Fetal Alcohol Spectrum Disorder

Each year in the U.S. as many as 40,000 babies are born with a Fetal Alcohol Spectrum Disorder, the leading known cause of preventable mental retardation.[1].

Fetal Alcohol Spectrum Disorder (FASD) is a term that describes the effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and learning disabilities. The cost to the nation for Fetal Alcohol Syndrome (FAS) alone, the most severe form of Fetal Alcohol Spectrum Disorder, is about $6 billion a year. [2] "Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus."[3] The effects of alcohol on the fetus may involve brain damage, including damage to or absence of the corpus callosum, the area of the brain that contains the nerve fibers that bridge the two hemispheres of the brain.

In 2008, UniHealth Foundation awarded a grant to the Violence Intervention Program at LAC+USC Medical Center to expand services to foster children in Los Angeles County with a history of prenatal alcohol exposure. The County of Los Angeles has a system of Hub Clinics that provides comprehensive medical facilities to children in the child welfare system. Under Dr. Astrid Heger's leadership, the Hub Clinics now include extensive FASD diagnostic and treatment services for children. Professionals in both medical and behavioral health at all of the clinics receive training on FASD screening, including how to obtain prenatal alcohol exposure histories, when available, and identify characteristic facial features of children affected by FASD. While the term FASD is not intended for use as a clinical diagnosis, the identification of children exposed to alcohol in utero enables providers, educators and parents to better understand the behavior of a child affected by FASD and provide appropriate interventions and treatments.

Dr. Heger explains:

“When you run children's programs, you are not simply dealing with children. You must treat the whole family. A positive FASD screening triggers a set of assessments, both neurodevelopmental and medical, as well as contact with social workers and expedited mental health services. We also work with the parents on how to deal more effectively with their child, explaining learning modalities and the importance of repetition. If these strategies are used while the child is young, there is a better chance of increasing the executive functions in the child's brain. In addition, if we know a child has FASD, this can lead to foster placement in a home with more resources. The procedures and protocols for the screening, assessment, and treatment of FASD is the same across all Hubs. We have also shown that this effort and the expanded services are budget neutral given entitlement funds. Our next challenge is prevention.”

One of Dr. Heger's most striking characteristics is her ability to see solutions where others may see only problems. "If I were satisfied with making diagnoses, I would have quit a long time ago. But I have wanted to build programs that have impact. No one at LAC+USC Medical Center has said 'no' to that drive in me and I have been able to move forward with the support of the University and the County to build programs that can change lives." The challenge that lies ahead is the integration of primary prevention among high risk families. While daunting, Dr. Heger reminds us that it is doable.

[3]Stratton, K.; Howe, C. and Battaglia, F., Eds. 1996. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. Washington, DC: National Academy Press.