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Fetal alcohol spectrum disorders for mental health
professionals - a brief review
Paula J. Lockhart
Fetal alcohol spectrum disorders, characterized by emotional,
behavioral, cognitive and/or social disability, is an important
condition to those providing mental health treatment worldwide.
With no safe level of alcohol consumption found during
pregnancy, symptoms at the severe end of the spectrum can be
obvious, easily diagnosed and extremely debilitating; at the mild
end of the spectrum the disabilities may be subtle, and often
attributed to other causes. Common symptomatology in an
individual with fetal alcohol spectrum disorders includes:
attention problems, impulsivity, mood disorders, conduct and
oppositional defiant disorder symptoms, drug and alcohol
problems, impaired executive functioning, memory
disturbances, learning disabilities, poor social skills and
reduced ability to function independently as an adult. Because
of the lack of widespread knowledge of this disorder by mental
health providers, especially in the absence of mental retardation
or dysmorphic features, individuals with fetal alcohol spectrum
disorders are often not identified as having an organically based
mental health, and/or cognitive disorder; thus reduces their
ability to qualify for special support services found to improve
long-term outcome. Despite the great need for neuropsychiatric
treatment research that could lead to improved fetal alcohol
spectrum disorders targeted multilevel mental health, and social
support services, there is much the mental health professional
can provide at this time to improve the lives of these individuals.
Accordingly, the mental health community needs to be
prepared, as the disorder becomes more widely recognized by
affected patients and their families; they will be requesting
formal diagnoses and sensitive, creative options to prenatal
alcohol related problems in all areas of neuropsychiatric
treatment. Curr Opin Psychiatry 14:463±469. # 2001 Lippincott Williams &
Wilkins.
The Kennedy Krieger Institute, Baltimore, Maryland, USA
Correspondence to Paula J. Lockhart, MD, The Kennedy Krieger Institute, Baltimore,
MD, USA
E-mail: lockhart@kennedykrieger.org
Current Opinion in Psychiatry 2001, 14:463±469
Abbreviations
ADHD attention deficit hyperactivity disorder
ARND alcohol-related neurodevelopmental disorder
CNS central nervous system
FAS fetal alcohol syndrome
FASD fetal alcohol spectrum disorders
# 2001 Lippincott Williams & Wilkins
0951-7367
Introduction
Fetal alcohol spectrum disorders (FASD) are leading
causes of preventable emotional, behavioral, cognitive,
and social dysfunction currently encountered by psychiatrists
and other mental health professionals
[1 . ,2,3,4 .. ]. Despite the high pro®le these disorders
hold in society, this spectrum of conditions often escapes
recognition by mental health professionals, and may
represent one of the most under treated of the life long
developmental disabilities in psychiatry and the other
mental health disciplines [4 .. ].
Experts in the ®eld emphasize that there is a great need
for an in-depth understanding of these conditions by
mental health practitioners because of the high prevalence
of these disorders [4 .. ]. Despite the volumes of
information known on the neurobiology and neuropsychology
of FASD, there remains a paucity of
neuropsychiatric treatment research available to help
the practitioner [4 .. ].
Parents and guardians who have children with FASD
struggle in managing the severe behavior, emotional and
cognitive problems of these individuals. They especially
struggle with the poor adaptive living skills, developmentally
impaired social skills, and dependency that
are so characteristic of this population [3]. In addition,
the criteria that are required to be eligible for disability
assistance is much narrower than the disability itself.
This leads to the problem of many individuals not
qualifying for the ®nancial assistance they require to
support a lifetime of psychosocial dysfunction [3,4 .. ].
This article will highlight the current concepts of
prenatal alcohol related disability from a neuropsychiatric
perspective. The current body of literature is vast with
new and exciting developments, however only speci®c
issues will be covered in this article because of space
considerations. General approaches to treatment will also
be offered, with the understanding that we know far
more about the etiology and description of these
disorders, but comparatively little about the amelioration
of many of these life-long symptoms.
Historical perspectives
Lemoine et al. of Nates, France, was one of the early
investigators who originally observed changes in 127
offspring of mothers with alcoholism that became known
as the signs and symptoms of fetal alcohol syndrome
463