Behavioral Problems and Fetal Alcohol Exposure

Behavioral Problems Associated with Fetal Alcohol Exposure

Laura Arensmeyer

April 2004

I. Introduction

A. Ethanol crosses the placenta and causes CNS cell death by apoptosis, and reduces neural cell genesis.

B. Fetal Alcohol Syndrome (FAS)

1. Prenatal or postnatal growth retardation.

2. CNS dysfunction.

3. Syndrome-specific craniofacial abnormalities.

C. Fetal Alcohol Effects (FAE)

1. Fulfilling only two of the above three criteria.

D. Alcohol-Related Neurodevelopmental Disorder (ARND)

1. Signs of persistent cognitive difficulties and subsequent learning problems.

2. Growth retardation and typical facies are usually absent.

E. Cost to society.

1. Prevalence of FAS is estimated at 1 to 1.5 cases per 1000 live births.

2. Annual cost estimates for FAS range from $74.6 million to $9.7 billion per year.

3. Lifetime cost of care per case in excess of $1.4 million.

II. Association of Prenatal Alcohol Exposure with Behavioral and Learning Problems in Early Adolescence.

A. Recruitment

1. 1529 women interviewed during 5^th month.

2. 250 infants of social drinkers vs. 250 infants of infrequent drinkers/abstainers selected at birth.

3. At 14 years, neuropsychological and psychosocial testing by single examiner with no knowledge of history.

B. Assessment of Alcohol exposure

1. By maternal report, average social drinker has 2-2.5 drinks per occasion before pregnancy, about 2 drinks per occasion by mid pregnancy.

C. Assessment of Adolescent Learning and Behavior

1. Adolescent self-report.

2. Parental Interview.

3. Examiner report.

D. Conclusions

1. Increasing levels of alcohol intake correspond to subtle impairment in learning and behavior in adolescence.

a) Impairment occurs even when alcohol consumption is mild.

b) Highest risk is early in pregnancy and binge drinking.

2. No alcohol related growth deficiencies or facial dysmorphology were seen, but disturbances in function were present in adolescence.

3. Common behavior problems included: Antisocial behavior, substance use, school difficulties, and laboratory observations of impulsivity and disorganization.

A. Children were grouped according to morphologic damage and compared using the Developmental Behavioral Checklist (DBC).

B. Group 1 and Group 2 scored significantly higher (worse behavior) for disruptive, self-absorbed, communication disturbance, anxiety, autistic and antisocial behavior than the Group 3, however, Groups 1 and 2 were not significantly different from each other.

A. Randomized, double-blind, cross-over study of two placebos and methylphenidate in four Native American children significantly improved scores of hyperactivity, but not daydreaming-attention scores.

A. Teratogenic alcohol effects, even in children with low level exposure and no dysmorphic features, can cause organic brain injury that may be the basis for behavioral and learning problems. These effects should be considered in order to formulate a plan with appropriate interventions to give the best treatment to the child.

A. Burd, Larry, et al. Recognition and management of fetal alcohol syndrome. 25 Neurotoxicology and Teratology 681-688, (2003).

B. Carmichael Olson, Heather, et al. Association of Prenatal Alcohol Exposure with Behavioral and Learning Problems in Early Adolescence. 36 J. Am. Acad. Child Adolescent Psychiatry 1187-1191, (1997).

C. Dotson, Jo Ann Walsh, et al. A public health program for preventing fetal alcohol syndrome among women at risk in Montana. 25 Neurotoxicology and Teratology 757-761, (2003).

D. Eustace, Larry W., et al. Fetal Alcohol Syndrome: A Growing Concern for Health Care Professionals. 32 Journal of Obstetric, Gynecologic and Neonatal Nursing. 215-221, (2003).

E. Oesterheld, JR, et al. Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and ADHD: a controlled pilot study. 8 J. Child and Adolescent Psychopharmacology. 39-48, (1998).

F. Steinhausen, Hans-Christoph, et al. Behavioural phenotype in foetal alcohol syndrome and foetal alcohol effects. 45 Developmental Medicine and Child Neurology 179-182, (2003).