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Tristen Yagyagan

Mr. Donald

Writing for College – B5

17 April 2018

Drunk at Birth

No responsible mother, father, or caregiver would intentionally allow a young infant to

drink alcohol. However, that’s not the case for many young and expectant mothers. As it’s not

ethical to give an infant alcohol after birth, it’s also unethical to feed a fetus alcohol while in

utero. Fetal Alcohol Spectrum Disorder, more commonly known as FASD, is an umbrella term

used to describe the biological, mental, social, behavioral, psychological, and cognitive defects

in the development of infants who are exposed to alcohol in utero (Green). Infants and children

who are exposed to alcohol while being carried in their mother’s womb suffer from many health

and cognitive defects, with the most common being brain deformities, which cause inadequate

learning, thinking, and problem-solving skills. The diversity and variation of the effects of

alcohol on the fetus also depend on when and how much the mother drank in her term. The

effects of FASD are noticeable from birth and they are lifelong; doctors have yet to find a cure

that will completely eliminate the side effects of alcohol exposure. FASD is 100% preventable;

but through proper diagnosis, specialized treatment plans, and successful caretaking techniques,

children with FASD can learn techniques to manage their behaviors.

Fetal Alcohol Spectrum Disorder and Fetal Alcohol Syndrome are not national health

priorities. In order to accommodate and understand the population of those affected by alcohol in

utero, there has to be further awareness of the disorders and behaviors associated with FAS and

FASD. FASD is a “non-diagnostic spectrum term used to refer to the wide range of disorders
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derived from prenatal alcohol exposure in utero” (Murawski). According to Doctor Nathen J.

Murawski, a FASD specialist,

“Prenatal alcohol exposure is one of the hardest disorders to diagnose due to the

extensive list of criteria one must meet in order to qualify for a FASD diagnosis.

Diagnosing FASD continues to be a challenge, but advances are being made at both basic

science and clinical levels’’ (Murawski).

Ironically, the highest, and hardest to find, criteria for the diagnosis of FASD is factual evidence

of alcohol exposure. Admittance can often be unreliable or unavailable, especially for foster care

and adopted children plagued by the effects of prenatal alcohol exposure. As of 2017, doctors

have not yet established a set level of alcohol a mother must ingest for the effect to be apparent

in the child. Any amount of alcohol at any point in the full-term pregnancy can potentially cause

various levels of harm. Without an admittance of alcohol usage during pregnancy from the

child’s mother, doctors must then follow another list of criteria a child must meet in order to

qualify for FASD treatment. Some of these more physical signs of alcohol exposure are obvious

growth retardation, central nervous system dysfunction, and craniofacial abnormalities.

Additional criteria concerning the diagnosis of FASD is that the child in question must have a

standard intelligence quotient, or IQ, below 70 points, which is well within the retarded range

(“Fetal Alcohol Spectrum Disorder”). If children who are, indeed, exposed to alcohol during

pregnancy do not meet these criteria, they cannot officially be diagnosed with FASD and

therefore cannot receive the necessary medications and treatments. However, most children

suffering from the effects of prenatal alcohol exposure show none of these physical

abnormalities and do not meet the definitive criteria for diagnosis. Doctors responsible for

diagnosing FASD, FAS, and other prenatal alcohol exposure disorders have developed their
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distinct criteria because their diagnosis signifies permanent brain damage and lifelong treatment.

For this reason, it is important doctors establish FAS early on in the pregnancy so the proper

treatments can be taken to decrease its effects. Once children have been diagnosed, the next task

for doctors is to determine the exact disorders they have acquired.

