Report: Diagnosing fetal alcohol syndrome important to futures


Tue Apr 29 09:05:07 2003


An individual's place, and success, in society is almost entirely determined by neurological functioning.

Many of society's most persistent problems stem from a single source - pregnant women drinking alcohol causing neurological damage to the child," according to a study on Fetal Alcohol Syndrome by the TRIUMF Project and Support Network.

The injured child is unable to meet the demands of parents, family, peers, school, career, adherence to rules, and enters a lifetime cycle of failures. Often the neurological damage goes undiagnosed, but not unpunished.

The report says early diagnosis can help prevent secondary disabilities such as mental health problems, dropping out of school, trouble with the law, and substance abuse.

Often times, these children fall prey to the legal system. The most common category in the juvenile justice system is Oppositional Defiant Disorder, and more dangerously, Conduct Disorder, according to Kathryn Page, Ph. D., in her report Fetal Alcohol Syndrome - The Hidden Epidemic in Our Courts, published in the Juvenile and Family Court Journal in the fall of 2001.

"When a person can't communicate his or her needs very well, can't figure out the cues of others, is often physically uncomfortable, does badly in school and at home, can't organize or even remember tasks or materials, we have a recipe for resistance and defiance," Page said. "Any of these diagnostic categories is partly accurate. The problem with each is that they do not begin to cover the broad tapestry of dysfunction suffered by people with alcohol-related brain damage."

The constellation of FAS/E behaviors that most commonly comes to the attention of educational, legal or medical caregivers is really the umbrella of symptoms called Attention Deficit/Hyperactivity Disorder. As with ADHD, bipolar symptoms are certainly part of the package of fetal alcohol damage, Page said. These often include a lower IQ, more severely impaired executive functioning such as planning, judgment, impulse control, organization, focus and concentration, and future orientation. Others are inflexibility of thinking, brain-based difficulty in telling truth from fantasy, and sensory integration difficulties.

These disabilities can turn into troubling or dangerous behavior when they are not identified and treated, Page said. In a series of studies spanning over 15 years, Ann Streissguth of the University of Washington has followed a group of 500 people with FAS/E. She found that in the absence of identification and appropriate treatment, life outcomes she calls secondary disabilities develop in the following proportions:

Disruptive school experience plagued 60 percent of the adults and adolescents; 60 percent of the adolescents and 14 percent of the children had trouble with the law, with shoplifting and theft as the most frequent type of crime. Fifty percent of adolescents and adults had been confined, either in mental health programs, inpatient drug and alcohol treatment, or jail. Dependent living characterized 80 percent of the sample, and 80 percent had problems with employment.

Streissguth's explanation for these high levels of secondary disabilities found in people with FAS/E is that the preliminary disabilities of permanent organic brain damage are hidden, leading schools, families, the justice system, and society at large to expect normal behavior and reasoning. Without a low IQ score, obvious mental illness, or physical signs of birth defect, societal protection in lacking and blame or punishment is all too often the only response.

Streissguth's primary conclusion from this study was a strong recommendation that early diagnosis be made available wherever warranted so that support services could be mobilized, appropriate educational and parenting practices could be implemented, and self-image could be enhanced rather than continually eroded.

Page says it is an experience-based belief that poor executive functions is behind most of what we normally call "irresponsibility", and behind a great deal of what we attribute to deliberate bad choices and weak moral character. People with FAS/E can only parrot these principles by rote; they cannot apply them meaningfully to their own lives.

The primary disabilities of prenatal alcohol damage have been described by researchers, clinicians and caregivers. While a common caveat in FAS/E thinking is that there is no one profile and every person is different, the following core disabilities occur with great frequency:

Inability to read social cues, little ability to recognize and articulate feelings, externalization of blame, excessive demand for attention, and even seizures.

Useful responses for youths with FAS/E include accurate diagnosis, education of caregivers about the nature of the brain damage, medication support, accommodations in school and the legal system, sentencing alternatives, and to whatever degree possible, coaching or mentoring and education of the youth.

"Brain damaged delinquent youth are not only out of control themselves," Page said, "they are often the victims of bullying and exploitation."

The damage to children caused by the prenatal abuse of alcohol is profound, Page said in conclusion, not only on an individual basis, but to society as a whole. Children's lives are stunted - education and interpersonal relationships are abandoned as too difficult, and delinquency and failure are easy substitutes. Until we succeed in eliminating prenatal alcohol abuse, recognition, proper diagnosis and treatment are the keys to helping these innocent youths live worthwhile, productive lives.

Source: Red Bluff Daily News


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