Alcohol Effects on Women
There are unique health risks facing women who drink at risk levels. According to national guidelines, if a woman drinks 7 or more drinks per week or 3 or more drinks on a given day, she is considered at risk for developing alcohol-related problems.

Women become more impaired than men do after drinking the same amount of alcohol. This is because women’s bodies have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol becomes more highly concentrated in a women’s body than in a man’s.

Negative effects of alcohol consumption for women include liver damage, fertility problems, increased risk of breast cancer, and, for pregnant women, miscarriage or potential fetal damage.

A woman should not drink alcohol:

• When pregnant, planning a pregnancy, or breastfeeding.
• If sexually active and not using birth control correctly.
• While driving or taking certain medications.
• If she has been diagnosed with alcoholism or is a recovering alcoholic.
• If she has health problems that can be made worse by drinking (for example, Hepatitis or diabetes).

Alcohol’s Effects on the Fetus
No amount of alcohol has been proven safe to drink during pregnancy. Fetal alcohol syndrome and all alcohol-related effects are preventable when a pregnant woman does not consume alcohol. When a pregnant woman drinks alcohol, so does her baby.

Through the blood vessels in the placenta, the mother’s blood supplies the growing baby with nourishment and oxygen. If the mother drinks alcohol, the alcohol, in the same concentration, crosses the placenta entering the blood supply of the embryo or fetus.

When alcohol reaches the blood supply of the embryo or fetus, it can cause permanent defects to the major organs and central nervous system. Early exposure (i.e. the first three months of pregnancy) presents the greatest risk for serious physical defects, and later exposure increases the chances of miscarriage or neurological and growth deficiencies of the fetus.

Effects of FAS/FASD throughout the Lifespan:
Most children diagnosed with fetal alcohol-related problems are not identified before they reach school age, when they are referred for a learning disability or an attention deficit disorder. If clinicians can identify alcohol-related effects early, intervention approaches can minimize the potential impact of these effects.

Information courtesy of the Fetal Alcohol Syndrome Information Website: http://fas-info.uwe.ac.uk/index.htm

Physical Findings

• Small stature/short for age/tiny
• Thin/slight/skinny/scrawny
• Small head
• Low nasal bridge
• Shortened eye openings - distance between the eyes is wider that the width of the eye opening itself
• Droopy eyelids
• Flattened mid -face (cheeks) - may be more noticeable in profile
• Short, upturned nose
• Distance between nose and upper lip may be longer or shorter than normal
• Thin upper lip
• Small chin may be receding
• Fingers may taper or narrow towards the tip, most noticeable in index and small fingers
• Had/has heart murmur/defect
• Had/has vision problems; wears glasses
• Differences in sensory awareness (hypo or hyper) to pain, cold, heat, touch etc.
• Under or over reacts/sensitive/resistive: child may "flinch" or "shudder when touched or not react to real pain
• Poor sleep cycle - may need very little or a lot of sleep or may have a very erratic sleep patter
• Either does not eat or overeats
• Persistent problems with toileting
• Frequent illnesses

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Communication/Language Use

• May be non-verbal or slow to talk, combine words or use sentences.
• Ignores verbal instructions and is non compliant with (doesn't listen to) verbal restrictions e.g. No
• Is not responsive to subtle facial expressions/body language
• Can repeat back instructions but seems unable to follow them
• Uses behavior to communicate
• Frustrated with inability to speak and/or understand speech

Socialization/Play

• Does nor pay attention to what is happening around him/her
• Frequently seems very anxious
• Not afraid of strangers (will go with anyone)
• Too trusting
• Easily frustrated or annoyed by the actions of other children
• Difficulty turn taking or waiting
• Stands too close to people "in your face"
• Poor understanding of body language, non-verbal cues
• Overly affectionate with people he does not know
• Charming, friendly then over-intrusive
• Highly affectionate, "touchy-feely"
• Prefers playing with younger children or the company of adults to same age peer group.
• Requires constant supervision
  

Behavior

• Destructive, may be willful
• Frequent lengthy temper tantrums
• Demands immediate gratification - wants things now
• Low tolerance for frustration
• Self-stimulating behavior (rocking, head banging)
• Accident prone
• Oppositional (you say yes he says no)
• Exhibits extremes in behavior (very loving to very hateful: very co-operative to very oppositional)
• Reacts badly and/or resists change in activity, routine, environment
• Disregards consequences for misbehavior
• Behavior deteriorates when upset or frustrated
• Fearless unable to comprehend danger
• Does not seem to learn from experience
• Inconsistently responds to a reward or consequences
  

