by Peggy Seo Oba, RDH, MPA, MBA
Executive Director of the Fetal Alcohol Syndrome Information Network (since 1997)
Fourteen year member and resource person for the FASLink (Fetal Alcohol Syndrome Listserv) http://www.faslink.org
Six Year Member Steering Committee, Eight Year Trainer and Technical Assistant for the Fetal Alcohol Spectrum Disorders Center for Excellence (SAMHSA and CSAP) http://fascenter.samhsa.gov/
2007 Member International Advisory Group for the International Conference on Fetal Alcohol Spectrum Disorders sponsored by the Interprofessional Continuing Education Division of the University of British Columbia.
Fetal Alcohol Syndrome (FAS) is a type of neurological brain disorder that happens while the baby is still in the mother's womb or even while she is breastfeeding. Depending on when the pregnant women drinks, either on a regular basis or periodic bingeing and the amount, her baby can be born with a range of brain disorders that run the gamut from mild to very severe. Full FAS may manifest itself in the form of physical abnormalities, Cerebral Palsy, epilepsy, learning disabilities and most importantly, it can lead to severe behavioral problems.
The percent change in drinking in Japan from 1970 to 1996 was an increase of 29.18 %; US drinking declined 9.48 % during the same period (from the 1999 WHO Global Status Report on Alcohol).
The percent of Japanese women who drink on a regular basis is 61% vs 66% for U.S. women (percentages are derived from a 1992 joint US-Japan study.) In 1991-1992, Japanese women who died of chronic liver disease were 4.3 per 100,000 compared to 5.0 per 100,000 for women in the US (from a WHO Report in Alcohol and Women by Moira Plant).
Full FAS occurs .2-2 times per 1,000 births in the US vs Japan's official total of 56 children (last reported in 1995). In 1993, the Japanese female population was approximately 63,500,000 or roughly one-half of the US female population. If 61% of women above the age of 15 and below the age of 41 (12,887,134) drink on a regular basis and 76% (9,794,222) of Japanese women marry with an average fertility rate of 1.5 children at just 0.2 cases per 1,000 live births in one generation, there might be a minimum of 2,938 Japanese babies born with some degree of full FAS. At 2 cases per 1000 live births, the number jumps to 29,382. . Fetal Alcohol Spectrum Disorders, which includes full FAS as well as a wide range of behavioral disabilities without the physical problems, may occur as high as 1 per 100 live births. For Japan, that would translate to 146,913 cases of FASD.
The first report of only one Japanese adult with FAS was made in October, 2004.
In November of 1989, our family was blessed with the addition of a new niece. In the beginning, Hiromi (not her real name) looked just like any other new baby. She came in at 3625 gm or just under 8 pounds at 8:18 in the morning. The Japanese hospital did not measure her, so we do not know her length. We do know she had a great deal of hair and slept a lot. The only other things she did were jerk her head and stretch backward with a cry. And she would blink. She would blink about 9-12 times and then cry. Hiromi's cries were a soft, "Ah, ah, ah" and the sound only lasted four or five seconds, with the rest of her crying in a silent mouthing. She also had a limp right eye. It would close and she would not be able to open it even if her left eye was wide open. As a toddler she would not be able to open her eyes wide in surprise or to squint. We were to find out later that these were all neurological signs that something was wrong. Later, there would be a whole host of other mild but definite symptoms that pointed toward a particular problem that was Fetal Alcohol Syndrome.
At one month of age, Hiromi's face was a dark red. She had rashes that circled her head and body and ran up her nose. Her left arm seemed to be immobilized from the shoulder down. When she played with her daruma (dah-roo-mah) or roly-poly doll, she would only bat at it with her right hand. At three months, she began to smile (normally, smiling begins at 6-8 weeks). She could only smile with the left side of her mouth. As she grew older, she could only smile with her lower lip. Her abdomen was unusually swollen. Later research would indicate her mother had been drinking while she was nursing and the baby's immature liver could not metabolize the alcohol in her mother's breast milk. That is what caused the swelling.
