This Is Your Child's Brain on Alcohol

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BY MARY JANE ROTHERAM-BORUS AND MARK TOMLINSON SEPTEMBER 12, 2014

IDEAS

Mary Jane Rotheram-Borus is a professor of psychology and the director of the UCLA Global Center for Children and Families.
Mark Tomlinson is a professor of psychology at Stellenbosch University in South Africa.

Social scientists have calculated that detrimental effects of alcohol cost the U.S. some $223.5 billion a year. We’re talking health issues such as liver disease, impaired driving, lost work due to hangovers, and emergency room visits. Alcohol costs substantially more to Americans than the harmful effects of illicit drug use ($151.4 billion) or tobacco ($167.8 billion).

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But there’s a more disturbing cost that you might be surprised to learn about that’s not even factored into those staggering numbers: fetal alcohol spectrum disorders, the conditions that can result when a mother drinks during pregnancy. (When all of the disorders are present, in their most severe forms, we call it fetal alcohol syndrome.) According to the U.S. Centers for Disease Control and Prevention, almost all of these children will have mental health problems as adults and 82 percent will not live independently. During adolescence, they also face an increased risk of drug and alcohol addiction. As a result, the lifetime cost of providing services to just one person with fetal alcohol spectrum disorder in 2002 was about $2 million. And 40,000 children are born each year in the U.S. with the disorders.

While both of us will have a beer or glass of wine with friends, neither Mary Jane nor Mark’s wife had a drink of alcohol while pregnant. Our friends and our doctors, along with casual reading on the subject, had impressed on us the serious risks and we decided it was not worth it. Only about 12.2 percent of pregnant women drink in the United States; however, in low- and middle-income countries about double that number of women will drink during pregnancy.

The two of us really saw the visceral impact of fetal alcohol spectrum disorders when we started working on improving mothers’ and children’s lives in South Africa. Fetal alcohol spectrum disorder affects as many as one in 10 children entering first grade in South Africa, the highest reported rate in the world.


Up until the 1990s, black South Africans were partially paid for their work in fields with a “DOP” or portion of wine. Drinking alcohol continues to be a part of the daily fabric of life in the townships—including brewing (and drinking) beer or spirits at home and visiting local bars known as shebeens. Alcohol is directly related to the high unemployment rates, especially for men in the townships—up to half of the young men are un- or under-employed over their lifetime.

The impacts of a mother drinking during pregnancy are not seen immediately. Brain damage slowly shows itself when the baby is small and fails to grow, speech comes late, colors are not learned by kindergarten, and school becomes a daily challenge. As we walked through informal settlements in Cape Town and Worcester—shacks without running water or flush toilets—we saw stunted and malnourished children playing outside all day long, many with the telltale signs of the disorder. Their faces feature foreshortened chins, thin upper lips, a flat mid face, short nose, and low nasal bridge. We couldn’t help but think ahead to the problems these children will have in school and their increased likelihood for dropping out. Their futures evaporated before they had a chance to grow, because of what their mothers knowingly or unknowingly drank before they were even born.

About one in four pregnant women in South Africa drink alcohol before recognizing she is pregnant and, without intervention, women who drank before realizing they were pregnant drank much more throughout their pregnancy. Even though there has lately been much chatter about how the occasional glass of wine with dinner should be OK, there really is no known “safe” amount of alcohol to drink during pregnancy. There is also no known safe period to drink during pregnancy. Binge drinking is by far the worst thing to do while pregnant—large doses (even if infrequent) are far worse than a small amount of alcohol routinely. Unfortunately, among alcohol drinkers in America, one in four binge drink, typically on weekends. This includes women who knowingly or unknowingly binge drink while pregnant.

The variations in how and when people drink may be the reason we have not been able to eliminate the negative consequences of alcohol during pregnancy. While access to drugs is often limited in many parts of the world, alcohol is almost universally available, especially in low-income countries because it can be manufactured locally. Brief, one-time counseling sessions that focus on the vulnerability of a fetus during pregnancy can help mothers understand the risks and reduce their drinking while pregnant. At sessions we offered to expectant mothers in South Africa, the influence of alcohol on a developing brain is starkly demonstrated by cracking an egg in alcohol at room temperature—the egg poaches. A child’s brain is fried when alcohol is circulating through its body. However, most women worldwide do not have access to these interventions. Compounding the problem: local healers throughout the world often use alcohol-laced remedies to help their clients relax. Pregnant women are often encouraged to take brews that include alcohol.

