April is Alcohol Awareness Month

April is Alcohol Awareness Month and April 5 is National Alcohol Screening Day. To highlight these events, the Centers for Disease Control and Prevention has produced a Web spotlight on Women and Alcohol . 

 According to the CDC,  having more than one alcoholic drink per day increases a woman’s chances for high blood pressure, stroke, some types of cancer, injury (e.g., motor vehicle crashes, violence),  and suicide. Alcohol use, especially binge drinking (four or more drinks in about two hours), might also lead to an unplanned pregnancy, a sexually transmitted infection, or sexual assault. Some people, including pregnant women and women who might become pregnant, should not drink alcohol at all.

Drinking alcohol during pregnancy is one of the top preventable causes of birth defects and developmental disabilities, known as fetal alcohol spectrum disorders (FASDs). (Information on FASDs is also available in Spanish.)

• The good news is that FASDs are 100% preventable—if a woman does not drink alcohol while she is pregnant.

• There is no known amount of alcohol that is safe to drink while pregnant.

• There is no safe time to drink during pregnancy—alcohol can harm a baby at any time during pregnancy.

• All drinks with alcohol can hurt an unborn baby. A 12-ounce can of beer has as much alcohol as a 5-ounce glass of wine or a 1-ounce shot of liquor.

• FASDs can cause problems related to how a person grows, learns, looks, and acts. FASDs can also cause birth defects of the heart, brain, and other major organs. These problems can last a lifetime.

• About 1 in 12 pregnant women in the United States reports alcohol use.

Click on Women and Alcohol above to learn more about FASD and the importance of screening women.

 

Fetal Alcohol Spectrum Disorder History Series-Addition Made

FASD History is the title of the series many of you have seen for several days. Please note that an addition was added to Part 3 of the series.

History of FASD Pt. 9

This is a continuation of the article written by Peggy Seo Oba, click here for part 1 and Peggy’s bio

2000. Tenth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA. Pages 282-338.

FAS-foreningen was founded in August, 2000 in Sweden by Katarina Wittgard. It started with a network in 1999 with the support of Dr. Marita Aronson, one of the foremost researchers on FASD in Europe.

2001. The SAMHSA FASD Center for Excellence was initiated. The U.S. Congress authorized the Center in Section 519D of the Children’s Health Act of 2000, which included six mandates (Section b of 42 USC 290bb-25d or Public Law 106-310). The mandates focus on exploring innovative service delivery strategies, developing comprehensive systems of care for FASD prevention and treatment, training service system staff, families, and individuals with an FASD, and preventing alcohol use among women of childbearing age.

Craig Lesley writes Storm Riders, a fictionalized account of his adopted son who has FAS. Picodor Pubishers.

2002. FASworld Deutschland was founded on September 7, 2002 by Ann Gibson.

FAS Stichting Nederlands was officially founded on 23 September 2002.

Dr. Nancy Day of the University of Pittsburgh finds that as little as one drink a day can cause physical deficits. (Study in the journal Alcoholism: Clinical and Experimental Research.) Report in Reuters News Service, October 17, 2002.

2003. CalFAS (California FAS) was founded by Diane Kerchener. It started through a meeting with SAMHSA, who encouraged CA’s three state representatives, Diane Kerchner, Kathy Page and Michael Monti along with NOFAS to start a state organization.

2004. NIAAA National Advisory Council approves the definition of binge drinking as 4 or more drinks for a female and 5 or more for a male.

Damaged Angels by Bonnie Buxton. The second internationally distributed book on FASD and its effectson a Canadian family. It was first published in Canada and soon to be published in the United States in May of 2005.

Dr. John W. Olney of Washington University in St. Louis says even two drinks during pregnancy can cause neurological damage. (From a presentation to the American Association for the Advancement of Science.) (Reported in the Associated Press, February 14, 2004.) Read more

History of FASD Pt. 8

This is a continuation of the article written by Peggy Seo Oba, click here for part 1 and Peggy’s bio

1977. The Merck Manual: Thirteenth Edition. Fetal Alcohol Syndrome is not mentioned in this edition.
Minimal Brain Dysfunction is now under the heading, Learning Disorders and “More common labels include brain injury, brain damage, minimal brain damage, hyperkinesis, perceptual deficits and dyslexia.”
Under treatments:
“… to keep the child in his regular classroom and to schedule some periods with a teacher who is trained to provide special help-technics which succeed in improving poor
performance…”
The use of stimulants to improve attention is again mentioned.
Under Personality Disorders, only the Hysterical (*histronic) Personality, Psychopathic (*Sociopathic or Antisocial) Personality and the Inadequate Personality are still included. The quotes beside psychopathic personality are the Merck’s quotes. This indicates that for many in the medical field, the sociopathic/antisocial/psychopathic diagnoses are interchangeable. The etiology of the two conditions are identical to those descriptions in the Twelfth Manual (1972).

The National Institute of Alcohol Abuse and Alcoholism (NIAAA) issues the statement that 6 or more drinks per day incurred the risk that a woman could produce a child with birth defects.

1978. Third Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome. published by the Department of Health and Human Services and the National Institute of Alcohol Abuse and Alcoholism (NIAAA). This was the first time FAS became an integral part of this specially commissioned report to the U.S. Congress. Each report adds information to the previous report on alcohol and other related topics. Therefore, information presented in these reports to Congress seldom repeat each other except for the introductions. Contents cover etiology, symptoms, physical signs, physical damage to organs, psychological aspects, economic costs and current research. Extensive bibliography accompanies each section.

