How to recognize fetal alcohol syndrome?

We have always heard that drinking during pregnancy is harmful to the baby, but little has been said about the possible consequences. Nowadays fetal alcohol syndrome It is a phenomenon that, luckily, is having more visibility for a greater and earlier detection by the professionals, and so that families can feel better cared for and guided in raising their children with this condition.

• Related article: "Alcoholism: these are the effects of dependence on drink"

What is the SAF?

The so-called fetal alcohol syndrome, also known as FAS, was identified in 1973 by Kenneth Lyons Jones and David W. Smith. These investigators found a common pattern of limb and facial features, cardiovascular defects associated with prenatal growth deficiencies, and developmental delays (Jones et al 1973, p. 1267).

Among the common characteristics found, although not always as we will see later, there is a characteristic appearance: low height, low weight, small head, poor coordination, low IQ, behavior problems, and deafness or impairment visual. The face of these children presents a separation between the eyes somewhat greater than that of other children, and perhaps as a most characteristic feature, the nasolabial fold is smooth.

How to identify fetal alcohol syndrome?

The reasons why parents seek consultation for fetal alcohol syndrome are mainly the following:

• Learning disabilities and difficulty in school.
• Speech and language delays.
• Hyperactive behavior
• Attention and memory difficulties.
• Difficulty in impulse control, transgression of rules due to difficulty in learning the consequences.
• Feeling of not listening, it seems that they should always repeat the same thing and they continue to ignore it.

Whenever alcohol is drunk the baby can suffer from SAF?

Not all, but some of the chronic alcoholic women may have children who suffer from the so-called Fetal Alcohol Syndrome (FAS), the highest degree of involvement in the spectrum of alcohol spectrum disorders (TEAF). It is a pathology present at birth that consists of a set of malformations in the development of the cerebral cortex. It can show up on brain scans as a normal brain image, as they are sometimes subtle.

Due to its difficulty in learning due to the damage in the systems involved in the correct functioning of memory, these children have a hard time learning and therefore, they can carry out disruptive or illegal behaviors that lead them to commit crimes, not because of excessive aggressiveness, but because of a lack of distinction between what is right or wrong, engaging in inappropriate behaviors and with the danger of being highly influenced by others.

These boys and girls also show a statistical tendency to engage in risky sexual activities, and they are more vulnerable to drug addiction.

It is common for them to have difficulties in studies, get involved in problems with the police and even pass a time in boarding schools or juvenile centers, being able to end up in jail and families in debt to pay bonds or penalties.

Types of SAF

Currently we can distinguish 4 classifications within the TEAF.

1. SAF

This category includes cases with or without a confirmed history of fetal alcohol exposure.

2. Partial SAF

It occurs with or without a confirmed history of fetal alcohol exposure.

4. Alcohol-related birth defects (ARBD)

Presence of physical abnormalities and other alcohol-related organic malformations that require confirmation of prenatal alcohol exposure (by declaration of the mother or by laboratory analysis).

5. Alcohol-related neurodevelopmental disorder (ARND)

There is no presence of physical abnormalities or growth retardation. It requires confirmation of prenatal exposure to alcohol (by the mother's statement or by laboratory analysis).

Difficulty in diagnosis

Many of the children with FAS are adopted children, especially according to recent data from Russia and Ukraine. However, for parents who are not adopters, there is a stigma and at the same time a certain prejudice on the part of the professional who must ask the question compromised on the consumption of alcohol during pregnancy, even speaking of a class syndrome typical of parents from a disadvantaged social level or marginal.

In recent years, the adoption associations and public bodies themselves have begun to provide information and training on the possibility that adopted children may present FAS, especially if they come from high-risk countries such as the named, achieving some psychological preparation for adoptive parents and that they can know that this possibility exists.

Most of the parents come to the consultation after a long pilgrimage and several diagnoses. Recently things are improving as, in Barcelona, ​​the Vall d'Hebrón and the Joan de Déu Hospital are doing a great research work where they have units of professionals specialized in the diagnosis and investigation of SAF.

The common definition would be a difficult child, who has trouble concentrating and maintaining attention, many times diagnosed with attention deficit with or without hyperactivity, ADHD. However, the child with ADHD tends to have more conserved habits of care, in the day to day, greater abilities social and present more problems of sustained attention, while in the FASD there are more problems of attention divided.

We can also find children who have been diagnosed with ASD, autism spectrum disorder. However, unlike ASD, children with APS do not present echolalia, stereotypes, social desire, and clearly express a wide range of emotions, although it is true that it is difficult for them to regulate them, especially in intensity, and they have difficulties in matters related to the theory of mind. Described by the psychologist and anthropologist Gregory Bateson, the theory of the mind is defined as the "capacity to reflect and understand their own and other's sensations ”normally acquired between 3-4 years (Pozo J.I, 1998).

And once we have the diagnosis?

Common guidelines for families who have been most effective in their children's behavior are as follows.

• Consistency, with stable patterns, clear routines, concise and ideally with visual support.
• The written rules, with visual support and with consequences similarly discussed, immediate to the action that we want to reduce or increase.
• Repeat, repeat and repeat. It is important to remember that they have serious learning problems due to memory impairment.
• Affection and displays of affection.

Author: Raquel Montero León. Child and adolescent psychologist at ARA Psychology.

Bibliographic references:

• Alonso Esteban, Y. and Alcantud Marín, F. (2011). Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders: Level of knowledge and attitudes of socio-health professionals. Program III Cycle: Research in Psychology.
• Evrard, G. (2008). Alterations in brain development in maternal-fetal alcoholism: role of the serotonergic system and astroglia. On: https://www.researchgate.net/publication/265965043_Alteraciones_del_desarrollo_cerebral_en_el_alcoholismo_materno-fetal_rol_del_sistema_serotoninergico_y_de_la_astroglia.
• Landgraf M.N., Nothacker M., Heinen F. (2017). Diagnosis of fetal alcohol syndrome (FAS): German guideline version 2013. Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians, University of Munich, Lindwurmstrasse 4, 80337 Munich, Germany.
• Montoya Salas, K. (Sep. 2011). Fetal alcohol syndrome. Med. leg. Costa Rica. vol.28 n.2 Heredia. Recovered from http://www.fundacionmencia.org/noticias/sindrome-alcoholico-fetal/.
• Well Municio, J. I. (1999) Apprentices and teachers. Madrid: Editorial Alliance.
• Svetlana Popova, PhD Shannon Lange, MPH Charlotte Probst, MSc Gerrit Gmel, MSc Prof Jürgen Rehm. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Volume 5, ISSUE 3, Pe290-e299. PhD Open AccessPublished: DOI: https://doi.org/10.1016/S2214-109X (17)30021-9.