Here in the U.S., alcohol is embedded in almost all of our social rituals. Mary Jane’s parents in Los Angeles never drank, but they always had liquor to offer friends who came over for dinner. She does not know a male colleague who does not fancy himself a wine connoisseur and has been flabbergasted at the amount of money peers will spend on bottles of wine. Christmas, Yom Kippur, football tailgate parties, and practically all developmental milestones (graduations, child births, deaths) are marked with alcohol.

Given that alcohol permeates our lives—and every individual responds differently to alcohol—we have a responsibility to support one another and create a culture where “yes” is not the expected answer to, “Do you want a drink?” Genetic influence when it comes to alcohol abuse is real and scary. Some people are able to drink and never develop an addiction, while for others alcohol is a daily craving that is difficult to control. Previous attempts at controlling alcohol use that frame it as a question of willpower didn’t work. We need a more community-level approaches with policies like the ones we already have with the minimum age of drinking, restriction of bars in the proximity of schools, demonstration of a legal I.D. in order to purchase alcohol, and punishment of bar owners who continue to serve intoxicated customers.

National rates of tobacco smoking decreased as a result of structural and policy changes, including higher tobacco taxes, bans on smoking in restaurants and workplaces, and limits to the ability to when and where tobacco can be bought. Alcohol use could be similarly regulated—through higher alcohol taxes, continued limits on buying liquor based on the time of day or day of the week, and limiting alcohol at sports events, especially collegiate sports, or at educational events and professional conferences. Changing social rituals – such as bringing alcohol to parties, celebrating major achievements with champagne, marking the end of a work week with getting drunk- will take much longer to shift. Perhaps we could bring premium fruit juices to dinner parties instead.

In the next year, another 40,000 infants will be born with fetal alcohol spectrum disorders in the U.S. Following on the heels of Fetal Alcohol Spectrum Disorder Awareness Day earlier this month, we encourage you make a personal pledge to watch out for yourself, your friends, and people you encounter casually who may be at risk of creating a child with the disorder. The price to our children, our families, and our future is too high.

Mary Jane Rotheram-Borus is a professor of psychology and the director of the UCLA Global Center for Children and Families. Mark Tomlinson is a professor of psychology at Stellenbosch University in South Africa. They wrote this piece for Zocalo Public Square.

Contact us at editors@time.com.

How The Justice System Failed Cyntoia Brown

How The Justice System Failed Cyntoia Brown

LEAH CARROLL

LAST UPDATED DECEMBER 12, 2018, 9:11 AM

Find the original article here.

On December 6, the Tennessee Supreme Court ruled that Cyntoia Brown, a woman convicted of first degree murder as a teen, would have to serve 51 years in prison before being eligible for parole. The decision disregards many factors including that Cyntoia Brown was solicited for sex by a 43-year-old man when she was only 16, the fact that both Tennessee and U.S. law has changed significantly when it comes to prosecuting minors since Brown’s first trial in 2006, and the outrage expressed by hundreds of thousands in a number of petitions protesting the egregious sentencing of an at-risk-child at the mercy of a series of a predatory men.

The Case Against Cyntoia Brown

On August 7, 2004 Nashville Police responded to a 911 call and found the body of 43-year-old Johnny Allen. Allen was nude, lying face down in his bed. He’d been shot in the back of the head. In the early morning hours of August 8, police found Allen’s white pick up truck in a parking lot and arrested 16-year-old Cyntoia Brown in connection with the shooting. At the time, she was staying in a nearby hotel with a man she referred to as “Cut Throat.” Brown had taken Allen’s wallet and some of his guns.

She waived her Miranda Rights and told investigators that Allen had solicited her for sex on August 6 and driven her to his home where he showed her guns and became violent. She feared for her life and shot him with a .40-caliber handgun she had in her purse, killing him in self defense.

PHOTO: LACY ATKINS/THE TENNESSEAN/AP PHOTO.

PHOTO: LACY ATKINS/THE TENNESSEAN/AP PHOTO.

On December 6, the Tennessee Supreme Court ruled that Cyntoia Brown, a woman convicted of first degree murder as a teen, would have to serve 51 years in prison before being eligible for parole. The decision disregards many factors including that Cyntoia Brown was solicited for sex by a 43-year-old man when she was only 16, the fact that both Tennessee and U.S. law has changed significantly when it comes to prosecuting minors since Brown’s first trial in 2006, and the outrage expressed by hundreds of thousands in a number of petitions protesting the egregious sentencing of an at-risk-child at the mercy of a series of a predatory men.

