**2. A conceptual understanding of the spectrum of effects of prenatal alcohol exposure**

In the same vein as Autistic Spectrum Disorders, Fetal Alcohol Spectrum Disorders (FASD,) initially described by Streissguth & O'Malley in 2000 is an umbrella term to describe the continuum of complex neuropsychiatric, cognitive, behavioral, social, language, communica‐ tion and other multi-sensory deficits. There are, however, two conditions within this spectrum which describe the range of conditions caused by prenatal alcohol exposure. They are Fetal

© 2013 O'Malley and Rich; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Alcohol Syndrome (FAS) a dysmorphic syndrome, and Alcohol Related Neurodevelopment Disorder (ARND) a non dysmorphic condition and by far the more common of the two conditions.

teratogenic effects of alcohol. Thus, the clinical relevance of both ARBD and the facial features in FAS is that of biomarkers for heavy binge exposure early in pregnancy – and sometimes, but not always, may predict a worse neurodevelopmental prognosis (Riley and McGee, 2005, Coles et al 2011). Since both FAS and ARND have neurodevelopmental (CNS) involvement, essentially ARND is FAS without the characteristic facial features. (Rich& O'Malley 2012).

Clinical Implications of a Link between Fetal Alcohol Spectrum Disorders (FASD) and Autism or Asperger's…

http://dx.doi.org/10.5772/54924

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**A. Fetal Alcohol Syndrome (FAS), a specific dysmorphic phenotype, requires documentation of all of the**

• dysmorphic facial features based on racial norms (including all of the following: small palpebral fissures at or below 10th percentile, smooth philtrum, thin vermillion border) – this requires a clinical dysmorphologist with

• growth problems: confirmed prenatal or postnatal height or weight, or both, at or below the 10th percentile,

II. Neurological problems not due to a postnatal insult or fever, or other soft neurological signs outside normal

developmental delay in younger children) with performance below the 3rd percentile (2 standard deviations

B. Functional deficits below the 16th percentile (1 standard deviation below the mean for standardized testing)

6. other clinically relevant neurodevelopmental issues (i.e., sensory problems, pragmatic language

**B. Alcohol Related Neurodevelopmental Disorder (ARND) is a non-dysmorphic condition with the following**

documented at any one point in time (adjusted for age, sex, gestational age, and race or ethnicity).

III. Functional Performance substantially below that expected for an individual's age, schooling, or

A. Global cognitive or intellectual deficits representing multiple domains of deficit (or significant

• may or may not have a clear history of documented maternal alcohol use in pregnancy;

A. Head circumference (OFC) at or below the 10th percentile adjusted for age and sex.

B. Clinically significant brain abnormalities observable through imaging.

1. cognitive or developmental deficits or discrepancies

• must have a documented history of maternal alcohol use during pregnancy;

**following clinical features.**

I. Structural:

limits.

**features:**

an understanding of FAS diagnosis;

circumstances, as evidenced by:

5. social skills

below the mean for standardized testing) or

in at least three of the following domains:

2. executive functioning deficits 3. motor functioning delays

problems, memory deficits, etc.)

4. problems with attention or hyperactivity

• Central Nervous System (CNS) abnormalities:

However within FASD there are physical sequellae aside from the facial dysmorphology, which are associated with all levels of prenatal alcohol exposure (Stratton et al 1996). These Alcohol Related Birth Defects (ARBD), as they are called, can occur as early as the first few weeks post conception.So, before most women know they are pregnant (Sulik, et al., 1983).

The central nervous system (CNS) and brain are the most sensitive and vulnerable structures to the effects of alcohol and can be affected by moderate to heavy alcohol use at any point in gestation. There is no safe amount of alcohol (threshold) during pregnancy and the Surgeon General of the United States currently recommends all childbearing age women to avoid alcohol if there is a potential for pregnancy (US Surgeon General, 2005).

Early, frequent, and/or binge exposures with moderate to high blood alcohol concentrations can lead to a range of reproductive outcomes including infertility, miscarriage (spontaneous fetal loss), still birth, sudden infant death syndrome, and a wide range of physical and neurodevelopmental (functional) birth defects. Varying degrees of Fetal Alcohol Syndrome (FAS) may be seen clinically at this range of exposure (Jones & Smith 1973, Streissguth et al 1987, 1991). Alcohol-Related Neurodevelopmental Disorder (ARND, Stratton et al., 1996) are the neurodevelopmental/functional birth defects that manifest in individuals with FAS, as well as those who do not meet full criteria for FAS but have documented evidence of prenatal alcohol exposure. ARND can be associated with inattention, poor decision making, impulsiv‐ ity, processing and working memory issues, other areas of executive dysfunction, mood instability, social communication deficits, and difficulties understanding consequences of their actions. These deficits are best evaluated by a thorough neuropsychological exam, including the Vineland Adaptive behavioral scales, IQ testing, and assessment of executive functions, such as BRIEF., FASD includes two conditions FAS which is dysmorphic and ARND, which is non-dysmorphic (See Table 1.).

