Talk:Fetal Alcohol Spectrum Disorder

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Contents

[edit] Clarren

What is Dr. Clarren a doctor of, sociology? There is no presentation of the fact that some scientists believe that FAS is on par with phrenology and other pseudoscience.

There is no mention of the fact that genuine scientific study can not be conducted in the US because pregnant women are sanctioned from drinking in pseudo-legal manoeuvers that threaten their families, finances and freedom.

There is no mention of scientific studies which regard the fact that alcohol poisoning robs the body of oxygen, and the fact that foetal blood has a higher affinity for oxygen than maternal blood, and the fact that alcohol is metabolised relatively quickly in the body and that the placenta offers a blood barrier all suggesting that a foetus can not easily be affected by maternal alcohol consumption.

There is no mention of statistics about the frequency of 'identification incidents' relative to socio-economic status and race, which are strangely more correlative than with actual incidents of alcoholism. This is probably because there is no index for exposure to other home and workplace poisons in the FASD four digit diagnostic code. (posted by 195.137.78.175)

Hi 195.137.78.175, could you sign and date your posts please by typing four tildes after your post, like this ~~~~. Dr Sterling Clarren is one of the world's leading experts on FASD, based in the Fetal Alcohol and Drug Unit at the University of Washington in Seattle, which is the dept that first named the condition, along with a researcher in France. I believe he's a neurologist. If you can provide evidence of what you're saying, by all means do so, and if you're in doubt as to how to present it, post it here first, and someone will be glad to help out. SlimVirgin 01:54, Mar 19, 2005 (UTC)
More information on Sterling Clarren: he is the Robert A. Aldrich Professor of Pediatrics and former head of the Division of Congenital Defects at the University of Washington School of Medicine. Also currently the medical doctor for the University of Washington FAS Diagnostic and Prevention Network clinic and the director of Infant Inpatient Services for Children's Hospital and Regional Medical Center. He received his BA from Yale University and his MD from the University of Minnesota. His post-graduate training was in pediatrics, followed by a fellowship training in neuroembryology, teratology, and dysmorphology. He certainly counts as a good source for Wikipedia. SlimVirgin 02:13, Mar 19, 2005 (UTC)
Hi Slim, Why does he do statistics backwards by guessing a percentile and extrapolating diagnoses? Why do the attached statistics vary a hundredfold? Where has he been published?
A good opposing viewpoint is found in the work of Canadian Dr. Donna Mergler, but I don't have access to medline anymore.
Also, newspapers have had of accounts since the 80's of alcoholic women that have been incarcerated until they come to term, had their other children taken away under broad interpretations of child abuse laws, and women have even been charged with distributing controlled substances to a minor.
Even hard science has it's biases due to what one can obtain grant money to study, but "there are lies, white lies, and statistics" [195.137.78.175]195.137.78.175 14:25, 19 Mar 2005 (UTC)14:26, Mar 19, 2005

[edit] Normal drinking

Hey folks. The page mentions that normal drinking is safe - is this true? Most places recomend absolutly no drinking. Also, the word "normal" is a bit ambiguous ... If I always drink a fifth a day, does that make it normal, and thus safe? 128.104.102.148 21:29, 13 Jun 2005 (UTC)

I agree with the above comment as I have consistently read about complete abstinence in documents by researchers and the federal government. For example -- SAMHSA: “There is no proven safe amount of alcohol use during pregnancy.” Center for Disease Control: “There is no known safe amount of alcohol to drink while pregnant and there also does not appear to be a safe time to drink during pregnancy either.” Surgeon General: “No amount of alcohol consumption can be considered safe during pregnancy. … A pregnant woman should not drink alcohol during pregnancy.” DFurlani 18:18, 4 July 2006 (UTC)
To maintain a neutral point of view, the fact that most organizations (for lack of a better word) recommend total abstinence should be added (if it isn't already mentioned) and the fact that some studies seem to indicate that small amounts may not cause problems should also be included.
For a while the article had a short paragraph and linked to an off-site article about this, but a somewhat recent edit listed a huge number of studies one-by-one instead. On one hand, more sources are better than fewer, and stating the actual results of individual studies rather than a general interpretation of several put together is often more accurate. On the other hand, a long list may be overkill and the overwhelming length might itself be considered POV. I, for one, favor a return to an paragraph or two with an external link for those desiring more information. --Icarus 06:09, 5 July 2006 (UTC)