Attention, activity and impulsivity

• Unable to wait
• Unable to play quietly
• Unable to sit still; fidgets, wiggles, squirms
• Does not sustain attention to an activity for long
• Easily distracted by other stimulus in the environment (light, color, noise, movement, equipment, people etc.)
• Easily over-stimulated
• Does better in non-stimulating environments
• Requires direct adult supervision due to safety concerns
• Frequent injuries due to activity level
• May be under active
  

Physical Motor Skills (Applies to 5 year olds only)

• Poorly coordinated and clumsy (gross motor control problems)
• Fine motor control problems
• Difficulty throwing, catching, kicking a ball
• Needs some physical help with dressing
• Described as awkward
• Eyes and hands do not work together
• Fatigues easily with physical exertion
  

Cognition/Memory

• Developmental delay
• Difficulty in understanding anything abstract
• Seems unable to make connections between actions and consequences
• Problems with concept formation i.e. Understanding things like "soon", "when", "if, "before", "after", "tomorrow"
• Problems with sequencing counting, following directions, alphabet skills
• Learns a skill then quickly forgets it
• Has trouble making simple choices
• Does not grasp simple instructions
• Language lacks ideas and information: may use lots of words but says very little
• Seems unable to transfer a skill learned in one area to another area i.e. "don't hit" at home must be relearned at school as "don't hit" at school
• Poor problem solving skills - will persist with an approach that clearly does not work: does not use trial and error methods
• Chronically frustrated
• Is easily confused by things

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Communication/Language Use

• Has been considered a developmental receptive language disorder (doesn't seem to understand what is said)
• Speech problems (stuttering, stammering, hesitation)
• Excessively chatty/ talks too much
• Appears not to hear, hearing problems may be suspected
• Does not follow instructions using words such as he, she, you, we, they
• Can repeat back instructions word for word bur does not follow through and carry them out
• Is not responsive to subtle facial expressions or body language
• Difficulty in saying what he/she is thinking/means (talks in circles)
• May use a lot of language but says very little (quantity masks quality ) speech lacks content, ideas, information, original thought
• Gets lost quickly in conversation; loses interest
• Does not seem to hear without eye contact
• Argues a lot
• May respond to sign language and exaggerated gestures better than words
• Difficulty in responding to spoken instructions or general conversation
  

Socialization/Play

• Indiscriminate, people are seen as interchangeable, no preference for one over another
• Described as "in your face"; no sense of personal space, stands too close to people
• Poor understanding of things like body language, non-verbal cues
• No sense of stranger danger, would go with anyone
• Prefers being with adults or younger children over children of the same age
• Overly affectionate with people he/she does not know
• Seen as manipulative
• Poor understanding of social rules and expectations
• Misses/ misuses social cues
• Acts out/ temper tantrums when overwhelmed
• Abused and/or teased by other children, gullible, easily set - up, scapegoat
• Does not make connections between socially unacceptable behavior and the consequences to self; often seems angry or bewildered; remains disconnected his/her part in it
• Desires a lot of touch and affection or resists touch - will flinch or shudder
• Seems to prefer negative to positive experiences (seeks out trouble)
• Easily talked into things - lying, stealing, misbehavior, giving away lunch or possessions

Behavior

• Destructive deliberately or accidentally
• Physically aggressive - lashes out especially when frustrated or upset
• Non - compliant with adult requests - disobedient
• Reacts badly or resists changes to routine, activity, or environment, has problems adapting
• Lies and confabulates (makes things up)
• Steals has difficulty in understanding "ownership" or possessions of others
• Inappropriate touching of others (poor boundaries - may be sexually intrusive)
• Behavior regresses when frustrated, stressed or upset
• May exhibit extremes in behavior without intermediary steps - goes from very co-operative to very hostile, nothing in between, in a short space of time or major inconsistencies with behavior - can exhibit compliance for lengthy periods then switch for no apparent reason
• Does not seem to learn from experience
• Seems to show little remorse for actions
• Accident prone
• Acts in ways that place self at risk of harm
• Negative behavior difficult to "unlearn"
• Behavior problems may now have other diagnostic labels such as conduct disorder, oppositional disorder, attention deficit hyperactivity disorder, attachment disorder

Attention, activity and impulsivity

• Acts on impulse, without thinking
• Problems with taking turns and waiting
• Unable to sit still; fidgets, wiggles, squirms
• Unable to screen out distractions or prioritize them; in event tries to pay attention to everything at once
• Highly active - always running, jumping, climbing, skipping, moving
• Problem with motor impulsivity - tapping, hitting, throwing, touching, foot swinging
• Often has injuries without any ideas of how they occurred
• Requires constant supervision
• Always seems to be losing things
• Becomes agitated and confused when presented with options/choices, especially more than two
• Activity levels increase with stress
• Easily tired with the need to pay attention
• Bedtimes may be difficult; child unable to relax and self to sleep