From birth, there are obvious forewarnings of brain damage due to alcohol; however,

its effects are often confused with many other cognitive deficits which do not result from

prenatal alcohol exposure. Many of the behaviors exhibited by FASD children are parallel to the

behaviors one would expect to see in a child with autism. These disorders, under the umbrella of

FASD, range from physical to behavioral to learning disabilities. They have difficulty with

“abstract reasoning, cause-and-effect reasoning, making generalizations, telling time, memory,

and socialization” (O’Connor). Jaden, a seven-year-old living with FASD in New Zealand, has

difficulty interpreting and understanding his wrong actions. “When he calms down he

understands what he’s done wrong, he just doesn’t understand it in the moment,” says Jaden’s

parents about his inability to see the consequences of actions (“Fetal Alcohol Spectrum

Disorder”). FASD children also experience high levels of attention deficit hyperactivity disorder,

also known as ADHD, as a result of their inability to contain their actions and emotions. Other

early psychological behaviors common among FASD youth are insecure attachments and

minimal bonding with mothers and caregivers.

Normally, infants not affected by alcohol exposure form strong bonds with their mothers

within the first few minutes after birth. However, “the mothers of these more negative [FASD]

infants interacted in ways that were less responsive and developmentally stimulating, and their

infants displayed higher levels of insecure attachment behaviors" (O’Connor). They don’t form

the same normal bond average infants would with their mothers and instead experience
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negativity or indifference towards their presence. This type of insecure attachment to their

mothers and caregivers during infancy correlates with their inability to form interpersonal

relationships during their teen and adult years (O’Connor). The infants also show common

behaviors of jitteriness, irritability, slow habituation, low levels of arousal, and disturbed sleep

patterns. During early childhood, these same infants will experience separation anxiety disorder

and general anxiety disorder (O’Connor). During their teen and adulthood years, FASD children

will often become antisocial and show higher levels of conduct disorder. They exhibit behaviors

closely related to illicit substance use disorders, alcohol dependency, and antisocial/behavioral

disorders. They are more likely to become addicted to and misuse alcohol and other drugs as

they mature. They also develop a strong dependence on toxic substances earlier in life than the

average person (O’Connor).

Across the globe, FASD is recognized as an inconvenience rather than a disorder, and

society fails to realize the burdensome impact of prenatal alcohol exposure. FASDs and other

disorders caused by drug dependency and alcohol exposure in young children are a fairly new

epidemic, quickly spreading through foster care systems across the nation. With this influx of

FASD children in the foster care system, and with little experience with the proper actions to

treat them, the states and foster care systems do not know how to properly take care of these

children. “Basic research also is pointing toward potential new interventions for FASD

involving pharmacotherapies, nutritional therapies, and exercise interventions,” assures Dr.

Murawski. Because the disorders are unique and specific to each child suffering with FASD,

most children have to go through multiple treatments to find the one that suits them the best,

which is a hassle for parents and caregivers. Many education systems and professional learning

institutions “don't know what to do with these kids. People say: 'They should know better.
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What's wrong with them?' They fall through the cracks in school, tend not to qualify for services

and don't get a lot of their needs met” (Banks). “We balance daily as parents walking the fine

line between encouraging our child’s dreams and also helping them understand reality,” says

parents Sarah and Travis Coumbe-Guida, Minnesota Organization on Fetal Alcohol Syndrome

(MOFAS) Family Resource Coordinators. They, like many other parents and caretakers, have

difficulty balancing between allowing their children to be independent and helping them

understand their circumstances won’t always allow them to pursue their dreams (Coumbe-Guida

and Coumbe-Guida).

While in utero, one of the last organs to become fully functioning is the liver, whose sole

function is to detoxify chemicals and teratogens and metabolize drugs that are pumping through

the bloodstream. Because a fetus’s liver is not fully functioning until the latter trimesters of

pregnancy, the fetus relies on the mother to purify nutrients entering their digestive systems

through the placenta. When exposed to alcohol, the fetuses are vulnerable to alcohol, which

causes damage to many organs–most importantly, the brain. Damage to one or several brain

regions causes major cognitive, behavioral, social, and emotional defects within the child (Shea).

“An individual with FAS may experience a lifelong litany of both physical and intellectual

challenges,” conveys Doctor John Mersch. They tend to score within the range of average IQ

scores of 100 when it comes to tests of analytical intelligence; however, FASD children have

difficulty balancing, maintaining, and understanding their practical intelligences, such as dealing

with their emotions, behavior, and social interactions (Shea).