[edit] Expanding

I'm going to try expanding this article some more over the next few days/weeks. My apologies if it looks a little odd during the process, perhaps with points repeated in various sections. This is a feature of working on a little bit at a time. I'll try to tidy up as I go along. SlimVirgin (talk) 08:32, 21 January 2006 (UTC)

[edit] POV check

Fetal alcohol spectrum disorder needs to be checked. I doubt that the article presents a neutral point of view: the statement that "small amounts of alcohol during pregnancy might not pose a risk to the fetus" has disappeared. the article also lists links like this [1] --Melaen 22:19, 25 February 2006 (UTC)

[edit] Citation

Icarus, can you say what kind of paper this is, and whether this is a complete citation? "The American College of Obstetricians and Gynecologists. Alcohol and Your Unborn Baby. Washington, DC: American College of Obstetricians and Gynecologists, 1987" Cheers, SlimVirgin (talk) 03:38, 22 April 2006 (UTC)

The website that had the list of studies on the effects of light drinking is no longer around (though it exists in archive). I've selected one of the studies to use as the footnote for that section. Should others be included as well (so it doesn't look like it's one single rogue study that's never been duplicated, and is thus unreliable) or would that be overkill and/or unintentionally POV? Now that the site that was once linked to is down, it seems a shame for that compilation of sources to simply disappear if they can be preserved somehow. --Icarus 03:40, 22 April 2006 (UTC)
We'd need to know exactly what the source said. With something like this, it's best to cite a scholarly source. SlimVirgin (talk) 03:44, 22 April 2006 (UTC)
I've reverted because you don't know that the source said what you wrote: "Although some studies have shown that small amounts of alcohol during pregnancy might not pose a risk to the fetus, pregnant women are usually advised to abstain entirely as every fetus is different and there may be less visible (but still damaging) effects that these studies failed to pick up on." SlimVirgin (talk) 03:47, 22 April 2006 (UTC)
Correction: I was just browsing the "Further reading" section" and saw that while the link I knew of is now only available in archive, one of the links there is to a site with the same information. Maybe this external link can somehow be used instead of the one single citation. Would that be possible/stylistically appropriate? Here's the entire quote that had that particular source in the article I found it:
The American College of Obstetricians and Gynecologists concludes that "there is no evidence that an occasional drink is harmful. Women who drink heavily throughout pregnancy may have smaller babies with physical and mental handicaps, but women who drink moderately may have babies with no more problems than those women who drink rarely or not at all."
There are several other sources cited in that article. I just chose one for the sake of having something to put down for a reference. If another one has a wording that's easier to work into the article, then it can be changed to that one. I do not understand, however, why you thought it had to be removed from the article entirely. I'll leave it that way for right now to avoid accidentally starting an edit war, but please explain why the non-wikipedia article and/or its sources don't count as a source for this article. (Or was it just a case of you reverting it before I finished posting this? The letters crossing in the mail, so to speak.) --Icarus 03:55, 22 April 2006 (UTC)
Thanks, Icarus. If we're going to make medical or scientific points, we need to use the best sources to make them, and not websites about courses for nurses, because they may be worded loosely. If you can find such a source, by all means go ahead and add something, sticking closely to what the source says. This is a contentious point, so we need to get it right. Yes, I think we did have a bit of cross-posting there. :-) SlimVirgin (talk) 04:08, 22 April 2006 (UTC)

[edit] Famous and successful people with FASD

Do we know any famous or successful people who have foetal alcohol spectrum disorder, whether they be full FAS, FAE or ARND? Remember, ARND is diagnosed at 4-5 times the rate of full FAS. What have they done and what are they famous for? Any writers, artists, scientists ... --Bronwyn Gannan 09:13, 9 May 2006 (UTC).


I have wondered about this as well. It would be nice to know!

Though, I'll tell you this. I have Fetal Alcohol Effects and attend a two-to-five year college. I'm an aspiring author, web and office technologist. I'm far from famous, but I'd say I'm fairly successful, despite the burden of my disabilities.

