Fetal Alcohol Spectrum Disorder E-Book

• Herausgeber: Wiley-VCH
• Kategorie: Wissenschaft und neue Technologien
• Serie: Health Care and Disease Management
• Sprache: Englisch

Seitenzahl: 924

Veröffentlichungsjahr: 2011

Beschreibung

Reflecting the recent increased public awareness of the topic, this is the first and most comprehensive resource for over a decade on the molecular basis, prevalence, treatment options, socioeconomic impact and prevention strategies of FADS. Edited by world-renowned experts, this compendium includes the latest research results to provide new insights and realistic estimations of FADS frequencies in Western communities.
An invaluable resource for every professional dealing with the diagnosis, prevention and treatment of FADS, from researchers via health professionals to social workers.

Leseprobe

Contents

Cover

Half Title page

Title page

Copyright page

Preface

List of Contributors

Chapter 1: Prenatal Alcohol Exposure, FAS, and FASD: An Introduction

1.1 Introduction

1.2 History

1.3 Diagnosing the Effects of Prenatal Alcohol Exposure

1.4 Risk factors influencing FAS and FASD Conditions

1.5 Prevalence and Impact of FAS and FASD

1.6 Prevention

1.7 Interventions

Acknowledgments

References

Part One: Incidence, Prevalence, and Economic Aspects of FASD

Chapter 2: Researching the Prevalence and Characteristics of FASD in International Settings

2.1 Introduction

2.2 Maternal Risk Factors and FASD

2.3 Determining the Prevalence of FASD: How the Methods Have Influenced the Rates

2.4 The Prevalence of FASD from In-School Studies

2.5 Summary Rates of FASD and Their Meaning

References

Chapter 3: Frequency of FASD in Canada, and What This Means for Prevention Efforts

3.1 Introduction

3.2 Challenges to Obtaining Accurate Incidence and Prevalence Rates

3.3 Incidence of FASD

3.4 Prevalence of FASD

3.5 Rate of Exposure to Risk

3.6 Gaps in the Data

3.7 Policy Considerations

3.8 Conclusions

Acknowledgments

References

Chapter 4: Costs of FASD

4.1 Introduction

4.2 Methods

4.3 Results

4.4 Discussion

4.5 Conclusion

4.6 Appendices to Chapter 4

4.6.2 Appendix 2: Summary of Included Studies

References

Part Two: Causes and Diagnosing of FASD

Chapter 5: Direct and Indirect Mechanisms of Alcohol Teratogenesis: Implications for Understanding Alterations in Brain and Behavior in FASD

5.1 Introduction

5.2 Fetal Programming: Programming of the HPA Axis by PAE

5.3 Altered Epigenetic Regulation of Gene Expression: A Possible Mechanism Underlying Fetal Programming of the HPA Axis and Altered Neuroendocrine-Immune Interactions

