On the Trail of Fetal Alcohol Syndrome

 1977.  The Merck Manual:  Thirteenth Edition.  Fetal Alcohol Syndrome is not mentioned in this edition. 
    Minimal Brain Dysfunction is now under the heading, Learning Disorders and "More common labels include brain injury, brain damage, minimal brain damage, hyperkinesis, perceptual deficits and dyslexia."
    Under treatments:
    "... to keep the child in his regular classroom and to schedule some periods with a teacher who is trained to provide special help-technics which succeed in improving poor
performance..."
    The use of stimulants to improve attention is again mentioned.
    Under Personality Disorders, only the Hysterical (*histronic) Personality, Psychopathic (*Sociopathic or Antisocial) Personality and the Inadequate Personality are still included.  The quotes beside psychopathic personality are the Merck's quotes.  This indicates that for many in the medical field, the sociopathic/antisocial/psychopathic diagnoses are interchangeable.  The etiology of the two conditions are identical to those descriptions in the Twelfth Manual (1972).

     The National Institute of Alcohol Abuse and Alcoholism (NIAAA) issues the statement that 6 or more drinks per day incurred the risk that a woman could produce a child with birth defects.

 1978.  Third Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome. published by the Department of Health and Human Services and the National Institute of Alcohol Abuse and Alcoholism (NIAAA).  This was the first time FAS became an integral part of this specially commissioned report to the U.S. Congress.  Each report adds information to the previous report on alcohol and other related topics.  Therefore, information presented in these reports to Congress seldom repeat each other except for the introductions.  Contents cover etiology, symptoms, physical signs, physical damage to organs, psychological aspects, economic costs and current research.  Extensive bibliography accompanies each section. 

[The NIAAA determined that the consumption of  2 drinks per day or one ounce of absolute alcohol was the definition of heavy drinking.  (Absolute alcohol is that part of a beverage that is alcohol minus the other non-alcohol ingredients.) (That would be the equivalent of one 12 ounce can of beer, a four ounce glass of wine or one shot glass of hard liquor.)]

 1979.  By this year, over 600 cases of FAS had been reported worldwide.  Dr. Ernest Abel in Fetal Alcohol Syndrome and Fetal Alcohol Effects.  (New York:  Plenum Press.) reported that incidences of FAS were in articles from Australia, Belgium, Brazil, Canada, Chile, Czechoslovakia, France, Germany, Hungary, Ireland, Italy, Reunion, South Africa, Spain, Sweden, Switzerland, and the U.S.

 1980. Research Society on Alcoholism (RSOA) issues three criteria for a diagnosis of FAS.  "A pattern of characteristic facial features, pre-postnatal deficit in height and weight, and central nervous system damage."

 The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) is published by the American Psychiatric Association.

 1981.  Fourth Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA.  Pages 59-111.

    The Surgeon General of the United States issues a health advisory recommending that pregnant women or women considering getting pregnant abstain from using alcohol because of possible harm to the unborn child.

 1982.  The Merck Manual:  Fourteenth Edition.  Nine years after the first international paper on the etiology of Fetal Alcohol Syndrome was published, FAS finally appears in the Merck Manual.  Under Section 16: Pediatrics and Genetics, Chapter 189:  the Newborn, Metabolic Conditions:
    "...The most serious consequence is mental retardation..."
    Under Section 23: Clinical Pharmacology, Chapter 274:  Drug Toxicity, Drugs in Pregnancy: "...borderline mental deficiency..."  No other serious behavioral problems are discussed.   
    Under Section 12:  Psychiatric Disorders, Chapter 142: Personality Disorders are described for the first time in the nomenclature of the Diagnostic and Statistical Manual of Medical Disorders (DSM-III).
   The diagnostic section, the following has been added  to coping mechanisms (5)  Turning against one's self allows aggression towards others to be expressed indirectly andineffectively through passivity.  It includes failures and illnesses that affect others more than one's self, and silly, provocative clowning.  The mechanismunderlies most sadomasochistic relationships.
    The Hysterical (*histronic) and Antisocial Personalities (*psychopathic, sociopathic) (*quotes are from the Merck Manual) are the only two that remain under personality disorders.
    " The Histronic (Hysterical) Personality is described in various terms such as "
egocentric...attention seeking...theatrical behavior...emotional immaturity...childish, emotional response...lively manner...rarely deeply involved emotionally...insatiable need for affection...easily repress or forget unpleasant or discreditable experiences...responsiblity for misfortunes and failures is usually ascribed to others."
    " The Antisocial Personality "(previously used designation:  psychopathic,
sociopathic) characteristically act out their conflicts and flout normal rules of social order.  ...impulsive, irresponsible, amoral, unable to forego immediate gratification. They cannot form affectionate relationships with others, but their charm and plausability may be highly developed and skillfully used for their own ends.  They tolerate frustration poorly, and opposition is likely to to elicit hostility, aggression, or serious violence.  Failure and punishment rarely modify their behavior or improve their judgment and foresight."
    Suggested therapies or treatments, "Although these mechanisms may not be breached by reason or interpretation, they respond to improved interpersonal relationships and to supportive but forceful confrontation in prolonged psychotherapy or peer encounters."