Zetco 02:36, 16 September 2006 (UTC)zetco

I know of a local (Twin Cities) person who has FAS and speaks frequently to groups and trains others on FAS. His website is http://www.peoplefirstmn.org/misc/hunter_sargent.html

MLHarris 20:39, 4 February 2007 (UTC)

It has been suggested that Alfred E. Neuman, the mascot of Mad Magazine, manifests physical characteristics typical of Fetal Alcohol Syndrome. Will someone familiar with this please add the appropriate material to the article on Alfred E. Neuman. Josh-Levin@ieee.org 01:47, 23 February 2007 (UTC)

[edit] Picture and associated caption

As a disabled person, I am not altogether comfortable with the finger-pointing going on in the image demonstrating a FAS child and "blaming" him for the welfare costs. It vividly brings to mind the infamous T4 poster. It's perfectly fine to point out that FAS is costly, but let's not associate it with a person who bears no personal responsibility for his FAS. HuckFinn 22:42, 4 September 2006 (UTC)

It doesn't seem in the least like "blaming" of the baby to me. (The responsibility for FAS is quite clear, unlike many problems.) Nevertheless, I see it could be taken that way. Why don't you just move that part of the caption into the text, say into the last para of the intro? -R. S. Shaw 02:57, 5 September 2006 (UTC)
It's Ridiculous! It's clearly the mother's reponsibility not to poison the foetus during pregnancy. —The preceding unsigned comment was added by 172.143.38.170 (talk) 13:57, 13 December 2006 (UTC).

[edit] Good Article

This page is a good article because:

  • It is well cited and referenced.
  • It is very notable in modern society.
  • It is well written.
  • It is stable.
  • It is well organized

[edit] Treatment Considerations

I would like to suggest adding a section about treatment of FASD. Public understand and awareness of FASD lag behind that of other, better known disorders, such as Autism, Down Syndrome, ADHD, and so forth. Although each disorder is unique, there seem to be some aspects of describing disorders that are common across all (or at least, many) of them. Paying particular attention to FASD in this regard will likely help increase understanding and awareness of it and bring its understanding up to par with that of other disorders. Given my experience in diagnosing and treating FASD, it seems like adding a treatment section might be the next logical step for this article. I would like to take a stab at that, but welcome any and all comments about it. Thanks. MLHarris 18:22, 28 January 2007 (UTC)

[edit] Diagnostic Considerations

Now that I think about it, the Diagnosis section could use some updating as well. There are essentially three U.S. diagnostic systems--the University of Washington's 4-digit code system (best documented), the CDC's system (an amalgamation of expert opinion and experience across the U.S.), and the OIM criteria. This does not include any Canadian systems or the Minnesota model of diagnosing FASD, both of which are related to and similar to the other three systems, but have a few peculiarities of their own. The current listings in the article do not account for these systems. I will attempt to add language that includes acknowledgement of these as well. MLHarris 04:29, 29 January 2007 (UTC)

[edit] Goal: Featured Article Status

I'd like to suggest that we aim for Featured Article status on FASD. I've looked at the A-Class article criteria, and that is doable; then FA-Class would be the natural next step. FASD is such a prevalent but relatively unknown disability that those with FASD deserve the best article possible. I'm planning to make a To-Do list after figuring out what should be listed. Any and all help, views, suggestions, or comments are welcomed. MLHarris 12:43, 5 February 2007 (UTC)

Additions have been made to diagnosis and treatment sections, as well as fleshing out other subsections. It seems appropriate to add a To-Do list to attract additional editors to review the article in preparation of submitting for FA-class review, and I will respectfully do so.
To-do list for Fetal Alcohol Spectrum Disorder: edit  · history  · watch  · refresh


Here are some tasks you can do:
  • Copyedit: for general cohesion, grammar, syntax
  • Other: Polishing for peer review request

MLHarris 17:35, 24 February 2007 (UTC)
Priority 4

MLHarris 17:17, 24 February 2007 (UTC)

I suggest before considering FA candidacy, the name and scope of the article will need to conform with established medical knowledge; there is no such medical condition as Fetal Alcohol Spectrum Disorder. SandyGeorgia (Talk) 16:10, 25 February 2007 (UTC)

