and nicotine at an early age it will damage its growth.

When a woman is pregnant she must be careful of what she eats and drink. In my project all 3 times, the lima beans soaked in alcohol and cigarette water did not germinate. The 3 lima beans soaked in regular water germinate but it took 2 weeks or more. However, the 3 lima beans soaked in milk germinated in less than 1 week. From my project I can now tell a pregnant woman to drink more milk and that drinking alcohol and smoking during pregnancy is dangerous for the baby.

There is a connection between physical defects among newborns and when their mother smoking or drink alcohol during pregnancy. Some of these conditions last for as long as they live. Smoking or drinking alcohol during pregnancy is believed to be the possible causes of Sudden Infant Death Syndrome (SIDS). SIDS is when the baby dies while sleeping with no apparent reason.

Smoking may cause the mother to lose the baby before it is born. This is called a miscarriage.
Children born to mothers who smoked during pregnancy may have trouble learning.
Smoking can cause a baby’s heart, lungs or other organs to be damaged.
Baby may have behavioral problem.

Baby can be born with Fetal Alcohol Syndrome (FAS) that can cause a baby to look different than normal babies.
The baby may be below normal size and weight at birth. Affected children never ‘catch up’ in later life.
Physical appearance could include a small head, narrow flat nose, and thin upper lip.
Bones, muscle, skin, eyes, heart and sex organs could be damaged.
Baby usually restless, irritable, have poor coordination and hyperactive.
Child may suffer from mild to moderate retardation and learning disability.

In my project the seeds soaked in alcohol just didn’t grow. As a matter of fact, the one soaked in rum stayed the same size as when it was first planted. It got soft and mashed away. The one soaked in beer swollen up and then got soft and mashed away. The seeds soaked in cigarette water just got black and then mashed away. The ones soaked in regular water and milk grew.

copyright Clarence Williams

Thanks to my Mother for helping me on the computer with my research. To my father and my brothers who helped me to put my board together. Thanks also to Dr. Loretta Logan for getting the cigarette smoke water for my project. Thanks to Ms. Debra Logan and her daughter Cherelle Gadsden a student at St. Luke School in the Bronx for giving me the idea of the project. Thanks to Fabio Loiaza the WIC Coordinator at North General Hospital in Manhattan for the books and poster on pregnancy. Also thanks to Mr. Taino Soba for drawing the picture of the seeds soaking in the liquids.

1. American College of Obstetricians and Gynecologists, Pregnancy Basics: Your Complete Guide to a Healthy Pregnancy, 1999

2. American Council of Science and Health, Cigarettes: What the Warning Label Doesn’t Tell You, United States, 1/00

3. Citizens Task Force on Child Abuse and Neglect, Having a Baby: A Family Guide to Pregnancy, 5/94

4. Kitzinger, Sheila, The Complete Book of Pregnancy and Childbirth, US

5. The Guest Choice Network, GCN: Nanny War on Alcohol, United States

6. The Guest Choice Network, GCN: Nanny War on Cigarette, United States

7. http://www.aap.org

8. http://arium.org/

9. http://www.modimes.org


An Education Misdirected

by Kirk Van-Beer

A college paper – including bibliography
Written from a Child and Youth Care Counsellor’s point of view.

The Abstract: Fetal Alcohol Syndrome (FAS), is something whose mere mention implies different things to different people. It is a ’syndrome’ immersed in stereotypes by the North American society in which we live, the majority of which are sadly negative. In the paper that follows, though written from a North American perspective, I will refrain from examining the specifics of these stereotypes, for to acknowledge them would only give them attention that I do not believe that they deserve in the context of this article.

This paper is about FAS and the way we, as a North American society, educate people about its known, and possible, causes. The paper is split into six sections. It begins by looking at a history of the discovery of FAS and Fetal Alcohol Effects, (FAE) and goes on to define each to avoid confusion within the paper. Having dealt with descriptions of FAS/FAE, it briefly examines four articles that offer a contrasting view to that of the mother being soley responsible for a child with it, by showing that alcohol is a teratogen on the sperm, and suggesting that this may effect the fetus. The paper then offers a suggestion as to why FAS/FAE is seen to be such a social and societal leper by comparing its public awareness to the initial awareness of Acquired Immuno Deficiency Syndrome (AIDS) in the 1970’s and 80’s, and suggesting that a different approach is needed to the education of the subject. The conclusion is very deliberate.