5.4 Prenatal Alcohol Exposure: Early Experience, Stress Responsiveness, and Vulnerability to Depression

5.5 FASD and Substance Abuse

5.6 Summary and Policy Considerations

Acknowledgments

Glossary

Abbreviations

References

Chapter 6: Genetic Factors Contributing to FASD

6.1 Introduction

6.2 The Evidence

6.3 Genetic Factors in Alcohol Metabolism

6.4 Some Genetic Factors

6.5 Epigenetics, the Environment and Nutrition

6.6 Conclusions, and Some Policy Recommendations

6.7 Glossary

References

Chapter 7: Diagnosis of FASD: An Overview

7.1 History of Diagnosing FASD

7.2 How Does Prenatal Alcohol Exposure Cause Damage?

7.3 Screening for FASD

7.4 The Diagnostic Process

7.5 FASD Across the Lifespan

7.6 Implications of a Diagnosis of FASD

7.7 Conclusion and Future Directions

7.8 Policy Considerations

References

Part Three: Prevention Policies and Programs

Chapter 8: FASD: A Preconception Prevention Initiative

8.1 Introduction

8.2 Prevention Strategies

8.3 Research Relationships

8.4 The CIHR Guidelines for Research Involving Aboriginal People

8.5 Summary

Acknowledgments

References

Chapter 9: Bringing a Women’s Health Perspective to FASD Prevention

9.1 Introduction

9.2 Applying Gender-Based Analysis to FASD Prevention

9.3 Developing a Framework for Women-Centered Prevention Practice

9.4 Evidencing the Framework

9.5 Conclusions

References

Chapter 10: Next Steps in FASD Primary Prevention

10.1 Introduction

10.2 Current State of FASD Primary Prevention in North-Western Canada

10.3 Campaign Evaluation: What Is It and Why It Is Important

10.4 Incorporating Social Marketing Strategies

10.5 Creating Behavioral Change: Protection Motivation Theory

10.6 Future Considerations for Health Promoters and Policy Makers

References

Chapter 11: Preventing FASD: The Parent–Child Assistance Program (PCAP) Intervention with High-Risk Mothers

11.1 Introduction

11.2 FASD Prevention

11.3 Background

11.4 The PCAP Intervention

11.5 PCAP: A Two-Pronged Intervention

11.6 Preventing Alcohol- and/or Drug-Exposed Births

11.7 PCAP Outcomes

11.8 PCAP Cost Effectiveness

11.9 PCAP Intervention with Women who Themselves Have FASD

11.10 Policy Recommendations: Collaborative Approaches for Preventing Alcohol-Exposed Pregnancies

References

Chapter 12: FASD in the Perspective of Primary Healthcare

12.1 Primary Care Approaches to FASD

12.2 Barriers to Screening

12.3 Impact of Healthcare Reform

Reference

Part Four: FASD and the Legal System

Chapter 13: The Manitoba FASD Youth Justice Program: Addressing Criminal Justice Issues

13.1 Introduction

13.2 The Legislative Context

13.3 The Information Gap

13.4 The Manitoba FASD Youth Justice Program

13.5 Screening

13.6 The Preassessment Period

13.7 Medical Assessment

13.8 The Doctor’s Report and Its Use

13.9 Sentencing Conferences

13.10 The Sentencing Process

13.11 The Statistical Outcomes

13.12 One-Day Snap-Shot of Age of Majority Youth (28 February 2010)

13.13 Other Initiatives

13.14 Strengths and Challenges

References

Chapter 14: Understanding FASD: Disability and Social Supports for Adult Offenders

14.1 Fetal Alcohol Spectrum Disorder (FASD) is a Disability

14.2 Correctional Environment in Canada for Adults with FASD

14.3 Interventions and Social Supports for Adults with FASD after Release

14.4 Policy Considerations for Adults with FASD

References

Chapter 15: Policy Development in FASD for Individuals and Families Across the Lifespan

15.1 Introduction

15.2 Birth

15.3 Childhood

15.4 Adolescence/Teenage Years

15.5 Adulthood

15.6 A Disability Paradigm for FASD

15.7 Cultural Fairness

15.8 Life Trajectory Policy Model

15.9 Conclusions

References

Chapter 16: The Impact of FASD: Children with FASD Involved with the Manitoba Child Welfare System

16.1 Introduction

16.2 Study One: Children in Care with Disabilities

16.3 Study Two: The Trajectory of Care for Children with FASD

16.4 Study Three: Youth with FASD Leaving Care

16.5 Study Four: The Cost of Child Welfare Care for Children with FASD

16.6 Study Five: Economic Impact of FASD for Children in Care

16.7 Conclusions

References

Chapter 17: British Columbia’s Key Worker and Parent Support Program: Evaluation Highlights and Implications for Practice and Policy

17.1 Introduction

17.2 Background

17.3 Program Model and Components

17.4 Literature

17.5 Evaluation Methods

17.6 Formative Evaluation Findings

17.7 Summative Evaluation Findings

17.8 Discussion

17.9 Policy Considerations

17.10 Conclusions

References

Chapter 18: FASD and Education Policy: Issues and Directions

18.1 Introduction

18.2 Where Do Students with FASD Fit Into the Education System?

18.3 Students with FASD within Special Education Systems

18.4 Education Professionals and FASD

18.5 Inter-Agency and Community Supports for Students with FASD

18.6 Policy Indications

18.7 Conclusions

References

Chapter 19: Shifting Responsibility from the Individual to the Community

19.1 Introduction

19.2 Why Do We Need to Make a Shift?

19.3 Examples of Individual’s Situations

19.4 One Model of Community of Care

19.5 History

19.6 Future

19.7 Policy Considerations

19.8 Conclusions

Acknowledgments

References

Chapter 20: A Social Work Perspective on Policies to Prevent Alcohol Consumption during Pregnancy

