1. 2448 Hamilton Road, Bright's Grove, Ontario N0N 1C0
FASlink Fetal Alcohol Disorders Society
2448 Hamilton Road, Bright's Grove, Ontario N0N 1C0
Phone: (519) Website:

2. Don’t Ask My Child to Fly
© Bruce Ritchie 1997

3. Don't ask my child to fly,
for he has not wings. .

4. Don't ask my child to remain calm amid the din,
for her ability to screen out the noises has been taken away.

5. Don't ask my child to be careful with "strangers",
for he is affectionate with everyone and prey for the unscrupulous. .

6. Don't ask my child to "settle down",
for the clock which works for you and I,
does not exist for her. .

7. Don't ask my child to not play with the toys of others,
for he has no concept of property.

8. Don’t ask my child to remember you tomorrow,
although you met today. .

9. Don't ask my child to heal your wounds,
for her hands cannot hold a scalpel or sutures.

10. Don't ask my child to meet the challenges set by society,
for you have denied her the tools. .

11. Don't ask my child to forgive you for standing idly by,.
while he was in trouble in his mother's womb,

12. for he will,
but He may not.

13. An individual’s place, and success, in society is almost entirely determined by neurological functioning.

14. A neurologically injured child is unable to meet the expectations of parents, family, peers, school and career and can endure a lifetime of failures.
The largest cause of neurological damage in children is prenatal exposure to alcohol.
These children grow up to become adults.
Often the neurological damage goes undiagnosed, but not unpunished.

15. What is FASD? Fetal Alcohol Syndrome (FAS),
Fetal Alcohol Effects (FAE),
Partial Fetal Alcohol Syndrome (pFAS),
Alcohol Related Neurodevelopmental Disorders (ARND),
Static Encephalopathy (alcohol exposed) (SE) and
Alcohol Related Birth Defects (ARBD) are all names for a spectrum of disorders caused when a pregnant woman consumes alcohol.

16. "Of all the substances of abuse, including heroin, cocaine, and marijuana, alcohol produces by far the most serious neurobehavioral effects in the fetus.”
--Institute of Medicine 1996 Report to Congress

17. Ethanol alone was found to interact with over 1000 genes and cell events.
Ethanol responsive genes directly regulate and are themselves regulated by the activity of other proteins and cell processes.
Genetics
Uddin RK, Treadwell JA, Singh SM Department of Biology and Division of Medical Genetics, The University of Western Ontario

18. There is no safe level of alcohol consumption during pregnancy.

19. FASD is 100% Preventable

20. Legally intoxicated is defined as a Blood Alcohol Level (BAL) of .08%.
Permanent brain cell damage begins at a BAL of .07%.
A 100 lb (45 kg) female consuming 5 standard drinks will reach a BAL of .25% - three times the legal limit. BAL reduces .01% per hour.
A drink equals a 12 oz. regular beer, 1 oz. shot of 100 proof liquor, 1.5 oz. shot of 80 proof liquor, or 4 oz. glass of regular table wine.

21. Statistics Canada, Canadian Community Health Survey, 2000/01
6.8% of girls ages 12 to 14
19.8% of girls age 12 to 19
26.0% ages 20 to 24
19.9% ages 20 to 34 consumed 5 or more drinks on each occasion 12 or more times per year An additional:
13.8% of girls ages 12 to 14
32.2% ages 15 to 34 consumed 5 or more drinks on each occasion 1 to 11 times per year.

22. Prenatal Alcohol Exposure
37% of babies have been exposed to multiple binges (5+ drinks/session), often before the girl knew she was pregnant.
Another 42% are exposed to multiple sessions of 1 to 4 drinks per occasion.
15% to 18% continue to drink throughout the pregnancy, 4% at elevated levels.

23. Maternal prenatal alcohol consumption even at low levels is adversely related to child behavior.
The effect was observed at average exposure levels as low as 1 drink per week.

24. Alcohol Startle Response
Just one glass of wine a week can make babies “jump” in the womb throughout a nine-month pregnancy. Experts believe this abnormal hyperactive behaviour is the result of alcohol slowing or retarding the formation of the central nervous system.
Ultrasound image of fetus when exposed to alcohol

25. FASD is so grossly under-reported that the traditional FAS statistics are almost meaningless.
Very few doctors have received any training in diagnosing FASD
Many will not diagnose FASD for fear of stigmatizing the child and/or the mother.