The Case Against Cyntoia Brown

On August 7, 2004 Nashville Police responded to a 911 call and found the body of 43-year-old Johnny Allen. Allen was nude, lying face down in his bed. He’d been shot in the back of the head. In the early morning hours of August 8, police found Allen’s white pick up truck in a parking lot and arrested 16-year-old Cyntoia Brown in connection with the shooting. At the time, she was staying in a nearby hotel with a man she referred to as “Cut Throat.” Brown had taken Allen’s wallet and some of his guns.

She waived her Miranda Rights and told investigators that Allen had solicited her for sex on August 6 and driven her to his home where he showed her guns and became violent. She feared for her life and shot him with a .40-caliber handgun she had in her purse, killing him in self defense.

Prosecutors argued that Brown’s real motive was robbery and despite her age she was charged as an adult with first-degree felony murder and aggravated robbery. She was sentenced to two concurrent life sentences.

Cyntoia Brown’s Childhood

At her original trial, Brown wasn’t allowed to testify on her own behalf and her attorneys didn’t offer into evidence her traumatic childhood history and severe neurodevelopmental disorder.

Brown’s mother drank alcohol — as much as "a fifth a day, if I could get it" she later admitted —throughout her pregnancy. As a result Brown is on the fetal alcohol spectrum disorder which can result in “poor impulse control and a disconnect between thought and action.” At eight-months-old, Brown entered the foster care system and became a runaway in her early teens. She experienced numerous rapes and assaults during this time.


In 2004 she began living in a series of hotels with the 24-year-old man she called “Cut Throat.” Her relationship with Cut Throat was sexually, physically, and emotionally abusive. He pulled a gun on her multiple times and once choked her so hard she passed out. Eventually he forced her into prostitution.

Brown later testified that, "He would explain to me that some people were born whores, and that I was one, and I was a slut, and nobody'd want me but him, and the best thing I could do was just learn to be a good whore.”

On the night of August 6, he ordered her to go out and “get money.” Brown met Allen later that evening in the parking lot of a Sonic franchise. He agreed to pay $150 for sex and drove them both back to his home where she later shot him.

Brown’s Case Gains Publicity

Filmmaker Dan Birman had been following Brown’s case since her arrest, after being tipped of to the story by a forensic psychiatrist who’d been asked to interview her. In 2011, his film, “Me Facing Life: Cyntoia’s Story” debuted on PBS. The documentary took on many of the complicated angles of the case including juvenile justice reform, Brown’s flawed first trial and the ways in which it was prejudiced by the fact that she was a woman of color engaging in sex work, and the lack of a social safety net available to young at-risk women like Brown — who are at a high risk for sex trafficking.

On December 6, the Tennessee Supreme Court ruled that Cyntoia Brown, a woman convicted of first degree murder as a teen, would have to serve 51 years in prison before being eligible for parole. The decision disregards many factors including that Cyntoia Brown was solicited for sex by a 43-year-old man when she was only 16, the fact that both Tennessee and U.S. law has changed significantly when it comes to prosecuting minors since Brown’s first trial in 2006, and the outrage expressed by hundreds of thousands in a number of petitions protesting the egregious sentencing of an at-risk-child at the mercy of a series of a predatory men.

The Case Against Cyntoia Brown

On August 7, 2004 Nashville Police responded to a 911 call and found the body of 43-year-old Johnny Allen. Allen was nude, lying face down in his bed. He’d been shot in the back of the head. In the early morning hours of August 8, police found Allen’s white pick up truck in a parking lot and arrested 16-year-old Cyntoia Brown in connection with the shooting. At the time, she was staying in a nearby hotel with a man she referred to as “Cut Throat.” Brown had taken Allen’s wallet and some of his guns.

She waived her Miranda Rights and told investigators that Allen had solicited her for sex on August 6 and driven her to his home where he showed her guns and became violent. She feared for her life and shot him with a .40-caliber handgun she had in her purse, killing him in self defense.


Prosecutors argued that Brown’s real motive was robbery and despite her age she was charged as an adult with first-degree felony murder and aggravated robbery. She was sentenced to two concurrent life sentences.

Cyntoia Brown’s Childhood

At her original trial, Brown wasn’t allowed to testify on her own behalf and her attorneys didn’t offer into evidence her traumatic childhood history and severe neurodevelopmental disorder.

Brown’s mother drank alcohol — as much as "a fifth a day, if I could get it" she later admitted —throughout her pregnancy. As a result Brown is on the fetal alcohol spectrum disorder which can result in “poor impulse control and a disconnect between thought and action.” At eight-months-old, Brown entered the foster care system and became a runaway in her early teens. She experienced numerous rapes and assaults during this time.