Physical Motor Skills

• Gross motor control problems
• Fine motor control problems
• Does nor have a dominant hand
• Poorly coordinated; clumsy described as awkward
• Problems with visual motor perception (what is seen is distorted, reproduced incorrectly); difficulty drawing shapes, copying letter or numbers
• Accident prone
• Becomes tired easily with activity
• Problem with written output; unable to produce quantity or quality
  

Memory

• Learns a skill and forgets it quickly
• Information seems to slip in and out - here today gone tomorrow, and back again sometime later
• Forgets how to do something after doing it for some period of time
• Inability to remember is frequently seen as deliberate
• Difficulty separating fact from fantasy
• Problems with sequencing (doing things in the proper order)
• Disorganized
• Loses track of what he/she is saying mid-sentence, mid-thought
• Problems with confabulation (lying) - distorted perception of what happened due to faulty memory - puts many different experiences together as one story and "remembers" it as true
• "crazy lying" lying in the face of obvious incriminating evidence
  

Cognition

• Known or suspected severe learning difficulties; borderline IQ
• Developmental delay
• Functions at lower levels than predicted by tests
• Problems with math
• Problems with language and arts comprehension
• Problems with concept formation; dealing with ideas;
• Understanding of words such as "soon", "if", "then", "before" or "after"
• Seems unable to transfer a skill learned in one area to another area i.e. "do not hit" learned at home must be re-taught elsewhere. Adding up in the green textbook in Mrs. Brown's class does not translate as the same thing as adding up in the red textbook in Mr. Smith's class
• Seems unable to make connections between actions and consequences, in the personal domain or in the larger world (i.e. If you do not share, people will not play with you, if you share they will, rain makes the plants grow, lack of rain causes them to die if you want clean clothes you have to wash them)
• Impaired rated of learning - one or more areas may be much further behind/ahead than others
• Gives up easily with new learning
• Easily confused
• Inability to plan
• Problems with incidental learning - does not learn through exposure to a learning situation but must be specifically taught the skill
• Unable to tell the time
• Might have trouble recognizing an emergency
• Difficulty in understanding jokes which depend on understanding language
  

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Physical Findings
The physical features remain the same as those found in the birth to thirty-six months section. The child is still short in height, below average in weight and with a smaller head than normal. However, after the age of 10, the facial features are much less obvious. By adolescence the most easily recognized features are

• Shortened eye openings - the distance between the eyes is wider than the width of the eye opening itself. The eyes may appear wide set, far apart or small. There may be a fold of skin over the inner corner of one or both eyes, giving the eye a slightly squared off looking inner corner, or may also arise under the eye as an extra fold of skin
• Droopy eyelids
• Thin upper lip
  

Communication/Language Use

• Low verbal IQ
• May have been considered a developmental receptive language disorder
• Speech problems (stuttering, stammering, hesitation)
• Has trouble following directions using words like he, she, you, they
• Is not responsive to subtle facial and body language
• Problems with word retrieval - can give you the use, color, where etc. but cannot name the thing e.g. "the silver thing to make hot water in the kitchen"
• May use a lot of words but quantity of language masks quality and content
• Surface verbal skills do not match the ability to communicate effectively
• Problems with sentence structure
• Problems with word meanings
• Gets lost quickly in conversation and loses interest
• Initially may be seen as intelligent; based on language use

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Physical Findings
The facial features of FAS are less clearly defined or recognizable in adolescence and adulthood. At this stage a history from childhood is useful particularly if there are some photographs of facial features and also some photographs of the child with friends of the same age. This enables a comparison to be made with a measure of average development at that age.

• Small for age
• Thin
• Mid-face may appear flattened especially in profile
• Absent groove under nose
• Heart murmur
• Problems with eyesight
• Problems with bones e.g. spine, knees, elbows,
• Problems with sleep, too much too little inconsistent patterns
• More than the usual amount of illness
  

Communication/Language

• Talks a lot, maybe even too much
• Appears not to hear but has no hearing loss
• Not responsive to subtle facial/body language
• Has problems in following complicated, long, non-specific instructions
• Has problems with instructions which are nor directed at her/him by name
• Has a good vocabulary but speech lacks information and ideas.