In April, when Hiromi was five months old, her mother had taken her to playground, dressed in a white snowsuit. (Although Hiromi sweats a great deal, her mother thinks she is cold and dresses her warmly even into late summer. We believe this is a problem with body temperature control and is caused by the FAS. Her hands are wet, cold and clammy.) Her mother had left her feet bare. It was then we noticed that Hiromi's feet looked more like hands held in prayer. The soles of her feet faced each other and the toes pointed up. This is a mild form of club foot called "eqinus vargus". Her hands also looked puffy and there was a deep crease across the back of her thumb. As Hiromi grew older, her thumb did not exactly oppose her fingers and this made handling objects rather difficult for her. She dropped things constantly until the relatives started to say she was clumsy.
At six months, her mother started supplementing her own breast feeding with formula. She said the doctor felt her milk was too "thin" and not providing the nutrients necessary for a healthy baby. Hiromi only weighed 7250 gm or 16 pounds (normal is around 18 pounds) and she was very small. No one seemed to notice she had a weak suck and could only nurse for a minute before getting tired.
We also had a chance to notice the shape of her head. From one side, her head was as round as a musk melon and from the other side, it looked just like a football. It is to be remembered that people's heads are not symmetrical and babies' head bones are still soft but even changing her sleeping position did not seem to help. Her hair did not grow as fast as other children's and when it did grow, it grew unevenly with the left side growing longer than the right. She had her first haircut at 14 months of age. Her brother and sister would not receive their first haircut until almost age two. Most babies have their first haircut within the first year of life.
At times, it seemed she could not see across a room. When her father called to her from behind the video camera, she would look up without recognition and pause with her hand in the air. When she was older, she could not see her father walking across the empty parking lot and would cry, "Papa, Papa?" while scanning the area for him.
When our daughter tried to play with her cousin, she would stare intently without any reaction except to roll her head back and forth against her babyseat, wearing a little bald spot in the back of her hair. This is the behavior of a "fragile" baby, a term used by Dr. T. Berry Brazelton, a renowned child developmental expert. It meant that Hiromi had an unusual sensitivity to sights/sounds. She was literally being overwhelmed by sensory input; this condition is called Sensory Integration Dysfunction.
As she grew older, Hiromi had some more unusual problems. While sitting or standing, she would often bow for no reason. She had a great deal of trouble grasping objects. If a toy was handed to her, she had no problem but if she had to use her own hand/eye coordination, she would have to grab three or four times before she could successfully make contact. When playing with her feet, she would have to grab the left foot with the right hand and then pass it to her left hand before she could grab the right foot and play with both feet.
Her thumb and forefinger worked independently of the other fingers of her hand and she had difficulty manipulating objects, especially if her hand were facing downward. Her method of crawling was unusual. On one side she would crawl on her hand and knee but on the other side she would be leaning on her hand but her knee was in the air with her foot on the ground. It gave the impression of a lopsided bunny hop. When she was older, she also tended to run with the right side of her body slightly ahead of the left side of her body. She also could not sit in a chair without holding on to the arm or the table for balance.
At the age of nine months, she started staring. She would pause in the middle of an activity, sag a little and stare. She would also come to have what we came to call her "startle positions". Her eyes would open hugely, she would twist or jerk and then turn back to look at us with a glazed look and then drool. She drooled so much that her mother had ten bibs; she wore one of them all the time. Or her head would tilt from side to side and her eyes would glaze and start to roll around. She made bizarre facial grimaces and although the family would laugh at her "antics", she would rub her face as if to make the "funny' faces go away. These "seizures" would only last for a few seconds and disappeared around age six. (She still grimaces upon occasion; if she is having seizures, her family is not disclosing this information to anyone.) At the same time, her mother would note that she had few facial expressions.
