Fetal Alcohol Effects on Adulthood

While studying to earn my teacher's certificate, I took an interest in studying the adverse impact of Fetal Alcohol Effects (FAE) or Fetal Alcohol Syndrome (FAS) on one's development. The following outlines how FAE/FAS alters a victims adult development.

Warning labels depicting a silohuette of a pregnant woman drinking alcohol enveloped in a red circle with a diagnal line through the center clearly tells the viewer that expecting women should not drink alcohol. Yet, to those directly affected by Fetal Alcohol Syndrome, this picture tells a more in depth story – it serves as a reminder that mothering starts before birth, and drinking alcohol during pregnancy is poor mothering. Years of speculation led to subsequent research studying the adverse ramifications caused by prenatal exposure to alcohol; and on February 25, 2004, the National Organization of Fetal Alcohol Syndrome along with several other delegations informed the United States House of Representatives that Fetal Alchol Syndrome (FAS) exists as the leading cause of mental retardation in America (www.nofas.org 2010). Since alcohol passes freely through the placenta to a growing fetus, gestational exposure to a teratogen like alcohol causes brain damage, stunts cell growth and compromises overall development. Depending on the amount and timing of alcohol imbibed by the mother, the developmental window of the fetus and the individual biological characteristic of both determines the severity of the condition and whether a full diagnosis is identified –discriminating facial features usually determine a FAS diagnosis. Since not all alcohol exposed pregnancies result in FAS, other disorders have been identified to better describe different yet related conditions - those include Fetal Alcohol Spectrum Disorder (FASD), Alcohol-Related Neurodevelopmental disorder (ARND) and Alcohol Related Birth defects (ARBD). Combined, these conditions occur estimatedly four times as frequently as FAS (Streissguth 1997). Of note, brain damage can be equally as severe for all diagnoses (Duquette, C. Stodel, E. Fullarton, S. Hagglund, K. (2006). The ramifications of of Fetal Alcohol Effects (FAE) inflict irrevocable harm on those individuals victimized compared to typically developing people. Its harrowing damage can reveal itself in all of the different stages of life, which may not always be diagnosised or predicted during infancy or childhood. The brain damage caused by FAEis incurable and causes those victimized to develop atypically when compared to their typically developing counterparts. FAEwreaks consequences throughout adulthood that can result in poor impulse control, cognitive learning delays, and impeded social skill development, which in turn can lead to poor job performance, depression and a hindrance to establish and maintain meaningful relationships (Kanter & Streissguth 1997).

In terms of adult development, theorist Jeffery Arnett (2000) dedicates a part of his work to the study of developing into an adult. He proposed the theory of classifying certain individuals into a status called the emerging adult. For the typically developing human his definition includes departing from childhood dependencies, yet not quite ready to adopt the responsibilities of normative adulthood, this is a season of exploration in what the world has to offer (Arnett, J. 2000, p. 469). For the FAE victim emerging adulthood can be a particularly difficult season of life because many people who suffer from FAE do not have the cognitive building blocks necessary to live productive lives; they often struggle to live independently due to poor judgment, unpredictable behavior and lack of social skills. Additionally those with this condition, particularly FASD, do not show outward signs of having a disability as would an individual with Down’s syndrome or a quadriplegic confined to a wheelchair would. Because these adults look like healthy adults, they are expected by society to behave as such – their disability is almost completely hidden (Robertson, T. 2007). Although the effects of FAE vary from each individual, to declare that a certain percentage of victims remain perpetual emerging adult is quite plausible – large groups within this population never gain the skills necessary to live independently, able to care for themselves without assistance and/or advocacy.

One problem confronting FAE victims is money management, which is a preliminary requirement for independent living. Many people with FAS rarely achieve higher than a third grade mathematics level and although a majority of those with FASD sometimes achieve higher status, they too encounter similar struggles with the logic and problem solving that mathematics require. This in the majority of cases leads to FAE victims falling into a cycle of poverty that can be seemingly impossible to escape without intervention or serious support. Similar to the low-income women studied and interviewed by Deborah Belle (1994), where their lives seemed wrought with unease and in one woman’s case an unsafe living environment due to lack of finances. For the FAE victim, their adult development is similarly and in many cases adversely affected due to their low-income status (often caused by substandard money management). In many instances they enter a cycle of poverty due to poor judgment from which many are unable to escape without substantial help (Kleinfeld 2000).