This paper does not try to give specific answers to the questions on FAS and our education of it. To do so would need a much longer and larger paper than is applicable to this assignment.. The idea of what follows is to give an overview of what we currently teach people around FAS and FAE and to show that from information that is now starting to be slowly become available, that we need to re-examine just what we are teaching. Whether or not the education that currently give people around this subject is fair and accurate remains to be seen. My hope is that this paper at least gives the reader food for thought.

A brief history:

In 1973, whilst doing research on human behavioral teratology (the study of birth defects) [Drs] Kenneth L. Jones and David W. Smith along with their colleagues in Seattle identified a specific pattern of malformations, growth deficiencies and Central Nervous System (CNS) dysfunctions that were observable in some offspring of alcoholic mothers (Jones, Smith, Ulleland & Streissguth, 1973), a pattern that two of them then named Fetal Alcohol Syndrome (FAS), (Jones & Smith, 1973). Though this had been previously brought to light some years before in clinical studies of alcoholic mothers, (Lemoine, Harousseau, Borrteyri & Menuet, 1968; Rouquette, 1957) once the two Seattle groups had had their findings published in the much read and respected medical magazine “Lancet”, interest in the subject quickly, yet quietly took hold of those whom read it. By the end of that decade FAS was recognised as one of the three leading causes of mental retardation and had a prevalence that was comparable to Down Syndrome and spina bifida (Smith, 1980). Of the three, FAS was the only one known to be preventable. It was around this time that, further research recognized other characteristics within children that were not FAS, but were linked to it and in 1978, the term Fetal Alcohol Effects (Clarren & Smith) was coined.


The terms Fetal Alcohol Syndrome, and Fetal Alcohol Effects are sometimes confusingly put together in the same phrase as if they mean the same thing. They are not, and so should be clearly defined:

Fetal Alcohol Syndrome (FAS) is defined and characterized by a cluster of congenital birth defects that develop in the womb as a result of exposure to alcohol either before (Jones, 1998) or during pregnancy. These birth defects are best recognized by pre and postnatal growth deficiency of the child’s, facial malformations, Central Nervous System disfunctions, and a varying degree of major organ system malformations. In effect, they are generally visibly recognisable.

Fetal Alcohol Effects (FAE), (or Alcohol Related Neurological Defects (ARND), a term now being recommended to replace FAE, (Jones, 1998) and which I will refer to for the rest of this paper) is as its name implies, structural and functional defects within the head attributed to prenatal exposure of alcohol. These defects as generally seen include a small head size and abnormalities in the brain which cause such things as poor motor skills, poor hand-eye coordination and leads to such things as learning difficulties within the classroom, and behavioral problems which include poor social interactions. This is seen in the actions of the child/youth/adult, but is not necessarily visibly recognisable. ARND is inclusive of FAS and provides a category for those whose birth defects do not fully meet the FAS case definition and who (for the most part) do not have the facial deformities, so outwardly they appear normal.

FAS/ARND are conditions which suffer on the North American continent from a bad case of stereotyping. Having only been officially acknowledged to have existed for some twenty to twenty five years, they are seen by the majority of educators and recognised text books that are primarily caused by a mother’s alcohol consumption either during or prior to pregnancy. (Streissguth, Bookstein, Sampson and Barr. p. 20) Though there are no definitive answers to just how much alcohol is needed to affect the womb, the writings that are available for the most part suggest, and in fact clearly point the finger of blame, solidly at the mother as the sole person responsible. Yet is, or was, this rush to judgement wrong?

Articles on the subject suggest what?:

In her paper “Effects on Future Generations of Paternal Exposure to Alcohol and Other Drugs”, (Winter 1987/88) Gladys Friedler looks at how exposure to alcohol and other drugs effects the offspring of fathers who are exposed to one or both. In citing research done at Boston University School of Medicine, Friedler informs us that drug research on mice indicates that exposure “can induce long-term changes in the normal developmental and behaviourial patterns of subsequent offspring”. (p. 128) She then goes on to inform the reader that alcohol, like opiates, is capable of profoundly altering the reproductive chemistry in males. For a paper that was written in 1987, in the context of things relating to what we know of paternal alcohol exposure, she had some interesting and far-sighted things to say on the subject. In her conclusion where she writes that more detailed research needs to be done on the subject. A thought echoed by almost everyone who was or is writing on this topic.