Basically Hiromi was not far behind on the typical baby milestones. She turned over, crawled, sat...all might have been a little late but they occurred within the normal range. The social milestones were a little different. She smiled very late at three months. The typical gurgling and giggling were never there. She was always a very quiet baby. The playing with the hands in front of the face and the general alertness of looking around and trying to participate with the family did not occur. Hiromi just sat and looked at television. It was her favorite occupation. She played with boxes and toys but without the intentness of the average child. She did not have a "lovie"...for her any old towel would do. She did not go out of her way to interact with the adults in her life. She showed very little curiosity and willingness to engage in activities with other babies and her contact with animals was limited to staring at them.
Her physical appearance was also a bit unusual. At age three, a child's head is approximately 1/3 of the length of her torso. By age 5, the length of Hiromi's head was still about 1/2 the length of her torso...she still looked very much like a baby. Her arms were so short that when she put them over her head, the fingertips just barely met. Her shoulders seem to lack the deltoid muscle and often it seemed as if her shoulders were only the bare bones beneath the skin. In contrast, her abdomen sagged as if there were no muscle control at all.
Her abdomen had other strange characteristics. Although she was not ticklish in that area, she could not bear to have tight clothes around her waist. She had little or no buttocks; her legs appeared directly attached to her abdomen. Her legs looked muscular and strong but the knees and ankles were extraordinarily small, giving her legs the look of hourglasses. Another problem that was her inability to be toilet trained. At five years of age, she was still having "accidents". Some of this could be related to her problems with expressive language (ability to make us understand her). We were to find that many children with FAS are incontinent. This might be caused by weak muscles and/or problems with feeling or nerve sensations. She simply cannot "feel' when she has to go and so cannot warn the family ahead of time about her need. It may also be a matter of mental coordination, her brother has only recently learned at age 6, to use the toilet standing up. (At age eight and a half, he was still wearing diapers.)
Her balance was poor and the family would complain of her many accidents. At the playground, she would look up if someone called her name and then she would fall. She could not squint her eyes and when she played close to the sand it almost always got into her eyes. She could not jump on a bed more than two or three times. She did not always remember in which direction was her grandparent's house even though they were only two blocks away.
She had difficulty with expressive language. She could not tell her father to push the swing higher or her mother that she had to go to the bathroom. Her communication relied on answering the correct question rather than telling others what she desired. She could not blow out a birthday candle in less than eight tries and she preferred salty foods over sweet ones. Her pronunciation of words is indistinct and often incorrect. Consonants are especially hard for her to manage as the pronunciation involves the articulate use of the tongue. At age three, she had over 13 cavities in her teeth, much of which was probably related to her weak cheek muscles that did not push the food onto the teeth but instead let the food sit in her cheeks up against her teeth.
At age fourteen, she could not find her way from one place to another unless she could retrace her steps through familiar landmarks. She cannot count out the proper amount of change to buy a train ticket. She still likes the children's cartoon shows and games and does best when she plays with her brother and sister. She cannot handle the practical aspects of day to day living.
In 1992, I read an article in the NATIONAL GEOGRAPHIC MAGAZINE that lead me to believe that Hiromi and her younger brother and sister have full Fetal Alcohol Syndrome (FAS). I believe Hiromi and her sister have what is termed the "hypo-active" type of fetal Alcohol Syndrome, because of the constant and enduring description that they are "good babies" and seldom cry. As they have grown, they are most often described as quiet children. Her brother (the eldest of fraternal twins born in 1994) has the more destructive type of FAS that compels him to destroy objects without responding to reprimands. The family calls him "stubborn" but his behavior more closely resembles the child with FAS who cannot respond to verbal commands because he does not understand them. As he has grown older, he is subject to periodic rages which are quite violent in nature but short lived. From a very early age he was also touching women on their breasts and buttocks.