[edit] I'm an Angry Puppy

My mother drank wine while she was pregnant with me and my sister. Finding out that caused FAS in my sister and me at age 12 totally sucks. Alcoholic Father + FAS Kids = Mega Disaster. Mummy dearest should have looked up drinking wine while pregnant a long time ago. Moofinluvr

[edit] Notes versus further reading

I'm noticing that the Notes and Further Reading sections might be a bit redundant in the way they are being used in this article. What about combining them into one section? (Probably Further Reading?) MLHarris 14:33, 17 February 2007 (UTC)

I went ahead and combined the sections. While doing so, I realized the article had been using two different citation styles (both Harvard and APA), which is probably why two ref lists arose. Being a psychologist, I'm more familiar and comfortable with the APA style and would like to recommend keeping that style... it keeps most information in the reference list, rather than in the text. It is also easier to "click" on the superscript to get the reference data, rather than having to scroll down the page, remember the author name, search alphabetically, etc. Hope this works for everyone.MLHarris 13:42, 18 February 2007 (UTC)
Have a look at WP:EL, WP:NOT and WP:GTL; I've pruned the External link farm (Wiki is not a Community resource guide, web directory, or a support group - there is probably a DMOZ category which can be linked to for support groups). External links, further reading, and references/notes are explained in the guide to layout. SandyGeorgia (Talk) 06:33, 13 March 2007 (UTC)
Thanks for your help and direction for proper formatting of this article.MLHarris 13:05, 14 March 2007 (UTC)

[edit] Article is incorrectly named

This article is incorrectly named, and incorrect wikilinks have been proliferated throughout Wiki. The recognized diagnosis and medical name of the condition is Fetal alcohol syndrome (acknowledged in the article). Almost all of the sources used refer to fetal alcohol syndrome. Google, Google Scholar, and PubMed all return orders of magnitude larger hits on Fetal alcohol syndrome than on Fetal Alcohol Spectrum Disorder, the condition is commonly known as FAS, so Wikipedia:Naming conventions (as well as WP:MEDMOS) suggest Fetal alcohol syndrome should be used as the article title. The main article should be FAS, referring as appropriate to the spectrum disorders.

  • Google hits on FAS 1,090,000; FASD 136,000
  • Google scholar hits on FAS 11,700; FASD 529
  • Pubmed for FAS 3166; FASD 63

Also, every link from our MEDMOS-approved infobox uses FAS:

Where is there any official use of FASD as a recognized medical diagnosis?

The article should be moved back to Fetal alchohol syndrome, with FASD redirected to FAS (and a lot of wikis and redirects still need to be fixed). Also, someone has been changing links to referenced works about FAS to FASD (which is how this article came to my attention); please don't do that, as the other articles refer to referenced reliable sources that mention fetal alchohol syndrome, and changing the terminology alters the accuracy of other articles. SandyGeorgia (Talk) 06:33, 13 March 2007 (UTC)

In case it matters, editors here should also know that the editor who listed this article at GA [2] was blocked long ago for sockpuppetry, and disrupted FAC. The article still looks close to GA to me, but ... SandyGeorgia (Talk) 06:50, 13 March 2007 (UTC)

Also, note the GA was conferred to the correct name of Fetal alcohol syndrome. SandyGeorgia (Talk) 15:48, 13 March 2007 (UTC)
And, because the article was already moved once from the correct article name, admin help will be needed to get it (and history) correctly moved back. SandyGeorgia (Talk) 15:58, 13 March 2007 (UTC)

Another note; a review of WP:MEDMOS may be helpful in getting this article in shape—the TOC is a bit rambling and unfocused. SandyGeorgia (Talk) 15:19, 13 March 2007 (UTC)