Another reoccurring obstacle that the FAE victim faces seems to be ineffective or short-handed coping skills. In studying the characteristic of FAE children and adolescents, structure and predictability proves to be necessary for those affected by this disability (Streissguth 1997). This does not change as the individual enters into social adulthood status; they still tend to react adversely to change and transition. Since life tends to distribute considerable amounts of change and transition to everybody that breathes, regardless of ability or disability status, developing necessary coping skills remains an important element to achieve subjective well being or happiness (Valliant, G. 2000)(Diener, E. 2000). Vaillaint theory suggests that adaptive mental mechanisms such as humor, altruism, sublimation, anticipation and suppression help a typically developing adult cope more adequately with change or crisis and the evidence certainly demonstrates its validity and these concepts usually holdfast in the typically developing human(2000, p 91). However, for FAE adults, in many situations when these mechanisms are conscious decisions they do not possess the cognitive development for such abstract thinking. FASD sufferer Liz Kulp (2000) discusses her bouts with frustration and anger when plans are changed or that she gets overwhelmed during the planning of a family vacation – she prefers to say at home where she remains comfortable and she knows she is safe. “Mom says we travel so I can learn and understand things better. She says I am a concrete thinker” (2000, p. 66). As an advocate for Liz, her mom.

The latter part of this statement parallels Jean Piaget’s Cognitive Development Theory, which suggests that typically developing humans grow cognitively in stages, where concrete operational thinking begin generally around age seven and then lead to formal operational thinking around age twelve (Crain 2005). Those inflicted with FAEare often eluded by the operatives required for abstract and hypothetical thinking suggested in formal operations. In fact to compare a FAE adult to an autistic adult in terms of concrete thinking seems quite plausible. Many adults on the autism spectrum require dialogue to be specific and instructions to be precise. Martha Hanes Ziegler (2010) offers this advice when dealing with her autistic daughter. “Be as concrete and specific as possible when talking to Mary Ann. She cannot deal with vague or approximate answers, such as ‘later’ or ‘when it is over’” (p. 95). This is the same advice given by advocates working in the FAS/FASD field; those inflicted with FAE in most cases need similar treatment to those on the autism spectrum with respect to precise articulation. When directives remain clear, yet firm, this helps enable expectations to be better understood, which in turn will likely positively contribute to FAE victim’s overall emotional state (Streissguth 1997).

The emotional state continues to be an area of interest when studying and advocating for those inflicted with FAE because this group consistently portrays erratic emotional behavior, outbursts and depression (Famy, C. Streissguth, A, Unis, A., 1998). Erik Erikson’s work remains today as revered and influential in the world of psychology as his theories study human development from a predominantly emotional perspective. His theory of Bio-Psycho-Social development targets developing adults into three stages which all consist of conflicts and if successfully endured an individual will ideally reach the desired outcome. For example in young adulthood people encounter intimacy vs. isolation in order to achieve love. Later on the conflict exists as generativity vs. self-absorption to reach the outcome of care and long standing adults encounter the conflict of ego integrity vs. despair to achieve wisdom (Crain. W. 2005). Erikson proposals describe typically developing adults and suggest that the desired outcome will be reached only after much effort is applied or perhaps even struggle is endured. We know that FAE causes humans to develop atypically (Streissguth 1997); therefore, the FAE victim could likely encounter more difficulties achieving the desired outcome from the three mentioned stages - although it is certainly not impossible. For instance due to cognitive delays, lack of impulse control and symptomatic attention deficit caused by permanent brain damage could cause an FAE adult to indulge inappropriately or contribute awkwardly toward a friendship or find themselves being taken advantage of in a romantic relationship due to a naïve nature. Therefore an individual with FAE will likely need a gracious, caring, accepting mate who has been educated on the characteristic of FAE in order to be party to a long-term, meaningful relationship to achieve the outcome of love.