Children diagnosed with FASD have serious disruptive problems concerning their

attentive abilities and behavior. A study performed by Carmichael Olson and colleagues found

that “sustained attention deficits… become evident among FAS/FAE on tasks that require active
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processing of information” (Jacobson and Jacobson). Their inability for sustained attention–

which refers to the ability to remain alert and focused over time–often leads FASD children to

become easily distracted and in need of stimulation. In an attempt to stimulate their brains, these

children may act rambunctiously and carelessly, discounting the reactions and perceptions of

those around them. Research has also shown that “prenatal alcohol exposure is associated with

increased levels of irritability during infancy” (Jacobson and Jacobson). Due to their increased

irritability, children with FASD draw attention to themselves in public settings when they display

episodes of their uncontrollable anger. Psychologist Sandra Jacobson suggests, “These children

[are] more likely to exhibit antisocial behaviors, lack consideration for the rights and feelings of

others, and to resist limits and requests made by authority figures.” Because of these tendencies,

FASD children are prone to episodes of public displays of disruptive behavior.

In response to their disruptive behaviors and tendencies, FASD children and their parents

are often placed under scrutiny from society. Parents with non-FASD children often “don’t

understand why parents [of FASD children] seem to over-coddling [their] children” (“Fetal

Alcohol Spectrum Disorder”). Due to a lack of awareness and knowledge, and the judgmental

attitude of the twenty-first century society, FASD children are extremely misunderstood.

Caretakers and educators don’t understand enough about FASD to treat FASD children with the

respect and patience that they deserve. When one comes across an FASD child during an

episode, it’s easy to attribute their sudden outburst to a lack of good parenting. According to the

parents of Katherine Law, a thirty-four-year old living with FASD, “The best parenting in the

world cannot change the brain damage caused by alcohol” (“Fetal Alcohol Spectrum Disorder”).

Parents and caretakers with FASD children work behind the scenes; they don’t receive enough

credit for the hard work and effort they put in to raising their children to be functioning members
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of society. Instead, they are ridiculed by other parents and onlookers for the apparent inability to

teach their children proper mannerisms (Banks).

Damage to the brains of FASD children often results in the malformation of the frontal

lobe, which is the primary center for organization, judgement, planning, and consequences of

choices. These children are often unable to understand the consequences of their misbehaviors

and are unable to comprehend the reason that they are being reprimanded. Parents and caretakers

often “have to tell [the child] a hundred times patiently and not get angry” (“Fetal Alcohol

Spectrum Disorder”). They often will yell and hit, not thinking about the consequences of their

actions. Onlookers will often judge and criticize parents for their inability to control their child’s

behavior. For this reason, FASD children spend much of their childhood being scolded for the

behaviors that they are physically unable to control. “[Katherine] became slow, delayed

development, and naughty because other people believed that she should have achieved these

milestones, that when she’s told to do something, she’ll do it,” says parents of Katherine Law.

They’re often bullied and demeaned by their classmates due to their lack of consideration and

their common outbursts. “People didn’t really want to be my friend, and I never understood why

because I like the same things and I had the same interests,” says Katherine (“Fetal Alcohol

Spectrum Disorder”). Children with FASD are criticized for their incontrollable impulsiveness.

In schools, children with FASD are unable to follow simple instructions and are cause for huge

disruptions on a daily basis. They may face harsh name-calling and bullying, without

understanding the reasoning behind the harshness of the adults and children around them–an

experience that severely harms their social development (Jacobson and Jacobson).

Children with FASD exhibit delinquent behaviors due to their predisposition to alcohol

and other substances prior to birth. As children, they learn to form poor interpersonal
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relationships and they struggle to grasp certain social cues (Jacobson and Jacobson). They tend

to become outcasts–socially excluded from the world around them. In their isolation, many turn

to alcohol and other substances to cope with the substantial amount of stress that they face daily.