[The NIAAA determined that the consumption of 2 drinks per day or one ounce of absolute alcohol was the definition of heavy drinking. (Absolute alcohol is that part of a beverage that is alcohol minus the other non-alcohol ingredients.) (That would be the equivalent of one 12 ounce can of beer, a four ounce glass of wine or one shot glass of hard liquor.)]

1979. By this year, over 600 cases of FAS had been reported worldwide. Dr. Ernest Abel in Fetal Alcohol Syndrome and Fetal Alcohol Effects. (New York: Plenum Press.) reported that incidences of FAS were in articles from Australia, Belgium, Brazil, Canada, Chile, Czechoslovakia, France, Germany, Hungary, Ireland, Italy, Reunion, South Africa, Spain, Sweden, Switzerland, and the U.S.

1980. Research Society on Alcoholism (RSOA) issues three criteria for a diagnosis of FAS. “A pattern of characteristic facial features, pre-postnatal deficit in height and weight, and central nervous system damage.”

1981. Fourth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA. Pages 59-111.

The Surgeon General of the United States issues a health advisory recommending that pregnant women or women considering getting pregnant abstain from using alcohol because of possible harm to the unborn child.

1982. The Merck Manual: Fourteenth Edition. Nine years after the first international paper on the etiology of Fetal Alcohol Syndrome was published, FAS finally appears in the Merck Manual. Under Section 16: Pediatrics and Genetics, Chapter 189: the Newborn, Metabolic Conditions:
“…The most serious consequence is mental retardation…”
Under Section 23: Clinical Pharmacology, Chapter 274: Drug Toxicity, Drugs in Pregnancy: “…borderline mental deficiency…” No other serious behavioral problems are discussed.
Under Section 12: Psychiatric Disorders, Chapter 142: Personality Disorders are described for the first time in the nomenclature of the Diagnostic and Statistical Manual of Medical Disorders (DSM-III).
The diagnostic section, the following has been added to coping mechanisms (5) Turning against one’s self allows aggression towards others to be expressed indirectly and ineffectively through passivity. It includes failures and illnesses that affect others more than one’s self, and silly, provocative clowning. The mechanismunderlies most sadomasochistic relationships.
The Hysterical (*histronic) and Antisocial Personalities (*psychopathic, sociopathic) (*quotes are from the Merck Manual) are the only two that remain under personality disorders.
” The Histronic (Hysterical) Personality is described in various terms such as ”
egocentric…attention seeking…theatrical behavior…emotional immaturity…childish, emotional response…lively manner…rarely deeply involved emotionally…insatiable need for affection…easily repress or forget unpleasant or discreditable experiences…responsiblity for misfortunes and failures is usually ascribed to others.”
” The Antisocial Personality “(previously used designation: psychopathic,
sociopathic) characteristically act out their conflicts and flout normal rules of social order. …impulsive, irresponsible, amoral, unable to forego immediate gratification. They cannot form affectionate relationships with others, but their charm and plausability may be highly developed and skillfully used for their own ends. They tolerate frustration poorly, and opposition is likely to to elicit hostility, aggression, or serious violence. Failure and punishment rarely modify their behavior or improve their judgment and foresight.”
Suggested therapies or treatments, “Although these mechanisms may not be breached by reason or interpretation, they respond to improved interpersonal relationships and to supportive but forceful confrontation in prolonged psychotherapy or peer encounters.”

1983. Fifth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA. Pages 68-82. In this report, one researcher estimated the lifetime cost of raising a child with FAS was $155 million.

1984. Fetal Alcohol Syndrome and Fetal Alcohol Effects. by Dr. Ernest Abel. One of the first textbooks to overview the mechanisms and laboratory research on the effects of alcohol upon laboratory animals and selected cases.

1985. A Poison Stronger than Love. by Anastasia Shkilnyk. A book that tells the story of FAS in an American Indian (Ojibway) community. New Haven: Yale University Press.

1987. The Merck Manual: Fifteenth Edition. Fetal Alcohol Syndrome is comprised of one paragraph on page 1887. “The most serious consequence is severe mental retardation.” There is no mention of other behavioral problems.
Under Section 12, Psychiatric Disorders, Chapter 137, Personality Disorders the diagnosis section and the Histronic (*Hysterical) and Antisocial (*Psychopathic, Sociopathic) Disorders section are copies of the Fourteenth Manual (1982) manual entries. (*quotes are from the MerckManual.)

Under Section 15: Gynecological and Obstetrical Care, Chapter 176: Normal Pregnancy, Labor and Delivery, Prenatal Care, the Merck states, “Recent studies indicate that…a daily intake of (less than) 2 ounces of wine probably would not cause fetal abnormalities.”

Sixth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and NIAAA. Pages 79-96.

[The NIAAA determined that the consumption of 0.1 ounce or less of absolute alcohol constituted a light drinker, 0.1-0.9 of absolute alcohol constituted a moderate drinker and 1.0 ounce or more of absolute alcohol constituted a heavy drinker. (0.1 ounce is less than 1/4 of a small can of beer, less than one ounce of wine or less than 1/4 of a shot glass of hard liquor.)]

1988. High Risk: Children Without a Conscience by Dr. Ken Magid and Carole McKelvey. A highly popular book at the time. It deals almost exclusively with psychopathic (antisocial) personalities. The problems therein are ascribed to working mothers, day care, teenage pregnancy, divorce, tv violence, schools, lack of religion, too much money, too little money, lack of bonding/trust, adoption and foster care…everything except prenatal alcohol exposure. The introduction was written by Congresswoman Patricia Schroeder. The topics brought up in this book are still being discussed as reasons for children’s behavioral problems.

