Effects of prenatal alcohol exposure on child development.

Maternal alcohol use during pregnancy contributes to a range of effects in exposed children, including hyperactivity and attention problems, learning and memory deficits, and problems with social and emotional development. Fetal Alcohol Syndrome The most serious consequence of maternal drinking during pregnancy is fetal alcohol syndrome (FAS). FAS was first described in the United States by Jones and Smith (1973), who identified a distinctive set of facial anomalies-short eyelid openings (palpebral fissures), flat midface, thin upper lip, and a flat or smooth groove between nose and upper lip (philtrum)-in children whose mothers drank very heavily during pregnancy. These children also exhibit growth retardation as well as significant cognitive and/or behavioral problems. In contrast with Down syndrome patients, who exhibit impairment in virtually all aspects of intellectual function, FAS patients often perform relatively well on language tests (e.g., Kodituwakku et al. 1995), although they tend to have difficulty with complex language tests, especially those tapping the pragmatic aspect of language. The most consistent deficits are in arithmetic (Streissguth et al. 1991; Clarren et al. 1994) and attentional function (Kodituwakku et al. 1995). Although many FAS patients are mentally retarded (i.e., have an IQ less than 70), a substantial proportion perform in the low average to average range on IQ tests (Streissguth et al. 1991). It is particularly instructive to consider studies comparing children with FAS with children not exposed to alcohol who have similar low IQ scores. In one such study, FAS children had reading scores similar to those of IQ-matched control subjects, but they performed significantly less well on arithmetic and certain aspects of attention (e.g., executive function, which is the ability to coordinate, plan, and execute appropriate responses and to modify behavior flexibly in response to feedback) (Carmichael Olson et al. 1998). Children with FAS have poorer socioemotional development (i.e., emotional, personality, social, and moral development) than would be expected based on their IQ scores (Thomas et al. 1998; Carmichael Olson et al. 1998). Fetal Alcohol Effects and Alcohol-Related Neurodevelopmental Disorder The term "fetal alcohol effects" (FAE) is applied to children whose mothers are known to have drunk heavily during pregnancy and who exhibit some, but not all, of the characteristics of FAS (Streissguth et al. 1991; Coles et al. 1997). The IQ scores of FAE patients are also depressed but tend to be somewhat higher than those found in FAS children. In an attempt to increase precision in diagnosis, an Institute of Medicine panel has recommended distinguishing among three forms of FAE (Stratton et al. 1996). The term "partial FAS" applies to children with confirmed heavy prenatal alcohol exposure, some components of the characteristic alcohol-related facial dysmorphology, and physical growth or neurodevelopmental abnormalities. "Alcohol-related birth defects" (ARBD) is applied to those with confirmed heavy prenatal alcohol exposure and one or more congenital abnormalities, usually cardiac, skeletal, renal, ocular, or auditory. "Alcohol-related neurodevelopmental disorder" (ARND) is applied to children with confirmed heavy prenatal alcohol exposure who exhibit measurable, albeit generally subtler neurobehavioral deficits than are seen with FAS. Although reduced IQ scores are not usually found (Goldschmidt et al. 1996; Jacobson et al. 1998a; but see Streissguth et al. 1990), ARND children exhibit developmental deficits in the domains that are most severely affected by FAS. That is, the most consistent deficits are in arithmetic (Goldschmidt et al. 1996; Streissguth et al. 1993), attention (Streissguth et al. 1994; Jacobson et al. 1998a), and socioemotional function (Carmichael Olson et al. 1998; Jacobson et al. 1998b). In comparison with FAS, ARND affects a much larger number of children, but the effects, although clinically important, are less severe. …