Stable home can lower the risk for problems arising from prenatal exposure to alcohol

A stable home and an early diagnosis can lower the risk for problems arising from prenatal exposure to alcohol, a new study says.

An estimated 12,000 to 30,000 American children are born each year with fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). Many experience serious problems at school, get into trouble with the law, exhibit inappropriate sexual behaviors or abuse drugs or alcohol.

But these children are not doomed to inevitable failure in life, says Ann P. Streissguth, Ph.D., of the University of Washington and colleagues in the Journal of Developmental and Behavioral Pediatrics.

“Adverse outcomes might be reduced by families, communities and physicians working together to assure that children with fetal alcohol spectrum disorders are raised in long-lasting, stable, nurturing homes and by assuring that early diagnostic evaluations are available,” Streissguth says.

Fetal alcohol syndrome and fetal alcohol effects are birth defects caused when a pregnant woman abuses alcohol.

The researchers collected information on 415 patients diagnosed with FAS or FAE and interviewed the people who cared for them. The patients ranged from 6 to 51 years old, although half were 14 or under. Eighty percent were not raised by their biological mothers, and 67 percent reported some physical or sexual abuse or domestic violence, Streissguth says.

By the time they were adolescents or adults, most displayed learning or behavior problems in school and elsewhere. Nearly two-thirds of the adolescents and adults had been arrested, charged or convicted in connection with a crime. Half had been in detention, jail or prison or hospitalized for psychiatric, alcohol or drug problems.

The home environment proved to be critical as both a risk and a protective factor in the lives of these children. Earlier research found that children with prenatal alcohol damage often lived with an alcoholic parent, were abused or neglected, were removed from their home by authorities or had a mother who died at an early age.

“A stable, nurturing home is the most influential protective factor in these analyses, reducing by three- or fourfold the risk of four of the five adverse outcomes examined,” she says. The less time the patients spent in good homes, the greater the risk of disrupted school experiences, trouble with the law, inappropriate sexual behaviors or alcohol and drug problems later on in life.

Diagnosing FAS or FAE early also reduced the odds of adverse outcomes. Being diagnosed at age 17 rather than at 9 nearly doubled the chances of school, drug or sexual problems.

Early diagnosis helps in other ways, too. On average, children affected by fetal alcohol have slightly below-normal IQs, but usually not low enough to be detected by routine testing. That means that IQ testing alone won’t qualify many for special services in schools or their communities. Streissguth says that better understanding of the full spectrum of fetal alcohol effects can help these children.

“More physicians can play a central role in detecting fetal alcohol syndrome and fetal alcohol effects,” she says. They must “be sensitive to the possibility of fetal alcohol problems among children of all ages, as well as youth and adults.”

The study was funded by the Centers for Disease Control and Prevention, the National Institute on Alcohol Abuse and Alcoholism, the Indian Health Service and the Dana Foundation.