Researching the effects of alcohol in utero
As a post-doctoral research fellow in the Fetal Behavior Research
Center, based at the Royal Maternity Hospital and School of Psychology,
Queen's University, Belfast, Ireland, my research examines neurobehavioral
functioning in fetuses exposed to relatively low amounts of alcohol
during pregnancy (approximately 4-5 drinks per week or less).
My interest in the prenatal period stems from the fact that this
is the time the building blocks for later development are established,
and any adverse experiences at this time may last a lifetime. The
behavior of the fetus is widely considered a direct reflection of
central nervous system (CNS) functioning and integrity because we
know that fetuses with CNS deficits display an altered behavior
pattern compared to normal, healthy fetuses. Therefore, fetal behavior
may be used to assess CNS functioning at the time when alcohol is
actually exerting its teratogenic effects of the developing fetus.
To date my work has found differences in the behavior of fetuses
exposed to alcohol compared to those of mothers who have abstained
from alcohol during pregnancy. Fetuses of mothers who drink alcohol
exhibit deviant spontaneous behavior—fetal movements such
as general body, breathing, mouthing and startle movements and hiccups—and
in their elicited behavior (their responses to stimuli_ they display
altered patterns of responding. However, not all fetuses appear
to be equally affected by similar levels of alcohol exposure. I
am presently attempting to use the behavior of the fetus as a means
of identifying those fetuses most at risk from the teratogenic effects
At the present time in the United Kingdom pregnant women are told
that it is safe to consume up to four units of alcohol each week
(1), despite the fact that we do not know how
much alcohol is safe to drink during pregnancy. Women receive mixed
messages from health professionals, some of whom advise complete
abstinence from alcohol, whilst others tell mothers it is fine to
have a few glasses of wine. In order to address this discrepancy,
Northern Ireland Mother and Baby Action (the charity that funds
my research) recently created an information leaflet targeted at
pregnant women and women planning to conceive. This leaflet, Alcohol
and Pregnancy: The Facts, was launched at all maternity units
throughout Northern Ireland. In addition, two seminars were organized
for health professionals in an attempt to increase awareness of
the very real risks associated with alcohol consumption during pregnancy.
I believe that it is our responsibility as researchers to ensure
that the results of our work reach women and other health professionals.
It is vitally important to educate health professionals and women
on the adverse effects of maternal alcohol consumption on the developing
fetus, and the life-long consequences of drinking alcohol whilst
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Recent Research Highlights
The 24th Annual Scientific meeting of the Research Society on Alcoholism
(RSA) was held the last week of June in Montreal, Quebec, Canada.
The 7-day conference covered topics of genetics, and of effects
of alcohol on neurophysiology, neurotransmitters (adults and the
unborn), behavioral pharmacology, endocrine and immune systems,
human alcohol intake, clinical issues of diagnosis and treatment
for problems with alcohol use, public health issues, relationships
of alcohol to HIV and suicide, customization of treatment strategies,
alcohol advertising, and of course, teratology of alcohol. Some
highlights of the conference:
The physiological effects of prenatal alcohol consumption
This year's RSA meetings advanced our knowledge about how in the
mother, alcohol alters thyroid-related responses and influences
maternal circulating cortical (a stress hormone), both of which
can effect the unborn child. In the unborn, prenatal alcohol exposure
causes very real alterations to fetal brain development. Numerous
presentations documented how prenatal alcohol exposure inhibits
creation of brain cells in the developing fetus, directly kills
some, and causes others to die before they are supposed to. Other
research expanded on our knowledge of how prenatal alcohol alters
neurotransmitters in the unborn. Fetal Alcohol Spectrum Disorders
(FASD) are truly birth defects.
How common is FAS?
A 1997 publication from the Fetal Alcohol and Drug Unit in Seattle
estimated that almost 3 per 1000 newborns in Seattle metropolitan
area probably have FAS and that the combined incidence of FAS/FAE
approaches 10 per 1000.
One research group attending this year's RSA conference reported
results from a screening of the entire school enrollment of a community
in South Africa where drinking among women is known to be prevalent.