1989. The Broken Cord by Michael Dorris. The first nationally distributed book on FAS and its effects on a family. Dr. Dorris cited 165 articles and books and three videos on the dangers of drinking during pregnancy.

U.S. law calls for the mandatory labeling of all containers of alcohol sold in the United States.

1990. Seventh Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA. Pages 138-161.

Formation of the Fetal Alcohol Syndrome Adolescent Task Force organization by Jocie and Don DeVries, Linda LaFever, Vicky McKinney, Ann Waller and DeLinda McCann. Now known as the Family Resource Institute on FAS (FAS*FRI), it also publishes the FASTimes newsletter.

August, 1990. NOFAS was incorporated in South Dakota. Patti Munter founded the organization along with Gwen Packard. Ms. Munter served as NOFAS Executive Director through 1996, and is currently a member of the NOFAS Board of Directors. NOFAS is currently located in Washington, D.C..

1991. Iceberg, a newsletter devoted to Fetal Alcohol Syndrome, published by the University of Washington Fetal Alcohol and Drug Unit.

1992. The Merck Manual: Sixteenth Edition. Fetal Alcohol Syndrome is mentioned in
Section 14: “borderline mental deficiency.”
Section 14: “…severe behavioral effects…” “…varying degrees of mental retardation, and abnormal neurobehavioral development.” “FAS is the leading known cause of mental retardation…”
Section15: “…most serious consequence is severe mental retardation…”
Section 15: “…and MR.”
Section 14 does state “In one study, an increased frequency of abnormalities was not found until 45 ml of alcohol (equivalent to 3 drinks per day) was exceeded.” [ The Surgeon General of the United States issued his warning against drinking during pregnancy in 1981.]
Personality Disorders are derived from the Diagnostic and Statistical Manual of Mental Disorders – Revised edition (DSM III-R) and include the Histronic (*Hysterical) Personality and the Antisocial (*Psychopathic, Sociopathic) Personality. (*quotes are from the Merck Manual)
Under treatment, the following has been changed and added:
“The physician’s job is to contain the patient’s externalization through setting limits, confrontation, and avoiding his own tendency to become overinvolved–first to rescue and then condemn. … Over the long term, the anxiety and and depression…are rarely abolished by pharmacotherapy…(exceptions are associated depression and compulsive disorders).
“Patients must be confronted with the way their behavior affects other people. Frequently, limits on behavior need to be set and reality issues dealt with. …the family should be involved, since group pressure seems to be effective. Group and family treatment, group living situations, therapeutic social clubs, self help groups, milieu hospital therapy–all can be valuable in treatment. …It is also important that those who undertaken treatment be aware of the difficulties and avoid the disappointment, annoyance , and moral judgments that tend to creep in.”
Finally, “Life expectancy is diminished but among those surviving, there is some tendency to stabilization after age 40.”

1992 to 1993. The University of Wisconsin’s Family Empowerment Network formed by Dr. Raymond Kessel and Dr. Georgiana Wilton as a direct response to family members who were asking for help in in dealing with Fetal Alcohol Syndrome. In 2002, FEN moved to the University of Wisconsin’s Department of Family Medicine.

1993. Eighth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA. Pages 202-232.

1995. FASLink, a support and information internet listserv, founded by Mrs. Val Surbey of Winnipeg, Canada along with the Canadian Centre for Substance Abuse..
Due to CCSA budget constraints, FASLink is now a nonprofit organization under Mr. Bruce Ritchie.

The Fetal Alcohol Syndrome Community Resource Center started out as a local prevention organization 1994. It was chaired by Gail Harris, PhD, who requested Teresa Kellerman to participate as a consultant for FAS issues. In 1995, the two remaining active persons on the Prevention Committee (Teresa Kellerman and Ron Barber) agreed that the Committee would be more aptly named the FAS Community Resource Center. Later the FAS CRC went on the internet as www.fasstar.com.

Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention and Treatment. edited by Kathleen Stratton, et al. This Institute of Medicine textbook was the American effort to consolidate the research and practical knowledge that was available up to that time and to provide a uniform basis for diagnosis.

Article on the effects of prental alcohol on mRNA (messenger RNA) by Dr.s H.C. Scott, R.T. Zoeller and P.K. Rudeen from the University of Missouri-Columbia. Implications for the generational affects of prenatal alcohol exposure.

1995-2004. The Merck Manual: Seventeenth Edition is online at http://www.merck.com.
Fetal Alcohol Syndrome is found in this volume. The behavioral aspects of FAS are as follows: Section 21, Chapter 286, “..with mental retardation and behavioral disturbances…”
Section 18, Chapter 250, “…varying degrees of mental retardation and abnormal neurobehavioral development.”
Personality Disorders are in Section 15: Psychiatric Disorders Chapter 191: Personality Disorders. The excerpts quoted are taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), under Cluster B: dramatic/erratic.
Antisocial Disorder (*previously called psychopathic or sociopathic) is essentially the same as the previous entries from prior Merck editions.
There are additional comments on the environment. “Antisocial personality disorder is often associated with alcoholism, drug addiction, infidelity, promiscuity, failure in one’s occupation, frequent relocation, and imprisonment. …more men have this personality disorder than women, and more women have borderline personality; these two disorders have much in common. In the families to patients with both personality patterns, the prevalence of antisocial relatives, substance abuse, divorces and childhood abuse is high. Often the patient’s parents have a poor relationship, and the patient was severely emotionally deprived in his formative years. Life expectancy is decreased but among survivors, the disorder tends to diminish or stabilize withage.”
Histronic (*hysterical) Personality is also essential the same as in previous editions of the Merck. There are no comments on therapies or treatment for this disorder
(*quotes are from the Merck Manual)

1996. Alcohol, Pregnancy and the Developing Child. edited by Dr. Hans-Ludwig Spohr and Dr. Hans-Christoph Steinhausen. The European effort toconsolidate the research and knowledge about FAS that was available up to that time. Spohr and Steinhausen also reported that papers on the occurrences of FAS had appeared in Germany in 1976, Sweden in 1979 and Japan in 1981.

