Case Report
Volume 1 Issue 1 - 2014
Alcohol Effects on Fetal Brain Development: The Case of Cynthia
W Sumner Davis1* and Siobhan Crosbie2
1Community Psychologist and Clinical Epidemiologist, Walden University, USA
2Psychotherapist & BPS Clinical Supervisor, APS Psychotherapy and Counselling, UK
*Corresponding Author: W Sumner Davis, Community Psychologist and Clinical Epidemiologist, Walden University, USA.
Received: November 25, 2014; Published: December 29, 2014
Citation: W Sumner Davis and Siobhan Crosbiee. “Alcohol Eff ects on Fetal Brain Development: The Case of Cynthia”. EC Neurology 1.1 (2014): 4-7.
Abstract
Fetal alcohol syndrome is a well-known and well-described condition in both psychiatric and pediatric literature. Somewhat less known is fetal alcohol effects or FAE. While not generally causing physical many of the characteristics of FAS, FAA has often-similar cognitive and emotional impact. Cynthia is just such a child. Born of an alcohol dependent and drug-abusing mother, she spent the first year of her life with her biological mother before the state intervened and a maternal aunt adopted her. What follows is a briefcase study examining how fetal alcohol effects may impact a child many years after birth and how children suffering from these effects often cope with the knowledge that they are somehow different.
Keywords: Fetal alcohol syndrome; Fetal alcohol effects; neuropsychology; Cognitive development; Cognitive delay; Executive function; Memory; Behavior modification; Case study; Paediatrics; Psychotherapy; Brain injury; Maternity
Abbreviations: KABC: Kaufman Assessment Battery for Children; FAE: Fetal Alcohol Exposure; FAS: Fetal Alcohol Syndrome; WISC: Wechsler Intelligence Scale for Children
Cynthia was a precocious 10-year-old with a quick smile and an infectious laugh. On the surface, she seemed like any other 10-year-old girl. She was interested in all the things that most 10-year-old girls are. She loved to read, although she often chose books that were a little beyond her years, and some of her favourites were mysteries and books about vampires. If you were to have met Cynthia, you would probably think that she was like any other typical 10-year-old girl, and you would have been right, at least in most respects.
If you had spent more than a few minutes with Cynthia, you might have noticed that she frequently had difficulty controlling her emotions. She got frustrated easily, and that often got her into trouble at school. She had conflicts with the other girls, although she responded well to her teachers. On tests like the Kaufman Assessment Battery for Children (KABC), Cynthia scored ‘average’ for memory and application tasks, but quite a bit lower than her peers on executive processing tasks. She also had great difficulty with novel tasks and she was easily frustrated.
When we read a book together, she often did not understand what she was reading, even though she pronounces the words correctly. If I were to ask her a few minutes later to tell me about what she had read, she remembered what the characters did, but often had difficulty explaining why they did them. She had been at different times diagnosed by clinical social workers or psychologists with Anxiety Disorder, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Bipolar Disorder. The more professionals she has seen, the more diagnosis she received, and all used behavior to make their diagnosis. None of these diagnoses helped Cynthia or helped to explain why she was different. Her problem went back to before school, before infancy even. It began in utero.
Cynthia's birth mother was a heavy drinker, and she did not stop while she was pregnant. As a result, Cynthia's brain was injured before she was born. Children exposed to prenatal alcohol exposure suffer insults to brain structure and function. Studies have shown these brain injuries play a role in a variety of behavioral effects seen later in childhood. Fetal alcohol exposure (FAE) is also associated with deficits in a range of areas of function, including both cognitive functioning which entails general intellectual functioning and the learning of new verbal information, as well as fine and gross motor performance. Neurological studies, particularly those of Berman and Hannigan [1] have analyzed the cognitive impairments of children with histories of prenatal alcohol exposure, and although many of these studies have focused on children diagnosed with fetal alcohol syndrome (FAS), and analyses have included children with lesser exposures to alcohol in utero. Another study by Clark Li et al. [2], show that strong similarities exist between (FAS) children and those exposed to lesser amounts of alcohol in utero or FAE.