They found about 48 in 1000 to have FAS (with the facial features).
Another group reported on studies of alcohol use and consequences
in Russia, the country that is believed to have the highest per
capita alcohol consumption in the world A Russian team that was
recently trained in diagnosis of FAS, examined children (age 6-18
years) living in special orphanages and boarding schools in Moscow.
They identified about 100 in 1000 as having FAS.
What influences people to drink?
It was reported that the alcohol industry spends over $1 billion
in advertising each year in the U.S., using such venues as TV, magazines,
billboards, kiosks (such as seen at shopping malls) and radio. Several
studies were consistent in the finding that this advertising does
appear to be correlated with increased drinking in young people,
but that the effect is "small". One wonders though: if
the effect is present (even if small) in a largely normal sample,
what effect does this advertising have on individuals who are born
with brain damage that manifests in high suggestibility and poor
judgment – especially when the advertisements tell them that
when they drink they will be happy, socialize easily, have good
times, and have friends?
Several studies concluded that expectations about drinking are
already observable in young children, and that appropriate expectations
about drinking can help mediate the effects of alcohol advertising.
Teaching children how to be happy, socialize, have good times,
and have friends without alcohol appears to be an important and
empowering tool against the alcohol advertisement dollar. If parents
don't teach their children about alcohol, their environment will.
What about treatment for problems with alcohol among the young?
The 1999 RSA meetings presented a forum for several groups independently
concluding that the traditional 12-step programs successfully used
by adults do not work as well for younger people due apparently
to their identity-development issues. This year's meetings presented
several encouraging experiments with customized "young-people's
treatment" that show more promise.
For more information about the conference, call 206-543-7155.
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SCREAMS: A parent's sweet sound of success
I'll never forget the day that I first realized the success I had
achieved as a mother of a young adult with FAS. When the light of
awareness went on in my mind, it was bright in contrast to the darkness
I had been carrying for years. I had been somewhat depressed over
the hopelessness of the idea that FAS is permanent brain damage.
What made this concept so devastating is that it is 100% preventable
– theoretically speaking, anyway.
My son John had just turned 18, that magical age when a person
legally becomes an adult. But I knew that he really was, and always
would be, a boy in a man's body, never able to function independently
in the true sense of the word. He would always need supervision
and support services. I had tried so hard all his life, worked so
diligently, to help him achieve his potential, and it was hard for
me to accept that, in spite of all my efforts, he would always need
to be in the care of others to stay safe and well and living within
a decent quality of live.
When I started my journey as John's mother, I was a foster parent
for special needs babies, and John came to me a scrawny little thing
a few weeks after his birth, at only 4 pounds, with a diagnosis
of FAS. As delighted as I was to have a diagnosis, it was not long
until I learned that there was almost no information available regarding
prognosis or intervention. His future was a big question mark, and
I realized I might have to rely on my "whatever works"
philosophy of intervention. After I adopted John, I followed Dr.
Ann Streissguth's continuing studies on children and adolescents
with FAS, and that helped me to know what behaviors to expect and
what problems to try to prevent. As other parents know, day-to-day
life was challenging, sometimes joyful, sometimes frustrating. And
as John reached adulthood without the abilities to live as an adult,
I felt discouraged that nothing I could do for him would reverse
the physiological damage of FAS. Until my "awakening"
to a new reality.
It was a September day in 1996 that Dr. Streissguth revealed the
results of her long-term studies on secondary disabilities associated
with FAS disorders. I was sitting in the auditorium in Seattle with
other conference attendees. Streissguth noted the primary disabilities
associated with FAS—the delayed growth, the facial characteristics,
the physiological anomalies, and the dysfunction of the central
nervous system. I recognized that John had just about every primary
disability that was mentioned. Then Streissguth talked about the
secondary disabilities that the individuals in her study developed:
mental health issues such as clinical depression that in 23 percent
of adults led to suicide attempts; dropping out or getting kicked
out of school; getting in trouble with the law; sexually assaulting
others, abusing alcohol and other drugs. These are among the secondary
disabilities that can result from FAS disorders – more devastating
than the primary disabilities, and all preventable! It was at that
moment that I realized that John had reached the legal adult age
of 18 without having incurred any of the secondary disabilities.