1997. Fetal Alcohol Syndrome: A Guide for Families and Communities, by Dr. Ann Streissguth, premier researcher on the behavior of children with FAS. Streissguth gives a partial list of countries reporting cases of FAS, France, Germany, Iceland, South Africa, and Canada.

Ninth Special Report to Congress on Alcohol and Health: Fetal Alcohol Syndrome. published by the Department of Health and Human Services and the NIAAA. Pages 192-246.

FASCETS founded by Diane Malbin in Portland, Oregon. Ms. Malbin had been studying and lecturing on FASD for ten years prior to the foundation of her organization.

1998. NOFASARDwas founded by Sue Miers and incorporated as an association in South Australia in 1998. Anne Russell came on board as Queensland representative for the organisation in 2001 and Vicki Russell as Tasmanian representative in 2003.

1999. FASWorld founded by Bonnie Buxton, Teresa Kellerman and Brina Philcox in Ontario Canada. Main purpose was to form a worldwide FASDay at 9 a.m., September 9th of every year to start a world response to the problems of FAS.

FASAwareUK founded by Gloria and Peter Armstead of Wigan, Great Britain. [Margaret Murch founded an organization two years earlier but it has not been active as of late.]

History of FASD Pt. 7

This is a continuation of the article written by Peggy Seo Oba, click here for part 1 and Peggy’s bio

1956. The Merck Manual: Ninth Edition. The Neuropsychiatric section is almost always seeped in Freudian Theory and uses the “id, ego and superego” as well as other Freudian terms for different types of psychoses.
This is the first time that Personality Disorders has its own chapter. Personality Disorders are “…characterized by developmental defects or pathologic trends in personality structure, with minimal subjective anxiety and distress. …these disorders are manifested by lifelong behavior patterns, rather than by mental or emotional symptoms.”
Under Personality Pattern Disturbances, “Prolonged therapy may improve functioning … but rarely accomplishes basic change in their inherent structures.”
The Inadequate Personality is defined as “In response to intellectual, emotional, social and physical demands, these individuals show inadaptability, ineptness, poor judgment, lack of physical and emotional stamina, and social incompatibility.”
Under Sociopathic Personality Disturbances, “Individuals…are ill primarily in terms of conformity with the prevailing cultural milieu, as well as in terms of personal discomfort and relations with others. Sociopathic reactions are often symptomatic of severe neurosis or or result from organic brain injury or disease.” (The sociopathic personality and the antisocial personality are combined in later editions of the Merck.)
The Antisocial Personality is described as: “…individuals who are always in trouble, profiting from neither from experience nor punishment, and maintaining no real loyalties to any person, group or code. They are callous and hedonistic, showing marked emotional insecurity. They lack judgment and a sense of responsibility but can rationalize their behavior so that it appears reasonable and justified. The term includes cases previously classified as ‘constitutional
psychopathic state’ and ‘psychopathic personality’.”
There are no suggestions for treatment or therapy.

1957. Jacqueline Rouquette in “Influence de l’intoxication alcoolique parentale sur le development physique et psychique des jeunnes enfants.” (Influence of intoxicated parents on the physical and psychological development of their young children.) These, Paris. Streissguth (in Fetal Alcohol Syndrome: A Guide for Families and Communities) says of her work: “…a medical thesis from Paris described 100 foundling home children born to alcoholic mothers and fathers who had malformations very similar to those now recognized as constituting FAS. She concluded that maternal alcoholism, in particular, posed very grave dangers for the developing fetus and child.”

From Steissguth’s Fetal Alcohol Syndrome: A Guide for Families and Communities, reports that D. Papara-Nicholson and I.R. Telford administered alcohol to pregnant guinea pigs and observed the resultant offspring had problems with low birthweight, poor locomotion, incoordination , feeding and sucking. Streissguth notes that this may have been the first report of the neurobehavioral effects of prenatal alcohol.

1960. Many physicians who graduated this year are nearing retirement in 2005.

1961-1966. The Merck Manual: Tenth and Eleventh Editions. These editions are nearly identical to the Ninth Edition. The theories of Sigmund Freud are quoted. Almost the same wording occurs in all three editions.
Again, Personality Disorders are deemed to be “lifelong problems rather than mental or emotional symptoms.”
In the Tenth Edition under Neuropsychiatric, Personality Disorders, Sociopathic Personality Disorders, Antisocial Reaction and in the Eleventh Edition, Section 16: Neuropsychiatric, Chapter 2; Personality Trait Disturbances, Psychopathic Personality Disturbances, Antisocial Reaction, “This term refers to individuals who are always in trouble, profiting neither from experience nor from punishment, and maintaining no real loyalties to any person, group, or code. Frequently they are callous and hedonistic, showing marked emotional immaturity. They lack judgment and a sense of responsibility but can rationalize their behavior so that it appears reasonable and justified.”
Note that the term changes from Sociopathic Personality Disorders to Psychopathic Personality Disturbances from the Tenth to the Eleventh edition.
The Inadequate Personality in also mentioned in both editions. The definition is the same, “In response to the intellectual, emotional and physical demands, these individuals show inadaptability, ineptness, poor judgment, lack of physical and emotional stamina, irresponsibility and social incompatibility.”
There are no recommended therapies.
The 10th Edition starts to include a section on Organic Brain Damage but that is almost exclusively of traumatic origin.

