Competency 1: Fetal Alcohol Spectrum Disorders FoundationCompetency 1: Fetal Alcohol Spectrum...

Competency 1 Fetal Alcohol Spectrum Disorders

Foundation

1 Description

2 Pretest

3 Learning Objectives

4 Historic Findings Related to Alcohol Use by Pregnant Women

5 Changes in US Perspectives on Alcohol Use During Pregnancy

6 Fetal Alcohol Spectrum Disorders Terminology and Prevalence Rates

7 Effects of Alcohol on the Developing Embryo and Fetus

8 Effects of Alcohol on the Developing Brain

9 Relationship between Prenatal Alcohol Use and FetalInfant Death

10 Comparative Effects of Alcohol and Other Substances on the Developing Fetus

11 Issues Related to Professional Values and Ethics

12 Matching Activity

13 Posttest

14 References


Foundation

Description

This competency describes historic findings related to alcohol use by pregnant women

US perspectives on drinking during pregnancy terminology related to fetal alcohol

spectrum disorders (FASD) prevalence rates of FASD and effects of alcohol on the

fetus It also discusses professional values and ethics related to the counselors role in

counseling women who have used alcohol during their pregnancies

Test Your Knowledge Questions Pretest

Pretests are designed to gauge your knowledge Click in the circle or box next to the

correct answer Circles indicate that only one correct answer is possible Boxes indicate

that more than one correct answer is possible A posttest is given at the end of the module

so that you can see what youve learned

1 In 1973 who identified a specific pattern of malformations and deficits in children

of alcoholic mothers

A Dr William Sullivan

B Johnson and Johnson

C Jones and Smith

D IOM

2 Which of the following are major components of FAS

A Growth deficiencies such as low birth weight

B Brain damage with neurologic deficits such as impaired fine motor skills

poor eye-hand coordination and tremors

C Maternal alcohol use during pregnancy

D All of the above

3 When a pregnant woman drinks the blood alcohol level of the fetus becomes equal

to or greater than the motherrsquos

True

False

4 In what year did the US Surgeon General issue warnings against alcohol use during

pregnancy

A 1970

B 1980

C 1981

D 1977

5 How does the rate for FASD compare with the rate of Down syndrome or spina

bifida

A Higher

B Lower

C Equal

6 Which substance produces the most serious neurobehavioral effects in the fetus

A Tobacco

B Heroin

C Cocaine

D Alcohol

7 The brain develops throughout pregnancy Alcohol exposure at any time during the

pregnancy can cause brain damage

True

False

8 The terms FASD and FAS are interchangeable

True

False

9 Based on which of the following factors do women experience the damaging

consequences of chronic alcohol use more severely and rapidly than men

Select all that apply

A Psychosocial

B Visual

C Medical

D Physiological

10 Women respond to alcohol differently then men do These differences include


A Co-occurring problems and issues interacting with alcohol use

B Patterns of alcohol abuse

C Context for the initiation and maintenance of alcohol abuse

D Problems and consequences ensuing from alcohol abuse

Submit

Learning Objectives

After completing Competency 1 the learner should be able to

Understand the significance of alcohol use disorders among women

Identify areas in which alcohol use disorders in women differ from those in men

Describe the basic historic foundation of FASD

Discuss the basic terminology related to FASD and the prevalence rates

Explain the effects of maternal alcohol exposure on the developing embryo and

fetus

Compare the adverse effects of alcohol on the developing fetus to those of other

substances

Identify issues related to professional values and ethics

Historic Findings Related to Alcohol Use by Pregnant Women

Throughout history women generally have used alcohol Women now account for an

estimated one-third of Americans with alcohol abuse or alcohol dependence disorders1

Research over the last two decades shows that women respond to alcohol differently than

men do Differences are found in

Predisposing factors contributing to the development of alcohol abuse

Patterns of alcohol abuse

Context within which the alcohol abuse is initiated and maintained

Problems and consequences ensuing from alcohol abuse

Co-occurring problems and issues interacting with alcohol abuse

Based on epidemiologic factors physiologic effects and psychosocial and medical

factors women experience the damaging consequences of chronic alcohol use more

severely and rapidly than men

A major issue related to alcohol and women is alcohol use during pregnancy Drinking

during pregnancy is associated with a variety of health consequences for the woman and

her child Current estimates indicate that 5 percent of women of childbearing age are

heavy drinkers (five or more drinks on the same occasion on 5 or more days) Nearly

one-quarter of women of childbearing age engage in binge drinking (four or more drinks

on the same occasion meaning at the same time or within a couple of hours of each

other)1 Both heavy and binge drinking increase the risk of harm to a fetus

For centuries people have known that alcohol can harm a fetus In the 17th century Sir

Francis Bacon warned women against drinking alcohol while pregnant Since then

knowledge about alcohol and pregnancy has increased leading to preventive measures

such as government warnings about the dangers of alcohol use during pregnancy As far

back as the 18th century the British government recognized the impact of alcohol on

pregnancy outcomes and took steps to reverse dangerous trends

The Gin Epidemic in England in the 1700s is believed to have led to alcohol-related birth

defects When the gin tax was lifted the price went down Drinking went up and so did

infant deaths2 In 1751 the government imposed sales restrictions

In time the problem was more widely recognized In 1834 a British House of Commons

report stated that infants of alcoholic mothers often have a starved and imperfect look3

About 30 years later a French physician described children exposed to alcohol as having

small heads peculiar facial features and nervousness2

Near the end of the 19th century many researchers began to examine the effects of

alcohol on the fetus For example in 1899 Dr William Sullivan compared the pregnancy

outcomes in 120 alcoholic prisoners with 28 of their blood relatives The infant death rate

was 20 percent higher among the women with alcohol problems2 Such studies continued

into the early 20th century

Historic Findings Related to Alcohol Use by Pregnant Women Continued

Twentieth Century

For decades physicians thought that the placenta provided a protective barrier that would

prevent teratogens such as alcohol from reaching the fetus Many believed children of

alcoholics had defects related to poor genetic stock rather than alcohol exposure That

was the conclusion in a 1946 article in the Journal of the American Medical Association

French researchers began to study alcohol and pregnancy in the 1950s An unpublished

thesis reported the prenatal effects of alcohol on children born to alcoholic parents In

1968 Dr Paul Lemoine published a study of 127 children from 69 French families4

Twenty-five children had distinct features related to prenatal alcohol exposure Dr

Lemoine called this alcoholic embryopathy

A few years later Christy Ulleland a pediatric resident in Seattle became interested in

babies with failure to thrive She noticed that many had alcoholic mothers In reviewing

delivery records she found more babies that fit the pattern Her colleagues Drs David

Smith and Kenneth Jones asked to have all the children examined at one time

In 1973 Jones and Smith identified a specific pattern of malformations growth

deficiencies and central nervous system defects in 10 children of alcoholic mothers

Their study not only noted the connection between prenatal alcohol and developmental

disabilities but gave it a name fetal alcohol syndrome (FAS)5

It was originally believed that malnutrition might be responsible for these defects

However the pattern of malformation associated with FAS is not seen in children born to

malnourished women In addition alcohol has been found to be acutely toxic to the fetus

independently of the effects of malnutrition67

Similar cases were found in Germany France and Sweden8-10

As a result FAS

prevention programs were developed in the late 1970s11

Changes in US Perspectives on Alcohol Use During Pregnancy

It has taken some time for the United States to recognize the dangers of alcohol use

during pregnancy Although no safe level of alcohol consumption during pregnancy has

been determined some physicians still tell their patients that it is okay to have a drink

now and then Even people who knew alcohol could harm a fetus were reluctant to say

anything to pregnant friends or relatives for fear of causing undue stress or jeopardizing

the relationship

In the past couple of decades attitudes and practices have begun to change In 1981 the

Surgeon General recommended warnings against alcohol use during pregnancy Congress

passed the Alcoholic Beverage Labeling Act in 1988 which required alcoholic beverage

labels to carry a warning about birth defects Today 19 States and the District of

Columbia have laws requiring warning signs at the point of sale about the dangers of

alcohol use during pregnancy

In February 2005 the Surgeon General issued an updated advisory on alcohol and

pregnancy He urged pregnant women and women planning to become pregnant to

abstain from drinking alcohol His advisory also urged health professionals to inquire

routinely about alcohol consumption by women of childbearing age and advise them

about the risks of drinking while pregnant

Larger Image

d

Despite these warnings 1 in 9 pregnant women drinks alcohol Nearly 1 in 20 pregnant

women engage in binge drinking (four or more drinks in one sitting)1 In addition about

half of all pregnancies are unplanned12

Women who binge drink before conceiving are

more likely to engage in other risky behaviors including drinking during pregnancy12

Fetal Alcohol Spectrum Disorders Terminology and Prevalence Rates

Experts now know that the effects of prenatal alcohol exposure extend beyond FAS

Fetal alcohol spectrum disorders is an umbrella term describing the range of effects that

can occur in an individual whose mother drank alcohol during pregnancy These effects

may include physical mental behavioral andor learning disabilities with possible

lifelong implications The term FASD is not intended for use as a clinical diagnosis13

FASD refers to conditions such as

Fetal alcohol syndrome including partial FAS

Alcohol-related neurodevelopmental disorder (ARND)

Alcohol-related birth defects (ARBD)

FAS consists of a pattern of neurologic behavioral and cognitive deficits that can

interfere with growth learning and socialization FAS has four major components

A characteristic pattern of facial abnormalities (small eye openings indistinct or

flat philtrum thin upper lip)

Growth deficiencies such as low birth weight

Brain damage such as small skull at birth structural defects and neurologic

signs including impaired fine motor skills poor eye-hand coordination and

tremors

Maternal alcohol use during pregnancy

Larger Image

d

Behavioral or cognitive problems may include mental retardation learning disabilities

attention deficits hyperactivity poor impulse control and social language and memory

deficits Partial FAS describes persons with confirmed alcohol exposure facial

anomalies and one other group of symptoms (growth retardation central nervous system

defects or cognitive deficits)

ARND refers to various neurologic abnormalities such as problems with communication

skills memory learning ability visual and spatial skills intelligence and motor skills

Children with ARND have central nervous system deficits but few or no facial

abnormalities Their problems may include sleep disturbances attention deficits poor

visual focus increased activity delayed speech and learning disabilities

ARBD describes defects in the skeletal and major organ systems Virtually every defect

has been described in some patient with FAS They may include abnormalities of the

heart eyes ears kidneys and skeleton such as holes in the heart underdeveloped

kidneys and fused bones

Fetal Alcohol Spectrum Disorders Terminology and Prevalence Rates Continued

Prevalence

Experts are unsure exactly how many individuals in the United States have an FASD

Studies by the Centers for Disease Control and Prevention have reported FAS prevalence

rates from 02 to 15 cases per 1000 births across various populations14-17

Other studies

using a variety of methods have produced estimates ranging from 05 to 20 cases per

1000 live births1819

Such rates are comparable with or above other common

developmental disabilities such as Down syndrome or spina bifida20

Some experts estimate that an FASD occurs in 10 in 1000 live births Thus of 4 million

infants born each year an estimated 40000 will be born with an FASD19

Studies of

particularly vulnerable populations yield even higher prevalence estimates For example

some Native Americans have FAS rates as high as 3 to 5 per 1000 children21-23

Because of the challenges of establishing accurate and timely prevalence information the

number of cases of fetal alcohol spectrum disorders could be greater than current data

indicate These challenges include

Lack of specific and uniformly accepted diagnostic criteria Only recently

have diagnostic guidelines been established for FAS No uniform guidelines exist

for other types of fetal alcohol spectrum disorders Thus health providers are

hampered in their efforts to screen and identify children with an FASD

FAS diagnosis based on clinical examination of features but not all children

with FAS look or act the same Because each symptom has a broad range of

possible diagnoses a clinician might miss or misdiagnose an FASD For instance

physicians are aware of the high prevalence of attention deficithyperactivity

disorders but might not link attention problems to an FASD

Lack of knowledge and misconceptions among primary care providers Many

professionals believe that an FASD can only occur if the mother is an alcoholic

poor African American or Native American Few know about the full range or

progressive nature of the neurobehavioral symptoms that result from prenatal

exposure to alcohol

Effects of Alcohol on the Developing Embryo and Fetus

Alcohol is a teratogen a substance that can harm a fetus When a pregnant woman drinks

alcohol easily crosses the placenta and enters the bloodstream of the fetus through the

umbilical cord The blood alcohol level of the fetus can be even higher than the mothers

It remains high longer because the fetus cannot break down alcohol the way an adult

can24

Researchers do not know the amount or timing of alcohol consumption that causes

damage There is no exact threshold amount As few as one drink per week may cause

damage25

A standard drink is 12 ounces of beer 5 ounces of wine or 15 ounces of

liquor Binge drinking four or more drinks in one sitting can be especially harmful26

Higher levels of consumption increase the risk of fetal damage Maternal metabolism and

alcohols interaction with other drugs are also factors that affect the amount of damage to

the fetus

The only statement that can be made with complete accuracy is that zero exposure equals

zero risk Therefore no woman should drink at any point during her pregnancy Women

who had alcohol before knowing they were pregnant should stop drinking immediately

Doing so can reduce the risk of fetal harm Research has established maternal alcohol

consumption as a leading preventable cause of birth defects and childhood disabilities in

the United States

FASD occurs after fertilization and is not caused by sperm By definition FASD cannot

be caused by the father The only cause of FASD is drinking alcohol during pregnancy

Larger Image

d

Source Moore KL and Persaud TVN 1993 The Developing Human Clinically

Oriented Embryology Philadelphia WB Saunders p 156

Findings are mixed on the effects of male alcohol use before conception Some studies

cite no discernible effects27

Others show that sons of fathers who drank alcohol have

memory deficits hyperactivity and other neurologic problems2829

There has also been

some research that suggests that alcohol use can affect the motility of sperm30

The only

way to completely avoid risk is for both parents to be alcohol free prior to conceiving a

child and for the mother to abstain from drinking alcohol throughout her pregnancy

Men may not cause FASD but they have a very important role to play in preventing

FASD They can encourage women not to drink during pregnancy They also can support

and respect a womans decision not to drink Men can also be role models for their

significant others By not drinking themselves they are modeling the safest behavior for

pregnant women Men can also help women get alcohol treatment and follow their

treatment plans These actions can help women remain alcohol free during their

pregnancies

Effects of Alcohol on the Developing Brain

Alcohol can damage the developing brain when it crosses the placenta Since the brain

develops throughout pregnancy alcohol exposure at any time can cause brain damage

Prenatal exposure to alcohol can change the brain structurally in ways that can be viewed

and measured including

Small head (microcephaly) usually below the 10th percentile

Hydrocephalus an abnormal accumulation of fluid31

that causes the brain and

skull to enlarge

Absence of the corpus callosum an area of the brain that contains nerve fibers

that bridges the two hemispheres of the brain MRIs have shown completely

missing areas of the brain in individuals with an FASD3233

Abnormal cysts or cavities in the brain

Neurologic problems such as seizures tremors and poor fine motor skills

Patterns of dysfunction on psychometric tests

Prenatal exposure to alcohol also can change the function of different parts of the brain

leading to deficits in executive functioning memory word retrieval concrete thinking

cognitive flexibility sensory integration difficulties and sleep disturbances The damage

can lead to developmental delays learning disabilities and behavior problems such as

Mental retardation

Problems with attention

Hyperactivity

Poor impulse control

Problems in social perception

Speech and language delays or deficits

Poor capacity for abstract thinking

Specific deficits in math skills

Poor judgment

Problems with cause and effect

Problems anticipating consequences

Problems changing behavior or response in different situations

Effects of Alcohol on the Developing Brain Continued

Effects of Alcohol on Specific Brain Function

Alcohol can affect specific parts of the brain in ways that impair several functions34

Corpus Callosum The corpus callosum connects the two hemispheres of the

brain allowing the left and right sides to communicate Prenatal alcohol exposure

can cause abnormalities such as thinning or complete absence These have been

linked to deficits in attention intellectual function reading learning verbal

memory executive function and psychosocial functioning

d

Source Mattson SN Jernigan TL and Riley EP 1994 MRI and prenatal alcohol

exposure Images provide insight into FAS Alcohol Health amp Research World 18(1)49ndash

52

Hippocampus The hippocampus is involved in memory but its precise function

is uncertain Alcohol can change the fibers and cause cell reduction Some

persons with prenatal alcohol exposure have deficits in spatial memory and other

memory functions associated with the hippocampus The hippocampus also acts

as a mood control center Damage to the hippocampus can affect the ability to

respond appropriately to emotions such as anger

Basal Ganglia The basal ganglia are nerve cell clusters involved in motor

abilities and cognitive functions Heavy prenatal alcohol exposure can reduce

basal ganglia volume This can affect skills related to perception such as the

ability to manage time or inhibit inappropriate behavior

Cerebellum The cerebellum is involved in both motor and cognitive skills The

cerebellum tends to be smaller in people with an FASD Damage to the

cerebellum can cause learning deficits and problems with motor skills such as

balance and coordination

Hypothalamus The hypothalamus helps maintain the bodys internal

environment through the receipt of sensory and chemical input It controls areas

such as appetite emotions temperature and pain sensation Persons with an

FASD may not experience pain or respond appropriately to hot or cold

Frontal Lobes The frontal lobes control executive functions such as planning

and problem solving They also control impulses and judgment Frontal lobes can

be smaller in teenagers and young adults prenatally exposed to alcohol Persons

with an FASD may have poor impulse control and self-monitoring They might

engage in risky or illegal activity to fit in with peers

Relationship Between Prenatal Alcohol Use and FetalInfant Death

Researchers identified an association between prenatal alcohol exposure and fetal death

more than 20 years ago The likelihood of miscarriage increased directly with alcohol

consumption Risk was twice as high in women consuming 1 ounce of absolute alcohol

as infrequently as twice a week35

More recently fetal mortality was found to be 77

percent higher when alcohol was consumed during pregnancy36

Prenatal alcohol

exposure is also associated with a higher rate of infant death37

A related research finding was that siblings of children with FAS had increased risk of

death due to infectious illness and sudden infant death syndrome (SIDS) compared with

controls A diagnosis of FAS is an important risk marker for mortality in siblings of an

individual with FAS even if the siblings do not have FAS Maternal alcoholism appears

to be a useful risk marker for increased mortality risk in diagnosed cases and their

siblings38

In some populations such as Northern Plains Indians binge drinking (four or

more drinks on one occasion) in the first trimester was associated with an increased risk

of SIDS39

Comparative Effects of Alcohol and Other Substances on the Developing Fetus

Commonly abused substances include

Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs

Of these alcohol produces by far the most serious neurobehavioral effects in the fetus40

The table shows various effects of different substances Only alcohol can produce all of

the noted problems In addition combinations of substances (eg alcohol and tobacco)

can produce more serious effects than either substance alone Many women use multiple

substances

Alcohol Tobacco Opioids Amphetamines Cocaine Marijuana PCP

Growth deficiency X X X X X X X

Behavior

problems X X X X X X

Cognitive

problems X X X X X

Motor deficits X X X

Developmental

delays X X

Facial anomalies X X

Physical defects X X X X

Source Briggs G G Freeman R K amp Yaffe S J (2002) A reference guide to fetal

and neonatal risk Drugs in pregnancy and lactation Philadelphia PA Lippincott

Williams amp Wilkins Plessinger M A (1998 March) Prenatal exposure to

amphetamines Risks of adverse outcomes in pregnancy Obstetrics and Gynecology

Clinics of North America 25(1) 119-138 Fraser Askin D amp Diehl-Jones B (2001)

Cocaine Effects of in utero exposure on the fetus and neonate Journal of Perinatal and

Neonatal Nursing 14(4) 83-102

Issues Related to Professional Values and Ethics

The role of the counselor in addiction treatment is to provide support and education

Addiction professionals also need to use treatment approaches that help women move

from unhealthy self-defeating self-devaluing behaviors to healthy self-enhancing and

self-nurturing behaviors The counselor needs to understand the roots of alcohol abuse

among women as well as symptoms motivation problems and issues to enhance

engagement and treatment effectiveness

It is important for the addiction professional to know and believe that women do not try

to hurt their babies Cases of women drinking to induce a miscarriage or harm the baby

are very rare Most women want healthy babies but some cannot stop drinking even

when they are pregnant Addiction professionals can provide needed support and

understanding as women go through the difficult process of recovery

Clients often feel a great deal of shame associated with their addictive behaviors Some

clients may learn about FASD and realize that their children might have an FASD This

discovery can increase their guilt and shame when they realize they have harmed their

children permanently Alcohol problems already carry a tremendous stigma in our

society particularly when women drink To help resolve those feelings of shame and

guilt the counselor should encourage the client to speak honestly about her addictive

behaviors and respond to the client with honesty gentleness and care

Issues Related to Professional Values and Ethics Continued

Counselor Know Thyself

Learning about FASD can raise many issues for addiction professionals Addiction

professionals have been socialized within a society that takes punitive measures against

women who abuse alcohol during pregnancy Elements of this attitude may consciously

or subconsciously exist within the professional Perhaps they have a preconceived notion

about how pregnant women are supposed to act feel or think They may have

insufficient knowledge and skills to build relationships that are respectful and safe for

women to explore painful issues such as having a child with an FASD

It is important for counselors to be aware that their own background socialization and

experiences influence the therapeutic relationship These include their personal

experience with alcohol use disorders as well as their attitudes values and biases

Addiction professionals need to recognize the limits of their competencies and expertise

A counselors self-assessment regarding his or her knowledge of women-specific alcohol

use disorders and appropriate women-specific interventions can help in establishing a

starting point and planning strategies for building capacity and quality care

Many addiction professionals are recovering from alcohol use disorders Others have no

alcohol abuse history of their own but have been close to someone elses active addiction

This firsthand experience of addiction can add to the counseling process In some cases it

may complicate the process Counselors might recognize signs and symptoms of FASD

in their own children and have feelings of guilt and shame

When professionals have not come to grips with their own issues they sometimes project

these issues onto others Often the pain and chaos of clients lives can trigger their own

intense pain and fear It is important to seek help to resolve these feelings and to get help

for ones children Recognizing these feelings and addressing them can help the counselor

set limits and protect boundaries and avoid transferring these feelings to the client In

addition it can help the counselor avoid self-disclosure that might make clients

uncomfortable or shift the focus to the counselor The focus must always be on the

clients recovery

Matching Activity

Match the word or term in column A with the appropriate description in column B

Type letter from column A into correct answer box in column B

Column A Column B

A) Alcoholic embryopathy Fetal alcohol spectrum disorders

B) Fetal Alcohol Syndrome A term identified by Dr Lemoine that describes

the distinct features related to prenatal alcohol

exposure

C) Alchoholic Beverage Labeling

Act of 1988 Pattern of neurologic behavioral and cognitive

deficits that can interfere with learning growth and

socialization

D) FASD A law requiring alcoholic beverage labels to

carry a warning about birth defects

E) Components of FAS Facial abnormalities growth deficiencies brain

damage prenatal alcohol exposure

Test Your Knowledge Questions Posttest

Posttests are designed to gauge what youve learned by reading the competency Click in

the circle or box next to the correct answer Circles indicate that only one correct answer

is possible Boxes indicate that more than one correct answer is possible



True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References

1 Office of Applied Studies 2005 Results from the 2004 National Survey on Drug

Use and Health National Findings NSDUH Series H-28 DHHS Publication No

SMA 05-4062 Rockville MD Substance Abuse and Mental Health Services

Administration (SAMHSA)

2 Abel EL 1990 Fetal Alcohol Syndrome Oradell NJ Medical Economics

3 Warner PH and Reset HL 1975 The effects of drinking on offspring an

historical survey of the American and British literature Journal of Studies on

Alcohol 36(1)1395-1420

4 Lemoine P Harousseau H Borteyru J-P et al 1968 Les enfants de parents

alcooliques Anomalies observees A propos de 127 cas [Children of alcoholic

parents Abnormalities observed in 127 cases] Ouest Medical 21476-482

5 Jones KL and Smith DW 1973 Recognition of the fetal alcohol syndrome in

early infancy Lancet 2999-1001

6 Phillips DK Henderson GI and Schenker S 1989 Pathogenesis of fetal

alcohol syndrome Overview with emphasis on the possible role of nutrition

Alcohol Health amp Research World 13(3)219-227

7 Randall CL 1987 Alcohol as a teratogen A decade of research in review

Alcohol and Alcoholism Suppl 1125-132

8 Majewski F Bierich JR Loser H et al 1976 Clinical aspects of

pathogenesis of alcohol embryopathy (authors translation)] Munchener

Medizinische Wochenschrift 118(50)1635-1642 [Article in German]

9 Dehaene P Samaille-Villette C Crepin G et al 1977 Le syndrome

dalcoolisme foetal dans le Nord de la France La Revue de lAlcoolisme 23145-

158

10 Olegard R Sabel KG Aronsson M et al 1979 Effects on the child of

alcohol abuse during pregnancy Retrospective and prospective studies Acta

Paediatrica Scandinavica Suppl 275112-121

11 Streissguth A 1994 A long-term perspective of FAS Alcohol Health amp

Research World 18(1)74-81





13 Naimi TS Lipscomb LE Brewer RD et al 2003 Binge drinking in the

preconception period and the risk of unintended pregnancy Implications for

women and their children Pediatrics 111(5 Part 2)1136-1141

14 Bertrand J Floyd RL Weber MK et al 2004 Fetal Alcohol Syndrome

Guidelines for Referral and Diagnosis Atlanta GA Centers for Disease Control

and Prevention

15 Centers for Disease Control and Prevention (CDC) 2002 Fetal alcohol

syndromemdashAlaska Arizona Colorado and New York 1995-1997 MMWR

51433-435

16 CDC 1997 Surveillance for fetal alcohol syndrome using multiple sourcesmdash

Atlanta Georgia 1981-1989 MMWR 461118-1120

17 CDC 1995 Update trends in fetal alcohol syndromemdashUnited States 1979ndash1993

MMWR 44249-51

18 CDC 1993 Fetal alcohol syndromemdashUnited States 1979-1992 MMWR 42239-

241

19 Cordero JF Floyd RL Martin ML et al 1994 Tracking the prevalence of

FAS Alcohol Health amp Research World 1882-85

20 May PA and Gossage JP 2001 Estimating the prevalence of fetal alcohol

syndrome A summary Alcohol Research amp Health 25159-167

21 Mirkes PE ed 2003 Congenital malformations surveillance report A report

from the national birth defects prevention network Birth Defects Research 67(9)

22 Sampson PD Streissguth AP Bookstein FL et al 1997 Incidence of fetal

alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder

Teratology 56317-326

23 Egeland GM Katherin PH Gessner BD et al 1998 Fetal alcohol syndrome

in Alaska 1977 through 1992 An administrative prevalence derived from

multiple data sources American Journal of Public Health 88781-786

24 Chavez GF Cordero JF and Becerra JE 1988 Leading major congenital

malformations among minority groups in the United States 1981-1986 MMWR

37(SS-3)17-24

25 Sood B Delaney-Black V Covington C et al 2001 Prenatal Alcohol

Exposure and Childhood Behavior at Age 6 to 7 Years I Dose-Response Effect

Pediatrics 108(2) e34

26 Jacobson JL and Jacobson SW 1994 Prenatal alcohol exposure and

neurobehavioral development Where is the threshold Alcohol Health amp

Research World 1830-36

27 Jacobson JL and Jacobson SW 1999 Drinking moderately and pregnancy

Effects on child development Alcohol Research amp Health 23(1)25-30

pubsniaaanihgovpublicationsarh23-125-30pdf

28 Livy DJ Maier SE and West JR 2004 Long-term alcohol exposure prior to

conception results in lower fetal body weights Birth Defects Research Part B

Developmental and Reproductive Toxicology 71(3)135-141

29 Abel E 2004 Paternal contribution to fetal alcohol syndrome Addiction Biology

9(2)127-133 discussion 135-136

30 Jamerson PA Wulser MJ and Kimler BF 2004 Neurobehavioral effects in

rat pups whose sires were exposed to alcohol Brain Research Developmental

Brain Research 149(2)103-111

31 Dare WN Natrona CC Kusemiju OT et al 2002 The effect of ethanol on

spermatogenesis and fertility in male Sprague-Dawley rats pretreated with

acetylsalicylic acid Nigerian Postgraduate Medical Journal 9(4)194-198

32 Berg S Kinsey K Lutke J et al 1995 A Laymans Guide to Fetal Alcohol

Syndrome and Fetal Alcohol Effects Surrey BC FASE Support Network

33 Mattson SN Jernigan TL and Riley EP 1994 MRI and prenatal alcohol

exposure Alcohol Health amp Research World 18(1)49-52

34 Mattson SN and Riley EP 1995 Prenatal exposure to alcohol What the

images reveal Alcohol Health amp Research World 19(4)273-277

35 Mattson SN Schoenfeld AM Riley EP 2001 Teratogenic effects of alcohol

on brain and behavior Alcohol Research amp Health 25(3)185-191

36 King JC and Fabro S 1983 Alcohol consumption and cigarette smoking

Effect on pregnancy Clinical Obstetrics and Gynecology 26(2)437-448

37 Hoyert DL 1996 Medical and life-style risk factors affecting fetal mortality

1989ndash90 Vital and Health Statistics 20(31)

38 Faden VB Graubard BI and Dufour M 1997 The relationship of drinking

and birth outcome in a US national sample of expectant mothers Paediatric and

Perinatal Epidemiology 11(2)167-80

39 Burd L Klug M and Martsolf J 2004 Increased sibling mortality in children

with fetal alcohol syndrome Addiction Biology 9(2)179-186 discussion 187-188

40 Iyasu S Randall LL Welty TK et al 2002 Risk factors for sudden infant

death syndrome among northern plains Indians JAMA 288(21)2717-2723

41 Stratton K Howe C and Battaglia F eds 1996 Fetal Alcohol Syndrome

Diagnosis Epidemiology Prevention and Treatment Washington DC Institute

of Medicine National Academy Press


Foundation

Description

This competency describes historic findings related to alcohol use by pregnant women

US perspectives on drinking during pregnancy terminology related to fetal alcohol

spectrum disorders (FASD) prevalence rates of FASD and effects of alcohol on the

fetus It also discusses professional values and ethics related to the counselors role in

counseling women who have used alcohol during their pregnancies










C Jones and Smith

D IOM






D All of the above



True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


bifida

A Higher

B Lower

C Equal


A Tobacco

B Heroin

C Cocaine

D Alcohol



True

False


True

False




A Psychosocial

B Visual

C Medical

D Physiological







Submit

Learning Objectives







fetus


substances









































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136






































C Jones and Smith

D IOM






D All of the above



True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


bifida

A Higher

B Lower

C Equal


A Tobacco

B Heroin

C Cocaine

D Alcohol



True

False


True

False




A Psychosocial

B Visual

C Medical

D Physiological







Submit

Learning Objectives







fetus


substances









































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























bifida

A Higher

B Lower

C Equal


A Tobacco

B Heroin

C Cocaine

D Alcohol



True

False


True

False




A Psychosocial

B Visual

C Medical

D Physiological







Submit

Learning Objectives







fetus


substances









































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136






























Submit

Learning Objectives







fetus


substances









































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























Learning Objectives







fetus


substances









































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136




































































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136












































Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136






























Twentieth Century























As a result FAS








the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136



































the relationship












Larger Image

d























tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136














































tremors


Larger Image

d
















Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136




































Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136






























Prevalence




Other studies







Studies of



















exposure to alcohol






can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136


































can24



damage25





the fetus






the United States



Larger Image

d







There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136



































There has also been


The only









pregnancies









skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





































skull to enlarge











Mental retardation


Hyperactivity






Poor judgment












d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





































d



52































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





















































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136




































Prenatal alcohol







siblings38



of SIDS39



Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136































Alcohol

Tobacco

Heroin

Methadone

Cocaine

Marijuana

Prescription drugs





substances



Behavior


Cognitive

problems X X X X X


Developmental

delays X X

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136

















































































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136












































































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136

























































clients recovery

Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























Matching Activity



Column A Column B




exposure




socialization











True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136



































True

False


pregnancy

A 1970

B 1980

C 1981

D 1977


A Tobacco

B Heroin

C Cocaine

D Alcohol





C Jones and Smith

D IOM



True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























True

False


True

False










A Psychosocial

B Visual

C Medical

D Physiological


bifida

A Higher

B Lower

C Equal






D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























D All of the above

References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136





























References








Alcohol 36(1)1395-1420
















158















and Prevention



51433-435




MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136
































MMWR 44249-51


241















37(SS-3)17-24














9(2)127-133 discussion 135-136















































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