A researcher who is much quoted in this field is [Dr] Ernest L. Abel. In his paper “Paternal exposure to alcohol”, (1992) Able offers us reference to peoples suspicions from as far back as the Talmud, that a males exposure to alcohol effected their offspring.

He also tells his readers of research on the subject (and its findings) done on rats and mice done by himself and a number of researchers throughout history. He throws in an interesting twist to his findings when he writes of a confusing fact that data collected two different sets of rats exposed to the same amount and type of alcohol differed greatly. (p.141) The paper is a fascinating mixture of history and detailed descriptions of experiments ending not with a solid conclusion but with the observation that in his experiments, alcohol would seem to have had damaging effects on the male sperms deoxyribonucleic acid (DNA). (In effect the make-up of each and every person!)

In his much quoted and now increasingly referenced piece of research “Effects of paternal exposure to alcohol on offspring development” [Dr] Theodore J. Cicero (1994) suggests the possibility that the view that a mother is solely responsible for a child who is born with FAS is wrong. By pooling a vast amount of research of the effect of alcohol consumption on mammals, animals and humans, Cicero theorises that we have overlooked just what the impact of a males consumption of alcohol may have on the offspring to be born. Whilst admitting that he offers no conclusive proof, he does none the less, offer some interesting food for thought on the subject stating in his ‘Conclusion’ that “. . . results relative to the paternal effect of alcohol on pregnancy are still in a very early stage of development . . .” (p, 40) and suggests that more work needs to be done in this field, possibly with animals being those that are studied. He also says that we need to clearly define just what the parameters should be for studies of this kind.

In the context of getting ones message out on the thoughts of a subject to the world, the Alaskan Department of Health and Social Sciences, Division of Alcoholism and Drug Abuse (Jones, 1998) put series of pages on the Internet about FAS and ARND that are as thought provoking as they are quietly controversial. In admitting that alcohol abuse is Alaska’s number one health problem, the pages look at the incidence and risk factors within the state and produce some very thought-provoking statistics. Like a person who is admitting that they have an addiction of some kind, the Internet pages have such headings as “Men Have Babies, Too”, and subsections with questions such as “Does FAS ever go away or get better?”. One point that is very well made and presented, is that of advising men to stop using alcohol and drugs at least three months before attempting to have children, and staying that way throughout the pregnancy or order to support the mother. It is a simply written and presented series of pages that are accessible and easily understood by all who chose to venture to this Internet site whatever their level, or lack of, education.

In comparing the four articles (deliberately presented here in chronological order), the one thing that stands out is the how, as we begin to understand and learn more on the subject of prenatal exposure to alcohol, so the way the way those who write about it, seems to get more interesting and easier to read. Research on this subject appears to show that we are only just touching the edge of the ice-berg of what there is to know on the subject, and we have to find ways of getting that message out to the public. When Friedler initially published her findings in 1987/8, the idea that a mans drinking could damage their unborn offspring was still a relatively unexplored field. The work published by people such as Doctors Able and Cicero, has added to that awareness by writing in about the subject in ways that the average person can understand. The final series of articles put out by Alaska’s Division of Alcoholism and Drug Abuse are the most readable and user friendly to understand of the four that I have written of here. Though FAS/ARND are rarely singled out for special mention in these articles, they are mentioned, and the fact that we are at last starting to acknowledge that alcohol does have an effect on a males sperm by being a teratogen, brings us to the question that is the reason for writing this paper: Have we missed the boat on the way we educate people, especially those wishing to have babies, on what we teach them around the effects of alcohol on the development of their offspring?

So why the confusion in what we know and understand?

Statistics indicate that alcohol consumption is on the increase. Yet our awareness of alcohol consumption, and the education of our expectant families,especially that of youth, primarily evolves around the mothers. Any kind of drug or alcohol prevention strategy needs three intertwining factors in order to work: ‘Health promotion’, ‘Research’ and the capability for ‘Intervention’. Once these three factors are in place, awareness and eduction programs can be targeted to particular populations. At the moment, that ‘awareness and education’ is primarily aimed at females, or at least focused on reduction of alcohol use for females.

Yet, there is a growing amount of evidence that suggests that male drinking may be just as likely as female drinking to cause damage to the fetus. Why then are we not more aware of these dangers?