Doctor Mary O’Connor suggests that,

“In addition to psychiatric symptoms, early work from the Seattle Longitudinal

Prospective Study on Alcohol and Pregnancy revealed a relation between exposure and

early experiences with alcohol among young adolescents that developed into heavy

drinking and alcohol-related problems in early adulthood” (O’Connor).

It’s almost as if their bodies are immune to the effects of alcohol from the moment they are

born. A follow-up of this study “revealed a strong relationship between prenatal binge drinking

and alcohol use disorders in the adult offspring,” about binge drinking in [FASD] adults”

(O’Connor). As adults, offspring exposed to alcohol show higher levels of conduct disorder than

in their early and middle childhood years. They exhibit behaviors closely related to illicit

substance use disorders, alcohol dependency, and antisocial/behavioral disorders. They are more

likely to become addicted to and misuse alcohol and other drugs as they mature; they also

develop a strong dependence on toxic substances earlier in life than the average person

(O’Connor). Researcher Kathryn Shea claims that a study on the neuropsychological

implications of prenatal alcohol exposure performed by Doctor Ann Steissguth proves that

“Suspension, expulsion, or drop out was experienced by 43% of children of school age

[FASD children]…involvement with the police, being charged or convicted of a crime

was experienced by 42% of those in the study, and by about 60% of those age 12 and

over. Alcohol and drug problems were experienced by 30% of individuals age 12 and

over” (Shea).
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This research insinuates that the disorders and cognitive delays associated with Fetal Alcohol

Spectrum Disorder are directly correlated to delinquent, uncontrolled behaviors in these children.

FASD and other prenatal alcohol exposure disorders fall under the spectrum of disorders

that are fully preventable. Children with FASD are completely innocent; however, they are the

ones who suffer the most. When in the womb, fetuses have no control over what they are being

exposed to; it is the responsibility of the mother to care for the fetus and protect them from harm.

Mothers must dutifully eat the right foods and take proper care of their bodies to ensure that they

can support the life growing within them. However, many mothers don’t think about the

consequences of their actions. They become selfish and drink alcohol, failing to think about the

harm that they are putting their unborn child in. Before taking a drink, they fail to think about the

mental and physical defects that they are putting their child in danger of; it is the child that is left

to suffer from their mother’s senseless drinking. Because of their mother’s recklessness, they live

under constant scrutiny for the behaviors that they are biologically and physically unable to

control. They live as outcasts, constantly on their own due to the fact that many people in our

society don’t understand or know about their condition. Though much of the American

population is ignorant about FASD, it is prevalent in about two to five percent of the United

States population of newborn children (May). The CDC website states that “experts estimate that

the full range of FASDs in the United States and some Western European countries might

number as high as 2 to 5 per 100 school children” (May). This, however, is not a proper

estimation of the prevalence of FASD in America. Alcohol-related disabilities are widely

un/misdiagnosed and FASD is not commonly included in health data measures (May). They

make no special effort to find FASD children among the population and, instead, rely on
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treatment or service data from health care facilities or birth records, which severely

underestimates prevalence rates (Banks).

Scientifically, it has been shown that there is a clear association between low

socioeconomic status (SES) and mothers with FASD children (Thanh et al.). According to recent

studies, “the risk of bearing a child with FASD is about sixteen times higher for women with low

SES even with comparable drinking levels” (Thanh et al.). Women who give birth to FASD

children have been found to have lower levels of education, lower income, and, more frequently,

are unemployed or underemployed (Thanh et al.). Due to the inability of mothers with FASD

children to properly care for their children and the responsibilities that coincide with raising an

FASD child, the prevalence of children with FASD is also rapidly spreading amongst the United

States foster care system (Banks). The population of foster children with FASD is “ten times

higher than the general population, because foster children often come from families with

histories of alcohol abuse” (Serres). This, in turn, is cause for a larger problem for FASD

children when they become of age. When children with FASD reach the age of eighteen, they

become legal adults, which makes taking care of themselves an obstacle. FASD adults at the age

of eighteen are not independent enough to be able to live on their own and take care of

themselves, however, they are not dependent enough for the state to care for them (Banks). At

this age, foster parents also stop receiving the funds to care for foster children after they become

legal adults, which, at most times, leaves children with FASD without the funds they need to

receive proper treatment for their permanent, lifelong disorders.