All the children are in school. Hiromi was performing below average scale in a highly structured Japanese public school. For her middle and high school education, her parents have moved her to a private school where her academic work has not improved. She has graduated, however, and is attending a 4 year Hospitality College. Her brother is being moved to a private school where his high level of activity can hopefully be handled by a lower teacher/student ratio. The younger sister is doing well in school but dislikes crowds and will often shut down when confronted by too much environmental stimulation. She was bullied in middle school and finished with homeschooling. There are no special education classes or teachers in Japan, except on the institutional level. If the children do not do well, they simply will not pass onto high school.
Our family already has one teenager who has had two unplanned pregnancies; her first was at the tender age of 14. We also have had one young thief who cunningly hid all her stolen objects in her bedroom. My husband and I feel there may be as many as four more people in our family who have Fetal Alcohol Syndrome.
Main FAS Characteristics
Full Fetal Alcohol Syndrome is characterized by problems in three main areas:
1) Central Nervous System (CNS) problems which include behavioral problems, sensory dysfunction, hyper/hypo-activity, and learning disabilities as well as the other physical symptoms displayed by our niece.
2) Small size and/or weight, usually below the 5-10 percentile before and/ or after birth. My nieces and nephew were small in utero. Their mother was hospitalized until the babies started to grow. The babies were all delivered at normal birth weights but are very small in comparison to their classmates. At age seven, my niece wore a size four and she can still wear many of her clothes for 2-3 years.
3) A set of distinctive facial features that include the following:
a) Very small eye openings that only show the pupil of the eyes. This gives the child a sweet, cartoon-like expression. (A 2010 report by Dr. Sterling Clarren indicates that the length of the palprebral eye openings will still fall within the normal range.)
b) The length of the eye when divided by the distance between the two should be about 80% for Asians and some American Indians and about 90-95% for Caucasians and Afro-Americans. A smaller percentage is considered to be a characteristic of FAS.
c) The philtrum or area between the bottom of the nose and the top lip line is long and ungrooved.
d) The top lip line is flat and the top lip is very thin.
e) Microcephalia is where the circumference of the head is about 3% smaller than the average child. An easy way top check this is to look at the face and draw an imaginary line across the center. This is the normal eyeline. If the child's eyes are above this line, her head should be measured by a medical professional to check for microcephalia.
Other signs include:
f) Small, short noses with no or little nasal bridge.
g) Micrognathia or a very small, pointed chin and tiny lower jaw. (This can lead to tooth crowding as the child grows older. The jaw may also overgrow in adolescence.)
h) Ear anomolies that show large ears laying back, lowset, and/or ex-verted with the ridges showing prominently on the outside of the ear, rather than being inside the ear. (Railroad track ear).
i) Less frequently seen are malformed and/or malocclused teeth, unusual amounts of hair on the face and body at birth, webbed fingers, crooked little fingers, small fingernails, single creases across the palms of the hands, curvature of the back, deep dimples at the base of the spine, hands that face forward instead of to the body, joint problems, and hemangiomas or purple birthmarks. These children may also have strabismus (crossed eyes), myopia (short-sightedness), increased ear infections, hearing difficulties and heart problems.
Any one or two of these signs can be found among the NORMAL population and are felt to be normal when seen independently of other FAS signs. It is only when several of these signs are seen together with behavioral problems that a family should consider consulting a specialist in the field of dysmorphology or genetics. The average children's pediatrician is not trained to diagnose FAS.
The cause of Fetal Alcohol Syndrome is directly related to a mother's drinking during her pregnancy. If a woman does not drink alcohol during her pregnancy and while she is nursing, the baby will NOT have Fetal Alcohol Syndrome even if she herself has FAS or is the child of an alcoholic.
Beer is the most toxic alcohol beverage to the developing fetus. And contrary to popular belief, one 12 oz. (353 ml) can of beer contains as much pure alcohol as a 1.5 ounce shot glass of hard liquor. A 4 oz. (117.7 ml) glass of wine, a half a small bottle of sake (125 ml), a 12 ounce (353 ml) wine cooler, an 8.4 ounce (247.3 ml)of malt liquor, a 3.5 ounce (102.8 ml)of dessert wine, a 2.5 ounce (73.4 ml)of liqueur, and a 1.5 ounce (44.2 ml)of brandy all contain as much pure alcohol as a 1.5 ounce (44.2 ml)shot glass of hard liquor. The only difference is that beer, wine, sake and other drinks contain more non-alcohol liquids and ingredients than hard liquor but that makes very little difference when the alcohol is circulating to the baby in the mother's womb.