 1983.  Fifth Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA.  Pages 68-82.   In this report, one researcher estimated the lifetime cost of raising a child with FAS was $155 million.

 1984.  Fetal Alcohol Syndrome and Fetal Alcohol Effects. by Dr. Ernest Abel.  One of the first textbooks to overview the mechanisms and laboratory research on the effects of alcohol upon laboratory animals and selected cases. 

 1985.  A Poison Stronger than Love. by Anastasia Shkilnyk.  Abook that tells the story of FAS in an American Indian (Ojibway) community.  New Haven:  Yale University Press.

 1987.  The Merck Manual:  Fifteenth Edition.  Fetal Alcohol Syndrome is comprised of one paragraph on page 1887.  "The most serious consequence is severe mental retardation."  There is no mention of other behavioral problems.
   Under Section 12, Psychiatric Disorders, Chapter 137, Personality Disorders the diagnosis section and the Histronic (*Hysterical) and Antisocial (*Psychopathic, Sociopathic)  Disorders section are copies of the Fourteenth Manual (1982) manual entries.  (*quotes are from the MerckManual.)

   Under Section 15:  Gynecological and Obstetrical Care, Chapter 176:  Normal Pregnancy, Labor and Delivery, Prenatal Care, the Merck states, "Recent studies indicate that...a daily intake of  (less than) 2 ounces of wine probably would not cause fetal abnormalities."
 
 Sixth Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome published by the Department of Health and Human Services and NIAAA.  Pages 79-96. 

[The NIAAA determined that the consumption of 0.1 ounce or less of absolute alcohol constituted a light drinker, 0.1-0.9 of absolute alcohol constituted a moderate drinker and 1.0 ounce or more of absolute alcohol constituted a heavy drinker.  (0.1 ounce is less than 1/4 of a small can of beer, less than one ounce of wine or less than 1/4 of a shot glass of hard liquor.)]

 The revised version of the third edition of the Diagnostic and Statistical Manual of  Mental Disorders (DSM-III-R) is published.

 1988.  Alcoholism and Women, Genetics, and Fetal Development by William J. Haugen Light. (1988)  Springfield, Illinois:  Charles C. Thomas. Dr. Light is from the Institute for the Study of Drugs, Alcohol and Addictive Behaviors. 

High Risk:  Children Without a Conscience by Dr. Ken Magid and Carole McKelvey.  A highly popular book at the time.  It deals almost exclusively with psychopathic (antisocial) personalities.  The problems therein are ascribed to working mothers, day care, teenage pregnancy, divorce, tv violence, schools, lack of religion, too much money, too little money, lack of bonding/trust, adoption and foster care...everything except prenatal alcohol exposure.  The introduction was written by Congresswoman Patricia Schroeder.  The topics brought up in this book are still being discussed as reasons for children's behavioral problems.

 1989.  The Broken Cord by Michael Dorris.  The first nationally distributed book on FAS and its effects on a family.  Dr. Dorris cited 165 articles and books and three videos on the dangers of drinking during pregnancy.

     U.S. law calls for the mandatory labeling of all containers of alcohol sold in the United States.

 1990.  Seventh Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA.  Pages 138-161.

 Formation of the Fetal Alcohol Syndrome Adolescent Task Force organization by Jocie and Don DeVries, Linda LaFever, Vicky McKinney, Ann Waller and DeLinda McCann.  Now known as the Family Resource Institute on FAS (FAS*FRI), it also publishes the FASTimes newsletter.

 August, 1990.  NOFAS was incorporated in South Dakota.  Patti Munter founded the organization along with Gwen Packard. Ms. Munter served as NOFAS Executive Director through 1996, and is currently a member of the NOFAS Board of Directors.  NOFAS is currently located in Washington, D.C..

 1991.  Iceberg, a newsletter devoted to Fetal Alcohol Syndrome, published by the University of Washington Fetal Alcohol and Drug Unit.