Our society must find solutions and preventions to combat the prevalence of FASD in the

population of American children. Nancy Poole and her team of obstetricians and gynecologists at

the Center of Excellence for Women’s Health in Vancouver, Canada have developed a four-part
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framework of FASD prevention to reduce the population of infants born with an alcohol-

exposure related disorder (Green et. al.). Their four-part system works to prevent and treat

alcoholism in new and expectant mothers and to improve women’s health, which will reduce the

overall FASD population (Green et. al.). There are four levels to their prevention process. Level

one deals with advertising and media. This is the foundation level of prevention. In this level,

pamphlets, advertisements, and warning labels are used to improve overall awareness of the risks

of drinking alcohol during pregnancy. Level two deals with brief intervention for all women of

childbearing age. The idea behind this stage is to start teaching girls at young age the risks of

alcohol usage during pregnancy. Discussions include “prenatal supports, contraception and

pregnancy planning, and the ways to cope without alcohol during pregnancy” (Green et al.).

Level three is designed to treat and educate girls and women at a higher risk of alcohol-exposed

pregnancy. They offer specialized, “holistic treatments for women with alcohol and health/social

problems” (Green et al.). Level four provides postpartum support for new mothers who have

already given birth to infants with FASD. At this level, they “provide support and

encouragement for these mothers to make, or continue to make, changes in order to prevent

another alcohol-exposed pregnancy” (Green et al.). They also help with child assessment and

development. So far, the four-part framework for FASD prevention has had a significantly

positive outcome. Poole has reported “there have been a successful reduction of alcohol-usage

during pregnancy and that more and more women and girls are seeking treatment at all levels”

(Green et al.). Though the program has shown much success since it was established, there are a

few barriers. One of the biggest obstacles to overcome is accessibility. Women in rural and

poorer cities do not have access to doctors or staff that are educated in the four-part prevention

system, or of FASD in general. Another obstacle would be the stigmatization of women with
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FASD children. Many women do not seek treatment for the fear that they will be judged by

doctors and staff providing the treatment that they need. Lastly, Poole found that most women do

not seek treatment for the fear of the involvement of child protective services. Child welfare

policies in Canada “mandate the reporting of alcohol use during pregnancy and act to separate

children from substance using mothers at birth” as opposed to the welcoming and supportive

community that Poole and her doctors have created in the four-part system (Green et al.).

Though there’s a large population of American youth affected by prenatal alcohol

exposure, Minnesota has become the first, and only, state to require that newly licensed foster

parents attend an hour of training on parenting strategies for children with FASD. Under this

law, “foster parents in Minnesota are far less likely to be in the dark about one of the leading

causes of developmental delays in children” (Serres). With the lack of awareness about the list of

deficiencies that fall under the umbrella of FASD, doctors, health care providers, foster parents,

and teachers are in the dark about how to properly treat children with FASD. Through this new

law, doctors and psychologists hope to increase awareness and proper parenting strategies for

parents. “The system isn’t broken for these kids. The system doesn’t even exist,” suggests Sara

Messelt, executive director of the Minnesota Organization of Fetal Alcohol Syndrome (Serres).

Because not much is known about FASD in general, there is also a high risk of misdiagnosing a

child with FASD. Early diagnosis is crucial for FASD because it dictates further treatment plans

for these children. Without it, children often cannot receive the correct treatment, or will receive

the wrong treatment, which could agitate their condition. There is also a high risk of the

condition being undiagnosed, leaving these brain-disordered children without a treatment.

Because of their misdiagnosis, parents are also unaware of how to reprimand and connect with

their children, often giving them harsh punishments for behaviors that they cannot control.
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Children with FASD often cannot understand the reason why they are being punished, which

only causes an increase in stress and agitation. In raising awareness about FASD, doctors also

hope to increase the amount of people that are trained to identify, recognize, and treat the effects

of prenatal alcohol exposure.