Appendix to Chapter 20

References

Chapter 21: A Cross-Ministry Approach to FASD Across the Lifespan in Alberta

21.1 Introduction

21.2 The Impact of FASD

21.3 Overview of Strategies

21.4 FASD Service Network Program

21.5 Ministry Initiatives Based on the Strategic Plan

References

Chapter 22: Critical Considerations for Intervention Planning for Children with FASD

22.1 Introduction

22.2 The Development of a Rational Service System for At-Risk Children

22.3 Factors Supporting the Development of Separate Specialized Services for Subgroups of At-Risk Children

22.4 Should Separate Specialized Services Be Developed for Children with FASD?

22.5 Policy Considerations: Strengthening the Service System for a Broader Range of Children At-Risk

Acknowledgments

References

Part Five: Research Needed on FASD

Chapter 23: FASD Research in Primary, Secondary, and Tertiary Prevention: Building the Next Generation of Health and Social Policy Responses

23.1 Introduction

23.2 Mapping Prevention: What Research is Needed Now, and Why?

23.3 Conclusions: Drawing a Road-Map for Integrated, Supportive, and Effective Care

References

Chapter 24: Focusing Research Efforts: What Further Research into FASD is Needed?

24.1 Introduction

24.2 FASD and Heterogeneity: An Encouraging Outcome

24.3 Models: Moving Beyond Description

24.4 Applying Neuroscience: Beyond the Mother?

24.5 Summary

References

Part Six: Personal Views from People Living with FASD

Chapter 25: Living with FASD

Chapter 26: Charlene’s Journey

Appendix: FASD Consensus Statement of the Jury

Acknowledgments

Process

Conference Questions

Introduction

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Conclusion

Jury Members

Conference Speakers and Topics

Planning Committee

Scientific Committee

Communications Committee

Disclosure Statement

Institute of Health Economics

IHE Board of Directors

FASD Research and Resources

Index

Edited by Edward P. Riley, Sterling Clarren, Joanne Weinberg, and Egon Jonsson

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The Editors

Prof. Dr. Edward P. RileySan Diego State UniversityCenter for Behavioral Teratology6363, Alvarado Ct. #209San Diego, CA 92120USA

Prof. Dr. Sterling ClarrenUniversity of British ColumbiaFaculty of Medicine — PediatricsL408 — Oak Street 4480Vancouver, BC V6H 3V4Canada

Dr. Joanne WeinbergUniversity of British ColumbiaDepartment of Cellular &Physioloical ScincesHealth Sciences Mall 2350Vancouver, BC V6T 1Z3Canada

Prof. Dr. Egon JonssonUniversity of AlbertaUniversity of CalgaryDepartment of PublicHealth ScienceInstitute of Health Economics10405 Jasper AveEdmonton, Alberta T5J 3N4Canada

Series Editor

Prof. Dr. Egon JonssonUniversity of AlbertaUniversity of CalgaryDepartment of PublicHealth ScienceInstitute of Health Economics10405 Jasper AveEdmonton, Alberta T5J 3N4Canada

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© 2011 Wiley-VCH Verlag & Co. KGaA, Boschstr. 12, 69469 Weinheim, Germany

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ISSN: 1864-9947

Preface

In October 2009, the Institute of Health Economics (IHE) staged a consensus development conference to address key questions about the prevention, diagnosis, and treatment of Fetal Alcohol Spectrum Disorder (FASD). Experts in the field presented scientific evidence to a “jury” about prevention and the social determinants that may induce drinking during pregnancy, the importance of diagnosis, the impact of FASD across a person’s lifespan, and the community supports needed for those living with FASD, as well as their families. After two days of hearings, the jury developed a statement which answered eight relevant and common questions about FASD, including suggested policy changes for enhanced prevention, and for improving the lives of people with FASD and their families. That statement is available in the Appendix of this book.

