Effects of prenatal alcohol exposure on child development.

The most serious consequence of maternal drinking during pregnancy is fetal alcohol syndrome (FAS). FAS was first described in the United States by Jones and Smith (1973), who identified a distinctive set of facial anomalies—short eyelid openings (palpebral fissures), flat midface, thin upper lip, and a flat or smooth groove between nose and upper lip (philtrum)—in children whose mothers drank very heavily during pregnancy. These children also exhibit growth retardation as well as significant cognitive and/or behavioral problems. In contrast with Down syndrome patients, who exhibit impairment in virtually all aspects of intellectual function, FAS patients often perform relatively well on language tests (e.g., Kodituwakku et al. 1995), although they tend to have difficulty with complex language tests, especially those tapping the pragmatic aspect of language. The most consistent deficits are in arithmetic (Streissguth et al. 1991; Clarren et al. 1994) and attentional function (Kodituwakku et al. 1995). Although many FAS patients are mentally retarded (i.e., have an IQ less than 70), a substantial proportion perform in the low average to average range on IQ tests (Streissguth et al. 1991). It is particularly instructive to consider studies com­ paring children with FAS with children not exposed to alcohol who have similar low IQ scores. In one such study, FAS children had reading scores similar to those of IQ-matched control subjects, but they performed significantly less well on arithmetic and certain aspects of attention (e.g., executive function, which is the abil­ ity to coordinate, plan, and execute appropriate responses and to modify behavior flexibly in response to feedback) (Carmichael Olson et al. 1998). Children with FAS have poorer socioemotional development (i.e., emotional, personality, social, and moral develop­ ment) than would be expected based on their IQ scores (Thomas et al. 1998; Carmichael Olson et al. 1998). Fetal Alcohol Effects and Alcohol-Related Neurodevelopmental Disorder