The growing prevalence of Fetal Alcohol Spectrum Disorder affected children is a

distress call to this generation. As leaders of the twenty-first century, teenagers and young adults

are obligated to decide the true value of a human life. From conception to natural death, each life

is precious. Only when society realizes and understands this concept can it become fully aware

of the effects of their actions. When women become pregnant, they acknowledge that they are

fully responsible for the life that is growing within them; whether they accept it or not, their

choices will affect their child’s life forever. Young leaders of this society must be educated from

a young age about the effects of drugs, alcohol, and other teratogens. As for adults, they are

responsible for teaching us about the dangers that coincide with the substance usage during

pregnancy. Teachers and administrators should incorporate lessons about pregnancy in their sex

education programs. There should also be an increased awareness for teachers, educators,

parents, and caregivers about FASD and how to properly manage its side effects. Hospitals and

clinics could provide training classes and programs for those who need to learn how to cope with

the primitive behaviors of FASD children. Though it’s a long and difficult process, awareness is

the only key solution in the prevention, and hopefully extinction, of Fetal Alcohol Spectrum

Disorder in the future.

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Works Cited

Banks, Sandy. "Raising a Foster Child Damaged By Alcohol." The Los Angeles Times. The Los

Angeles Times. 13 September 2017. Web. 18 May 2015

Coumbe-Guida, Sarah, and Travis Coumb-Guida. “The Journey to a Parents Island:

Developmental Disability.” What's Happening at MOFAS, MOFAS: Fetal Alcohol

Syndrome, 2018

“Fetal Alcohol Spectrum Disorder.” YouTube, uploaded by Attitude, 26 July 2016,

https://www.youtube.com/watch?v=5plu6_L6_lY

Green, Courtney, Nancy Hensing, Natalie Poole, Rose Schmidt. “Prevention of Fetal Alcohol

Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps.” British Columbia

Centre of Excellence for Women’s Health Vancouver, BC, Canada. Libertas Academica.

21 September 2017. Web. 2016.

Jacobson, Sandra. Joseph Jacobson. “FAS/FAE and Its Impact on Psychosocial Child

Development.” Fetal Alcohol Spectrum Disorders (FASD), Encyclopedia on Early

Childhood Development, Feb. 2003

May, Philip. “What is the prevalence of Fetal Alcohol Spectrum Disorders in the United

States?” NOFAS, National Organization on Fetal Alcohol Syndrome. 20 February 2018.

Web. 2 Feb. 2016.

Mersch, John. “Fetal Alcohol Syndrome (FAS): Learn the Symptoms and Signs.” Fetal Alcohol

Spectrum Disorder (FASD), MedicineNet, July 2013.

Murawski, Nathen J. "Advances in Diagnosis and Treatment of Fetal Alcohol Spectrum

Disorders." US National Library of Medicine. National Institutes of Health. 21 September

2017. Web. 2015

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O'Connor, Mary J. “Socioemotional Functioning of Individuals with Fetal Alcohol Spectrum

Disorders.” Fetal Alcohol Spectrum Disorder (FASD), Encyclopedia on Early Childhood

Development, Feb. 2011.

Serres, Chris. “Minnesota is the First State to Require Foster Parents Learn About Fetal Alcohol

Disorders.” Minnesota Star Tribune. Mayo Clinic. 04 October 2017. Web. 16 May 2016.

Shea, Kathryn. “Fetal Alcohol Spectrum Disorders: Increasing Potential for Children Prenatally

Exposed to Alcohol.” International Journal of Birth and Parent Education, vol. 4, no. 4,

Summer 2017, pp. 29-33

Thanh, Nguyen Xuan, Jonsson, E., Moffatt J., Dennett, L. “Poverty Trap?” Fetal Alcohol

Spectrum Disorder, University of Alberta Department of Medicine. 20 February 2018.

Web. Ndp.