These are all understandable comments. However, I would like to present an alternative point of view and idea. A new section after paternal effects begins that discussion. Thanks.MLHarris 13:05, 14 March 2007 (UTC)
Presenting what you call "an alternate point of view" in an FASD article about FASD is within Wikipedia policies; the problem here is that the alternate point of view has become the main article, against policies as outlined above. The main article (FAS) needs to be restored, and FASD presented in context, linked from FAS. There is a lot more work to do on restoring the links throughout Wiki. I hope you don't have aims on FAC soon, because a lot of work is needed here, and I would have to strongly object if it came to FAC in its current condition. The best place to start (after correcting the name and getting the article moved back to FAS) is to think in terms of article organizaiton of an encyclopedic entry and trimming the table of contents to conform more closely to WP:MEDMOS; the article rambles, has too much info crammed in, and could benefit from more tightly focused article organization. Also, there are many WP:MOS issues to be worked out still. The article is verging on issues of WP:NOT; the information presented is excellent, but encyclopedic focus is missing. I'll be traveling for a few weeks, but can help down the road; in the meantime, the name needs to be corrected. SandyGeorgia (Talk) 13:54, 14 March 2007 (UTC)
Thanks so much... additional information is presented below. I am committed to helping make this article the best it can be in concert with all the other editors, and would never submit it for FAC consideration before it is the right time, based on your and others' judgments. (The notes I made on the discussion page were intended to draw more editors in so that this very process would occur.) I don't want to sound defensive, but the FAS and FASD articles were merged before I submitted edits, so I just added information to the FASD article thinking that the article name matter had been settled before my time. I definitely understand and agree with the issues and suggestions you have brought forth and want to contribute in any positive way that I can. I can't tell you how much I appreciate your attention to this article.MLHarris 14:08, 14 March 2007 (UTC)
You've done an excellent job; nothing to be defensive about :-) The content is there; just needs some reorganization and focus, and some attention to some WP:MOS issues that can be hard to keep up with on Wikipedia, unless you're a regular FAC follower. When I first started working on Tourette syndrome, it was all over the place. I resisted for several months, but when I forced myself to organize it according to the sections in WP:MEDMOS, it did become more focused, with a cleaner Table of Contents and better article organization. I'm willing to help out in April; in the meantime, maybe you can consider separating the content into the FAS and FASD articles? SandyGeorgia (Talk) 14:20, 14 March 2007 (UTC)
PS, one of the things I can help with—in case you don't have time—is getting PMIDs added to all of your references; have a look at the references in Tourette syndrome. SandyGeorgia (Talk) 14:25, 14 March 2007 (UTC)
Thanks so much. I will review the recommended sections on style, recommended articles, and so forth to improve my contributions to our efforts here. I'm thinking that pruning and editing the FAS article would be the best next step for me in bringing improvement and separation to the FAS and FASD articles... I can work on that and would very much appreciate guidance on stylistic issues as I learn and clunk through the editing process. If you have time to address the PMIDs, SandyGeorgia, that would be great. I would really like to learn more about that over the course of this project but would be starting from scratch on that score. I'll catch on though. Looking forward to it, MLHarris 03:03, 15 March 2007 (UTC)
If you just focus on the text/content (which you clearly know well), I can work on stylistic things and PMIDs after I return from two weeks of travel—'til then. SandyGeorgia (Talk) 03:10, 15 March 2007 (UTC)

[edit] Paternal effect

I can find no mention of it here; PMID 15223537 SandyGeorgia (Talk) 20:25, 13 March 2007 (UTC)

This is a good point. There is emerging evidence of deleterious effects on offspring as a result of paternal alcohol use (aside from the better known environmental effects from growing up in an alcoholic family). Paternal effects seem limited to ADHD-like problems, learning problems (stemming from memory deficits as listed in the abstract of the article noted above), and a poor stress response (which I believe is partilly mediated by hormonal issues with cortisol, but I could be wrong on the exact mechanism). Technically, FAS and the other FASD conditions require maternal alcohol exposure (or unknown exposure) from a diagnostic perspective, so appreciation of paternal effects is only considered as part of central nervous system damage and not functionally or diagnostically distinguished from the maternal effects at this point in time. So, while this aspect of alcohol use is not directly related to FAS or FASD in the way that diagnostic criteria are currently established in the literature and in practice, noting this as an emerging area/concern is a great idea and reinforces that FASD is not just a mother's issue (i.e., mothers need support from partners' for prevention efforts). My thinking/suggestion is that a sentence or two on paternal effects would go into a broader FASD article, rather than a more specific FAS article. The reasoning for this is that FASD includes everything about fetal alcohol exposure, while FAS is very specific in its cause and expression.MLHarris 13:05, 14 March 2007 (UTC)
I'm going on memory here, and it sounds like you know the research thoroughly, but several years back (many years back?) I saw reports suggesting that FAS could be caused by paternal alcohol consumption. It stuck in my mind because it was the first time I had ever seen a photo of an FAS baby, and I recognized the features of a child whose mother was an acquaintance of mine who I don't believe drank in pregnancy, but whose father was alcoholic. Just wondering if there isn't more research in this area, or if my memory is wrong; the article I saw then was stating that paternal alcohol could be a cause of actual FAS, but I don't know/recall if it was a media report of a journal study. SandyGeorgia (Talk) 14:44, 14 March 2007 (UTC)