In 2004 she began living in a series of hotels with the 24-year-old man she called “Cut Throat.” Her relationship with Cut Throat was sexually, physically, and emotionally abusive. He pulled a gun on her multiple times and once choked her so hard she passed out. Eventually he forced her into prostitution.

Brown later testified that, "He would explain to me that some people were born whores, and that I was one, and I was a slut, and nobody'd want me but him, and the best thing I could do was just learn to be a good whore.”

On the night of August 6, he ordered her to go out and “get money.” Brown met Allen later that evening in the parking lot of a Sonic franchise. He agreed to pay $150 for sex and drove them both back to his home where she later shot him.

Brown’s Case Gains Publicity

Filmmaker Dan Birman had been following Brown’s case since her arrest, after being tipped of to the story by a forensic psychiatrist who’d been asked to interview her. In 2011, his film, “Me Facing Life: Cyntoia’s Story” debuted on PBS. The documentary took on many of the complicated angles of the case including juvenile justice reform, Brown’s flawed first trial and the ways in which it was prejudiced by the fact that she was a woman of color engaging in sex work, and the lack of a social safety net available to young at-risk women like Brown — who are at a high risk for sex trafficking.

Birman’s film also helped change the law in Tennessee: Now children under the age of 18 cannot be tried for prostitution. If she were to arrested today, Brown would be treated as a child human trafficking victim.

Charles Bone, a prominent national attorney, saw the film and took on Brown’s case, representing her for a 2012 appeal. Bone argued that although Brown has a high IQ, she functions at the cognitive level of a 13-year-old as a result of her fetal alcohol spectrum disorder, traumatic and violent past, and her abusive relationship with her trafficker Cut Throat.

In 2017, Brown’s case came back into the spotlight when Rihanna shared Brown’s story on Instagram in a post that read: "Imagine at the age of 16 being sex-trafficked by a pimp named 'cut-throat.' After days of being repeatedly drugged and raped by different men you were purchased by a 43 year old child predator who took you to his home to use you for sex. You end up finding enough courage to fight back and shoot and kill him.”

Kim Kardashian, Cara Delevingne and other celebrities shared the post inspiring the viral hashtag #FreeCyntoiaBrown. In May 2017, Brown had a clemency hearing, but the board was split on their decision with two voting for clemency, two against it, and two to make her eligible for parole after 25 years.

Brown’s lawyers have continued to argue her case saying her sentence is unconstitutional based on a 2012 Supreme Court ruling that found that life imprisonment sentences for minors violate the Eighth Amendment's ban on cruel and unusual punishment.


Where Is Cyntoia Brown Now?

On Thursday, the Tennessee Supreme Court ruled that Brown’s sentence was not unconstitutional based on a loophole that defines a “life sentence” as 60 years. In a statement the court wrote "under state law, a life sentence is a determinate sentence of 60 years. However, the sixty-year sentence can be reduced by up to 15 percent, or 9 years, by earning various sentence credits." In other words, the court ruled that because Brown’s sentence is 51 years and not 60, it is not technically a “life sentence” and therefore doesn’t violate the US Supreme Court ruling that forbids convicting minors to prison terms equivalent to death in prison.

Even more galling: Brown was able to receive the credits that reduced her 60-year-sentence as a result of her own model behavior. She received her associates degree in prison and mentors other female inmates.

Brown’s case is currently pending judgment by the U.S. Sixth Circuit Court of Appeals.


Canadian fetal alcohol programs inspire Australian researcher

Read the original article HERE.

Social Work’s Dorothy Badry shares successful approaches with Australian counterpart

By Bob Blakey

November 26, 2014

As a specialist in Fetal Alcohol Spectrum Disorder (FASD) with years of experience in social work, associate professor Dorothy Badry knows you can’t walk into a family’s home and launch straight into the dangers of drinking alcohol while pregnant.

Half a world away in Western Australia, Robyn Williams, an Aboriginal woman and PhD candidate from Curtin University, has learned exactly the same thing.

After meeting for the first time recently in Alberta, and sharing knowledge in conjunction with various Canadian conferences, organizations and experts, Badry has confirmed some problems are universal. And Williams returned to her hometown of Perth, Australia, after her month-long Canadian journey equipped with valuable, practical understanding about responding to FASD in both countries and invaluable academic and agency contacts that are now just a phone call or email away.

“I’m taking back with me a new level of confidence and experience that you just can’t get out of books,” Williams says. “The people I’ve met through Dorothy have shown me how extensive the resources are here. Alberta has fetal alcohol programs that simply don’t exist in my country.