26. FASD is not a threshold condition.
FASD is a continuum ranging from mild intellectual and behavioural issues to the extreme that often leads to profound disabilities or premature death.
It is somewhere in the middle of the continuum that the issues attract the attention of parents, educators, medical and social work professionals, and eventually the justice system.

27. Incidence
Most of the issues that attract sufficient attention are behavioural and performance issues.
"The most outstanding characteristics of FAS are bad judgment and the inability to make the connection between an act and its consequences." (Streissguth, AP)

28. Incidence
Approximately 20% of Canadian school age children are receiving special education services, most for conditions of the types known to be caused by prenatal alcohol exposure.

29. Alcohol as a teratogen
Foolish, drunken, or harebrain women most often bring forth children like unto themselves Aristotle in Problemata
Behold, thou shalt conceive and bear a son: And now, drink no wine or strong drink.
Judges 13:7 (1070 B.C.)

30. Effects of Alcohol as a Teratogen on the Baby

31. Brain damage resulting from prenatal alcohol
photo: Clarren, 1986

32. Alcohol is toxic at all concentrations
Damage varies due to volume ingested, timing during pregnancy, peak blood alcohol levels, genetics, mother’s health and nutrition, and environmental factors.

33. FASD is a lifetime disability
It is not curable. A child does not "grow out of it".
However, early diagnosis and intensive, and appropriate, intervention can make an enormous difference in the prognosis for the child.

34. FAS – Only the tip of the iceberg
Fetal Alcohol Syndrome
Partial Fetal Alcohol Syndrome
Alcohol Related Neurodevelopmental Disabilities
Alcohol Related Birth Defects
Clinically suspect but appear normal
Normal, but never reach their potential
Adapted from Streissguth

35. Early diagnosis can help prevent secondary disabilities such as
mental health problems
dropping out of school
trouble with the law and
substance abuse.

36. Parents often find that their ability to cope with the child's behavior changes dramatically when they understand that the problems are most likely based on organic brain damage, rather than the child's choice to be inattentive or uncooperative.

37. Prenatal alcohol damage can include:
Loss of intellectual functioning (IQ)
Mild to severe vision problems
Dangerously high pain tolerance
Severe loss of intellectual potential
Mental Retardation
Dyslexia
Serious maxilo-facial deformities
Dental abnormalities
Cleft palate

38. Immune system malfunctioning
Behavioral problems
Attention deficit disorders
ADD/ADHD
Extreme impulsiveness
Poor judgement
Little or no retained memory
Deafness
Little or no capacity for moral judgement

39. Little or no capacity for interpersonal empathy
Sociopathic behaviour
Epilepsy
Tremors
Cerebral palsy
Renal failure
Asthma
Complex seizure disorder

40. Developmental speech and language disorder
Developmental delay
Height and weight deficiencies
Tight hamstrings
Cognitive perseveration
Echolalia
Autistic traits
Rigidity
Sleep disorder

41. Developmental coordination disorder
Adaptive esotropia
Tourette's traits
Central auditory processing disorder
Night terrors
Precocious puberty
Social problems

42. Depression
Reactive outbursts
Heart defects
Heart failure
Suicide
Death

43. FAS Physical Abnormalities
98% are under normal height and weight
84% Microcephalic
89% Mental and Motor Retardation
80% Speech impediments
20% Hearing problems
20% Swallowing/Feeding problems
72% Hyperactive
58% Slack muscles
20% Autism/Aggressive/Social Problems

44. FAS Physical Abnormalities
95% Facial anomalies
29% Heart defects
10% Kidney defects
46% Genital deformities
25% Eye problems
16% Bent crooked little finger
51% Shortened and bent little finger
13% Underdeveloped fingers
9% Hip deformities
16% Small teeth

45. FAS Physical Abnormalities
30% Pigeon Chest
7% Concave chest
7% Cleft palate
44% Spinal dimple
12% Hernia
35% Hairgrowth on back of neck

46. Without diagnosis, FASD can create a number of secondary disabilities.

47. The girls get knocked up and the boys get locked up.
They are followers, easily misled, with little or no appreciation of consequences. Without intervention, many drop out of school, ride the justice system merry-go-round or become "homeless street people and squeegee kids".
They are required to compete in society but have been denied the tools to do so.