It take as little as two glasses (8 oz. or 235.5 ml) of any type of alcoholic beverage a day (including beer and coolers) or four or more drinks on any one occasion (bingeing) to produce a child with FAS. (A 2004 publication of the U.S. Centers for Disease Control has now changed that to 3 or more drinks on any one occasion.) Drinking while nursing also increases the chances that a child will have developmental problems.
Factors that Influence FAS
Other factors that influence FAS are:
1) The older the mother the more likely the child will have FAS.
2) Long term, regular drinking (since the teens or early twenties) by either parent may damage the reproductive cells before conception. Also, long term drinking produces a higher tolerance for alcohol and a person can consume greater and greater amounts over time and is more likely to produce a child with FAS even though the mother may be young.
3) If the mother is thin, the chances are that the alcohol is not eliminated from the body with as great efficiency.
4) Any drink that a woman takes is roughly the equivalent of two drinks for a man. (Women lack an enzyme to process alcohol and she has more body fat than a man so her absolute weight is even less.)
5) The mother's other health problems such as eating disorders, overall nutrition, anemia, liver function, etc. affect her baby.
6) Alcohol drunk before a meal or without food is more damaging than alcohol taken with a meal which includes carbohydrates.
7) How a woman drinks, whether she sips or gulps and how she spaces her drinks also influences the way the alcohol is metabolized by the liver. Slow sipping and spacing a single drink out over an hour helps the liver to be more efficient.
8) Paternal drinking also influences fetal development but does not cause Fetal Alcohol Syndrome. (There is a new area of research called epigenetics. It studies the effect of environmental toxins such as alcohol on RNA, both male and female. Therefore, it is suggested that both male and females refrain from drinking at least three months prior to conception.)
The IQ of the child with Fetal Alcohol Syndrome may range from 40 to 130. Their learning problems range from the extreme to almost none at all. These children may do well in spelling and have nice handwriting. They may find reading difficult or be 2-3 grade levels above average. Their greatest educational problem often lies in the area of mathematics. This is because mathematics involves abstract thinking. Early proficiency in math may level off drastically when the multiplication tables are introduced. Other learning problems include the inability to follow sequential instructions and hyper/hypo-sensitivity to lights, sounds, and touch in the school environment.
A child with FAS may have visual, hearing and/ or memory problems. What sounds normal to us may sound high pitched, loud or off-key to them causing a great deal of discomfort or confusion. Vision for a child with FAS may mean myopia or seeing only part of the visual field. Their memory is also spotty. What is remembered one week may be forgotten the next week and remembered again a month later. It is for this reason that children with FAS are often thought to be "lazy" or "not trying".
A child with FAS may be capable of repeating instructions that are given to her but to physically re-enact the instructions may prove to be an impossibility. It is important to give visual clues on a step by step basis with the use of photos and/or re-enactments. Failure at school or overstimulation during the day can cause frustration and anger.
Behavioral problems may range from something as simple as not being able to remember things to the inability to tell right from wrong. Behavioral problems may start in early childhood or suddenly appear during puberty.
Social relationships are difficult for children with FAS who do not recognize the verbal, physical and implied social cues of others. They may stand too close, talk too close, not follow the thread of the conversation, bring up subjects that are unusual and follow other's examples too readily. Many children with FAS are intiallly engaging but often cannot maintain relationships.