  1992.  The Merck Manual:  Sixteenth Edition.  Fetal Alcohol Syndrome is mentioned in
    Section 14: "borderline mental deficiency."
    Section 14: "...severe behavioral effects..." "...varying degrees of mental retardation, and abnormal neurobehavioral development."  "FAS is the leading known cause of mental retardation..."
    Section15: "...most serious consequence is severe mental retardation..."
    Section 15: "...and MR."
    Section 14 does state "In one study, an increased frequency of abnormalities was not found until 45 ml of alcohol (equivalent to 3 drinks per day) was exceeded." [ The Surgeon General of the United States issued his warning against drinking during pregnancy in 1981.]    
    Personality Disorders are derived from the Diagnostic and Statistical Manual of Mental Disorders - Revised edition (DSM III-R) and include the Histronic (*Hysterical) Personality and the Antisocial (*Psychopathic, Sociopathic) Personality.  (*quotes are from the Merck Manual)
    Under treatment, the followinghas been changed and added:
    "The physician's job is to contain the patient's externalization through setting limits, confrontation,  and avoiding his own tendency to become overinvolved--first to rescue and then condemn.  ... Over the long term, the anxiety and and depression...are rarely abolished by pharmacotherapy...(exceptions are associated depression and compulsive disorders).
    "Patients must be confronted with the way their behavior affects other people.  Frequently, limits on behavior need to be set and reality issues dealt with.  ...the family should be involved, since group pressure seems to be effective.  Group and family treatment, group living situations, therapeutic social clubs, self help groups, milieu hospital therapy--all can be valuable in treatment.  ...It is also important that those who undertaken treatment be aware of the difficulties and avoid the disappointment, annoyance , and moral judgments that tend to creep in."
    Finally,  "Life expectancy is diminished but among those surviving, there is some tendency to stabilization after age 40."

 1992 to 1993.  The University of Wisconsin's Family Empowerment Network formed by Dr. Raymond Kessel and Dr. Georgiana Wilton as a direct response to family members who were asking for help in in dealing with Fetal Alcohol Syndrome. In 2002, FEN moved to the University of Wisconsin's Department of Family Medicine.

 
 1993.  Eighth Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome published by the Department of Health and Human Services and the NIAAA.  Pages 202-232.

 1994.  The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is published by the American Psychiatric Association.

 
 1995.  FASLink, a support and information internet listserv,  founded by Mrs. Val Surbey of Winnipeg, Canada along with the Canadian Centre for Substance Abuse..
Due to CCSA budget constraints, FASLink is now a nonprofit organization under Mr. Bruce Ritchie.

 The Fetal Alcohol Syndrome Community Resource Center started out as a local prevention organization 1994.  It was chaired by Gail Harris, PhD, who requested Teresa Kellerman to participate as a consultant for FAS issues.  In 1995, the two remaining active persons on the Prevention Committee (Teresa Kellerman and Ron Barber) agreed that the Committee would be more aptly named the FAS Community Resource Center.  Later the FAS CRC went on the internet as www.fasstar.com.

Article on the effects of prental alcohol on mRNA (messenger RNA) by Dr.s H.C. Scott, R.T. Zoeller and P.K. Rudeen from the University of Missouri-Columbia. Implications for the generational affects of prenatal alcohol exposure.

La Grossesse et L'Alcool  by Dr. Philippe Dehaene. (1995)  Paris:  Presses Universitaires de France.

 
 1995-2007.  The Merck Manual:  Seventeenth Edition is online at http://www.merck.com.
Fetal Alcohol Syndrome is found in this volume.  The behavioral aspects of FAS are as follows:       Section 21, Chapter 286, "..with mental retardation and behavioral disturbances..."
    Section 18, Chapter 250, "...varying degrees of mental retardation and abnormal neurobehavioral development."
    Personality Disorders are in Section 15:  Psychiatric Disorders Chapter 191: Personality Disorders.  The excerpts quoted are taken from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), under Cluster B:  dramatic/erratic.
    Antisocial Disorder (*previously called psychopathic or sociopathic) is essentially the same as the previous entries from prior Merck editions.
    There are additional comments on the environment. "Antisocial personality disorder is often associated with alcoholism, drug addiction, infidelity, promiscuity, failure in one's occupation, frequent relocation, and imprisonment.  ...more men have this personality disorder than women, and more women have borderline personality; these two disorders have much in common.  In the families to patients with both personality patterns, the prevalence of antisocial relatives, substance abuse, divorces and childhood abuse is high.  Often the patient's parents have a poor relationship, and the patient was severely emotionally deprived in his formative years.  Life expectancy is decreasedbutamong survivors, the disorder tends to diminish or stabilize withage."
    Histronic (*hysterical) Personality is also essential the same as in previous editions of the Merck.  There are no comments on therapies or treatment for this disorder 
    (*quotes are from the Merck Manual)

 1996. Alcohol, Pregnancy and the Developing Child.  edited by Dr. Hans-Ludwig Spohr and Dr. Hans-Christoph Steinhausen.  The European effort toconsolidate the research and knowledge about FAS that was available up to that time.  Spohr and Steinhausen also reported that papers on the occurrences of FAS had appeared in Germany in 1976, Sweden in 1979 and Japan in 1981. 