Streissguth reported that the protective factors include early diagnosis,
stable home environment, and appropriate support services. John
came to me with the first, and I provided the others. I felt such
joy and pride that I must have done something right in raising John
to have helped him get at least this far in his life with absolute
The strategies I had been using all the years John was growing
up were not just haphazard ideas applied blindly. They were carefully
thought out strategies based on what I had leaned from Streissguth
and other FAS experts. There was a method to my madness, and that
method was something I decided to record and distribute for other
parents to use as guidelines in helping their children achieve success
as well. My model for intervention has been used by many other families
with great success, according to feedback I have received.
There are seven basic components that I apply, and they happen
to form the acronym SCREAMS.
Structure: a regular routine with simple rules
and concrete, one-step instructions
Cues: verbal, visual, or symbolic reminders can
counter the memory deficits
Role models: family, friends, television shows
and movies that show healthy behavior and life styles
Environment: minimized chaos, low sensory stimulation,
modifications to meet individual needs
Attitude: understanding by everyone that behavior
problems are primarily due to brain dysfunction
Medications: many individuals can increase control
over behavior with the right combination of medications
Supervision: 24/7 monitoring may be needed for
lifetime due to poor judgment and lack of impulse control.
Many people who know about FAS disorders are aware of the need
for structure, but sometimes this is confused with
control. While providing structure as a foundation, we need to offer
choices they can handle, remain flexible, and remember K.I.S.S.—Keep
It Simple, Sweetie!
Giving cues can be tricky, as we tend to give
only verbal reminders. I call it cueing; John calls it nagging.
Kids with FAS respond well to visual cues, to symbols and signs,
to music and rhythm.
Children with FAS disorders learn behavior primarily by mimicking
the behavior of others. This makes healthy role models
extremely important. I am reminded of this saying: "Children
learn by example; unfortunately they can't tell a good example from
a bad one." We need to provide positive examples for dealing
with frustration and anger, for appropriate social interactions,
and for life styles that are healthy. Our kids need to be shown
how to act in ways that will keep them out of trouble. John learned
to walk away from being shoved or hit. He learned to express his
anger with words that explain what he is feeling rather than words
or actions that might hurt others. When we observe unhealthy behavior,
like inebriation or violence or disrespect, we talk about it and
we play-act healthy reactions to difficult situations that are likely
Behavior modification is not on my list, because it has not been
provided to be very effective when dealing with my son's behavior.
Our kids might understand consequences, but they aren't necessarily
able to learn from them. What works better for our kids attention
to the environment. Timeout may not teach them
to change their behavior either, but quiet time can be used when
they are overwhelmed or over-stimulated as an opportunity to self-calm
before rejoining a group. Avoid noisy, crowded places; reduce the
chaos; and prepare in advance some coping strategies for unavoidable
situations that might be too stimulating.
Understanding the nature of FAS as a neurological disability helps
to minimize unrealistic expectations. Dr. Calvin Sumner stated that
the greatest obstacle our kids must overcome is chronic frustration
from unreasonable exceptions of others. I believe this attitude
of understanding by all who are in the individual's life could reduce
the risk of depression and suicidal tendencies later. The parents
whose children experience the most success are those who have achieved
an attitude of acceptance that their child may not fulfill their
dream of "normalcy." Again, unrealistic expectations for
full independence might set the teen up to fail. The teens and young
adults who enjoy the most success are those who have accepted the
limitations of their disability and the need for protective restrictions.
Medications are usually initially prescribed for
ADHD, but meds can help more than just reduce hyperactivity. In
my experience, the right meds or combination of them can normalize
the balance of brain chemicals, and can somewhat restore function
and give the individual more control over behavior, increase learning
ability, and enable the individual to function more appropriately
in social interactions.
