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Summary: A look at our roles as ministers to the large number of people in our churches and societies that suffer from this phenomenon known as Fetal Alcohol Syndrome/Fetal Alcohol Effect and by the broader term Alcohol Related Neurological Birth Defects ARND.

Can Your Church work with Alcohol Related

Neurological Birth Defected

Adolescents and Adults

Dealing with Difficult People

By: Bruce Landry

I. What Are the Issues of Alcohol Related Birth Defects

The issues that are relevant to children and adults who are born and are living daily with Alcohol Related Birth Defects are numerous. We are aware that this is a condition that can be eliminated if we can stop a mother from ingesting alcohol during any period of pregnancy. A definition of Alcohol Related Neurological Birth Defects (ARND) refers to a group of physical and mental birth defects caused by alcohol ingestion during pregnancy.

Drinking during pregnancy can cause a wide range of harmful effects to the child. These effects can range from a characteristic pattern of physical features and mental impairment to more subtle cognitive (thinking) and behavioral (actions) dysfunction’s. Fetal Alcohol Syndrome (FAS) causes a spectrum of clinical effects on facial dysmorphology and can effect the central nervous system. Fetal alcohol syndrome (FAS), first described in the published medical literature in 1968, refers to a constellation of physical abnormalities, most obvious in the features of the face and in the reduced size of the newborn, and problems of behavior and cognition, in children born to mothers who drank heavily during pregnancy. These latter features lead to the most concern. The costs of FAS and related conditions can be quite high—for the individual, for the family, and for society. Rates of FAS in several of the most complete studies are similar—on the order of 0.5 to 3 cases per 1,000 births. Assuming an annual birth cohort of approximately 4 million, this translates into 2 to 12 thousand FAS births per year in this country. These incidence figures are offered not as established facts but to emphasize the magnitude of a problem that has serious implications—for the individual and for society.

Following is some very basic data to understand the effects of Alcohol on the body of our fellow believers who suffer from this:

Alcohol is a "teratogen" (substance that is toxic to the baby’s developing brain). Damage can occur in various regions of the brain. The areas that might be affected by alcohol exposure depend on which areas are developing at the time the alcohol is consumed. Since the brain and the central nervous system are developing throughout the entire pregnancy, the baby’s brain is always vulnerable to damage from alcohol exposure.

Not all damage from alcohol exposure is seen on brain scans, as lesions might be too small to be detected, yet large enough to cause significant disabilities.

Brain of normal 6-wk-old baby Brain of 6-wk-old baby with FAS

Alcohol Exposure During Stages of Pregnancy:

1. During the first trimester, as shown by the research of Drs. Clarren and Streissguth, alcohol interferes with the migration and organization of brain cells. [Journal of Pediatrics, 92(1):64-67]

2. Heavy drinking during the second trimester, particularly from the 10th to 20th week after conception, seems to cause more clinical features of FAS than at other times during pregnancy, according to a study in England. [Early-Human-Development; 1983 Jul Vol. 8(2) 99-111]

3. During the third trimester, according to Dr. Claire D. Coles, the hippocampus is greatly affected, which leads to problems with encoding visual and auditory information (reading and math). [Neurotoxicology And Teratology, 13:357-367, 1991]

The regions of the brain that might be affected by prenatal alcohol exposure in terms of ability to function include:

Corpus Callosum - passes information from the left brain (rules, logic) to the right brain (impulse, feelings) and vice versa. The Corpus Callosum in an individual with FAS/ARND might be smaller than normal, and in some cases it is almost nonexistent. (MRI images)

Hippocampus - plays a fundamental role in memory.

Hypothalamus - controls appetite, emotions, temperature, and pain sensation

Cerebellum - controls coordination and movement, behavior and memory.

Basal Ganglia - affects spatial memory and behaviors like perseveration and the inability to switch modes, work toward goals, and predict behavioral outcomes, and the perception of time.

Frontal Lobes - controls impulses and judgment. The most noteworthy damage to the brain probably occurs in the prefrontal cortex, which controls what are called the Executive Functions.

Prenatal Alcohol Exposure and the Brain, continued

Individuals with Fetal Alcohol Syndrome (FAS) and related disorders often have symptoms or behavior issues that are a direct result of damage to the prefrontal cortex, which is the part of the brain that controls “executive functions.”

Executive Functions

Executive functions ofthe prefrontal cortex: Effects of alcohol exposure on behaviorsrelated to executive functions:

· inhibition· planning· time perception· internal ordering· working memory· self-monitoring· verbal self-regulation· motor control· regulation of emotion· motivation · socially inappropriate behavior, as if inebriated· inability to apply consequences from past actions· difficulty with abstract concepts of time and money· like files out of order, difficulty processing information· problems with storing and retrieving information· needs frequent cues, requires “policing” by others· needs to talk to self out loud, needs feedback· fine motor skills more affected than gross motor· moody “roller coaster” emotions, exaggerated· apparent lack of remorse, needs external motivators

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