During the planning of that conference, IHE invited the experts – who included researchers, clinicians, economists, epidemiologists, social workers, and judicial workers – to expand on their speeches and write chapters for a book that would aim at a worldwide health policy-making audience. An overwhelming majority of the speakers were interested, and this book is the result of their hard work.

In addition to policy makers, this book is for anyone interested in FASD, including those with the condition, family members and other caregivers, researchers, clinicians and others in healthcare and social services, and the justice sector. The chapters describe the impact of FASD on the individual, their families and society, and the many complex issues involved in the condition’s prevention, diagnosis, and treatment. The book ends with personal accounts of life with FASD, written by Myles Himmelreich and Charlene Organ, that not only powerfully illustrate the challenges created by having FASD, but also serve as a reminder that FASD does not – and should never – define a person.

We would like to acknowledge the Government of Alberta FASD Cross-Ministry Committee, Canada Northwest FASD Partnership, Health Canada and the Public Health Agency of Canada for their financial support of the consensus development conference and the production of material to this book. We would also like to thank Minister Janis Tarchuk, who was Minister of Children and Youth Services at the time of the conference and Deputy Minister, Fay Orr, for their strong support. Special recognition should be given to Ms Denise Milne, who represented the Cross-Ministry Committee and assisted greatly in all aspects of the conference preparations. We are very grateful to the Honorable Anne McLellan for serving as Chair of the Jury for the conference, to Dr Gail Andrew, who acted as the Scientific Chair, and Ms Nancy Reynolds who acted as moderator. Special mention should be made to the Honorable Iris Evans, Minister of International and Intergovernmental Relations for Alberta, who has been a tireless supporter of initiatives to improve the lives of those affected by FASD. We would also like to give special thanks to Gail Littlejohn for her support in the editing process of this publication.

On behalf of the Institute of Health Economics (IHE) (www.ihe.ca)

Egon Jonsson

John Sproule

Liz Dennett

List of Contributors

Noreen AgreySaskatchewan Prevention Institute1319 Colony StreetSaskatoon, SaskatchewanCanada S7N 2Z1

Gail AndrewAlberta Health ServicesGlenrose Rehabilitation Hospital10230 111 AveEdmonton, AlbertaCanada AB T5G 0B7

Dorothy BadryUniversity of CalgaryFaculty of Social Work2500 University Drive NWCalgary, AlbertaCanada T2N 1N4

Patricia G. BaileyUniversity of AlbertaOccupational PerformanceAnalysis Unit1 - 78 Corbett HallEdmonton, AlbertaCanada T6G 2G4

Lola BaydalaUniversity of AlbertaDepartment of PediatricsMisericordia Child Health Clinic16930 - 87 AvenueEdmonton, AlbertaCanada T5R 4H5

June BergmanUniversity of CalgaryDepartment of Family MedicineFaculty of Medicine and Dentistry#1707, 1632 - 14th Avenue NWCalgary, AlbertaCanada T2N 1M7

Mary Diana (Vandenbrink) BerubeAlberta Children and Youth ServicesMinistry Support Services12th Floor, Sterling Place,9940 - 106 StreetEdmonton, AlbertaCanada T5K 2N2

Yagesh BhambhaniUniversity of AlbertaOccupational Performance AnalysisUnit1 - 78 Corbett HallEdmonton, AlbertaCanada T6G 2G4

Tamara BodnarUniversity of British ColumbiaDepartment of Cellular &Physiological Sciences2350 Health Sciences MallVancouver, BCCanada BC V6T 1Z3

Elizabeth BredbergBredberg Research and Consulting inEducation (BRACE)2620 W 37th AveVancouver, British ColumbiaCanada V6N 2T4

E. Sharon BrintnellUniversity of AlbertaOccupational Performance AnalysisUnit1 - 78 Corbett HallEdmonton, AlbertaCanada T6G 2G4

Marni BrownellUniversity of ManitobaManitoba Centre for Health PolicyCommunity Health SciencesFaculty of Medicine408 - 727 McDermot AvenueWinnipeg, ManitobaCanada R3E 3P5