As previously mentioned, Cynthia's cognitive ability had been reported as being on the borderline range of normal functioning; her IQ on the standardized tests like the Wechsler Intelligence Scale for Children (WISC), was lower than the range expected for kids her age, but the reason for the lower than expected IQ on such tests are not indicated. Both anecdotal information and the results from studies have demonstrated that this prenatal exposure to alcohol greatly affects memory and learning abilities in childhood and observations of children with FAE support this observation. Some studies show that children exposed to alcohol in utero demonstrated deficits in memorizing verbal information; this deficit resulted from difficulties with the acquisition of the information rather than the ability to remember the information over time [2].
Connor and Mahurin [3] found that learning deficits occurred in both verbal and nonverbal areas of information acquisition. For parents and teachers, this means that children whose brains were damaged due to teratogens like alcohol have an uphill battle when it comes to learning. These abnormalities are recognized as behaviours that are viewed as negative or disruptive. The behaviour further impedes learning and participation in the classroom, the social environment, and home-life. Children with FAE appear to be at increased risk for psychiatric disorders, alcohol abuse, drug abuse, and other maladaptation [2]. Children suffering from FAE are also more likely to be hyperactive, disruptive and impulsive. When these behaviours are combined with a diminished capacity for cognitive acquisition, these children are at a great disadvantage in the classroom. Teachers and parents often do not understand that the child is merely using the limited tools they have to try to fit in. Having a learning disability is tough. Having a behavioural disability is tough. Having both makes it nearly impossible to excel in today's ‘one-size-fits-all’ classrooms. In these surroundings, planning, organizing, and forming strategies are all aspects of social grouping that require a group of higher-level cognitive abilities called executive functioning.
Executive functioning is critical to the success of problem-solving, abstract thinking, planning and a flexible thought process. Cognitive abilities can be thought of as tools that the child uses to interpret their world; executive functioning refers to the ability to use these cognitive tools. Children with heavy prenatal alcohol exposure are at risk of impairments on executive functioning tasks. More importantly, a child’s deficits in executive functioning are often unrelated to their overall intellectual level, as indicated by studies among adults with FAE [4]. Moreover, deficits in executive functioning have real-life implications for people exposed to alcohol in utero. They may act without first considering the consequences of their behaviour, or they may have difficulties linking behaviour and consequence. These types of deficits help explain why children with heavy prenatal alcohol exposure, even those with average I.Q. scores, often have difficulty in school and in society in general.
The neuropsychological and behavioural issues described above manifest themselves in real life effects of prenatal alcohol exposure. The effect of alcohol on brain development has been noted in articles on FAS dating back to the 1970s. With the advent of structural imaging techniques such as MRIs and EEGs as well as imaging scanning devices for example PET and the Single Photon Emission Computed Tomography, researchers can now study the brains of alcohol affected children in non-invasive fashions [2]. What they're finding strengthens the argument against drinking while pregnant; longitudinal studies now show many complications, both psychological and physiological resulting not only with FAS, but also FAE.
FAE and following on from the example given in the above case study of Cynthia, the child that suffers with behavioural, emotional and educational difficulties resulting from neurological injury in utero are often forced to adopt somewhat antisocial defence mechanisms. This can result in anger becoming a predominant response to others. Children like Cynthia often become vulnerable to the verbal aggression of their peers and respond aggressively. Intellectually they may experience anxiety over the inability to perform educationally compared to peers. This anxiety can manifest as unwanted behaviours, and they can be extensive; Cynthia often used anger in communicating with her peers and even some adults. She would attempt to draw attention to herself, for example falling off her chair during class to illicit laughter from her peers. This drew the ire of her teacher, and in the long term, such behaviour often resulted in consistent rejection that reinforced her feelings of worthlessness. Children like Cynthia may also have greater difficulties in coping with themselves.
