(Submitted as part of the Coursera Course:
“Understanding the Brain”)
A number of years ago, our neighbours elected to take care
of a foster child.
The young boy was prone to screaming fits, making
inappropriate comments and had the habit of repeating the
same question over and over, even when his question was
I was told that his birth mother was an alcoholic and he had
fetal alcohol syndrome (FAS). It was mentioned that the FAS
left “holes”in his brain and this affected his behaviour.
This presentation will examine FAS and its effect on the
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 which
describes a continuum of permanent birth defects caused by
maternal consumption of alcohol during pregnancy.
Fetal Alcohol Syndrome (FAS) and Alcohol Related
Neurodevelopmental Disorder (ARND) represent different
degrees of FASD.
FAS is the most severe and is characterized by growth deficiency,
central nervous system disorders, and a pattern of distinct facial
1. In the first trimester, alcohol interferes with the migration
and organization of brain cells, which can create structural
deformities 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 FAS
than at other times during pregnancy.
[Early-Human-Development; 1983 Jul Vol. 8(2) 99-111]
3. During the third trimester, the hippocampus is significantly
affected.This leads to problems with encoding visual and
auditory 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 head
Philtrum: Groove on upper lip Epicanthal Folds: Upper eyelid folds
Vermillion: Upper lip Micrognathia: Undersized jaw
FAS facial features: smooth philtrum, thin vermilion and small
The brain of an FAS-affected individual has an overall
smaller and less-developed brain.
The FAS-affected brain has fewer gyri and sulci and
In some brain scans of FAS-affected individual show
actual holes in the brain.
Alcohol exposure appears to damage some parts of the
brain, while leaving other parts unaffected.
Not all damage from alcohol is seen on brain scans, as
the lesions can be too small to be detected with current
(Examples on next 3 slides)
National Organisation on FAS
The cerebrum (telencephalon) is ~6% smaller for an
individual 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 each
other) 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 to
alcohol: Its white matter is significantly reduced and its gray matter
density is significantly increased.
Frontal Lobes - This area controls impulses and
judgment.The most obvious damage to the brain
occurs in the prefrontal cortex, which controls the
Hippocampus - Plays a fundamental role in
memory, learning, and emotion.
Hypothalamus - Controls appetite, emotions,
temperature, and pain sensation.
- Location in the brain
Corpus Callosum - Passes information from
the left brain (rules, logic) to the right brain
(impulse, feelings) and vice versa.The Corpus
Callosum in an individual with FAS might be
smaller than normal, and in some cases it is
Cerebellum - Controls coordination and
movement, behavior and memory.
- Location in the brain
Basal Ganglia - Affects spatial memory and
behaviors like perseveration and the inability to
switch modes, work toward goals, and predict
behavioral outcomes, and the perception of time.
Amygdala –Central part of emotional circuitry,
senses danger, fear and anxiety; plays major role
in recognizing faces and facial expressions,
social behavior, aggression, and emotional
memory; critical for stimulus-reinforcement
The hypothalamus, amygdala, and hippocampus are part of the limbic
system, which regulates emotions, social and sexual behavior, the
“fight or flight”response, and empathy, all areas of concern for
individuals with prenatal alcohol exposure.
- Location in the brain
Normally developing “brain
circuits” (symbolically shown
as the six arrows on the left)
Drinking during pregnancy
causes the “brain circuits”
to become pruned, garbled,
impaired or missing.www.fasdwheel.com
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, inability
to 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 making
decisions Artist: Moriz89
Mental health problems prevalent among 90% of the group;
Disrupted schooling for 60% of the clients (suspension or
expulsion from school or dropping out of school)
Trouble with the law by ~ 50% of the group (having been in
trouble 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 looks
normal, but the permanent brain injury
results in unexpected, inconsistent, and
Too frequently it is assumed that someone with FASD is not trying
hard enough or does not want to cooperate.These children
disproportionately 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 FAS
behavior issues, shift the perspective from thinking the child
In 1987, fetal alcohol exposure was the leading
known cause of intellectual disability in the
FAS prevalence in the US and Europe is
estimated to be between 0.2-2 in every 1,000 live
The lifetime medical and social costs of FAS are
about US$800,000 per child
Surveys in the US report that 10-15% of pregnant
women having recently drunk alcohol and up to
30% drink alcohol sometime during pregnancy
There is no cure for FAS, because the
central nervous system damage creates a
permanent disability, but treatment is
As the damage can vary
from individual to
individual, there is no
one treatment type that
works for everyone.
The only certain way to prevent FAS is to simply
avoid drinking alcohol during pregnancy.
In the United States, the Surgeon
General recommended in 1981,
and again in 2005, that women
abstain from alcohol use while
pregnant or while planning a
pregnancy, the latter to avoid
damage in the earliest stages of
a pregnancy, as the woman may
not be aware that she has
Alaska Republican State Senator Pete Kelly
pregnancy tests in
bars as a solution to
the state’s fetal alcohol
Fetal Alcohol Syndrome is a preventable medical
condition that is caused by the excessive consumption
of alcohol by pregnant women.
The resulting brain damage affects many different
parts 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 close
supervision for the rest of their lives.