July 2014

(Submitted as part of the Coursera Course:“Understanding the Brain”)

A number of years ago, our neighbours elected to take careof a foster child.

The young boy was prone to screaming fits, makinginappropriate comments and had the habit of repeating thesame question over and over, even when his question wasanswered.

I was told that his birth mother was an alcoholic and he hadfetal alcohol syndrome (FAS). It was mentioned that the FASleft “holes”in his brain and this affected his behaviour.

This presentation will examine FAS and its effect on thebrain.

Alcohol is a toxin to the developing brains of fetuses.

The fetus brain is the most sensitive organ to alcohol damage.

Fetal Alcohol Spectrum Disorders (FASD) is a condition whichdescribes a continuum of permanent birth defects caused bymaternal consumption of alcohol during pregnancy.

Fetal Alcohol Syndrome (FAS) and Alcohol RelatedNeurodevelopmental Disorder (ARND) represent differentdegrees of FASD.

FAS is the most severe and is characterized by growth deficiency,central nervous system disorders, and a pattern of distinct facialfeatures.

1. In the first trimester, alcohol interferes with the migrationand organization of brain cells, which can create structuraldeformities or deficits in the brain.[Journal of Pediatrics, 92(1):64-67]

2. Heavy drinking during the second trimester, (the 10th to 20th

week after conception), causes more clinical features of FASthan at other times during pregnancy.[Early-Human-Development; 1983 Jul Vol. 8(2) 99-111]

3. During the third trimester, the hippocampus is significantlyaffected.This leads to problems with encoding visual andauditory information (reading and math).[Neurotoxicology And Teratology, 13:357-367, 1991]

From the College of Cognitive and Linguistic Sciences at Brown University, Providence, RI.

Palpebral Fissures: Eyelid openings Microcephaly: Small headPhiltrum: Groove on upper lip Epicanthal Folds: Upper eyelid foldsVermillion: Upper lip Micrognathia: Undersized jaw

FAS facial features: smooth philtrum, thin vermilion and smallpalpebral fissures

The brain of an FAS-affected individual has an overallsmaller and less-developed brain.

The FAS-affected brain has fewer gyri and sulci andappears smoother.

In some brain scans of FAS-affected individual showactual holes in the brain.

Alcohol exposure appears to damage some parts of thebrain, while leaving other parts unaffected.

Not all damage from alcohol is seen on brain scans, asthe lesions can be too small to be detected with currenttechnology.

(Examples on next 3 slides)

Affected Brain•Smoother•Has hole

HealthyBrain

National Organisation on FAS

The cerebrum (telencephalon) is ~6% smaller for anindividual who has had prenatal exposure to alcohol (PEA)and ~13% smaller for someone with FAS.

The cerebellum is ~4% smaller for PEA and ~17% for FAS.

Gray Matter = Density Increase White Matter = Density Decrease

Sowell et al., 2001

• White matter (contains the axons that connect nerve cells with eachother) decreases in density.

• Gray matter (contains the nerve cell bodies) increases in density.• The parietal lobe (involved in visual-spatial processing and in the

integration of sensory information) is especially susceptible toalcohol: Its white matter is significantly reduced and its gray matterdensity is significantly increased.

Frontal Lobes - This area controls impulses andjudgment. The most obvious damage to the brainoccurs in the prefrontal cortex, which controls theExecutive Functions.

Hippocampus - Plays a fundamental role inmemory, learning, and emotion.

Hypothalamus - Controls appetite, emotions,temperature, and pain sensation.

- Location in the brain

Corpus Callosum - Passes information fromthe left brain (rules, logic) to the right brain(impulse, feelings) and vice versa. The CorpusCallosum in an individual with FAS might besmaller than normal, and in some cases it isalmost nonexistent.

Cerebellum - Controls coordination andmovement, behavior and memory.

- Location in the brain

Basal Ganglia - Affects spatial memory andbehaviors like perseveration and the inability toswitch modes, work toward goals, and predictbehavioral outcomes, and the perception of time.

