Understanding fetal alcohol spectrum disorders

Singing, coloring, circle time – most kids are happy in preschool. But for children with fetal alcohol disorders, this is often the first place where they fail, getting labeled as lazy or difficult. As many as one in a hundred children are affected – yet the condition remains misunderstood and misdiagnosed.

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When a mother drinks alcohol during pregnancy, it reaches the fetus via the umbilical cord, potentially harming the developing baby's brain. In severe cases, prenatal alcohol exposure can lead to intellectual disability, distinct facial features with eyes set far apart, and small stature. This is what's commonly called Fetal Alcohol Syndrome. But experts say alcohol exposure can lead to a spectrum of disorders that vary in severity and symptoms:

Dubovsky: So what it does really is it affects behavior, it affects the way the brain processes information.

That's Dan Dubovsky, a mental health professional who educates people about the life-long effects of alcohol exposure in the womb. (FASD Specialist SAMHSA FASD Center for Excellence)

Dubovsky: so even if somebody is very bright, they have difficulty following three directions at once, and that has to do with the damage the alcohol causes to working memory and short term memory, which is what we use on a regular basis.

Even preschoolers need to be able to process several instructions at once. For example: get a crayon, grab a piece of paper, sit down, and draw a circle:

Charlie Tracy is an adorable three year old with a sweet smile – but he is clearly not enjoying dot-painting in his Chestnut Hill classroom (Charlie goes to United Cerebral Palsy of Philadelphia)

Charlie Tracy

Charlie has a therapist with him who coaches him through the different activities:

Liquori: My name is Jennifer Liquori Young and I'm an occupational therapist – some of his goals are just to follow the classroom routine, which includes snack time, writing, cutting, blocks.

Charlie's parents, Lynne and Gerald Tracy, knew Charlie had Fetal Alcohol spectrum disorder when they adopted him from the central Asian republic of Kazakstan. There's been a learning curve. Outbursts got Charlie expelled from two childcare centers. Charlie's dad, Gerald Tracy:

Tracy: He either knocks everything over, or pulls everything down he could reach, or worse still is the head banging, where he would just bang his head off of anything he could get to, and he could literally go at a full gallop into a wall.

Now, with help, Charlie does better and gets less frustrated. But many kids with the syndrome don't benefit from some of the breaks Charlie has received: involved parents, early diagnosis and consistent therapy.

Dubovsky says most settings – from school to sports to work – assume that people can process simple instructions. And that, he says, is exactly what children with Fetal Alcohol Syndrome can't do:

Dubovsky: We just set them up to fail over and over again, by expecting them to do things that they are not able to do.

Earlier diagnosis would help. Behavioral health centers in this region are stepping up efforts to screen for fetal alcohol disorders. Linda Bamberger is director of children's services at COMHAR – a Philadelphia human services organization. She says screening kids whenever there's a chance they were exposed to alcohol in the womb could help therapists find the right path:

Bamberger: just the fact that they know there is a reason why kids are not responding to traditional behavior interventions helps them to refocus their goals

The city of Philadelphia wants to send a strong message to pregnant women:

Schwartz: No amount of alcohol is safe during pregnancy in terms of potential effects on a fetus.

Don Schwartz is the city's health commissioner – he says Fetal Alcohol Syndrome is the only birth defect that is 100 percent preventable – but too many pregnant women have been misled into thinking that drinking in moderation is OK.

The Tracys want to help spread the word. They say because of the stigma associated with these disorders, most parents stay silent. And this silence, says Gerald Tracy, prevents other kids with Charlie's challenges from getting the right treatments.

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