Streissguth et al. (1999) have highlighted ongoing secondary disabilities. Intellectual tests show that average IQ is 85. 9 for fetal alcohol spectrum disorders. This group have an uneven profile of abilities and disabilities that means their average level of intellectual functioning is not truly reflective or predictive of their pattern of cognitive strengths and needs. They further show this group are vulnerable to life events. Ninety per cent have some form of diagnosable mental disorder.
These can be as diverse as ADHD (attention deficit hyperactivity disorder), social and communicatory impairments, personality disorder, schizophrenia, addiction and depression. Fifty per cent have some form of confinement in mental health or criminal justice situations; 50% some form of sexually inappropriate behavior. Much of this can be related to their inability to control and maintain their behavior attributable to damage caused to their executive function abilities combined with difficulties in receptive language and inability to consolidate memories because of temporal/hippocampal damage.
Causes FASD is nonhereditary; alcohol causes neuronal damage and cell loss in the fetal brain through direct action as a toxin. No prenatal period has been shown to be safe from the deleterious effects of alcohol. CNS damage may result from alcohol exposure in any trimester, even before the time of a pregnancy test. Women should be advised not to drink from the time of conception to birth. Although FASD is not inherited, there seems to be a genetic predisposition to problem drinking.
For example, in some persons of shared ancestry, such as Native Americans, the similarity in function of shared versions (alleles) of the gene that encodes alcohol dehydrogenase may contribute to an increased risk for alcohol dependence. Additionally, twin studies document similar outcomes in identical twins and different outcomes in nonidentical twins (Stratton et al. , 1996). Diagnosis Diagnosis of FASD should be considered based on the clinical presentation or suspicion of maternal alcohol exposure.
The Centers for Disease Control and Prevention diagnostic criteria for FAS require three specific facial findings (i. e. , smooth philtrum, thin vermilion border of the upper lip, and short palpebral fissures), growth deficits, and CNS abnormalities. In the absence of characteristic facial findings, the diagnosis of FASD still should be considered in children with growth problems, CNS abnormalities, and a history of prenatal alcohol exposure.
Because of the associated guilt or stigma, direct questioning or commonly used screening questionnaires such as the fouritem CAGE criteria (Cut down, Annoyance, Guilt, Eye-opener) may fail to identify women at risk for delivering a child with FASD. One study showed the T-ACE (Tolerance, Annoyance, Cut down, Eye-opener) assessment to be more effective than other screening tools (Mattson, 1998).