Socialization/Behavior

• No sense of personal space.
• Lacks personal boundaries
• Little understanding of social rules and norms
• May be sexually inappropriate
• Can be "talked into" inappropriate behavior
• May be abused, teased, bullied or "picked on" by other adolescents
• Unable to compromise
• Poor eye contact
• Too trusting
• Overly affectionate with people she/he does not know well
• Withdraws, cuts off or "acts out" when overwhelmed
• May show extremes of behavior very helpful to very unhelpful in a short space of time
• May be viewed as manipulative
• Reacts badly to and resists change
• Lies or confabulates
• Does not learn consequences of actions so may keep repeating mistakes
• Breaks promises, or agreements
• May have been diagnosed as having a conduct disorder
• May truant from school
• Very demanding of people's time and attention "burns out" people
• Likes intense experiences but is at risk as she/he cannot "work through the consequences of actions
• May bully or frighten others
• Acts in ways which put self or others at risk
• Would not recognize a sexual advance
• Would not know how to protect her/himself from a sexual advance
• May wander off without telling anyone where she/he is going
• Does nor recognize danger
• Cannot be left in charge of an older sibling, needs adult care at all times
• Unable to be left unsupervised
  

Attention/Activity

• Easily distracted
• Acts on impulse
• Fidgets, constantly moving e.g. foot swinging, kicking, throwing things
• Work is disorganized, messy and careless
• Always seems to be losing things
• Gets tired very easily especially if having to focus attention
• "Audible thinker" thinks it - says it
  

Memory

• Information seems to slip in and out -here today, gone tomorrow back again three days later
• Forgets how to do something she/he knows well
• Problems with remembering dates, times, phone numbers, tasks
• Inability to remember appears to be deliberate but is not
• Forgets what she/he is supposed to do in the middle of doing it
• Forgets to turn off cooker, lock doors etc
• Has difficulty separating fact from fantasy
• Lies even when the evidence is overwhelming
• Visual memory is better than auditory
• Long term memory better than short term
• Forgets to take medication
• Needs constant reminders to carry out daily events/tasks

Cognition

• Known or suspected learning difficulties
• Below average adaptive behavior scores
• Difficulties with math
• Problems with language comprehension
• Problems in concept formation e.g. time, money, rules
• Difficulty grasping new ideas
• Concrete thinker
• Difficulty seeing alternatives or compromises
• Difficulty making choices tends to stick with the first choice
• Doesn't make connections between physical state and required act e.g. cold, dark, hungry, time to go home
• Does not understand connections in the larger world e.g. seasons/weather/climate Can't see that relationships exist in the absence of visual proof
• Often frustrated
• Unable to ask for help even in a crisis
• May still be unable to tell time and has no sense of time can't tell the difference between 10 minutes and 1 hour
• Labeled as lazy, immature unmotivated
• Problems understanding right from wrong
• Day to day functioning is poorer than would be predicted
  

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Communication and Language

• Does not always follow instructions if they are not clearly for addressed to him
• Is not responsive to subtle facial expressions or body language
• Does not seem to hear what is said accurately
• Speech lacks content, information, ideas
• Argues a lot

Socialization

• "in your face" - no sense of personal space
• Poor understanding of what regulates social interactions
• Lacks personal boundaries
• Poor eye contact
• Sexually inappropriate
• Problem compromising or co-operating
• Withdraws, shuts down or acts out when overwhelmed
• Does not make the connection between behavior and consequences

Behavior

• May be viewed as manipulative
• Reacts badly to or resists change in routine
• Behavior deteriorates when stressed, upset or frustrated
• Lies and confabulates (makes up stories to cover up for poor memory)
• Unpredictable
• Seems unable to resist peer pressure
• Demanding of time and attention
• Acts in a way that places self at risk of harm
• Acts in a way that places others at risk of harm (includes abuse and neglect of children)
• Unable to safely walk the streets or use public transport
• Bullies/threatens/intimidates others
• Likes intense experiences "living on the edge"
  

Attention, Activity and Impulsivity

• Acts on impulse
• Loses interest quickly
• Disorganized, messy, sloppy
• Has trouble doing things quietly
• Audible thinker "thinks it-says it"
  

Memory

• Problems remembering dates, times, appointments, daily tasks
• Information seems to slip in and out- here today, gone tomorrow and back again three days later: inability to remember seems to be deliberate "selective memory"
• Forgets to take medication
• Unable to take and/or pass on a message
  

Cognition

• Severe learning difficulties known/suspected; borderline IQ or below average verbal performance scores
• Easily confused
• Often frustrated
• Illogical, irrational
• Poor problem solving skills will persist with an approach which clearly doesn't work
• Unable to tell time or use analogue watch
• No sense of time can't tell the difference between ten minutes and one hour
• Difficulty seeing alternatives or unable to compromise
• Labeled as lazy, immature or unmotivated
• Problems understanding right and wrong