1966. Coffey, T.G. “Beer Street: Gin Lane Some Views of 18th Century Drinking.” Quarterly Journal Alcohol Studies.

Fuchs, A.R. “The Inhibitory Effect of Ethanol on the Release of Oxytocin During the Parturition of the Rabbit.” Journal of Endrocrinology.

1968: Dr. Paul Lemoin publishes “Les infants de parents alcooliques; anomolies observees a propos de 127 cas.” Ouest. Med. This was not published internationally and received relatively little notice.

1970. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) is formed.

1972. Cantwell, D.P. “Psychiatric Illnesses in the Families of Hyperactive Children.” Achives of Genral Psychiatry.

The Merck Manual: Twelfth Edition. This edition is notable for finally dropping the Freudian theories that were predominate in the prior editions that covered nearly 25 years of psychiatry. It also includes a pediatric section for the first time.
This is an excerpt from the 1972 edition of the Merck Manual.
Under Section 18: Psychiatric Disorders, Numbers 3. Mental Subnormality and 4. Disorders of Childhood:
Number 3. “Mental Subnormality (Mental Deficiency, Mental Retardation, Feeblemindedness)” “Etiology (includes)…(3) Birth trauma or physical agent (6) Unknown prenatal influence (Alcohol is not mentioned as a possible cause in either case.)
Number 4. “Minimal Brain Dysfunction (also known as) Minimal Brain Damage (and) Hyperkinetic Impulse Disorder.” “This syndrome has received much attention over the past decade and is being diagnosed with increased frequency”
[* Minimal Brain Dysfunction is cited in the 1978 Third Special Report to Congress on Alcohol and Health as possibly being part of the FAS spectrum of physical and behavioral disorders.]
Under symptoms and signs:
“…characterized by inappropriate activity, either hyperkinesis or listlessness and withdrawal.”
“Activity is impulsive and occasionally destructive or aggressive.”
“Emotional lability, low stress tolerance and intellectual deficits…”
“The child’s attention span is short and he is hyperresponsive to environmental stimuli, as if there were no selective filtering out of less meaningful stimuli.”
“Intellectual deficits…may include difficulty with arithmetic, slowness in learning to read and write, and deficits in abstract concept formation.”
“…coordination difficulties, perceptual motor difficulties, and a delay or failure in developing (right-or left-handedness).”
“…various signs of psychiatric disability, possibly the result of ‘innate’ high anxiety or an impaired ability to handle stresses.”
“These children are often developmentally slow and require more and longer lasting support than normal children.”
Under diagnosis:
“The neurologic examination may show a variety of ’soft’ neurologic signs such as clumsiness, impairment in rapid successive movements , mild choreo-athetosis, mixed laterality of with right-left confusion, finger agnosia and evidence of dyslexia or dyspraxia.”
“The EEG may be useful in detecting a seizure disorder or cerebral dysrhythmias.”
“Psychological testing …should include standard intelligence tests and perceptual-function test to document the visual perceptual difficulties, problems with spatial organization and distractable behavior…”
Under prognosis:
“The syndrome appears to be self limited, since many of the characteristics fade during early adolescence. Though the hyperkinesis and behavioral order usually subside, some of the
learning or emotional difficulties continue and the child is often left with school problems,
continued high levels of anxiety and low self esteem.”
Under treatment:
Amphetamines are mentioned as a way to increase attention span.
“Special education, geared to the child’s individual needs, is necessary, especially for
children…regarded as poorly motivated or retarded…”
“Raising these children in a supportive atmosphere requires education inunderstanding by most parents.”
“It is important that parents and school both provide the child with sensory experiences that are more clearly defined and of controlled intensity.”
The edition prior to this one, the Eleventh Edition, published in 1966 does not mention minimal brain dysfunction. The edition following this, the Thirteenth Edition, published in 1977, lumps minimal brain dysfunction under learning disorders and Fetal Alcohol Syndrome is not mentioned even though the international paper on FAS appeared in 1973.
Under Section 18: Psychiatric Disorders: Disorders of Psychogenic Origin,
Personality Disorders are discussed as being “…relatively fixed and inflexible… Individuals may show patterns of repetitive, maladaptive and…self defeating patterns of behavior, inadequate handling of impulses, or restricted and inappropriate feelings. …limited variety of responses to stress. …tends to show little anxiety or mental or emotional symptoms. …low self esteem, paucity or relative superficiality of intimate relationships, difficulty in sustaining interests, low frustration tolerance, difficulty in postponing gratification and inability to learn from experience. (It is recommended) …that early interpersonal relationships are important to establishing modes of defense and their rigidity.”
Number 8: Antisocial Personality ..”formerly referred to as ’sociopathic’” still remains the same.
Other Personality Disorders that have been added in this edition are:
Number 4: Explosive Personality: “…characterized by sudden tantrum-like outbursts of rage or verbal or physical aggressiveness. Despite guilty and regretful feelings, these individuals are unable to control their outbursts. They are easily excited by environmental frustrations. Recently, questions have been raised as to whether underlying minor organic brain changes predispose to this explosiveness.”
Number 6: Hysterical (*histronic) (*quote is from the Merck Manual) Personality: “…characterized by dramatic and attention-seeking behavior, excitability, emotional instability and over-reactivity, self-centeredness, and a provocativeness or sexualization ofnon-sexual relationships often with sexual frigidity or fears. Though superficially self assured, such people have major doubts as to their identity and goals. Their difficulty in expressing genuine feelings further intimate relationships. Such relationships are affected by the individual’s need for affection.”
(In the 15th edition of the Merck Manual under Antisocial Personalities, it states “In our culture, men are more often labeled as antisocial and women as histronic personalities but the two patterns have much in common.”)
Number 7: Asthenic Personality: “…characterized by lack of enthusiasm, low energy and capability, difficulty in developing a broad sense of enjoyment and pleasure, and a poor response to even small physical or emotional stresses.”
Number 10: Inadequate Personality: “…describes individuals whose response to any form of stress seems ineffectual. Their behavior shows poor judgment, ineptness, lack of energy, poor long-range planning, and poor performance. Incentive is lacking, especially to achieve culturally desired levels. These people are marginally involved in social relationships, tend to drift and take non-demanding jobs. There is no evidence for physical or mental defects.”
The “Nervous” section found in previous manuals has been changed to “Neurological Disorders” and covers most diseases of the brain and spinal cord. Reactions to exposure to toxins are limited to the adult experience.

