Fetal Alcohol Spectrum Disorder and Complex Trauma

A couple of weeks ago I attended a day long workshop on Fetal Alcohol Spectrum Disorders (FASD) present by Dr. Susan Adubato Ph.D. and Dr. Mary DeJoseph of the New Jersey Regional FASD Diagnostic Centers. The following will give you a brief summary of what FASD is and then I will discuss how this effects the work we do with survivors who are using alcohol.

From the website http://www.fascenter.samhsa.gov/



What is FASD

FASD is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. Each year in the U.S., as many as 40,000 babies are born with an FASD. The cost to the nation for FAS alone is about $6 billion a year.

The term FASD

The term FASD refers to a spectrum of conditions that include fetal alcohol syndrome (FAS), fetal alcohol effects (FAE), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD). Although disorders within the spectrum can be diagnosed, the term FASD itself is not intended for use as a clinical diagnosis.

Fetal Alcohol Syndrome has been an evolving issue. Initially, from the 1950’s until the mid 90’s FAS was the term which applied to those children who were born with certain facial characteristics - thin upper lip with a small philtrum (the midline groove in the upper lip that runs from the top of the lip to the nose), low birth weight, small eye openings, and small head circumference. However, as neuroscience and the ability to study fetal development has advanced, it is now known that the physical characteristics of FAS do not need to be present for a child to be born with FASD. When and how much drinking occurred during fetal development influences what the effects will be.

The most serious symptoms of FASD are the invisible symptoms of neurological damage that results from prenatal exposure to alcohol. These include: attention deficits (with or without hyperactivity, memory deficits, difficulty with abstract concepts (math, time, money), poor problem solving skills, difficulty learning from consequences, poor judgment, immature behavior, poor impulse control. Adults with FASD have difficulty maintaining successful independence. They have trouble staying in school, keeping jobs, or sustaining healthy relationships. Without appropriate support services, these individuals have a high risk of developing secondary disabilities such as mental illness, getting into trouble with the law, abusing alcohol and other drugs, and unwanted pregnancies. Children and adults with FAS are also quite vulnerable to physical, sexual and emotional abuse (Teresa Kellerman of the FAS Community Resource Center 2005). This is very similar to the issues faced by persons with a history of complex trauma.

This presents a challenge. FASD is considered to be a birth defect that is organic in nature and needs to be treated differently than you would someone with complex trauma. How are we to know that difference? We more than likely don’t. However, there is the likelihood that we are working with survivors who have FASD in addition to dealing with trauma. Knowing the family history is the only way to know if it is possible and it can only be diagnosed by a doctor who specializes in FASD.

Along with the generational abuse that occurs in families, we can now ascertain that the legacy of growing up in an alcoholic family may include FASD in addition to complex trauma. I have to admit that I find this information a little overwhelming. It explains why there appear to be some survivors who continue to have difficulty problem solving and making changes even when we provide support and empowerment. This may explain why some survivors have difficulty making decisions, processing information, and developing new healthy relationships long after the trauma has ended and they are living in a safe environment and not experiencing triggers or flashback.

I would be interested in hearing how you feel this information plays a part in the work that you do, your response to survivors with complex trauma who grew up in alcoholic families, and how you respond to pregnant women who are using alcohol.

According to the research, there is no safe amount or safe time during a pregnancy for a woman to drink alcohol. Many women have already incurred damage on the fetus even before they know they are pregnant. Does this information change your thinking in regards to choice when it comes to using alcohol, particular for women of childbearing age?

Contact me for more information or do a search for Fetal Alcohol Spectrum Disorder.