I Had No Idea!
© 2004 Teresa Kellerman

Most professionals in the field of social services know that FAS stands for Fetal Alcohol Syndrome.  Most of these people think of FAS as caused by heavy drinking throughout pregnancy that results in mental retardation, short stature, physical defects, specific facial features, and developmental delays during infancy.  Here is what most people don't know but need to know if they are to be effective in their job of helping and healing individuals they serve through their professions:

·     FAS is just the tip of the prenatal alcohol effects iceberg.  Compared to the 5,000-7,000 babies born in the U.S. every year with full FAS, there are at least 35,000 more born with less obvious but just as serious Fetal Alcohol Effects (FAE). 

·     Fetal Alcohol Spectrum Disorders (FASD) comprise an array of disorders caused by alcohol damage that results in mild learning disabilities, to memory and attention deficits, to birth defects, to developmental delays, to serious behavior disorders, to sudden infant death syndrome.

·     Most babies who are significantly affected do not have recognizable facial features, which occur only with heavy alcohol exposure at a specific time during pregnancy.  Furthermore, the facial features are not especially distinctive during infancy and often dissipate during adolescence and may eventually completely disappear. 

·     Only 11% of those with FAS or FAE are diagnosed before school age.

·     Only 25% of those with full FAS have mental retardation, and 90% of those with FAE have an IQ in the normal or above normal range. (Streissguth, 1996).  This means that only 15% of those with FASD qualify for disability services.

·     Just one drink a day can cause permanent damage to the developing brain.  One session of binge drinking can cause irreversible brain damage in the developing baby.  One drink a day during pregnancy is equal to 30 baby bottles full of liquor.

·     The most common problems observed in those with FASD include immaturity, memory deficits, lack of impulse control, and poor judgment.  It appears that the poor judgment is the factor that causes the most serious problems over the years.

·     The most serious aspect of FASD is behavior disorders, primarily dysfunction in the realm of social skills and relationships.  These behavior disorders are sometimes subtle but often with serious consequences, including expulsion from school, loss of jobs, difficulties with relationships, inability to parent effectively and safely, and general difficulty with poor judgment and decision-making that results in grave risk to harm for the individuals and others.  Prenatal alcohol exposure "represents the largest environmental cause of behavioral teratogenesis yet discovered and, perhaps, the largest single environmental cause that will ever be discovered." [Riley, E. P., and Vorhees, C. V. (1986). Handbook of Behavioral Teratology. Plenum Press, New York, NY]

·     Most individuals with FASD have serious mental health issues, including clinical depression (over 50% in adulthood), suicidal ideation (43%) and suicide attempts (23%).  [Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., "Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE)," Final Report to the Centers for Disease Control and Prevention (CDC), August, 1996, Seattle: University of Washington, Fetal Alcohol & Drug Unit, Tech. Rep. No. 96-06, (1996).]

·     Almost all mothers who have babies with FASD have a history of abuse (physical and sexual), and at least half of them are alcohol affected themselves.  But most of the time these mothers are not recognized or diagnosed with FAS or FAE.

·     Mothers who drink heavily after their babies are born were most likely drinking at the same rate at the time they became pregnant.  Even if they quit drinking after they realized they were pregnant, their babies were exposed during the first trimester and are at risk of having brain damage that may result in behavior issues and learning disorders that do not become apparent until the school years but still put the child at increased risk of abuse and/or neglect.

·     Of the 80% of child abuse cases that are investigated, a majority of children are alcohol exposed, and are being raised in an alcohol-friendly environment by parents who may be alcohol-effected themselves.  This may go unnoticed by social workers, service providers, medical professionals, and judges, resulting in treatment that may be ineffective, and case management that may actually place the children and their families at risk for further abuse, neglect, or mistreatment by the system.

When I have presented my workshops on FASD to professionals in the social services field, there is an overwhelming audible gasp of, "I had no idea!"  They never were taught in their training about the serious effects of alcohol exposure that are invisible and that go untreated.  They are often amazed at how much they did not know about FASD.  They repeatedly say that everyone needs to attend these workshops and learn more about FASD so they can be more effective in their professions. 

These intelligent, educated professionals had no idea that FASD is so prevalent (one in one hundred live births).  They had no idea that most of the children in the “system” are probably affected to some degree and that their parents may be as well, and that is the reason why there is a high rate of treatment failure or recidivism.  They had no idea that symptoms of attachment disorder or sexual abuse may actually be a result of brain damage from prenatal alcohol exposure.  They had no idea that those with the less obvious effects were at higher risk of serious problems.  They had no idea that many of their clients are children in adults’ bodies who can never grow up or become truly responsible for their behavior.

When we in the "system" tell individuals in trouble that they need to be accountable for their actions and become responsible for their behavior, we need to be reasonable in our expectations.  And we need to be accountable ourselves in responding to individuals who may be alcohol-affected and be responsible in the way we provide services.  The only way we can do that is by educating ourselves about FASD and how it impacts individuals in the various service systems, especially child protective services, which may be their first contact with the "system," and with the criminal justice system, where most of them end up in the future.  They deserve treatment that actually helps them, and we owe it to ourselves as a society to help them to succeed, as a way of preventing serious problems that are costly to individuals, families, and communities.