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.