Ulleland, Christy. “The Offspring of Alcoholic Mothers.” (1972) Annals of New York Academy of Sciences. 1972.

1973. Fetal Alcohol Syndrome was first presented in an internationally recognized study published by a team of researchers at the University of Washington (Dr. Christy Ulleland, Dr. Kenneth Jones, Dr. David Smith, and Dr. Ann Streissguth).

1974. University of Washington Fetal Alcohol and Drug Unit (FADU) began in 1974. FADU received its first federal funding for work on various aspects of alcohol and pregancy. This is the date of the beginning of the NIAAA support for “Alcohol in Pregnancy: Offspring Development”, which was known locally as the “Pregnancy and Health Study” and later as the “Seattle 500. Initially a 3-year grant, this research project is still in progress, and was awarded an NIH Merit Award several years ago. Dr. Ann P. Streissguth is still the primary investigator (P.I)., and the work is continuing in her retirement.

Marita Aronson, a psychologist in Goteborg, Sweden, began a series of studies on children of mothers who had  alcoholism.

An Article Sure to Stimulate Discussion

The New York Times published an article addressing the pros and cons of parents teaching adolescents to drink responsibly at appropriate times under their supervision.  As the article notes, “Abundant research shows the dangers of heavy drinking and the necessity of getting help with teenage alcohol abuse.  But little guidance is offered on teaching teenagers about the pleasures of wine with a meal.”

The article also poses the question:  Do you think teenagers drinking wine with their parents at home encourages reckless drinking or more responsible habits with alcohol later in life?

Click on the New York Times above to read the full article.  Please let us know what you think!

History of FASD Pt. 6

This is a continuation of the article written by Peggy Seo Oba, click here for part 1 and Peggy’s bio

1941, 1964, 1982. The Mask of Sanity by Hervey Cleckley. This book is considered to be such a classic, I have found citations from three editions published that have covered five decades. Dr. Cleckley based much of this book on the male patients at the Veteran’s Administration Hospital in Augusta, Georgia, one of the largest in the country at the time of his writing. He estimated that well over 40% of the patients in the Augusta, Georgia VA’s psychiatric ward fitted the description that he classified as “semantic dementia”, Cleckley describes this as “…a mind or personality so damaged that experiences as a whole cannot be grasped or utilized in its significance or meaning.” Cleckley goes on to say, “…in semantic dementia, the purposiveness, the significance of all life striving and of all subjective experience are affected without obvious damage to the outer appearance of the personality.” “…the persistent maladaptation at the personality level, the inevitable purposelessness of behavior, suggested at times not a lack of purpose so much as a negative purpose. The person despite all his opportunities, his intelligence and his plain lessons of experience, seem to go out of his way to woo misfortune.” The families of the patients in Cleckley’s book are described as “…sound if not superior stock.” even though each of the patients described were alcoholic by nature and abused it constantly throughout their lives.