48. The brain's Frontal Lobes control:
judgement, inhibition, concentration, self-control, conscience, personality and emotional traits as well as cognition and memory, motor speech and movement skills.

49. The Left Hemisphere deals with language based memory
logical interpretation of language
mathematics
abstraction and reasoning
facts and rules (such as safety and social).

50. The Right Hemisphere deals with holistic functioning
processing of images, sound, touch,
for a "holistic" picture.
Memory here is visual, auditory and spatial.

51. So, the Left side is logic, facts, rules.
The Right side is sensory input and reactive.

52. The Corpus Callosum
connects right and left sides to allow communication between the hemispheres.

53. The Right side senses input, checks with the Left side to see if there are rules to deal with this pattern of input, integrates the stored information and reacts in a modified way.
Damage to any of these systems causes very poor, impulsive and inappropriate response.

54. Corpus callosum abnormalities
Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

55. Alcohol seriously damages the physical structures, "wiring" and brain chemistry.

56. FAS (Fetal Alcohol Syndrome) individuals have a distinctive physical appearance and lower IQs, but have lower crime and addiction rates than individuals with FAE/ARND as they get earlier diagnosis and can be better protected by society and their parents.
photo: Clarren

57. While individuals with FAE (Fetal Alcohol Effects) / ARND (Alcohol Related Neurodevelopmental Disabilities) may lack the outward physical appearance of alcohol damage, the internal damage to the brain and other organs can be just as serious as FAS with the outward physical appearance features.

58. However, because individuals with ARND / FAE "look normal" they are expected to perform normally. These issues lead to secondary disabilities.

59. Individuals with ARND / FAE between the ages of 12 and 51:
95% will have mental health problems;
68% will have "disrupted school experience";
68% will experience trouble with the law;
55% will be confined in prison, drug or alcohol treatment centre or mental institution;
52% will exhibit inappropriate sexual behaviour.

60. Individuals with ARND / FAE between 21 and 51:
more than 50% of males and 70% of females will have alcohol and drug problems;
82% will not be able to live independently;
70% will have problems with employment

61. It is useless and cruel to punish someone for having been born with a disability.
You cannot cure brain injury with punishment.

62. Costs of FASD:
Each individual with FAS individual costs the taxpayer more than $3 million (Canadian Funds) in his or her lifetime (health problems, special education, psychotherapy and counseling, welfare, crime, and the justice system).
More than 50% of prisoners are affected by prenatal alcohol exposure.
It costs approximately $120,000/year to imprison a Young Offender and $82,000 for an adult offender.

63. Add on: the lifetime loss of income
the high costs to the families (foster, adoptive or biological) who raise and care for children and adults with FASD
the lost income of a parent who must care for the exceptionally high needs of a child with FASD

64. Add on:
the costs to families whose child with FASD is permanently dependent upon them
the costs of legal services for defending their child in the courts
the cost of stress caused divorce, etc.
The list goes on and on.

65. That is your baby's brain on alcohol.
Demonstration
Break a raw egg into a wine glass. Add one ounce of alcohol. Watch the clear part develop white streaks as the alcohol "cooks" it.
That is your baby's brain on alcohol.

66. Student Checklist learns a simple task but forgets quickly
hurts others by biting, kicking, etc.
has not developed any friendships
seems not to hear so a hearing loss is suspected
frequently does not attend to social / environmental stimuli
does not use toys appropriately

67. does not follow simple commands that are given once
strong reactions to routine/changes in environment
does a lot of lunging and darting about
not responsive to other people's facial expressions/feelings
has special abilities in one area of development which seems to rule out mental retardation

68. Speech does not follow simple commands involving prepositions
severe temper tantrums or frequent minor tantrums
does not imitate other children at play
does not wait for needs to be met, wants things immediately
difficulties with toilet training
often frightened or very anxious

69. looks through people
frequently unaware of surroundings and may be oblivious to dangerous situations
is very destructive
a developmental delay was identified at or about 30 months of age
stares into space for long periods of time

70. as a baby was irritable with weak sucking reflex
as a baby had feeding difficulties
as a baby experienced difficulty establishing regular sleeping patterns
not afraid of strangers
short for age
small head
strong need for bodily contact (patting, touching, etc.)