To imply that the disability of Fetal Alcohol Syndrome or Fetal Alcohol Spectrum Disorder causes its sufferers to lead unproductive lives is simply untrue. In many cases brain damage and subsequent cognitive delay may alter their opportunities for success and prosperity, but it certainly hasn’t eliminated them entirely. In his 1983 book, Frames of Mind, Dr. Howard Gardner proposed the theory of Multiple Intelligences. His work studies human potential and his ideas teach that human development consists of eight intelligences where all people posses each one to some varying degree. These eight intelligences are identified as linguistic, mathematical, musical, spatial, kinesthetic, interpersonal, intrapersonal and natural. This does not imply, however, that each individual possess high levels of each intelligence. In most cases, people have some highly developed intelligences, some that are somewhat developed and still others that are rather weak. Regardless, the theory sustains that each one exists in every individual and each can grow to a level of competency barring injury or disease (NDPC, 1998). This is not to say that the theory of Multiple Intelligence does not apply to those who sustain some sort of disability; in fact to pursue this notion with respect to those suffering with FAE is certainly worth mentioning. Frequently the general public assumes that individuals with disabilities exist as weak in all eight intelligences – which is altogether inaccurate. Though, as noted earlier, FAE victims endure several cognitive and emotional deficits compared to those individuals who develop typically, it remains important to emphasize and help develop an intelligence in which the FAE sufferer shows promise or strength; this will benefit him or her immensely. For example, Ann Ruggles Gere noticed that her adoptive daughter Cindy struggled with mathematics and language curriculum all throughout her childhood and adolescence likely due to fetal alcohol exposure; however, she excelled considerably with spatial concepts such as mazes, directions and creative, hands-on endeavors like sculpture and painting. As an advocate for her struggling daughter, Anne helped guide Cindy’s academics toward more art based curriculum. Anne’s effort to identify and optimize Cindy’s stronger intelligence certainly paid off as Cindy not only successfully completed high school, but also studied painting at Detroit’s Center for Creative Studies, received her AFA from the Institute for American Indian Art in Santa Fe, and earned her BFA and teaching certificate from the University of Alaska at Fairbanks (Kleinfeld, J. 2000).

This examples helps prove the need for advocacy for this population as an advocate can truly change the life trajectory of those affected by fetal alcohol exposure. Ann Streissguth (1997) illustrates this important point by noting:

Although people with FAS may speak easily – and even colorfully – they often have difficulty speaking effectively for themselves, understanding and expressing their real needs, and applying good judgment to life situations. Naïve and trusting, they are vulnerable as both children and adults. Therefore, individuals with FAS (and FAE) need advocates, spokespeople who not only have their best interests in mind but also understand the nature of their disability and how best to help them lead healthy, productive lives (p 146).

Because fetal alcohol exposure affects both perception and cognition, it often renders the adult unaware of his or her own limitations; therefore a sincere advocate can help establish goals and decisions based on a realistic assessment of that individual’s own strengths and weaknesses.

Since fetal alcohol exposure isn’t always diagnosed at birth, tracking exact birth frequency often eludes statiticians. However reasonable estimates indicate that approximately 40,000 Fetal Alcohol Syndrome (FAS) births occur each year in the United States.

Arnett, J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, vol 55, no. 5, p. 469-480.

Crain, W. (2005). Theories of development: Concepts and applications, fifth edition. New Jersey: Person Prentice Hall.

Duquette, C. Stodel, E. Fullarton, S. Hagglund, K. (2006) Teaching students with developmental disabilities; Tips from teens and young adults with fetal alcohol spectrum disorder. Teaching Exceptional Children, Vol 39, No 2, p 28-31.

Gardner, H. (1983). Frames of mind: The theory of multiple intelligences. New York: Basic Books.

Kanter, J., Streissguth, A. (1997). The challenge of fetal alcohol syndrome: Overcoming secondary disabilities. Seattle: University of Washington Press.

Kleinfeld, J. (2000). Fantastic Antoine grows up: Adolescents and adults with fetal alcohol syndrome. University of Alaska Press.

Kulp, L., Kulp, J. (2000). The best I can be: Living with fetal alcohol syndrome or effects. Brooklyn Park, MN: Better Endings New Beginnings.

Robertson, T. (2007). Fetal alcohol syndrome: The invisible disorder. Retrieved from http://minnesota.publicrado.org/display/web/2007/11/15/adultfasd/ on January 12, 2011.

Streissguth, Ann. (1997). Fetal Alcohol Syndrome: A guide for families and communities. Baltimore, MD: Paul Brooks Publishing Co.

United States. National Organization on Fetal Alcohol Syndrome. (2001-2011) Retrieved December 30, 2010 from http://www.nofas.org/educator/teaching.asp.