Though there are many theories on this, the most probable, (and no doubt controversial!) would seem to be that it is seen to be a condition that effects those on the outer edge of societal norms. An example here would be that of Acquired Immuno Deficiency Syndrome (AIDS): When AIDS first showed its face on North American shores in late 1970’s and early 1980’s, we had Conservative and Republican Governments in power, and our collective military prowess or might, was far more important than the welfare of those who were not wealthy or middle class. AIDS seemed to only effect homosexuals, drug users, blacks, Hispanics, and others seen to be on the outer edges of the American dream. They were not seen as Christian, white, popular, or God fearing, such was the mood of our continent at the time. They were not stars or media icons either. No-one in mainstream society looked up to them, so they were pushed gently to one side and quietly told to shut up and go away! Then, seemingly out of no-where, someone who was famous was reported to be a carrier of the virus, and then another, and another, and another! Quite suddenly, all these famous people who were a part of that ‘American Dream’ had AIDS! In hindsight, it seems to have happened overnight. But it didn’t! People had had it for years and were too frightened of the stereotypes to go public about it. Then, for reasons such as proven facts that you didn’t have to be ‘gay’, or a ‘drug user’, to be a carrier, it became okay to admit that you had it! The governments were forced by the people to acknowledge it, and those responsible for the ‘American Dream’ even sponsored charities to help raise money for it!

Which leads us to the question then, that if FAS and ARND have been around for as long as AIDS, why is it still seen as such a social leper and why is there not better public awareness of this either in hospitals, doctors offices, or in the media? The reason, I believe, would seem to be that it’s because no one who is remotely famous has either had it themselves or admitted to having a child born with it. Until that happens public perception just will not change. For something to get noticed these days in our society, some rich media icon of a person has to stand up and take notice of it to get everyone else’s attention.

Within this truthfully sad statement of fact about North American society lies the basic reason for the problems of education and miseducation around FAS and ARND. Unless the subject gets some major media attention, those who research it, will remain in the dark shadows of our medical and public perceptions. And without that public attention, those who need the educating the most on this matter, (Our youth!) may chose not to take any notice of just what alcohol can do to their offspring, so we will see a continued rise in the number of children born to young parents effected by this.


With FAS now recognised as the leading cause of mental retardation among new born children, (and still the only one of the top

three known to be preventable!) the need for the education of our expectant families and youth can surely not be clearer. Whilst there are a number of excellent peer educational workshops, groups, and resources such as those put out and by the ‘Alcohol and Drug Education Service of British Columbia’ [Canada], (Carr, 1998) the need for both male and female youth education ‘of self’ is now abundantly clear. Unless we, the Child, Youth and Family Counsellors of today’s society, can get the message to them through the media, and somehow make the message of these dangers worth taking notice of, it would appear that things may not move along very fast.

In looking at ways to get that message across, we cannot wait for public opinion to make the subject popular. We need to change what we are focussing on and perhaps begin to look at gearing the education on the males contribution to the equation of a child first. After all, education aimed at females has not worked that well so far! The idea that both male and female drinking may damage a fetus is not a pleasant one to think about for an adult, yet alone our youth. For the last twenty five years the finger of blame has pointed solely and squarely at the female. With evidence now suggesting that the males alcohol consumption ‘may’ have an effect on fetal development, it is definitely time to take a look at the focus on who we are trying to educate here.

For a government and its people, much like a single human being, it is hard to look in the mirror and own up to the possible flaws in oneself. Twenty five years ago, North American society was biased, racist, and closeted in many ways. Yet can we, as a people, admit to ourselves and our children, that we may have made a mistake? That we may have gotten our education on alcohol, the fetus and FAS wrong? That quite possibly, the male may be as guilty as the female for the problems that happen to the development of the child within the womb?

There is an old saying about how ‘prevention is better than cure’. There is no cure for FAS or ARND, yet there is prevention! The question of whether or not ‘Alcohol, the fetus and FAS’ is an education that we have misdirected is not one that is easily answered.

Until such time as concrete evidence is shown to the contrary, there are many who will refuse to believe that the fault and the responsibility can not be anyone’s other than the mothers. As ‘Child, Youth and Family Counsellors’, I do not believe that we have the right or power to make a judgement on the case one way or another, even if it turns out the initial education was misdirected. I do believe however, that we have a moral obligation to educate those whom we work with of ‘all’ the information that is out there. Then let people make their decisions on their own. After all, isn’t that what good counselling is all about?

copyright Kirk Van-Beer