The child with FAS does not respond to punishment. The FAS mind cannot look far enough into the future to recognize and fear the consequences of their actions. Verbal reprimands and descriptions do not help a child who is visually and hands-on oriented. Problems in one or more of these areas may lead a parent to believe the child is stubborn or non-compliant without realizing the child is having difficulty processing verbal instructions, is distracted from over-stimulation, has insufficient memory retrieval and cannot comply rather than will not comply. Punishment without recognition of these conditions may lead to more frustration on the child's part because she does not understand why she is being punished, especially in the face of dealing with numerous sensory and memory problems she neither recognizes nor understands enough to explain.
Dr. Ann P. Streissguth, a leading researcher in the field of FAS, says that the defining characteristic of the child or adult with Fetal Alcohol Syndrome is the LACK OF GOOD JUDGMENT and/or THE INABILITY TO UNDERSTAND THE CONSEQUENCES OF THEIR ACTIONS. This is true even in the absence of the physical characteristics of the face and body. If behavior is a problem with a child, it is always wise to examine the background for possible alcohol abuse of the birth mother.
In the United States and Canada, the problem is at least recognized and early intervention strategies have been developed for aiding the memory, reducing environmental stimulation, and dealing with some of the frustrations of these children. But for the Japanese, the recognition of FAS has yet to become a reality...the Japanese government does not even provide for health warnings on their bottles and cans of alcohol. Six brewers have voluntarily placed warnings on their products but other brewers and foreign brands are not required to use warning labels. Young Japanese women are increasing their consumption of wine and beer (beer being the most toxic to the fetus) at an earlier age and well into their child-bearing years. Whatever the personal, social, or emotional issues, drinking is becoming a way of life for the Japanese woman. And if she does have a problem with drinking, there few organizations that would provide her with help and support. Alcoholism and alcohol abuse are still considered to be personal problems in Japan and not a neurological addiction that requires the medical and psychological help of a medical team and a network of support from peers.
There are other conditions (the majority are genetic and there are tests that can detect them) that resemble FAS and they should be explored and considered. But parents who drink always run the risk of having a child with Fetal Alcohol Syndrome if they continue to drink before conception, during pregnancy and while nursing.
The following are additional behavioral problems from "A Fetal Alcohol Behavior Scale" published in the *Alcoholism: Clinical and Experimental Research* journal by Dr. Ann P. Streissguth <http://depts.washington.edu/fadu>.
Behaviors in the Scale can include the following and are presented in order of frequency:
unaware of consequences of an action
poor attention (may not be true attention deficit disorder)
can't take hints
likes to be the center of attention
likes to talk
often described as "...tries hard but..."
out of context
touches people frequently
chats but no content
can't play team sports
difficulty performing even though can repeat instructions
unusual topics of conversation
inappropriate behavior at home
inappropriate behavior outside the home
sensitive to noises
loud, unusual voice
problems with sexual function
Other Central Nervous System symptoms that have been reported by other researchers may include:
mental retardation (IQs of these children can range from 40 to 130)
Cerebral Palsy symptoms
short term memory loss
intermittent long term memory problems
perseveration (does things over and over)
speech and language problems
receptive language disorder
sensory integration dysfunction
has trouble learning new motor skills
fine motor skills are problematic
sensitive or insensitive to bright lights
has dry, flakey skin
distinct odor to self or room or clothes
stomach and/or bowel problems
unusual eye and hearing problems
problems with menstrual periods
may often be diagnosed as: ADHD, Asperger's. Autistic, Pervasive Developmental Delay, , Antisocial Personality, Hyperactivity, Borderline Personality Disorder.
Behavioral problems might be apparent at birth, start with schooling or may not appear until the child begins puberty. The description of the parents often includes the phrase, "There is something wrong but I just can't put my finger on it." Children with full FAS are more easily recognized as having problems. Children with Fetal Alcohol Effects (FAE)/Alcohol Related Neuodevlopmental Disorders (ARND)/partial FAS do not have all of the physical signs of FAS but have most of the behavioral problems. The majority of behavioral problems are not clearly evident until the child enters school.