Amygdala –Central part of emotional circuitry,senses danger, fear and anxiety; plays major rolein recognizing faces and facial expressions,social behavior, aggression, and emotionalmemory; critical for stimulus-reinforcementassociation learning.

The hypothalamus, amygdala, and hippocampus are part of the limbicsystem, which regulates emotions, social and sexual behavior, the“fight or flight”response, and empathy, all areas of concern forindividuals with prenatal alcohol exposure.

- Location in the brain

Normally developing “braincircuits” (symbolically shownas the six arrows on the left)

Drinking during pregnancycauses the “brain circuits”to become pruned, garbled,impaired or missing.www.fasdwheel.com

InhibitionProblem solvingSexual urgesPlanningTime perception Internal orderingWorking memory

Self-monitoringVerbal self-

regulationEmpathyRegulation of

emotionMotivation Judgment

Socially inappropriate behavior (as if inebriated)

Inability to control sexual impulses,esp. in social situations

Inability to learn from past actions

Storing and/or retrieving information

Diminished sense of remorse, inabilityto understand others

Needs frequent cues, requires policing by others

Needs to talk to self out loud; needs feedback

Moody and exaggerated roller-coaster emotions

Inability to weigh pros and cons when makingdecisions Artist: Moriz89

Mental health problems prevalent among 90% of the group;

Disrupted schooling for 60% of the clients (suspension orexpulsion from school or dropping out of school)

Trouble with the law by ~ 50% of the group (having been introuble with authorities, charged, or convicted of a crime)

Confinement was experienced by about 50% of the clients;(includes treatment for mental health problems, alcohol/drug problems or incarceration for a crime)

Inappropriate sexual behavior noted by 50% of the group;

Alcohol/drug problems registered by ~30% of the clients;

Problems with employment experienced by 80% of group.

An FAS-affected individual often looksnormal, but the permanent brain injury

results in unexpected, inconsistent, andunpredictable behaviors.

Too frequently it is assumed that someone with FASD is not tryinghard enough or does not want to cooperate. These childrendisproportionately receive diagnoses of

• Attention Deficit Hyperactivity Disorder (ADHD),

• Oppositional Defiant Disorder,

• Pervasive Developmental Disorder, or

• Conduct Disorder (Coles, 2001). It is the brain damage that is creating problems and their

behavior problems is organic in origin. To better understand FASbehavior issues, shift the perspective from thinking the child“won't”to “can't”.

In 1987, fetal alcohol exposure was the leadingknown cause of intellectual disability in theWestern world

FAS prevalence in the US and Europe isestimated to be between 0.2-2 in every 1,000 livebirths

The lifetime medical and social costs of FAS areabout US$800,000 per child

Surveys in the US report that 10-15% of pregnantwomen having recently drunk alcohol and up to30% drink alcohol sometime during pregnancy

Wikipedia

There is no cure for FAS, because thecentral nervous system damage creates apermanent disability, but treatment ispossible.

As the damage can varyfrom individual toindividual, there is noone treatment type thatworks for everyone.

Photo: www.iamsleep.com

The only certain way to prevent FAS is to simplyavoid drinking alcohol during pregnancy.

Photo: www.mommyish.com

In the United States, the SurgeonGeneral recommended in 1981,and again in 2005, that womenabstain from alcohol use whilepregnant or while planning apregnancy, the latter to avoiddamage in the earliest stages ofa pregnancy, as the woman maynot be aware that she hasconceived.

Alaska Republican State Senator Pete Kellyproposed puttingpregnancy tests inbars as a solution tothe state’s fetal alcoholsyndrome epidemic.

www.msnbc.com/the-last-word/birth-control-irresponsible-people

Fetal Alcohol Syndrome is a preventable medicalcondition that is caused by the excessive consumptionof alcohol by pregnant women.

The resulting brain damage affects many differentparts of the brain and resulting in children that: Have attachment issues, Display inappropriate sexual behaviours, Show poor judgment, Have difficulty controlling their impulses, Are emotionally immature, and Need frequent reminders of rules.

As a result, many will require the protection of closesupervision for the rest of their lives.