Cleckley’s Section XXII: Clinical Profile of the patient with semantic dementia is revealing:
“He is usually a very attractive person superficially and makes a strong positive impression when one first meets. him.”
“He is free from…any marked …psychoneurosis.”
“…he has no sense of responsibility whatsoever to others.”
“…appears to have a total disregard for truth…”
“…much of his trouble is his own fault.”
“…he cheats and lies without any apparent compunction.”
“…he continues to show the most execrable judgment about attaining…his own ends.”
“…His inability to learn or profit by experience no matter how chastening his experience may be.”
“…distinguished by egocentricity.”
“…shows no more real evidence of object love.”
“His absolute indifference to the hardships, financial, social, emotional, physical, and others, that he brings upon those for whom he professes love…”
“But mature, wholehearted anger, true or constant indignation, honest, solid grief, sustaining pride, deep joy, despair are never found within this scale.”
“…he does not show anything that could be called woe or despair or serious sorrow.”
“The emotional poverty, the complete lack of stronger or tragic feeling…”
“…lacks the insight to a degree seldom if ever found in other mental disorders.”
“He has absolutely no capacity to see himself as others see him.”
“…he has no ability to know how others feel when they see him or to feel anything comparable himself about the situation.”
“…blaming his troubles on others with the flimsiest of pretexts but with elaborate and and subtle rationalization.”
“…to have little or no ability to feel the significance of his situation, to experience the real emotions of regret or shame, or determination to improve.”
“…clever statements have been purely verbal, even his expressions without underlying content; an excellent mimicry of insight.”
“…apparently a total lack of insight as a real and moving experience.”
“…uses all the words that would be used by one who understands and who could define all the words, but who is still blind to the meaning.”
“The psychopath shows little of the ordinary responsiveness to special consideration or
kindness.”
“Alcoholic indulgence is very frequently prominent in the psychopath’s life story.”
“…an independent and pre-existing personality maladjustment is primarily causal.”
“…their almost total lack of self imposed restraint.”
“…a striking inability to follow any sort of life plan consistently whether it be regarded as good or evil.”
“…seems to go out of his way to make a failure of life.”
“…he cuts short by some incomprehensible and untempting piece of folly or buffoonery, any activity in which he is succeeding, no matter whether it is crime or honest endeavor.”
“…that some unconscious purpose to fail has been active, some unrecognized drive at social and spiritual self-destruction.”
“He shows no real insight into his condition. There is a persistent tendency to project the source of his troubles to the environment. We see a striking lack of normal and appropriate emotional response, a general flattening or hollowness in affect, such as marked impairment of ordinary judgment that he fails repeatedly to adapt himself in the social group. His record furthermore reveals not one but a series of follies and disasters involving himself and others and brought about for no discernible purpose. We may, therefore, say that he is psychotic, incompetent, and incapable of carrying on the usual activities of life without constant supervision.”
Cleckley goes on to state:
“…it is a different type of psychosis from all those now recognized, and one which differs more widely in its general features from any of those than they differ from one another.”
“The first and most striking difference is…in other psychoses, one finds…a more or less obvious alteration of reasoning processes or of some other demonstrable personality feature. In the psychopath, one…is confronted by with a convincing mask of sanity. All the outward features of this mask are intact; nor can it be displaced or penetrated by questions directed toward
deeper personality levels. …The thought processes retain their normal aspect even if
psychiatrically dissected. One finds…a solid and substantial structural image of the sane and
rational mind.”
“…one usually finds verbal and facial expression, tones of voice and all the other signs we have come to regard as implying conviction and emotion and the normal experiencing of life as we know it …and we assume it to be in others. Only very slowly, and …by intuitive judgment,
does the conviction come upon us that, despite these intact rational processes and their
consistent application in all directions, we are dealing here not with a complete man at all but
with what might be thought of as a subtlely constructed reflex machine which can mimic the
human personality perfectly.”
On treatment, Chapter 25:
“The present writer humbly confesses he has found all true examples of semantic dementia to be very little influenced by therapeutic efforts.”
“…..makes it necessary to place him on wards where patients are closely confined and
supervised…”
“An old physician…suggested that they be carefully gathered from all over the earth, placed on some large habitable island with all the equipment and supplies needed to establish
themselves, and then forgotten by the rest of humanity.”
On occurrence, Chapter 25:
“In this writer’s opinion approximately as many beds as those now occupied by all other
psychotic patients in the nation would scarcely be an exaggerated estimate.

1942. Butler, F.O. ” The Defective Delinquent.” American Journal of Mental Deficiency.

Chesler, A., LaBelle, G.C. and Himwich, H.E. “The Relative Effects of Toxic Doses of Alcohol on Fetal, Newborn and Adult Rats.” Quarterly Journal Studies in Alcohol.

****************************************************************************** 1942. Howard W. Haggard and E.M. Jellinek received a grant from the Rockefeller Foundation to conduct a study that refuted the research that indicated that maternal drinking adversely affected the unborn child. (from Philip Pauly. “How Did the Effects of Alcohol on Reproduction Become Scientifically Uninteresting in the Early Twentieth Century.” Journal of the History of Biology.)
E.M. Jellinek became famous for his work, The Disease Concept of Alcoholism, New Haven: College and University Press, published in 1960. It was the first work that suggested that alcoholism was a disease rather than a matter of personal choice or a flaw of character.

******************************************************************************
1944. Crime and the Human Mind by Dr. David Abrahamsen of the Department of Psychiatry, Columbia University. Morningside Heights: Columbia University Press. Dr. Abrahamsen writes in Chapter VI: The Psychology of the Individual Offender: Classification of the psychopathic offender.
“…we have discussed criminals with neurotic characters, including in this group, those persons who are known…as psychopathic personalities. Since this term has been in use for over a hundred years…it is probably impossible to dispense with it…”

“…one is inclined to designate as psychopathic personalities all those persons who do not fit into…other groups.”
“…the term psychopathic personality has been used to mean a certain person who because of deviations and inadequacies in his personality and in his mental make up is neither mentally defective nor psychotic, but has a defect, especially regarding his character or emotions.”
“We…will define a psychopath as an abnormal personality who suffers because his aberrant character or one who because of his abnormalities disturbs society.”
“A psychopath may…show less valuable qualities.”
“…we find among offenders persons with a superior intelligence who are endowed with a capacity to accomplish criminal acts which are not only…well done but also eccentric.”
“…most of them should be classified in the near neurotic or in the neurotic character group.”
“…usually self centered, aggressive and emotionally unstable.”
“…superior attitude…showed little inclination to be corrected.”
“There has been an inclination to include practically all chronic criminals in this group and even to restrict it to the antisocial.”
“The psychopath cannot express love.”
“…earliest childhood…caused trouble by truancy, petty stealing or some other antisocial activity.”
“D.K. Henderson has given this definition: The term psychopathic state is the name given to those individuals who conform to a certain intellectual standard, sometimes high, sometimes approaching the realm of defect…who have…exhibited disorders of conduct of an antisocial or social nature…which have proved difficult to influence by methods of social, penal or mental care and treatment and for whom we have no adequate provision of a preventative or curative nature.”
“It is usually found that the age distribution varies from about fifteen to thirty-five or forty, the peak age being about twenty.”
“…the psychological development extends over a longer period of time (than the normal person).”
“..his instability begins in childhood, reaches a peak in young adulthood and then drops down in the late twenties and early thirties.”
“Partridge wants to change the term psychopath to sociopath…”
In Chapter X, Treatment and Research, Abrahamsen goes onto say about the Neurotic Character: “The offenders with neurotic characters represent the most difficult problem to the psychiatrist and prison authorities.”
“Punishment is without success, except that incarceration protects society…”
“…one may consider the possibility of whether a training program…might be considered. This could only be accomplished by keeping them under a continued disciplined regime in a friendly way.”
“…treat them firmly but at the same time, let them know they are not rejected.”