From The August 1996 Final Report: Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE). This report may be ordered through the Fetal Alcohol and Drug Unit, University of Washington, 180 Nickerson, Suite 309, Seattle, Washington 98109-9112. Tel: 206-543-7155. Website: http://depts.washington.edu/fadu
*****"The most outstanding characteristics of FAS are bad judgment and the inability to make the connection between an act and it consequences."*****
Dr. Ann Streissguth, University of Washington
Note: Many researchers are now saying that Secondary Disabilities might be primary in accordance with the initial damage to the cells of the brain by the alcohol.
Secondary disabilities are defined as those disabilities that a person is not born with and those disabilities that could be prevented or made less severe through better understanding and practical intervention. In a study conducted by the University of Washington on 473 clients, the following results were noted:
178 clients (almost 38%) were diagnosed with full FAS and had an average IQ of 79.
(In all evaluations, a score of 100 is considered to be normal)
Average Reading score was 78; Average Spelling score was 75; Average Math score was 70; Average Adaptive Behavior Score was 61.
295 clients (over 62%) were diagnosed as having Fetal Alcohol Effects, most commonly called FAE and medically referred to as Alcohol Related Neurodevelopmental Disorders and had an average IQ of 90.
Average Reading score was 84; Average Spelling score was 81; Average Math score was 76; Average Adaptive Behavior score was 67.
Of these clients, 415 were selected for a life history questionnaire and these were the results: Mental Health Problems were by far the most prevalent secondary disability experienced over the entire age sample (90%). (Ages 3-51 years).
The following results were found for those age 12 and older:
*Disrupted school experience (defined as having been suspended or expelled from school or having dropped out of school) was experienced by 60% of the clients.
*Trouble with the law (defined as ever having been in trouble with authorities, charged or convicted of a crime) was experienced by 60% of the clients.
*Confinement (including inpatient treatment for mental health problems or alcohol/drug problems, or ever having been incarcerated for a crime) was experienced by almost 50% of the clients.
90 clients age 21 and older were selected for questions about self sufficiency or independent living skills.
80% of the clients, age 21 and older, were not self sufficient in the areas of *Getting Dressed
*Using Public Transportation
*Staying Out of Trouble
*Structuring Leisure Time
*Getting Medical Care
*Getting Social Services
80% of the 90 adults age 21 and over were still having employment problems that dealt with
*Problems with Supervisor
*Poor Task Comprehension
***Clients with FAE or Alcohol Related Neurological Disorders have a higher rate of ALL secondary disabilities except for mental health problems. Mental Health Problems were by far the most prevalent secondary disability experienced over the entire age sample (94%). (Ages 3-51 years).***
To read this in Japanese, please go to http://www.fasjapan.web.fc2.com
To read this in Chinese (Simplified or Traditional), please go to:
FAS in Spanish: http://www.cdc.gov/ncbddd/Spanish/fas/default.htm
FAS Center for Excellence: http://fascenter.samhsa.gov/
The FASD Center for Excellence in Spanish: http://fasdcenter.samhsa.gov/fasdsp/index.cfm
National Directory of Professionals, Treatment Centers and Support Groups for the United States: http://www.nofas.org/resource/directory.aspx
National Directory for Canada: http://www.ccsa.ca
For help in diet, exercise and different types of therapy, please go to http://www.betterendings.org/
For free brochures, please go to http://www.fasalaska.com
EDUCATIONAL RESOURCE SITES
Understanding Tests and Measurements:
Characteristics of Students with FAS:
When Your Child Does Not Qualify for Special Education:
Training Teachers about FAS/E:
Array of Disabilities:
Using the Vineland Adaptive Scales:
Teaching Students with Fetal Alcohol Syndrome:
http://www.education.gov.yk.ca/publications.html (Making a Difference: Working with students who have Fetal Alcohol Spectrum Disorders)
Vocational Rehabilitation Program:
Central Nervous System Abnormalities Associated with Fetal Alcohol Syndrome: http://cdc.gov/mmwr/preview/mmwrhtml/rr541a2.htm
Alcohol Equivalents for Different Drinks:
Other FAS Links