Fetal Alcohol Syndrome:  Diagnosis, Epidemiology, Prevention and Treatment.  edited by Kathleen Stratton, et al.  This Institute of Medicine textbook was the American effort to consolidate the research and practical knowledge that was available up to that time and to provide a uniform basis for diagnosis.  The term "Alcohol Related Neurodevelpomental Disorders" (ARND) was suggested as a substitute for the term "Fetal Alcohol Effects" which is often mistakenly considered a mild form of FAS.

 Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome and Fetal Alcohol Effects:  Final Report, August, 1996.  by Dr. Ann Streissguth.  One of the few studies that discusses the outcomes of FAS/FAE when intervention is not applied.

 October, 1996.  The Interagency Coordinating Committee on Fetal Alcohol Syndrome (ICCFAS) was created in response to recommendations of an expert committee of the Institute of Medicine (IOM) to coordinate Federal activities on FAS and other disorders associated with prenatal alcohol exposure. The ICCFAS is chaired by Dr. Kenneth R. Warren, Associate Director for Basic Research, NIAAA. The ICCFAS seeks to improve communication, cooperation, and collaboration among disciplines that address health, education, developmental disability, research, justice, and social service issues relevant to FAS and related disorders caused by prenatal alcohol exposure. The committee meets semi-annually.

The ICCFAS includes representatives from the following agencies:
The Department of Health and Human Services (DHHS): Agency for Healthcare Research and Quality (AHRQ); Centers for Disease Control and Prevention (CDC); Health Resources and Services Administration (HRSA)'s Maternal and Child Health Bureau (MCHB); Indian Health Service (IHS); National Institutes of Health (NIH): National Institute on Alcohol Abuse and Alcoholism (NIAAA), and National Institute of Child Health and Human Development (NICHD); Substance Abuse and Mental Health Services Administration (SAMHSA); Department of Education (ED), Office of Special Education and Rehabilitative Services (OSERS); and Department of Justice (DOJ), Office of Juvenile Justice and Delinquency Prevention (OJJDP).

   1997. Fetal Alcohol Syndrome:  A Guide for Families and Communities,  by Dr. Ann Streissguth, premier researcher on the behavior of children with FAS.  Streissguth gives a partial list of countries reporting cases of FAS, France, Germany, Iceland, South Africa, and Canada.

 Ninth Special Report to Congress on Alcohol and Health:  Fetal Alcohol Syndrome. published by the Department of Health and Human Services and the NIAAA.  Pages 192-246.

 FASCETS founded by Diane Malbin in Portland, Oregon.  Ms. Malbin had been studying and lecturing on FASD for ten years prior to the foundation of her organization.

 1998.  NOFASARDwas founded by Sue Miers and incorporated as an association in South Australia in 1998.  Anne Russell came on board as Queensland representative for the organisation in 2001 and Vicki Russell as Tasmanian representative in 2003.

 1999. FASWorld founded by Bonnie Buxton, Teresa Kellerman and Brina Philcox in Ontario Canada.  Main purpose was to form a worldwide FASDay at 9 a.m., September 9th of every year to start a world response to the problems of FAS.
 
FASAwareUK founded by Gloria and Peter Armstead of Wigan, Great Britain. [Margaret Murch founded an organization two years earlier but it has not been active as of late.]

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• #1 Comment from fastxfarnwide 
  10/26/05 9:30 PM | Permalink

  psoba
  thank you very much for your research into this history of fetal alcohol. saying thank you is wholly inadequate; and i wish i could dance a little jig to show you just how happy my heart is to see how far this field has come since first we met. there really IS now a fetal alcohol field and you are certainly one of the leaders in that field; a headlight in the movement. AND you do that all through caring. how do you do that? i have nowhere near your dedication. i manage my daily day okeh but you carry so much more on your own shoulders than most of us can support. we are blessed to have you blogging along here for all of our families and professionals to visit and consult. thank you.
  lindalee