I have a child in my class who is said to have Fetal Alcohol Syndrome. He is living in a foster home. I have some medically related questions about his condition.

• What do you see as the problems that could arise with that misdiagnosis?
• How do you feel that professionals can better identify FASE without making the mistake of going toward an ADHD evaluation?
• What kind of effect do you see in FAS/FASE children treated with ADHD medication? Is it beneficial?
• At what age do you see more FAS/FASE diagnosed? How are they brought to your attention?

Thanks

Answer:

We, here at the Diagnostic center see special education children whom the local school districts have questions about. Therefore, we are not seeing a normal cross section of the special education population. We are usually not the first person making a diagnosis such as fetal alcohol syndrome, or fetal alcohol effects.

In order to answer your questions, I need to explain my approach to children with “syndromes”. We look at the child as a whole and evaluate their strengths and weaknesses and the mechanisms behind their behavior disorder. Therefore, even if we are looking at a child with Fetal Alcohol Syndrome, we would look at the child’s particular strengths and weaknesses and not define the child by the difficulties that may characterize the syndrome. When we look at any child this way, then even if we miss the diagnosis, the recommended interventions would continue to be appropriate.

As with the child in your class, most children with Fetal Alcohol Syndrome are not raised by their natural parents and are frequently in foster care. Also, contrary to popular opinion, not all women who drink excessively during pregnancy give birth to an alcohol- effected baby. However, if a mother has had one fetal alcohol child and drinks during subsequent pregnancies, she is likely to have another child similarly affected.

These children vary considerably because of environmental and hereditary differences. As is inherent in excessive use of alcohol, there is a significantly increased load of mental illness in the parents, as well as low socio-economic status. These factors significantly contribute to the child’s presentation. Also, if a mother only drinks excessively during a certain part of her pregnancy then the alcohol can affect the child differently, such as effects on the facial features during the 1 st trimester, effects on growth during the 3 rd trimester and effects on the brain at any time during the pregnancy.

One of the main reasons for a diagnosis is to try and prevent the mother from having further effected children and instigate mental health treatment and comprehensive social services support. This has been found to reduce the number of such children born.

Fetal Alcohol Syndrome was first described in 1975 and obstetricians started advising pregnant women not to drink at all. Presumably, this significantly reduced the incidence of Fetal Alcohol Syndrome babies but the literature is not available since it was not a diagnosis made prior to being described and labeled. The incidence went up after 1979, with the 1992 literature quoting an incidence of 5 children per 10,000 births. It is difficult to tell whether the increase might be related to increased identification of these children.

Although researchers say that the behavioral picture is somewhat different from Attention Deficit Hyperactivity Disorder, I have seen children successfully treated with stimulant medications. Again, one needs to look at the characteristics of the behavior and treat appropriately with medication, rather than treating the syndrome itself.

I hope that I have answered your questions and given you a picture of how to view fetal alcohol syndrome. There is a great deal of literature available on children with this syndrome and with fetal alcohol effects. I have found the following site very useful.

http://www.niaaa.nih.gov/