Exploring the Complexities of Prenatal Alcohol Exposure

  • Prenatal alcohol exposure remains the leading cause of mental retardation in the United States
  • Children prenatally exposed to alcohol demonstrate distinct deficits in social and adaptive behavior
  • Researchers have found that children in psychiatric treatment who were not prenatally exposed to alcohol have the same deficits
  • As prenatally exposed children age, however, their social difficulties become more pronounced

Prenatal alcohol exposure is the leading cause of mental retardation of known origin in the industrialized world. Children prenatally exposed to alcohol are less likely to consider consequences to their actions, lack appropriate initiative, can be unresponsive to subtle social cues, and often lack reciprocal friendships. They also have increased behavioral and learning difficulties during adolescence, and frequently exhibit hyperactivity, attention deficits and/or concentration difficulties. Similar deficits have been described in clinical samples of children who are in psychiatric treatment but were not prenatally exposed to alcohol. A study in the July issue of Alcoholism: Clinical & Experimental Research compares these two groups of children.

"Our study is the first to compare prenatally exposed children to clinically referred children with no prenatal exposure," said Shannon E. Whaley, assistant research psychologist at the UCLA Neuropsychiatric Institute, and lead author of the study. "Multiple studies have provided clear evidence that children prenatally exposed to alcohol show distinct social and adaptive behavior deficits as compared to normal children of the same age. If these deficits are unique to the prenatally exposed children, then they are important not only for the diagnosis of fetal alcohol syndrome (FAS) or the more common alcohol-related neurodevelopmental disorder (ARND), but also for the course of treatment. If, however, these behaviors are not unique to prenatally exposed children, they remain crucial for intervention but are less useful for specific diagnosis."

The study found that the behavior deficits of the prenatally exposed children are not particularly different than those exhibited by children with other psychiatric difficulties. However, as prenatally exposed children become older, their difficulties with socialization skills in particular (making and keeping friends, understanding social cues, behaving appropriately in social situations) become more pronounced.

"It is vitally important to examine social and adaptive functioning among these children because any attempt to help them will be shaped by their problems," said Marian Sigman, professor of psychiatry and psychology at UCLA School of Medicine. "Social functioning is critical for how children live and develop. If children exposed to alcohol prenatally are not getting along with others, adults need to find ways to help them with their social relationships. Adaptive functioning reflects a broader set of abilities, such as the capacity to take care of one's basic needs, and communication skills. These are very important for the quality of the children's lives as well as their development. The finding that the adaptive deficits were similar across both groups is important because it means that adaptive deficits are not unique to children prenatally exposed to alcohol, but [instead] characterize children with a variety of problems. The fact that social deficits became more significant with age may mean that that these children might have more serious social deficits when they are older. We need to understand what can be done to stop this developmental pattern."

The study used the Vineland Adaptive Behavior Scales, a widely used measure of adaptive functioning, to test the children. Both groups demonstrated distinct difficulties across three domains of age-appropriate functioning: basic daily living skills, communication and socialization behavior. Daily living skills included tasks like helping to put things away, feeding and dressing one’s self completely without assistance, knowing the date, reading the clock, and knowing the value of money. Communication skills included reading and writing, paying attention at school, articulating clearly, and expressing ideas in more than one way. Socialization skills included making friends, following rules, initiating activity, and carrying on socially appropriate play and conversation. Unlike previous studies, researchers found that none of the deficits in these three domains were attributable to deficits in intellectual functioning.

"The fact that the social deficits were not attributable to deficits in IQ shows that it is not only the children with cognitive problems who are having social and adaptive difficulties," noted Sigman. "Accordingly, attempting to improve the intellectual abilities of these children might not have any effect on their social and adaptive functioning."

"In the early years," summed up Whaley, "social deficits of prenatally exposed children are likely to look similar to those exhibited by other children referred for psychological/psychiatric treatment. In fact, the lack of differences in social and adaptive behavior exhibited by the two groups of children shows how easy it is for prenatally exposed children to ‘blend in’ to clinical settings." Whaley said that during the critically important examination that doctors and clinicians make to determine potential contributors to social deficits, prenatal exposure is often missed and thus, not addressed.

"As prenatally exposed children become older," she added, "their difficulties with social skills are likely to become more pronounced than those exhibited by clinically referred children who were not prenatally exposed. Thus, after about age six or seven, prenatally exposed children show more difficulty than clinically referred children with the social skills required of older children and early adolescents. This includes things like making and keeping friends, having a group of friends, responding appropriately to strangers, controlling hurt feelings when they don't get what they want, initiating conversations, refraining from asking questions that might hurt or embarrass others, and responding to hints or indirect cues in conversation. This is an interesting finding, and particularly important for intervention with these children."

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Whaley, S. E., O'Connor, M.J., & Gunderson, B. (2001, July). Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample. Alcoholism: Clinical & Experimental Research, 25(7), 1018-1024.

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