Fetal Alcohol Syndrome Follow-up

Updated: Oct 22, 2016
  • Author: Keith K Vaux, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Follow-up

Deterrence/Prevention

The US Institute of Medicine has outlined a public health model of prevention for fetal alcohol syndrome (FAS). This model includes 3 levels: universal, selective, and indicated.

Universal prevention attempts to promote the health and well-being of all individuals in a society or particular community by educating women about the risks of alcohol for the developing fetus and about the importance of avoiding alcohol consumption during pregnancy. This type of prevention can be accomplished with public education and primary care.

Selective prevention and intervention is targeted to individuals in the population who are at increased risk (ie, women of reproductive age who drink alcohol and who have the potential to become pregnant). This step can be accomplished with effective screening for alcohol use and with brief interventions.

Indicated prevention and intervention is intended for the highest-risk women who are drinking risky amounts of alcohol and who are likely to become pregnant (eg, women who have previously delivered an affected child and who continue to drink). This level of prevention and intervention might be accomplished with treating such women for alcohol dependence and with case management.

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Prognosis

The prognosis for individuals with fetal alcohol syndrome or fetal alcohol syndrome disorder (FASD) is wide ranging. Some data suggest that having a confirmed diagnosis of fetal alcohol syndrome improves the prognosis, perhaps because this improves access to services. Other studies of fetal alcohol syndrome suggest that early diagnosis improves the prognosis because implementation of early intervention programs occurs at a younger age.

In one study, researchers followed up the natural history of a group of individuals with fetal alcohol syndrome or fetal alcohol syndrome disorder aged 12-51 years. Although no comparison group was included, rates of various mental, social, and legal problems were documented as follows:

  • Mental health problems (95%)
  • Confinement in prison, a drug or alcohol treatment center, or a mental institution (55%)
  • Trouble with the law (60%)
  • Inappropriate sexual behavior (52%)
  • Inability to live independently (82%)
  • Problems with employment (70%)
  • Alcohol and drug problems (>50% of male subjects, 70% of female subjects)

In a more recent study, Swedish investigators evaluating the psychosocial outcomes of 79 adults with fetal alcohol syndrome also found higher rates of special education, unemployment, disability, prescriptions for psychotropic drugs, and hospitalizations for alcohol abuse and psychiatric disorders compared to their age-, sex-, and birth place – matched cohorts. [12] However, both groups had similar levels of criminal offences.

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Patient Education

Keys to working successfully with children who have fetal alcohol syndrome or fetal alcohol syndrome disorder are structure, consistency, variety, brevity, and persistence. Because children with fetal alcohol syndrome or fetal alcohol syndrome disorder lack internal structure, caretakers need to provide external structure for them. Be consistent in response and routine so that the child believes the world is predictable.

Because of serious problems maintaining attention, be brief in explanations and directions but also use various ways to get and keep the child's attention.

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