Linda BurnsideManitoba Family Services andHousingDisability Programs and Employment& Income Assistance305 114 Garry StreetWinnipeg, ManitobaCanada R3C 4V7

Kelly ButtsUniversity of British ColumbiaUBC Institute of Mental HealthDepartment of Psychiatry5950 University BlvdVancouver, BCCanada BC V6T 1Z3

Albert E. ChudleyUniversity of ManitobaProgram in Genetics and MetabolismProfessor, Department of Pediatricsand Child HealthDepartment of Biochemistry andMedical GeneticsFE 229 - 840 Sherbrook StreetWinnipeg, ManitobaCanada MB R3A 1R9

Magdalena CismaruUniversity of ReginaFaculty of Business Administration3737 Wascana ParkwayRegina, SaskatchewanCanada S4S 0A2

Sterling ClarrenCanada Northwest FASD ResearchNetworkL408 - 4480 Oak StreetVancouver, BCCanada V6H 3V4

Wendy ComeauUniversity of British ColumbiaDepartment of Cellular &Physiological Sciences2350 Health Sciences MallVancouver, BCCanada BC V6T 1Z3

Jennifer CoppensUniversity of AlbertaDoctor of Medicine ProgramFaculty of Medicine & Dentistry11025 Jasper Avenue #608Edmonton, AlbertaCanada T5K 0K7

Matthew DahlUniversity of ManitobaManitoba Centre for Health PolicyCommunity Health SciencesFaculty of Medicine408 - 727 McDermot AvenueWinnipeg, ManitobaCanada R3E 3P5

Linda De RiviereUniversity of Winnipeg515 Portage AvenueWinnipeg, ManitobaCanada R3B 2E9

Liz DennettInstitute of Health Economics#1200, 10405 Jasper AveEdmonton, AlbertaCanada T5J 3N4

Sameer DeshpandeUniversity of LethbridgeCenter for Socially ResponsibleMarketingD548, 4401 University DriveLethbridge, AlbertaCanada T1K3M4

Aileen Wight FelskeMount Royal UniversityFaculty of Health and CommunityStudies4825 Mount Royal Gate SWCalgary, AlbertaCanada T3E 6K6

Fay FletcherUniversity of AlbertaFaculty of Extension2 - 254 Enterprise Square10230 - Jasper AvenueEdmonton, AlbertaCanada T5J 4P6

Don FuchsUniversity of ManitobaFaculty of Social WorkWinnipeg, ManitobaCanada R3T 2N2

Rebecca J. GilbertsonComprehensive Biobehavioral Core,Clinical and Translational ScienceInstitute and Department ofPsychiatryP.O. Box 100256Gainesville, FL 32610 - 0256USA

Myles Himmelreich2534a 15 Avenue SECalgary, AlbertaCanada T2A 0L5

Charlene Organ106 27 132 Avenue NWEdmonton AlbertaCanada T5E 0Z4

Therese M. GrantUniversity of Washington School ofMedicineDepartment of Psychiatry andBehavioral SciencesFetal Alcohol and Drug Unit180 Nickerson Street, Suite 309Seattle, WA 98109 - 1631USA

Mary Kate HarvieProvincial Court of Manitoba5th Floor, 408 York AveWinnipeg, ManitobaCanada MB R3C 0P9

Carol HubbersteyNota Bene Consulting Group2776 Dewdney AvenueVictoria, British ColumbiaCanada V8R 3M4

Sharon HumeNota Bene Consulting Group2708 Dunlevy StreetVictoria, British ColumbiaCanada V8R 5Z4

Monica JackUniversity of CalgaryDepartment of PeadiatricsAlberta Health Services, Public HealthInnovation and Decision Supportc/o 2888 Shaganappi Trail NWCalgary, AlbertaCanada T3B 6A8

Philip JacobsInstitute of Health Economics#1200, 10405 Jasper AveEdmonton, AlbertaCanada T5J 3N4

Egon JonssonInstitute of Health Economics#1200, 10405 Jasper AveEdmonton, AlbertaCanada T5J 3N4