71. problems in fine motor control
problems in gross motor-control
trouble with sequencing (counting, etc.)
difficulty controlling impulses
Difficulty predicting consequences
difficulty understanding abstract concepts
difficulty seeing sameness in daily living situations and in making generalizations

72. Some Solutions: Medical Education
Teach physicians and other health professionals to screen, diagnose and treat FASD.
Recognize and deal with the continuum, not just the extremes of FASD.
Actively screen for alcohol use in all patients and give advice.
Recognize medical issues of alcohol and all personal, family and societal ramifications.

73. Some Solutions: FASD Prevention
Folic Acid should be added to all beverage alcohol.
Break the cycle. Properly fund addiction intervention and rehabilitation programs.
Identify women at risk of having children with FASD and intervene.
Meconium testing for Fatty Acid Ethyl Esters should be mandatory for every birth.
Intensive family and social service supports for FASD and recovering alcoholics.
Poverty is a result of, and breeds, substance abuse. Deal with it.

74. Some Solutions: Alcohol Vendors
The beverage alcohol industry pays less than 1% of the total damages caused by their products. Increase taxes on beverage alcohol.
All tax revenue to be returned to support rehabilitation programs and victims of alcohol.
Remove all incentives for governments to promote alcohol.

75. Some Solutions: Alcohol Vendors
End all government supports for beverage alcohol industry, including "wine and beer tourism".
End all alcohol advertising.
Alcohol must be served with food.
Breathalyzers in all alcohol establishments.
Ban alcohol sales incentives, contests, games.
Ban "Happy Hour" discounted promotions. They encourage binge drinking.

76. Some Solutions: Public Education
Educate the public that addiction is a medical issue not a moral failure.
Educate children from a very young age about dangers of alcohol.
Have youth design anti-alcohol programs targeting youth.
The ONLY purpose of beverage alcohol is to make your brain take a hike.

77. Some Solutions: Research
Better diagnostic tools for the full range of FASD damage.
True incidence and scaling of FASD damage.
Chemically turn-off addiction center in brain.

78. Prevention – The Birth to 3 Program
Parent-child assistance program
Intensive home visitation model for the highest risk mothers
Paraprofessional Advocates
Paired with client for 3 years following the birth of the target Baby
Link clients with community services
Extensively trained and closely supervised
Maximum caseload of 15
Outcomes
Fewer alcohol/drug affected children
Reduced foster care placement
Reduced dependence on welfare
Grant, T.M., 1999; Ernst, C.C., et al

79. Discussion Topics FASlink Support Family environment Community healing
The Professionals
Addiction recovery
Medication
Calming techniques
Furniture safety
Sleeping tent
Early diagnosis
Early intervention
School intervention
Justice System
Careers
Financial Help
Disability Income
Special Services at Home
Disability Tax Credit
Friendships
Scouting
School
Music

80. FASlink
provides Internet online information and support resources for those dealing with medical, legal and educational issues of children prenatally exposed to alcohol.

81. FASlink www.faslink.org
FASlink serves parents (birth, foster, adoptive and grandparents), caregivers, adults with FAS, doctors, teachers, social workers, lawyers, students, government policy makers, and others whose lives are touched by Fetal Alcohol Syndrome.

82. FASlink FASlink’s website serves more than 400,000 people annually.
FASlink receives about 100 letters per day to be shared with the members through the FASlink Discussion Forum.

83. FASlink
The FASlink Archives are an online searchable database of more than 100,000 letters and articles on FASD issues.
It is the largest FASD resource in the world.

84. FASlink provides:
Information, advocacy and support services for individuals and families dealing with FASD
Education of professionals (medical, educational, social services and justice)
Electronic publishing of Internet and CDROM based FAS information and tools

85. FASlink provides: Initiatives in public information and education
Monitoring of company, governmental and NPO activities, research and legislation that may affect FAS individuals.
International co-operation and support
Concept development for long-term care options.

86. FASlink provides:
Initiatives for the development of diagnostic clinics
Concept development for rehab facilities for pregnant substance abusers and their dependant children.
Development of alternatives to justice system incarceration for individuals with prenatal brain injury.

87. FASD is 100% Preventable