Both FAS, dysmorphic and ARND. non-dysmorphic conditions can be associated with physical sequellae resulting from alcohol exposure in pregnancy. The Institute of Medicine describes these physical manifestations collectively as Alcohol Related Birth Defects (ARBD), including abnormalities in the developing eye, ear, teeth, heart, kidney, and skeletal system (Stratton et al, 1996; O'Malley & Streissguth, 2000; Chudley et al, 2005; BMA, 2007). Like the typical FAS facial features, ARBD occur in the first 8 weeks of embryonic development (organogenesis). Many of these conditions may not be diagnosed or evident at the time of a patient's psychiatric evaluation (Iich 2005, Nowick Brown et al 2011).

The major difference between dysmorphic (i.e., FAS) and nondysmorphic (ARND) phenotypes is whether or not the collective cardinal (dysmorphic) facial features are present. The facial features correlate to heavy maternal blood alcohol concentration (e.g., the equivalent of 5 to 6 servings of alcohol) during the earliest points in gestation (late 3rd week to early 4th week of embryonic development) (Sulik, 1983). Both the facial features and ARBD are due to early embryonic changes, disruptions in cell migration, and cell death (apoptosis) due to the teratogenic effects of alcohol. Thus, the clinical relevance of both ARBD and the facial features in FAS is that of biomarkers for heavy binge exposure early in pregnancy – and sometimes, but not always, may predict a worse neurodevelopmental prognosis (Riley and McGee, 2005, Coles et al 2011). Since both FAS and ARND have neurodevelopmental (CNS) involvement, essentially ARND is FAS without the characteristic facial features. (Rich& O'Malley 2012).

Alcohol Syndrome (FAS) a dysmorphic syndrome, and Alcohol Related Neurodevelopment Disorder (ARND) a non dysmorphic condition and by far the more common of the two

However within FASD there are physical sequellae aside from the facial dysmorphology, which are associated with all levels of prenatal alcohol exposure (Stratton et al 1996). These Alcohol Related Birth Defects (ARBD), as they are called, can occur as early as the first few weeks post conception.So, before most women know they are pregnant (Sulik, et al., 1983).

The central nervous system (CNS) and brain are the most sensitive and vulnerable structures to the effects of alcohol and can be affected by moderate to heavy alcohol use at any point in gestation. There is no safe amount of alcohol (threshold) during pregnancy and the Surgeon General of the United States currently recommends all childbearing age women to avoid

Early, frequent, and/or binge exposures with moderate to high blood alcohol concentrations can lead to a range of reproductive outcomes including infertility, miscarriage (spontaneous fetal loss), still birth, sudden infant death syndrome, and a wide range of physical and neurodevelopmental (functional) birth defects. Varying degrees of Fetal Alcohol Syndrome (FAS) may be seen clinically at this range of exposure (Jones & Smith 1973, Streissguth et al 1987, 1991). Alcohol-Related Neurodevelopmental Disorder (ARND, Stratton et al., 1996) are the neurodevelopmental/functional birth defects that manifest in individuals with FAS, as well as those who do not meet full criteria for FAS but have documented evidence of prenatal alcohol exposure. ARND can be associated with inattention, poor decision making, impulsiv‐ ity, processing and working memory issues, other areas of executive dysfunction, mood instability, social communication deficits, and difficulties understanding consequences of their actions. These deficits are best evaluated by a thorough neuropsychological exam, including the Vineland Adaptive behavioral scales, IQ testing, and assessment of executive functions, such as BRIEF., FASD includes two conditions FAS which is dysmorphic and ARND, which

Both FAS, dysmorphic and ARND. non-dysmorphic conditions can be associated with physical sequellae resulting from alcohol exposure in pregnancy. The Institute of Medicine describes these physical manifestations collectively as Alcohol Related Birth Defects (ARBD), including abnormalities in the developing eye, ear, teeth, heart, kidney, and skeletal system (Stratton et al, 1996; O'Malley & Streissguth, 2000; Chudley et al, 2005; BMA, 2007). Like the typical FAS facial features, ARBD occur in the first 8 weeks of embryonic development (organogenesis). Many of these conditions may not be diagnosed or evident at the time of a

The major difference between dysmorphic (i.e., FAS) and nondysmorphic (ARND) phenotypes is whether or not the collective cardinal (dysmorphic) facial features are present. The facial features correlate to heavy maternal blood alcohol concentration (e.g., the equivalent of 5 to 6 servings of alcohol) during the earliest points in gestation (late 3rd week to early 4th week of embryonic development) (Sulik, 1983). Both the facial features and ARBD are due to early embryonic changes, disruptions in cell migration, and cell death (apoptosis) due to the

alcohol if there is a potential for pregnancy (US Surgeon General, 2005).

patient's psychiatric evaluation (Iich 2005, Nowick Brown et al 2011).

conditions.

452 Recent Advances in Autism Spectrum Disorders - Volume I

is non-dysmorphic (See Table 1.).