Robyn Williams, left, made a wealth of academic and community contacts during her month-long visit to Alberta, thanks to Dorothy Badry, associate professor in the Faculty of Social Work.  Photo courtesy of Dorothy Badry

Robyn Williams, left, made a wealth of academic and community contacts during her month-long visit to Alberta, thanks to Dorothy Badry, associate professor in the Faculty of Social Work. Photo courtesy of Dorothy Badry


“Now that I’ve done an intensive study trip over here and had training with some of the world’s best, I’m confident I can go back and start at the right point in each case I encounter.”

Experts from Canada and Australia encourage each other

Academics cross paths Both women are advancing knowledge through research and academic organizations. Badry’s expertise includes child and adolescent development, child welfare practice, child trauma particularly in relation to FASD, curriculum development, disabilities, and field education. She is also the academic lead for the University of Calgary’s Certificate in Working with Homeless Populations.

Robyn Williams, one of the Noongar people who are indigenous to the Southwest area of Western Australia, is doing her doctoral research on FASD in Aboriginal communities in her country with a mixed-methods approach — survey and interviews with communities around Perth, the largest city in her state, with the largest Aboriginal population. She has worked for more than 25 years in Aboriginal affairs, including community-based agencies and academia, designing curriculum and teaching at two universities.

Williams was inspired by Badry’s work after concluding she needed to visit Canada to learn about this country’s advances in research and service delivery for FASD, a spectrum of disorders that includes Fetal Alcohol Syndrome. She knew she could discover much about her career specialty, and Badry knew Williams could broaden the knowledge of FASD among academics and social workers here. Badry’s work on FASD within the First Nations communities influenced and inspired Williams' approach in the development of a survey tool that could act as an icebreaker and begin sensitive conversations on FASD within Aboriginal communities in Western Australia.

Meeting with Aboriginal community members was a highlight of Williams' trip.  Photo courtesy of Dorothy Badry

Meeting with Aboriginal community members was a highlight of Williams' trip. Photo courtesy of Dorothy Badry

Prenatal alcohol exposure can lead to FASD, which causes physical and developmental anomalies in a fetus, particularly with binge drinking behavior. Thus the message that no alcohol is best during pregnancy is recommended. The conditions from which FASD emerges are complex, and concerns about FASD heighten when women experience poverty, historical abuse and use alcohol to self-medicate in response to their trauma.

Connecting on a human level through shared experience 

Once Williams arrived in Canada, she embarked on a whirlwind circuit of conferences in Alberta and Manitoba, with a side trip to Portland, Oregon for a training session. She also met with Aboriginal community members in several communities.

Williams says a particularly memorable experience was attending a Learning Circle (a gathering of social work students from across the province both in-person and via video conference) in Grande Prairie. There, she talked about her doctoral research and the importance of recognizing that individuals with FASD can only be understood if you accept that their condition is irreversible and that many supports are required over the lifespan. “The other thing I shared with them was that there’s grief and loss. There’s a grieving for knowing that they won’t have the same potential in life as what I would have, and so there is urgency to raise awareness and advocate for support for our families.”

Willliams shared her FASD research with Faculty of Social Work Learning Circle students from across the province. Students attended the session either in-person in Grande Prairie or via video conference from other Learning Circle sites.  Photo courtesy of Dorothy Badry

Willliams shared her FASD research with Faculty of Social Work Learning Circle students from across the province. Students attended the session either in-person in Grande Prairie or via video conference from other Learning Circle sites. Photo courtesy of Dorothy Badry

She was also touched by the way First Nations people greeted her warmly.

“I have lovely memories of this time,” Williams says. “I have been mistaken for a Cree lady. I’ve been called ‘relative.’ I have been welcomed by so many.

“We could talk like old friends, because our history of colonization is so similar. The issues that confront First Nations people (in Canada) confront us in Australia.” 

https://www.ucalgary.ca/utoday/issue/2014-11-26/canadian-fetal-alcohol-programs-inspire-australian-researcher

When is it OK to drink alcohol while pregnant? Never, doctors say by Rita Giordano

HEALTH & WELLNESS

When is it OK to drink alcohol while pregnant? Never, doctors say

by Rita Giordano, Posted: September 24, 2018

Click here to see the original article.

For such a little guy, Robert McCloud has worked very hard to get to where he is today.

At age 13 months, he weighs less than half of most babies his age. He has a cleft lip and trouble swallowing, so much of his nourishment comes through a feeding tube. Born with an undersized head and brain, he still can't sit up by himself, let alone walk. No baby coos, no "mama" or "dada" sounds.

But Robert is trying hard to learn to crawl, to laugh. He does roll over. He'll grab for anything. And, boy, can he smile.

"When he smiles," said Kimberly Martinez, the Philadelphia foster mother who hopes to adopt him, "it's like he's lighting up the whole room."

Robert's doctor says the baby's struggles are due to what his birth mother ingested while she was pregnant. A substance known to cause serious physical and neurological abnormalities in a developing fetus.

The opioid crisis has sparked fresh awareness of babies born dependent on the drugs their mothers used. But it wasn't heroin or pain pills that caused Robert so much harm. His mother chose something far more common and, scientists say, even more devastating.

"The best science we have right now shows that alcohol is by far the most dangerous recreational drug to use during pregnancy," said Kathleen Mitchell, spokeswoman for the National Organization on Fetal Alcohol Syndrome (NOFAS). Use and abuse of other drugs can lead to certain abnormalities or defects, but research shows that none seems to cause as many different kinds as alcohol.

Alcohol caused Robert's birth defects and developmental delays, according to his pediatrician, Renee Turchi, medical director of the Center for Children with Special Health Care Needs at St. Christopher's Hospital for Children.

Robert suffers from fetal alcohol syndrome, the most severe, physically disfiguring form of fetal alcohol spectrum disorder (FASD), a wide range of disabilities, birth defects and behavioral issues that experts say all too often get misdiagnosed or overlooked. Children born with an FASD may get ineffective treatment or none at all.

"Prenatal alcohol exposure is the most common preventable cause of intellectual and developmental delays and disabilities in the United States," stated a new report from the American Academy of Pediatrics (AAP) published Sept. 10 in the journal Pediatrics.

JOSE F. MORENO / STAFF PHOTOGRAPHER   Harold and Mildred Cambridge with their adoptive son Andrew at their home in Willow Grove. Andrew has fetal alcohol syndrome.

JOSE F. MORENO / STAFF PHOTOGRAPHER

Harold and Mildred Cambridge with their adoptive son Andrew at their home in Willow Grove. Andrew has fetal alcohol syndrome.

And alcohol-related birth disorders are far more common than previously believed. An article published this year in the Journal of the American Medical Association estimated conservatively that 1.1 percent to 5 percent of U.S. children have some sort of alcohol-related disorder  – as much as five times what had been previously thought and more than the approximately 1.5 percent of children with autism spectrum disorder.

Turchi, a lead author of the new AAP report, along with colleagues in the academy's ongoing education and awareness campaign, are encouraging doctors nationwide to learn more about FASD, screen all patients, and help their families get the therapy and support they need. The extent of the dangers, she said, are not widely recognized.

"We're still not there, even the medical community," said Turchi. "You still have some folks telling people, 'Oh, it's OK to drink [during pregnancy].' And it's really not."

Turchi said the message is clear. "There is no safe time, amount, or type of alcohol to drink when a woman is pregnant."

Meanwhile, child advocates are also urging more maternal education. While not all children exposed to alcohol in the womb end up with such problems as organ defects, unexplained aggression, or learning disabilities, subjecting an unborn child to any amount or form of alcohol could be dangerous.

There is no risk-free point in pregnancy to consume alcohol, including right after conception when the neurological system is starting to form, and many women don't realize they're pregnant. Nearly half of all U.S. pregnancies are unplanned. Studies have shown that drinking during weeks six through nine of a pregnancy has been linked to developing FAS' facial abnormalities.

Women do not need to be alcoholics to harm their babies.  For obvious reasons, it's not possible to run clinical trials on alcohol use during pregnancy, so just how much alcohol it takes to produce lasting problems is not clear. But even less severe forms of FASD, though they may produce no physical evidence, can have far-reaching effects.

Even for women who aren't pregnant, the amount of alcohol medical experts consider acceptable is far less than what many people think. "Moderate drinking" outside of pregnancy is classified as no more than one drink a day. Binge drinking for women is defined as four drinks within a two-hour period.

Mitchell is a self-described member of the drugs, sex, and rock and roll Woodstock generation. She thought she was reining in when she stuck to alcohol during her pregnancies in the 1970s.  At that time, the threat to a developing fetus was not widely known.

But when one of her children was a teenager, a diagnosis of suspected cerebral palsy was changed to FAS. Mitchell thought of two babies she had lost – one who died at birth and another lost to sudden infant death syndrome.

"I now believe that prenatal alcohol exposure was the main reason my children did not survive," said Mitchell, an addiction counselor.

Doctors and health providers, she said, should create a clearer road for women to seek help.

"We should be asking everyone at their annual exams about alcohol and drug use in a very matter-of-fact way that's not judgmental, that's not like a witch hunt," Mitchell said. "We ought to be treating this as a medical problem and take the blaming and shaming out of it."

Turchi agreed that some doctors were missing the opportunity to reach women using alcohol during pregnancies and help them and their babies.

She recalled the mother of one of her infant patients, a woman in opioid addiction. The baby's father said he would give his partner alcohol to try to keep her home, thinking it was better for their baby than her being out on the streets using heroin.

"It was horrible," Turchi said. "He felt like he gave his son fetal alcohol syndrome."

Many of these youngsters, for example, don't grasp the idea of stranger danger, leaving them vulnerable to predators. They also may be easily manipulated or can be very impulsive or emotionally immature, and many don't understand the concept of cause and effect — all of which can lead to trouble in school or even with the law. It's estimated that more than 60 percent of people with fetal alcohol disorders over age 12 have been charged with a crime, according to NOFAS.

Sometimes, their behaviors mimic other conditions. Dan Dubovsky, a Philadelphia resident who adopted a boy with FAS and now advocates for FASD children and families, said conventional therapies or medications often don't work with these youngsters — or worse.

Before Dubovsky's son Bill was eventually diagnosed with FAS, the boy's behavior in school was chalked up to attention deficit hyperactivity disorder, and he was prescribed Ritalin.

"It made him act out even more," Dubovsky said.

But there can be hope for children with FAS, too, especially when they get the right kind of help.

Take Andrew Cambridge, 19, of Willow Grove. When not at school or helping at his church, this dedicated artist is often working on the comic character he has created, "Rekomon! The Karate Cat," a martial arts feline full of untapped potential.

"He's just a kid, so there's way more power in there," Andrew said of the character he's created. "He doesn't know about his true ability yet."

JOSE F. MORENO / STAFF PHOTOGRAPHER Andrew Cambridge, smiles as he shows his drawings of “Rekomon! The Karate Cat” at his home in Willow Grove Pa.

JOSE F. MORENO / STAFF PHOTOGRAPHERAndrew Cambridge, smiles as he shows his drawings of “Rekomon! The Karate Cat” at his home in Willow Grove Pa.

His parents Mildred and Harold Cambridge took him into their home at age 6 months. Andrew was born premature at 26 weeks and 1.5 pounds. The Cambridges, who formally adopted him a couple of years later, were told he probably wouldn't live very long and would never walk or talk.

"I said, 'We'll see about that,' " said Mildred.

Turchi, now his doctor, said Andrew was exposed to alcohol and crack cocaine before birth, resulting in partial FAS, some intellectual disability, along with other birth defects. But the Cambridges, who have other adopted children as well as biological offspring, were steadfast advocates, making sure that he got into programs that could help him, such as Early Intervention, therapies, and supports in school.

JOSE F. MORENO / STAFF PHOTOGRAPHER Andrew Cambridge, interacts with his doctor, Renee Turchi, at his home in Willow Grove.

JOSE F. MORENO / STAFF PHOTOGRAPHERAndrew Cambridge, interacts with his doctor, Renee Turchi, at his home in Willow Grove.

"You can't underestimate [children with FAS]," Mildred said. "You never know what they will do."

And Andrew isn't done. He says his dream is to work for the Cartoon Network. He'd like to see "Rekomon! The Karate Cat" on TV.

"If that doesn't work," he said, undaunted, "we can try the Nickelodeon station."

AAP Article: “Myth: A Diagnosis of a FASD Does Not Change the Treatment Plan” – John Stirling, MD, FAAP

This article appeared the June edition of the Fetal Alcohol Spectrum Disorders (FASD) Regional Education and Awareness Liaisons (REAL) Champions Network e-newsletter, from the American Academy of Pediatrics (AAP).

Guest Editor’s Desk, John Stirling, MD, FAAP

Myth: A diagnosis of a FASD does not change the treatment plan

At first blush, it might appear that there’s little help in a diagnosis of a FASD. After all, most patients don’t come to the pediatrician with a Chief Complaint of Fetal Alcohol Spectrum Disorder. Instead, they show up with academic issues, or behavioral problems related to poor executive function (impulsiveness, ADHD), or emotional dysregulation (dramatic mood swings, violence). The medical diagnostic workup may reveal early exposure to alcohol, but whatever the etiology, the first priority of the treatment plan will always be to manage the behaviors. Second, prenatal exposure to a teratogen like alcohol results in lifelong impairment of CNS function, so even a firm diagnosis of a FASD won’t provide a cure.

On closer reflection, though, recognizing fetal alcohol exposure’s teratogenic effects can provide very useful information to clinicians attempting to manage behavioral problems like these. Consider:

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  • Unlike the neurodevelopmental consequences of early trauma or the functional disruptions caused by acute stress, a teratogen’s effects are fixed and permanent. Alcohol preferentially harms brain structures concerned with moderating stress and regulating emotion. These structural (and thus functional) alterations can impair the child’s ability to adapt after a trauma or to learn coping skills in therapy, and a therapist will necessarily take them into consideration in setting goals and choosing an approach.
  • Caregivers’ expectations play an important role in their own parenting choices. Children affected by an FASDoften present challenging behaviors, from oppositional toddlers to teens who lie and steal. It may appear to unsophisticated adults that the child is simply choosing to misbehave. Many parents or foster parents will take such defiance or disregard personally, with adverse consequences for the family relationships. When a caregiver understands that a behavior doesn’t arise so much from a conscious choice as from an uncontrollable impulse or a cognitive deficit (i.e. brain damage), they may find it easier to be patient. Patience and understanding are much more effective in modifying behavior than are anger and punishment, especially with children who cannot help but be poor learners.
  • A child with a FASD can be expected to have a more dramatic response to postnatal environmental stressors. Even when problem behaviors have other, more proximal causes (as in recent sexual abuse or the death of a loved one), the FASD diagnosis can alert professionals and caregivers that the child might have greater difficulty with resilience.

So, it’s really not much of a question after all. The therapeutic process begins with and depends on the provider’s understanding of the patient. Recognizing the influences of this common teratogen on the brain’s development is an important first step to proving relevant and effective interventions.

Dads' Age, Alcohol Consumption Cause Epigenetic Changes In Sperm That Increase Kids' Risk Of Fetal Alcohol Syndrome

May 15, 2016 12:14 PM By Dana Dovey @danadovey d.dovey@newsweekgroup.com 

Dovey, Dana. “Dad's Poor Lifestyle Choices Affect His Sperm, Child's Health.” Medical Daily, 15 May 2016, www.medicaldaily.com/dads-alcohol-consumption-epigenetics-fetal-alcohol-syndrome-386109.

Although we may put a lot of emphasis on how a mother’s lifestyle choices can affect the health of her future children, a recent review has shown that a father’s age and lifestyle may be just as important.

The study, now published online in the American Journal of Stem Cells, has identified the effect that male lifestyle can have on the health of his future offspring. The team reviewed past research that focused on how a man’s lifestyle could cause epigenetic changes in his sperm’s DNA that could eventually affect his offspring’s genome. Among its findings, the study revealed that fathers who are alcoholics could unknowingly influence the organ structure and gene expression in their offspring, causing significant health problems such as fetal alcohol spectrum disorder (FASD).

This is a serious health condition that causes significant birth defects and learning difficulties in children, and according to the study, can still be diagnosed in children whose mothers never consumed alcohol during their pregnancy. "Up to 75 percent of children with FASD have biological fathers who are alcoholics, suggesting that preconceptual paternal alcohol consumption negatively impacts their offspring," explained study author Dr. Joanna Kitlinska in a recent statement.

Pixabay, Public Domain

Pixabay, Public Domain

The research was based on epigenetics, a relatively new field of science that explores how our lifestyle and environment can change how certain genes in our DNA are expressed. Although our DNA is set in stone, recently researchers have noted that by altering the physical structure of DNA, certain factors can have an effect not only on your health, but also the health of future generations. For example, a study from 2014 found that endurance training can physically change the way our DNA creates skeletal muscle.

In addition to FASD, alcohol use in fathers was linked to decreased birth weight, marked reduction in overall brain size, and impaired cognitive function. The study also revealed that factors such as a father's age, diet, and stress level could all have effects on the eventual health of his children. For example, paternal obesity was linked to enlarged fat cells in the offspring, changes in metabolic regulation, diabetes, obesity, and even the development of brain cancer. In addition, past research has shown that traumatic events can alter gene expression as well and experiencing famine can “scar” the DNA of not only the individual but also their future offspring.

The team hopes their findings could help us better understand what influences the genetics and health of future offspring, and perhaps even be used to help recommend lifestyle alterations for people who wish to be parents. Thankfully, studies have shown that just as poor lifestyle choices can change DNA for the worse, correcting these habits can also reverse the effect.

"This new field of inherited paternal epigenetics needs to be organized into clinically applicable recommendations and lifestyle alterations," said Kitlinska. "And to really understand the epigenetic influences of a child, we need to study the interplay between maternal and paternal effects, as opposed to considering each in isolation."

Source: Day J, Savani S, Nguyen M, et al. Influence of Paternal Preconception Exposures on Their Offspring-Through Epigenetics to Phenotype. American Journal of Stem Cells. 2016.