Children suffering from FAE are often ill equipped to understand their behaviour and may be prone to criticism for behaving in ways that are not deemed socially acceptable or ‘normal’. The impact of the child’s neurological injury often manifests in struggles with memory or comprehension, which if not handled expertly can result in feelings of low self-esteem, internal anger or overt anger and high levels of anxiety. Feelings of isolation, confusion, frustration and anxiety are too often the result of failed interactions, and depending on the level of emotions involved may lead to serious self-harm as a way to deal with the frustration as these children progress to adulthood as a way to control the emotional chaos. This anxiety and need for control may be placed onto food that can result in Bulimia or Anorexia.
These feelings of rejection often turn inward through the child’s experiences with rejection from peers or adults from unwanted behaviour or being ‘slow’ educationally, or internally by the inability to feel understood or accepted. Anxiety can also manifest in social situations creating a self-perception of being ‘odd’ or ‘abnormal’. The reactions of peers and many adults often result in children like Cynthia feeling rejected, without understanding why, often leading to an extensive self-criticism and further rejection of themselves. Cynthia was referred from one therapist to another creating the perception that she was the problem, one that could not be ‘fixed’. As she was referred again and again, Cynthia’s feelings of rejection were further reinforced as each person who failed her was seen as a rejection.
In the case of Cynthia, the attachment style to her primary caregiver in infancy was extremely unhealthy. Developmental psychologists considered the first 12 to 18 months of a child’s life to be crucial in regards to the child’s primary caregiver, and that this earliest relationship is foundational for all future relationships [5].
The first 12 months of Cynthia’s life were spent with her birth mother before she was removed from custody and placed in the care of a relative. From the age of one, Cynthia’s childhood could be described as average, at least concerning her home life. However, the factors of her negative early attachment combined with FAE led to an avoidance of equal relationships: Cynthia attempted to control her friends and her siblings, and once commented to me that a person can only have one friend at a time. On several occasions, I witnessed her becoming very jealous and aggressive toward anyone approaching the person she deemed as her one friend. This controlling behaviour will often lead to problems with intimacy, and for children born with FAE, these perceptions, both internal and external, often result in avoidance of closeness for fear of rejection. As young adults, these can be manifested in relationships that are unhealthy or destructive, due to a lack of self-esteem or an inability to commit for fear of rejection.
What does seem clear is that children like Cynthia are somehow different. With this recognition comes a type of grieving process where the child must try to come to terms with his or her inability to be like everyone else. In children with FAE, the grieving process may be unconscious, reflective of the perceived inability to have emotional stability or security. This often results in further frustration, anger, and aggression, which may lead to depression as the child enters adulthood. The angry and frustrated child becomes the depressed teen, and we often see an increase in eating disorders, tendencies towards violence, or withdrawal and isolation.
The neurological, psychological, and social effects of FAE can be extensive. Unlike many similar fetal defects, prevention is simple: limit or cease alcohol consumption when pregnant. This can only come through a better awareness of drinking in pregnancy. If you are pregnant do not use alcohol. Check with your pharmacist about prescriptions that may be detrimental to your unborn child. The bottom line is simply this: what you put into your body you are putting it into your unborn child.
Bibliography
  1. Berman RF and JH Hannigan. “Effects of prenatal alcohol exposure on the hippocampus: special behavior, electrophysiology, and neuroanatomy”. Hippocampus 10.1 (2000): 94-110.
  2. Clark CM., et al. “Structural and functional Brain integrity of fetal alcohol syndrome in nonretarded cases”. Pediatrics 105.5 (2000): 1096-1099.
  3. Connor PD and RA Mahurin. “Preliminary study of working memory in fetal alcohol damage using fMRI”. Journal of international neuropsychological society 7.2 (2001): 206.
  4. Archibald SL., et al. “Brain dysmorphology in individuals with severe prenatal alcohol exposure”. Developmental medicine and child neurology 43.3 (2001): 148-154.
  5. Ainsworth MD., et al. Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, NJ: Lawrence Erlbaum, 1978.
Copyright: © 2014 W Sumner Davis., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


August Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the August issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for September Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the September issue of respective journals. Submissions are accepted on/before August 15, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk