About Us




December 2001


Using brain imaging to track FAS

by Edward Riley and Sarah Mattson

Ever since Jones and Smith identified fetal alcohol syndrome in 1973, we have been aware that prenatal alcohol exposure could have a negative effect on normal brain development. One had only to look at the early autopsy reports of infants and children with FAS to see the widespread damage that could occur. However, since most of these reports represented extreme cases of FAS, it was difficult to generalize to the typical case of FAS, let alone cases of FAE. But, about ten years ago we began to work with Terry Jernigan from the University of California San Diego to use magnetic resonance imaging (MRI) to study the living brains of alcohol-affected children in a relatively non-invasive fashion, giving us a better picture of the FAS mind.

Our imaging studies have revealed several brain areas that seem to be particularly affected by prenatal alcohol exposure. For example, the first child that we imaged had a thin corpus callosum, which is the major pathway between the two hemispheres of the brain. The left and right hemispheres coordinate their functions by communicating across the corpus callosum and if this structure isn't functioning appropriately, the two hemispheres can't coordinate effectively. Abnormalities of the corpus callosum have been linked to deficits in attention, reading, learning, memory, planning, decision-making, and psychosocial functioning, all of which are impaired in alcohol-exposed people. The next child that we imaged, to our surprise, was missing the corpus callosum altogether, a condition known as agenesis of the corpus callosum. In this child, the major connection between the two hemispheres of the brain was missing. We have identified three other children with FAS in San Diego with agenesis in their FAS subjects. However, like the first child that we scanned, most people with FAS and FAE do have an intact corpus callosum, but as in this child, we found that it tends to be smaller, particularly at the front and back parts.

Recently, in collaboration with Elizabeth Sowell and her colleagues at UCLA, we have analyzed the shape and location of the corpus callosum following prenatal alcohol exposure. Again, the corpus callosum was reduced in size, specifically in the back part, but it was also displaced in three-dimensional space. The average location of the corpus callosum for the children with FAS and FAE was displaced compared with the control children, with the biggest differences in the part of the corpus callosum closest to the back of the brain. Furthermore, this displacement was related to the children's performance on a verbal learning task.

One area of the brain that we have been particularly intrigued with is a group of subcortical structures known as the basal ganglia. Our studies have shown that the caudate, a part of the basal ganglia is disproportionately reduced in volume in children with FAS and FAE. The caudate is involved in cognitive functions, such as in the ability to shift from one task to another; inhibition of inappropriate behavior; and spatial memory, which are impaired in people with prenatal alcohol exposure. We believe that the reductions in the caudate account for some of the cognitive deficits seen in people with prenatal alcohol exposure. This notion is appealing because the caudate also has extensive connections to the frontal lobes of the brain, which traditionally are thought of as mediating higher cognitive functions.

Finally, we have shown that the cerebellum is also particularly sensitive to prenatal alcohol. The cerebellum or "little brain" is located at the base of the brain. It is involved in both motor and cognitive skills. for example, damage to the cerebellum has been implicated in deficits in learning as well as in balance and coordination, all of which are impaired by prenatal alcohol exposure. We recently found that the volume of the cerebellum was reduced in people with FAS compared with controls, in part replicating our previous reports.

Most recently, we have been looking at new ways of analyzing our brain data to provide additional insights about the damaging effects of prenatal alcohol exposure. using a technique known as brain mapping, we can now study the whole brain at one time, rather than focusing in on specific brain regions. Elizabeth Sowell and her colleagues have used this brain mapping technique to analyze and compare brain images of people with FAS and FAE and non-alcohol-exposed control subjects. We are showing greater reductions in the brain's white matter, which contains the nerve cells extensions (i.e., axons) that connect nerve cells with each other. These findings were particularly pronounced in the parietal love, an area that is involved in visual-spatial processing and the integration of sensory information.

One important point has to be made regarding our studies. We have always examined alcohol-exposed children with and without the facial features of FAS. while our findings are most prominent in the FAS or dysmorphic children, we also find effects in the non-dysmorphic children. While the facial features might provide some indication of brain changes, the absence of the FAS facial features does not preclude alternations in brain and behavior.

What are our current plans and where are we going in the future? We are currently trying to correlate our brain changes with the changes that we see in behavior. For example, how does having a small caudate relate to the ability to shift from one task to another? Our preliminarily findings indicate that in children with alcohol exposure histories, the reduction in the size of the caudate predicts overall performance on tests that require the ability to inhibit responding, as well as lean and recall verbal information. In the future we hope to utilize other imaging techniques such as functional MRI (see related article on page 4), where one examines not the size or volume of a particular structure, but rather how that structure functions. Normal size doesn't necessarily mean normal function, and reduced size doesn't always mean abnormal function. fMRI is a powerful technique to examine how the brain is working. We are also examining the possibility of using MRI spectroscopy to examine the brains of children with FAS. This technique provides additional information about the functioning of the brain. The use of new technology and refined use of existing techniques will allow us to continue to learn more about how prenatal alcohol affects brain development, what effect this has on behavior, and perhaps push us closer to developing adequate treatment and intervention strategies.

Edward Riley, Ph.D., and Sarah Mattson, Ph.D., are affiliated with the Center for Behavioral Teratology and the Department of Psychology at San Diego State University.


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24/7 vs. letting go

by Marceil Ten Eyck

Eleven years go, when my daughter was diagnosed with fetal alcohol syndrome, there was not much information about effectively parenting an individual with this disability. A fellow pioneer in the search for parenting tools said, "Parenting a child with FAS using available parenting information is like trying to get around Seattle with a map of San Francisco." How true! Since then, we parents have been struggling along using intuition, our best reasoning abilities, ideas from other parents, ideas from professionals, whatever we could find that might fit any given situation. I have heard many parents wish for a parenting recipe or a parenting map for FAS/E; I have been one of the loudest wishers.

Sidney, my daughter, is now 26 years old. She struggles daily to deep up with world that is too intricate, complicated, and moving too fast for her. She continues to amaze me with her determination and courage to be the best she can be. When I am asked how I parented her, I try to talk about strategies that worked for her and the many things I did that didn't work, the mistakes I made. I also believe it is important for me to say, over and over, she is only one individual with this diagnosis and generalizing to all individuals with this diagnosis can be dangerous as well as useless.

  • All individuals with FAS/E are alike.
  • All individuals with FAS/E are different.

Both these statements are true.

So what about the recipe book, the map that many of us have wished for? So far, I believe there is no one map or recipe that will fit all. What we now have is a wonderful bank of ideas to draw from. These ideas come from parents and professionals who have tried them and have had successes with them, and although one idea does not work for all, we can certainly mix and match to find those that will work for us.

So what about 24/7 (24 hours a day, 7 days a week) parenting and observation versus just letting go? Recently I heard radio advice host Dr. Laura Schessinger criticize a mother who called in about a daughter with FAS who had become pregnant while at a church picnic. Dr. Laura chastised the mother for letting her 16-year-old daughter out of her sight, for any length of time, anywhere. I was appalled that Dr. Laura presumed to criticize a mom for allowing her teenage daughter to go on a church picnic without her, FAS or no. A recent article I read about parenting noted that 24/y supervision would "be needed for a lifetime due to poor judgment and lack of impulse control." On the other hand, in an article in F.A.S. Times, Josie DeVries describes the alternative: "to abdicate our duties as parents—to let him go merrily on his way and allow him to make his own choices about how/where he would spend his future."

Although some individuals with FAS/E undoubltedly will need supervision 24/7, others will need some level of "letting go" in order to become successful and separate adults. This letting go might put us out of our comfort zone, knowing that we cannot keep our children safe every minute of every day.

Dr. Kieran O'Malley at the Fetal Alcohol and Drug Unit in Seattle told me about a young man who was being supervised 24/7 who ran away from home because he said it was the only way he could get out from under restrictions that were to tight for him. I suspect the parents supervising their son were being careful, concerned parents, wanting safety and the best for their son. If I had to do it over again, I would do more supervision of a junior-high-age daughter. I wanted my daughter to be safe, and to be the best parent I could be. Yet, each of us was parenting differently, and each child/adult may well be successful.

Finding the place between supervision 24/7 and "letting him go merrily along his way" may be one of the most difficult parenting tasks we face. The need to keep our challenged individuals safe can be overwhelming, keeping us from allowing them the risks they need to take to grow. At the same time, knowing when to surround them with safety can be problematic too. When they are children, it is easy. When a child becomes an adolescent, then an adult, the choices become much harder. There is no tried and true recipe, there is no map here. I also believe it is important not to criticize parents who may be parenting differently than us, even if it is only done indirectly by saying, "my way is the right way." It is tough enough to be a pioneer in this endeavor without other pioneers telling us we did it the wrong way.

Marceil Ten Eyck is a founder of Iceberg and has a daughter with FAS and a daughter with FAE.


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Using active imaging to unlock the secrets of FASD

by Paul D. Connor, Ph.D.

An important aspect of researching Fetal Alcohol Spectrum Disorders (FASD) has always been listening. The knowledge that we gain by listening to those who lives are affected by FASD can be used to design studies that will both contribute to our understanding of FAS and assist those who live with this syndrome. One of the major hurdles that those dealing with FASD often face is the challenge of obtaining appropriate services. One effective way of gaining services is to demonstrate the presence of brain damage.

A number of studies are currently being conducted in Seattle and San Diego that use structural brain imaging in an attempt to determine whether or not there are significant structural changes in the brains of people with FASD. Using a combination of structural Magnetic Resonance Imaging (MRI) and neuropsychological testing, researchers can compare physical changes in the brain (obtained from the MRI) to changes in cognitive functioning measure separately by neuropsychological testing. This approach has been and continues to be very effective; however, the information we gain from combining these two sets of data provides only an indirect measure of how the brain is functioning.

Ideally, we would like to get a more direct picture of the brain's activity while the neuropsychological testing is being performed. For that, we need to turn to imaging methods that allow us to observe brain functioning while neuropsychological testing is being performed. One way to do this is to use a relatively new technology called functional Magnetic Resonance Imaging (fMRI).

Functional MRI uses the same equipment as structural MRI, a sophisticated computer that uses a very large magnet to excite the molecules in the body and then record how long it takes for those molecules to "relax." However, unlike structural MRI that looks at molecules such as hydrogen to build a picture of the structure of the brain, fMRI looks at blood oxy generation to see the function of the brain while a person does a task. The theory behind fMRI is that when the brain is active on a task, it needs more oxygen than when at rest. The fMRI scanner can detect those regions of increased oxygen use and show pictures of them. We wanted to use this technology to look at the functioning of brains of people with FASD, something that has not previously been done.

We have recently conducted a small pilot study to look a the activity of the brain of four subjects with FASD and two control subjects by having them do a working memory task while scanning their brains. Working memory is a complicated task that requires the person to remember information and in some way manipulate that information for short periods of time. For example, keep a running memory of letters that are shown to you on a computer screen and decide if the letter you just saw was the same as one you saw two letters ago.

Because fMRI works by looking at the difference in blood oxygen of the brain between actively doing a test and when resting, we also had the subjects doing a "rest" task. The goal of the study was to see how the brains of subjects were performing on a working memory test, but we were not really interested in the parts of the brain responsible for seeing the letters, recognizing them as letters, and moving their hands when responding. However, if we simply had the subject close their eyes and do nothing during the "rest" period, all of these areas would be seen as active in the final functional image. So we needed to devise a task that had almost all of the same requirements as the working memory test but not the actual working memory part. We did this by asking the subject to watch a series of letters and respond when he or she saw a particular letter.

Other studies have shown that when performing this task in the fMRI a certain part of the frontal lobes of the brain called the dorsolateral prefrontal cortex (DLPFC) becomes active. In our study we found that all of the subjects with FASD showed significant activations in this part of the brain. In fact, at least two of the subjects with FASD showed activation of this area in both hemispheres, suggesting that they needed to recruit more brain tissue in order to complete the task. By contrast, neither of the control subjects showed significant activations of the DLPFC when performing this task. Initially we thought this finding was a little odd. However, other researchers have found that when a working memory test is not very challenging, the DLPFC does not get involved with the tasks and only with increased difficulty of the task will these regions become activated. This seems to be the case with the control subjects in this study.

All of the subjects with FASD had difficulty with this task and thus needed to use the DLPFC quite a bit, but the control subjects found this task relatively easy and thus didn't need to involve this region of the brain. With a more complicated task (remembering letters presented three previously, for example) control subjects would probably need to activate this region. However, with that increased difficulty, would subjects with FASD recruit even more brain tissue or would the task be so great that their brains "shut down" or give up on the task thus resulting in less activation? These are questions that will be posted with follow-up studies that we have submitted for funding from the National Institute on Alcohol Abuse and Alcoholism.

Our small pilot study has shown that there appears to be differences in activation of regions of the brain between control subjects and those with FASD. This finding is very promising and hopefully, with replication in larger samples and on other tasks that subjects with FASD have difficulty with (such as arithmetic, disinhibition, attention, and motor coordination), more light can be shed on the brain functioning of people damaged by prenatal exposure. This information can then be used to better advocate for much needed services. Also, once we have established that there are differences in the way that the brains of patients with FASD function, we can use fMRI as a technique to evaluate the effectiveness of treatment by seeing if there is a change in brain function following treatment. This has been used in a number of other populations including ADHD. The future is looking very active indeed! Stay tuned.

Paul D. Connor, Ph.D., is affiliated with the Fetal Alcohol and Drug Unit at the University of Washington Department of Psychiatry and Behavioral Sciences.


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New book offers insights

by Julie Gelo

It was with a true sense of honor that I was given the opportunity to review the new book, Watch for the Rainbows. The first edition was published in May 2001 and is a collection of true stories for educators and other caregivers of children with Fetal Alcohol Spectrum Disorder (FASD). The stories are written as a unique and special collaboration between the education system and the medical system. Dr. O'Malley wrote, "It is my hope that these clinical vignettes will serve as a lesson and guide for educators, patients, and other caregivers to seek 'the hidden rainbow' in the child, and celebrate and strengthen its appearance."

Watch for the Rainbows: True Stories for Educators and Other Caregivers of Children with Fetal Alcohol Spectrum Disorders

by Frances M. E. Kapp, B.Ed., M.A. Ph.D., and Kieran D. O'Malley, M.B., D.A.B.P.N. (P)

Frances Kapp Education, Calgary, Alberta, Canada
First Edition, May 2001

I think that most of the professionals and the caregivers of those special individuals who have been diagnosed with Fetal Alcohol Syndrome and Related Conditions or FASD clearly agree that it is not primarily a dysmorphic disorder, but a central nervous system disorder and that the effects of prenatal alcohol exposure on the central nervous system can be wide ranging.

The book is formatted using true stories that were related to Dr. Kapp by parents, teachers, and physicians that she interviewed during the data collection process for her doctoral dissertation about FASD. Her hope was to illustrate some of the traits that are common to many children with FASD and that caregivers will have greater insight into more patient means of helping these children if they realize that certain behaviors are a natural part of the syndrome. She does, however, remind us all to bear in mind that each of these children, like all other children, has his or her own unique personality.

Dr. Kapp resides in Calgary, Alberta, Canada, and has been in the educational field for a number of years and has received the Community Achievement in Education Award and Gonzaga University's prestigious School of Education Leadership Award for the Doctoral Programs. She has her own business, Fances Kapp Education, which specializes in all phases of FASD.

Following the specific stories or vignettes are then comments by Dr. O'Malley explaining and exploring these vignettes from a medical and psychiatric arena. Dr. O'Malley is a board certified psychiatrist and board eligible child psychiatrist. Currently, he is an acting assistant professor in the Department of Psychiatry and Behavioral Sciences and the Jackson School of International Studies at the University of Washington in Seattle, Washington, and also maintains a small community psychiatric consultation practice in Calgary, seeing only patients with FASD or autistic spectrum disorders.

The vignettes that are covered in the book include topics of "The Joy of Creativity," "Physical Fats Without Fear," "Dealing With Stress," "A Sensitive Nature," "Extroverted Children," "Detour!: The Need for Supervision," "The Issue of Lying," and "Teaching Strategies." These are followed by recommendations for further reading and a summary of recommendations by parents, physicians, and teachers for caregivers of children who have FASD compiled by Dr. Kapp along with explanations of the neuropsychiatry of FASD by Dr. O'Malley.

As the birth, foster, and adoptive mother of many children with FASD, I would highly recommend this book for all those whose lives are touched by individuals with FASD. It offers wonderfully sensitive and positive stories of our children along with a medial and psychiatric explanation of these behaviors that we can all understand. It truly reminds us that our children are the "rainbows" behind the storms of their behaviors.

To order

In Canada:

Frances Kapp Education
Suite #335
305-4625 Varsity Drive NW
Calgary, AB T3A 0Z9
$19.50 + $6.50 shipping and handling for one copy

In the U.S.:

Dr. Kieran D. O'Malley
UW Dept of Psychiatric & Behavioral Sciences
Fetal Alcohol & Drug Unit
180 Nickerson St, Suite 309
Seattle, WA 98109
$14.95 + $5.00 shipping and handling for one copy


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