Supervision is difficult to impose, especially
as the child reaches the teen years and wants the same independence
they think their peers are given. Unfortunately, giving privileges
due to an 18-year-old to a person with the judgment and impulse
control of 6-year-old could result in total loss of freedom, if
they end up in the hospital, on the streets, in jail or in the morgue.
I have overcome criticism of being overprotective and of not letting
go. My son is healthy and happy and productive, and I am proud of
the success he has achieved. His quality of life is better than
that of most non-disabled people. The only scrams in our family
are scrams of excitement and joy. Especially now that John is pursuing
a romantic relationship with a new female friend. But that's another
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Journey Through the Healing Circle
Through the Healing Circle: A Book and Video Series about
FAS for Parents and Families
Journey Through the Healing Circle is a beautifully
crafted book and video series about fetal alcohol syndrome
throughout the lifespan. Four different tales are presented
using traditional Native American story telling techniques
and brilliant illustrations by Raoul Imbert:
• The Little Fox (ages birth to 5)
• The Little Mask (age 6-11)
• Sees No Danger (ages 12-17)
• Travels in Circles (age 18-22)
In each story, the challenges faced by children with FAS
and alcohol related conditions are described and represented
through animal characters at four different stages of development.
Through the characters we learn how drinking during pregnancy
can cause FAS, how FAS is diagnosed, and the different types
of health and developmental difficulties children and young
adults may experience. The second section in each story reviews
the effects of alcohol on brain development, elaborates on
some of the challenging behaviors related to prenatal alcohol
exposure, and provides practical suggestions to help individuals
with FAS and related conditions succeed in their world. The
videos also emphasize healthy behaviors for pregnant women
and how to prevent FAS. Although it reflects a Native American
style, the educational series is appealing for a cross-cultural
audience, and appropriate for parents, caregivers, children
and professionals alike. A discussion guide also accompanies
Journey Through the Healing Circle was developed by Robin
LaDue and Carolyn Hartness with support from the Washington
State Department of Social and Health Services. the video
series has won several awards including the Emerald City Gold
Award for excellence in an informational video, the Neal Shipman
award for editing, the Telly Award for film and video production
and the National Videographic Award for outstanding educational
The book and videotape series, (4 books and 2 videotapes)
costs $24.00 US. A complete package (4 books, 2 videotapes,
4 CD's, 2 posters, and a coloring book) is available for $60.00
US. The series and other individual items can be ordered by
Helpline Clearing House
3700 Rainier Ave.
Seattle, WA 98144
Washington state residents can check out the video series
from local libraries. The series is also available from the
Washington State Foster Parent Training Institute by calling
800-662-9111. Books accompanying the video can be downloaded
from the DSHS Web site at www.wa.gov/dshs/fosterparents.
the Healing Circle- A Family's Perspective
The series Journey Though the Healing Circle has
been a wonderful addition to our home. My husband Lynn and
I have seven children, either adopted or in guardianship,
and they all have fetal alcohol syndrome or related conditions.
Our children range in age from 2 to 17 with varying degrees
of disabilities. Because the children all have an increased
risk for alcoholism, we are always looking for ways to discuss
the importance of abstinence for them. They also know that
they have differences in their learning processes and in the
way that their brains function because of their biological
moms' use of alcohol during pregnancies. But we want them
to understand and believe that their moms didn't drink to
hurt them or because they didn't love them.
This series of books and videos has opened avenues of discussion,
often at the children's initiation, about some of the above
subjects. Michael and I had a very long talk about his awareness
that his birth mom didn't drink to hurt him but that she just
didn't know any better, like Mama Fox in the first video.
We have also talked about the difficulties and differences
of children being raised in foster homes instead of their
family homes. The second video about the raccoon children
being raised in foster care by Grandma and Grandpa Otter helped
with that topic. The videos have helped the children understand
why sometimes they are in different classes at alcohol, or
why they need more structure and supervision.
The Native American Storytelling format, using animals of
the forest, along with the great storyteller Floyd Red Crow
Westerman, holds my children's interest and they stay remarkably
focused on the stories. There is no sense of blame, shame,
or humiliation. They have watched these videos many, many
times. In addition, each video comes with a teacher/video
guide, which gives examples of questions and answers to help
facilitate group discussions.
I would recommend this series to any family, classroom, or
service provider working or living with children or adults
with FAS or related conditions.
Through The Healing Circle- A Professional's Perspective
by Kieran O'Malley, MD
I reviewed the first two books and video tapes in the series,
The Little Fox and The Little Mask.
The videos are more successful than the books. It says that
they are for foster parents, but could also be used by adoptive
parents or birth parents. The little Fox with FAS is personified
as the character "Stays in the Moment," which is
an apt description. The journey to the Healing Circle is lead
by the rather enigmatic Coyote and the circle is presided
over by Dr. Raven. The book and video use animals to describe
the different professionals. It is unfortunate that the book,
and the video to a lesser extent, did not acknowledge Dr.
Sterling Clarren and Dr. Susan Astley at the Seattle FAS-DPN
clinic and their coworkers, as both offer a concise description
of this unique clinic's working operation. The journey through
the Healing Circle is really a journey through the Seattle
The illustrations in the book are wonderful as is the music
in the video. Only the books offer concrete suggestions for
parents on strategies to help their child, especially The
Little Fox book.
The books and video seem to be for a specific population
of Native American parents or foster/adoptive parents of native
children. Some of the animal images would not be the best
fit in other cultures. For example, while the video presents
the Raven as the leader of the healing circle, the raven is
quite a dark image in Jungian psychology (most associated
with Jung's analysis of Franz Kafka's "The Secret Raven"),
and it is the harbinger of death in Celtic cultures, as portrayed
in W.B. Yeat's play "The Death of Cuchulain". Mental
health professionals may want to review the video carefully
before recommending it to families of certain cultural groups.
Finally, the books' narratives were more of a conventional
description of the operation of a medical diagnostic clinic,
but the haunting music an lilting native elder's tones gave
a certain "spiritual" quality to the video version
of these same stories.
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Dr. Sterling Clarren honored
for FAS research
The University of Washington's Sterling K. Clarren, M.D., was honored
with the Rosett Award at the adjunct meeting of the Fetal Alcohol
Study Group at the Research Society of Alcoholism's annual meeting
in Montreal. Henry Rosett, was an addictions psychiatrist who did
important early work in the mid-1970's on offspring of heavy-drinking
mothers in Boston. He died prematurely and in his honor the FAS
Study Group initiated an annual award to honor an outstanding FAS
researcher. On June 23, Dr. Clarren was so honored for his many
contributions to the field, including his important primate studies
on offspring effects of prenatal alcohol exposure.
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Grant aims to "prevent double jeopardy"
The Parent-Child Assistance Program (P-CAP) at the University of
Washington in Seattle has recently received funding from the March
of Dimes Washington State Chapter for a project called "Prevent
Double Jeopardy" that will provide services to women with FAS/E
in order to prevent more cases of FAS. Women who themselves have
FAS/E and become pregnant have a high likelihood of drinking during
pregnancy and producing yet another generation of children who are
also damaged by prenatal alcohol exposure. The March of Dimes $24,869
gift will allow a P-CAP clinical social worker to educate community
providers about FAS, and to develop specialized strategies to help
those affected access and utilize even the most basic services.
The March of Dimes was the first professional organization to recommend
not drinking during pregnancy and initiated the first stat network
of FAS diagnostic sites in Washington in 1994. More people are now
being diagnosed with FAS, but their needs go unmet because community
service networks are unfamiliar with the unique characteristics,
capabilities and requirements of these people as adolescents and
P-CAP, in the UW School of Medicine's Department of Psychiatry
and Behavioral Sciences, Fetal Alcohol and Drug Unit, is an award-winning
intervention model. The program has proven to be highly effective
in intervening with pregnant and postpartum mothers who abuse alcohol
and drugs so that their children will not be prenatally affected
by these substances.
For more information, call Dr. Therese Grant at 206-543-7155.