Birth Moms and FAS Q&A 
Prepared by Teresa Kellerman

The following data is based on the keynote address given by Dr. Sterling Clarren at the 2002 Yukon FAS Conference in Whitehorse regarding his studies of FAS and clinical practice in the state of Washington.

Part 1: Understanding why women are still having babies with FAS after 25 years of public knowledge about the dangers of drinking during pregnancy

Q: What percentage of children with FAS are being raised by their birth mothers?
A: Only 10%

Q: What percentage of these birth mothers also have FAS related conditions themselves?
A: Approximately 50%

Q: What percentage of these birth mothers were victims of serious physical and/or sexual abuse?
A: 100% were victims of serious abuse, and 90% have Post Traumatic Stress Disorder.

Q: What percentage of these birth mothers had alcoholism?
A: 100%, but 5% had not been previously diagnosed.

Q: What percentage of these birth mothers suffer from major depression?
A: 90% have depression, and many have a mental health disorder such as phobia, anxiety, mania, bulimia and schizophrenia.

Q: What is the treatment preferred by the birth mothers to ease the pain of the mental health disorders?
A: Self medication with alcohol.

Q: Why did the birth mothers not get treatment for their substance abuse problem?
A: They didn't have anyone to leave their kids with. They were afraid they would lose their kids. Their partner wasn't supportive. It was too expensive. They didn't have insurance. 

Q: What percentage of the birth mothers sought substance abuse treatment when they got pregnant?
A: About 95%. They get support while they are pregnant and in treatment. But they end up having their children taken away from them. And then they get no support or treatment until they get pregnant again.

Q: Over the long term, what percentage of these birth mothers will be able to achieve recovery?
A: About half.

Q: What did the mothers who found recovery have that the other mothers did not have?
A: The mothers with successful recovery had a higher IQ and a strong social support network.

Q: What is most helpful to the birth mother in finding and maintaining recovery and preventing a subsequent alcohol-exposed pregnancy?
A: There is a program that seems to work well called the "new best friend" program that provides daily personal support by a mentor for three years. 

Part 2: Understanding FAS as a starting point to finding the right interventions 

Q: What is FAS?
A: FAS is permanent brain damage.

Q: What percentage of children with FAS have a small head circumference or seizures?
A: Only 25% have small head or seizures. But 100% have brain damage. But the brain damage only shows up in brain imaging tests in 50% of cases of full FAS.

Q: What facial features are criteria for a diagnosis of FAS?
A: Small eyes, smooth philtrum, thin upper lip.

Q: When during pregnancy does alcohol cause damage that results in these facial features?
A: The mother's drinking on the 20th day of pregnancy will result in the facial features of FAS. If the mother does not drink on the 20th day, the child may not have the features, and therefore will not get a diagnosis of FAS, but will still sustain permanent brain damage from drinking after the 20th day.

Q: What does alcohol do to the brain of the developing baby?
A: Anything it wants.

Q: What systems can alcohol disrupt in the developing baby?
A: All of them.

Q: In a child with FAS who has a brain of normal size and structure, what causes the brain dysfunction?
A: The brain dysfunction is caused by abnormal neurochemicals.

Q: How can we test the neurochemicals in these children?
A: We can't. But we see it in the child's behaviors. Alcohol is a behavioral teratogen.

Q: How can we determine that alcohol is the specific cause of certain behavioral maladies?
A: We can't, because of the presence of other determining factors such as genetics and environmental factors such as abuse and neglect and multiple home placements.

Q: What percent of children with FAS have suffered from physical abuse?
A: Of children with FAS, 75% are victims of physical abuse. 

Q: What diagnosis is more important for the child than the diagnosis of FAS?
A: The diagnosis of brain damage, because that is what will get appropriate intervention. 

Case example: Mother tells the child, "Don't run in the street, or you might get hit by a car." This lesson is repeated and learned. The child goes out the door, and runs into the street. Why? We cannot jump from the behavior to FAS. There could be several reasons. For example, he could have misunderstood his mother and taken the direction literally. In his concrete thinking, he ran ACROSS the street but didn't run IN (down the middle of) the street. Or he might have forgotten the rule. Or he may have had a moment of poor judgment and didn't know how to apply the rule. Or it could have been his attention deficit disorder, or he was just oppositional and did it intentionally. Or he might have been depressed and thought that it would be a good idea to get hit by a car. A diagnosis of FAS is a starting point to getting a needs assessment to determine proper treatment.

Dr. Sterling K. Clarren is the Robert A. Aldrich Professor of Pediatrics and past Head of the Division of Congenital Defects at the University of Washington School of Medicine in Seattle, Washington. He is currently the medical doctor for the University of Washington FAS Diagnostic and Prevention Network clinic. He has published over 100 research articles and has received research funding from the National Institute on Alcohol Abuse and Alcoholism, the Centers for Disease Control, the Glaser Foundation, and the March of Dimes.

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