1947. Developmental Diagnosis: Normal and Abnormal Child Development by Drs. Arnold Gisell and Catherine Amatruda. Dr. Gisell was a professor in the Clinic of Child Development at the Yale School of Medicine. Under the chapter, Amentia of High Grade, Section 4 is titled “Inferior Endowment” and contains the following statements:
“…those individuals who without being definitely defective are nevertheless well below average with respect to developmental status…”
“…border on amentia without being certifiably feebleminded.”
“…a highly diversified category…distinguished (by) three types: (1) borderline dull (2) borderline unstable (3) borderline defective.”
“Borderline dull denotes a mild degree of retardation and a general reduction of performance particularly in the fields of language and adaptive behavior.”
“Borderline unstable denotes a similar inferiority combined with impulsivity, highly changeable and other atypical emotional reactions.”
“Borderline defective. …The behavior is relatively well organized and balanced. In quality and caliber it is defective but not sufficiently so as to warrant a diagnosis of frank amentia.”
Gisell warns, “The foregoing distinctions must rest on clinical impressions rather than on precise objective criteria. They are useful as descriptive diagnoses.” He goes on to elaborate on borderlineunstable: “A borderline unstable child displays unsteadiness and exaggeration in his emotional reactions and atypical deviations in one or more fields of behavior. …Discrepancies and disparities become apparent when his maturity is separately evaluated for the several fields of behavior.”
Gisell goes on to describe four cases:
“…over active, over afraid of men, not interested in toys…touches objects in a gingerly manner…”
“…rapport between himself and the examiner was shallow and variable.”
“…perservative and stereotyped manner…”
“..described as ’stubborn, backward, slow, very jealous, craves an unusual amount of attention’…”
“Screams at about 5 o’clock and refuses to eat supper; moans in bed; wakes at night with weird cries; clings to bottle; refuses cup.”
“…rocked back and forth incessantly…”
“…failure to carry out differential commands…”
“..her amiable personality cast a spell which tended to conceal her fundamental limitations…”
“The somewhat inferior quality of her intelligence and judgment make it necessary to provide good supervision and training throughout adolescence. If she is adequately protected, there is an excellent prospect of her making a satisfactory social and vocational adjustment in adult life.” (Gisell, however, does not follow this case into adulthood.)
Section 5 is titled “Pseudo-Symptomatic Retardation” and contains the following observations:
“There is a type of retardation which is falsely ascribed to such causative factors (unfavorable institutional or home environments), but which in reality a true amentia…”
“He does some thing so well.”
“He understands so much.”
“It is though he were thwarted and as though something were holding him back.”
“He has an excellent disposition.”
“He has more abilities than he likes to use.”
“He seems unhappy.”
“…there are residues of behavior which resemble the normal so much…”
“…the child may show extreme fixations on one toy, or on one pastime…”
“There may be an excessive amount of rocking or mouthing, ofjargoning, of chewing, clicking, respiratory and other mannerisms.”
“…heedlessness to sound or oblivious to persons…”
“…frequently found in association with hyperactivity.”
“…the activity and the bizarre exaggeration are frequently associated with an attractive
countenance and a far-away, wistful expression which builds up an impression of dormant or
obscured normality.”
“Parents go to heroic lengths to re-educate the child and remove the obstructions which they believe are retarding or deflecting the child’s development.”
“…the parents of these children do a lot of ’shopping around’. They try one expedient or one program after another.”
“But the retardation is…organic and symptomatic.”
“…the mental deficiency may be of either high or low grade.”
“..heedlessness to the spoken word and the failure to talk.”
“…slow weight gains.”
“Any progress he makes will be exceedingly slow.”
“School, in the ordinary sense, will be quite beyond him.”
Gisell and Amatruda also noted that “The parents are encouraged to believe that the child will find himself in time.” But they advise, “If you can bring yourself to shaping your child’s need to her needs…your own distress will be reduced. If there is a remote chance that a change will occur, you will be increasing that chance more by these means than by constantly sustained efforts to teach her beyond her capacity to learn.”. Advice often promoted by today’s experts in FAS education.

1950-1972. The 26 page study, “The Effects of Drinking on Offspring: A Historical Survey of American and British Literature.” by Rebecca Warner and Henry l. Rosett. (1975) in The Journal of Studies on Alcohol. cites 14 articles written in this period that warn of the danger of drinking during pregnancy. Copies of these articles are not included in this study. I may include them at a later date if I can obtain them.

1950. The Merck Manual: Eighth Edition. The first six editions of the Merck Manual, starting in 1899, were pharmaceutical references which listed medicinal remedies for specific conditions. Starting with the Sixth Edition in 1934, the Merck Company started to include diagnostic indications but did not include pediatric, psychiatric or psychological sections. Therefore, I have not included the editions prior to 1950.
The Eighth Edition was the first to contain a section on Neuropsychiatric and Psychosomatic conditions, none of which are recognizable as descriptive of FASD behavior.
In modern times, the Merck Manual is considered to be the “medical handbook” for medical and ancillary medical personnel. It is used as a reference, diagnostic and therapeutic guide.

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