[edit] Maybe there are two articles

[edit] Background

Understandable comments about whether or not this is a correctly named article have been brought forth, and in many ways, this is a reflection of the somewhat unwieldy growth and emergence of the field. Unlike many medical conditions, fetal alcohol syndrome (FAS) was named after its cause by the person who discovered it in the early 1970s. This break from traditionally having eponymously named syndromes was made on the (now seen to be naive and incorrect) assumption that people would refrain from alcohol use during pregnancy if they knew it would cause such permanent disabilities in their children. Unfortunately, addictions do not often respond to logical persuasion, and the syndrome's name actually activated the shame and stigma of hurting one's children by (often incorrect) social conventions that a choice was involved in addictive behavior. This, of course, complicated accurate diagnosis, because many people with untreated addictions minimize or deny their addictive behaviors, making accurate diagnoses more challenging.

The situation was further complicated when it was later found that disabilities existed in individuals without the full expression of FAS. This condition was initially called fetal alcohol effects (FAE), to distinguish it from the "full-blown" condition. The problem, though, was that individuals with FAE often have more secondary disabilites than those with FAS. This occurs because such individuals have the central nervous system damage (and challenging functional behaviors) but no visual cues that they have a disability (i.e., facial characteristics, growth deficiency). They look "normal" but have disabilities which are often attributed to willfulness, and so they are typically misdiagnosed with ADHD, ODD, Autism, or other problems, rather than FAE, and fail to get proper treatment.

To correct this, "the field" began to talk about the higher risks of those with FAE, asserting (correct)statements that "FAE is not a lesser condition than FAS" (because of the higher rates of secondary disabilities). There began to be talk of doing away with the term FAE altogether (citation in the current article) because it misdirects a layperson into believing that less intervention is needed for FAE, when in fact the opposite is usually true.

Enter "Fetal Alcohol Spectrum Disorder" (FASD). This is a recent (within the last four years or so) effort to focus the field and laypersons on the deleterious effects of prenatal alcohol exposure without particular regard to facial features or growth deficiency (which have little or no obvious primary disability in and of themselves--they are signals of FAS and some FASD conditions, but not a causal factor of any functional challenge).MLHarris 13:54, 14 March 2007 (UTC)

[edit] Current directions

Recent books and articles--indeed, two of the diagnostic systems have it in their title (4-Digit and Canadian), and the CDC guidelines acknowledge FASD in its contents--are all moving toward the term FASD, while including FAS within that spectrum. The effort is aimed at enhancing the attention and greater challenges of other FASD conditions while placing FAS in a more appropriate perspective. This would explain the greater number of article hits for searches on FAS than FASD, and is the basis of my proposal to have two articles--similar to that for Autism and Autism spectrum.

I have more thoughts, which I will add later, but I have to go to work now. In any event, this is a great discussion opportunity. Thank you.MLHarris 13:54, 14 March 2007 (UTC)

I'm not at all opposed to two articles; in fact, it's what I advocate. Fetal alcohol syndrome is the recognized condition; it needs to be the main article per naming conventions, supported by search data. FASD can expand the topic further, and would not be an insignificant article. But we do need to get this straightened out. The GA was problematic to begin with, and was conferred to FAS. After setting up the two articles correctly—including links to each other and the use of summary style—then you can decide which one goes to WP:FAC, but FAS needs to be the main article. SandyGeorgia (Talk) 14:10, 14 March 2007 (UTC)
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