Laura KreftinUniversity of AlbertaOccupational Performance AnalysisUnit1 - 78 Corbett HallEdmonton, AlbertaCanada T6G 2G4

Anne LavackUniversity of ReginaFaculty of Business Administration3737 Wascana ParkwayRegina, SaskatchewanCanada S4S 0A2

Sally E.A. LongstaffeUniversity of ManitobaManitoba FASD CentreManitoba FASD NetworkChildren s Hospital Room CK 265,840 Sherbrook SteetWinnipeg, ManitobaCanada R3A 1S1

Shelagh MarchenskiUniversity of ManitobaFaculty of Social WorkWinnipeg, ManitobaCanada R3T 2N2

Philip A. MayUniversity of New MexicoCenter on AlcoholismSubstance Abuseand Addictions (CASAA)2650 Yale SEAlbuquerque, New Mexico 87108USA

Audrey McFarlaneLakeland Centre for Fetal AlcoholSpectrum DisorderBox 479Cold Lake, AlbertaCanada T9M 1P3

John D. McLennanUniversity of CalgaryDepartment of Community HealthSciencesTRW Building, 3rd Floor, 3280Hospital Drive NWCalgary, AlbertaCanada T2N 4Z6

Denise MilneAlberta Children and Youth ServicesCommunity Partnerships10th Floor, Sterling Place,9940 - 106 StreetEdmonton, AlbertaCanada T5K 2N2

Tim MoorhouseAlberta Children and Youth ServicesResearch Innovation6th Floor, Sterling Place,9940 - 106 StreetEdmonton, AlbertaCanada T5K 2N2

Andria MudryUniversity of ManitobaFaculty of Social WorkWinnipeg, ManitobaCanada R3T 2N2

Tanya T. NguyenSan Diego State University/Universityof CaliforniaSan Diego Joint Doctoral Program inClinical Psychology6363 Alvarado Ct #103San Diego, CA 92120USASan Diego State UniversityDepartment of Psychology and theCenter for Behavioral Teratology6363 Alvarado Ct #209San Diego, CA 92120USA

Sara Jo NixonUniversity of FloridaComprehensive Biobehavioral CoreClinical and Translational ScienceInstituteP.O. Box 100256Gainesville, FL 32610 - 0256USA

Nancy PooleBC Centre of Excellence for Women sHealth4500 Oak Street E311, box 48Vancouver, British ColumbiaCanada V6H 3N1

Robert A. PratherUniversity of FloridaDepartment of PsychiatryP.O. Box 100256Gainesville, FL 32610 - 0256USA

Edward P. RileySan Diego State UniversityDepartment of Psychology and theCenter for Behavioral Teratology6363 Alvarado Ct #209San Diego, CA 92120USA

Deborah RutmanUniversity of VictoriaNota Bene Consulting Group andSchool of Social Work1434 Vining StreetVictoria, British ColumbiaCanada V8R 1P8

Amy SalmonCanada Northwest FASD ResearchNetworkL408 - 4480 Oak StreetVancouver, BCCanada V6H 3V4

Anjili SawhneyUniversity of AlbertaOccupational Performance AnalysisUnit1 - 78 Corbett HallEdmonton, AlbertaCanada T6G 2G4

Kesa ShikazeHealth and Wellness23rd Floor, Telus Plaza NT, 10025Jasper AvenueEdmonton, AlbertaCanada T5J 1S6

Joanna H. SliwowskaPoznan University of Life SciencesInstitute of ZoologyDepartment of Histology andEmbryologyul. Wojska Polskiego 71c60 - 625 Pozna nPoland

Nguyen Xuan ThanhInstitute of Health Economics#1200, 10405 Jasper AveEdmonton, AlbertaCanada T5J 3N4

Robin ThurmeierUniversity of ReginaFaculty of Business Administration3737 Wascana ParkwayRegina, SaskatchewanCanada S4S 0A2

Suzanne C. ToughUniversity of CalgaryDepartments of Pediatrics andCommunity Health ServicesAlberta Centre for Child, Family andCommunity ResearchChild Development Centrec/o 2888 Shaganappi Trail NWCalgary, AlbertaCanada T3B 6A8

Kristina A. UbanUniversity of British ColumbiaDepartment of Psychology2136 West MallVancouverCanada BC V6T 1Z4

Joanne WeinbergUniversity of British ColumbiaDepartment of Cellular &Physiological Sciences2350 Health Sciences MallVancouver, BCCanada BC V6T 1Z3

Stephanie WorrellUniversity of AlbertaDepartment of PediatricsMisericordia Child Health Clinic16930 - 87 AvenueEdmonton, AlbertaCanada T5R 4H5

Chapter 1

Prenatal Alcohol Exposure, FAS, and FASD: An Introduction

Tanya T. Nguyen, Jennifer Coppens, and Edward P. Riley

1.1 Introduction

Prenatal Alcohol Exposure (PAE) can result in a wide range of physical, psychological, behavioral, and social problems that affect the individuals, their families, and their communities. Indeed, PAE is a major public health issue placing undue burden on all aspects of society. Among the most severe outcomes of PAE is the Fetal Alcohol Syndrome (FAS), which is characterized by growth deficits, facial anomalies, and neurobehavioral problems. However, FAS is not the only detrimental outcome of heavy gestational alcohol exposure, and the majority of individuals affected by such exposure do not meet the diagnostic criteria of FAS. Currently, PAE is increasingly understood as the cause of a continuum of effects across many domains. Fetal Alcohol Spectrum Disorder (FASD) is a nondiagnostic term used to identify the wide array of outcomes resulting from prenatal exposure to alcohol. These outcomes range from isolated organ damage or subtle developmental disabilities to stillbirths and FAS. Perhaps the most pervasive outcome following prenatal alcohol exposure is what is now commonly referred to as an Alcohol-Related Neurodevelopmental Disorder (ARND). While individuals with ARND may exhibit many of the alcohol-related brain and behavioral abnormalities of FAS, they may not display the characteristic facial dysmorphia required for an FAS diagnosis. Although cases of FASD are often not as easily recognized as FAS, they can be just as serious. Unfortunately, missed diagnoses of FASD can have devastating consequences, placing heavy emotional, financial and social stresses on the individual and all parties involved (Riley and McGee, 2005).

Although the relationship between alcohol consumption during pregnancy and abnormal fetal development has been alluded to throughout history (Warren and Hewitt, 2009), FAS went unrecognized until the late 1960s and early 1970s (Lemoine et al., 1968; Jones and Smith, 1973; Jones et al., 1973). Since those initial defining case studies, the scientific literature on the effects of PAE on the developing fetus has grown rapidly. A simple search of pubmed.gov (U.S. National Library of Medicine) using “fetal alcohol syndrome” as a search term turned up almost 3500 citations. This research has improved our understanding of the relationship between alcohol exposure and developmental deficits, and has resulted in an increased social awareness of the risks of drinking during pregnancy, prevention efforts to reduce these risks, and development of intervention programs to help promote positive outcomes for individuals with FASD. However, despite our current knowledge and the progress that has been made, many challenges remain in understanding how alcohol exerts its effects, in developing efficacious and effective prevention and intervention programs, and how best to improve the daily functioning of these individuals.

1.2 History

It has been suggested that the adverse effects of alcohol on the developing fetus have been recognized for centuries. Some of the earliest references date back to Greek and Roman mythology and Judeo-Christian tradition, such as the ancient Carthaginian custom that forbade bridal couples from drinking wine on their wedding night, and the belief that alcohol consumption at the time of procreation leads to the birth of defective children (Jones and Smith, 1973). Passages in Robert Burton’s allegedly quote Aristotle describing an association between alcoholic mothers and disabled children in : “… foolish, drunken and harebrained women [for the] most part bring forth children like unto themselves, morose and languid” (Burton, 1621). However, there remains much controversy regarding the validity of these claims and sources. Although many authors have assumed Burton to be quoting Aristotle’s words verbatim, there is no evidence of any such statement in , nor in any of Aristotle’s other works (Abel, 1999). Others have claimed that the Carthaginians did not truly understand that drinking during pregnancy caused problems; rather, they believed that intoxication at the led to the birth of a deformed offspring (Calhoun and Warren, 2007).