Fetal Alcohol syndrome in adulthood - Psychological, psychosocial, and neuropsychological aspects of life in individuals who were prenatally exposed to alcohol

Abstract: Alcohol’s teratogenic effect on the developing fetal brain is devastating, resulting in, for instance, structural abnormalities as well as behavioral and neuropsychological impairments in the child. The umbrella term Fetal Alcohol Spectrum Disorders (FASD) is used to describe the range of effects, from neuropsychological dysfunctions to complete Fetal Alcohol Syndrome (FAS). The disabilities associated with FASD have a major impact on life for children, and perhaps even in adulthood. However, only a few studies have addressed the long-term outcome in adults prenatally exposed to alcohol, especially with a diagnosis of FAS, from a psychological perspective. The main aim of this thesis was to investigate the psychological, psychosocial and neuropsychological consequences of FAS in adulthood. Participants in the studies in this thesis consisted of 79 adults (mean age: 32 years) with an FAS diagnosis. In Study I, data on the adults with FAS and a gender- and age-matched comparison group were obtained from national registers. The results showed that 25 % of the FAS group had attended special education. The adults with FAS were less often employed (49.2 % vs. 85.3 %) but had a low rate of criminal offenses, comparable to that of the comparison group (ns). Those in the FAS group had higher hospital admission rates due to psychiatric disorders, and were more often prescribed psychotropic drugs (57 % vs. 26.5 %). In Study II, data from childhood medical records on environmental conditions were related to adult psychosocial outcomes in adulthood. No significant differences related to childhood conditions in the adult outcomes were found. The results were suggested to show that, due to the heterogeneity in the FAS group, interventions should be functional-need-oriented to each individual. Data in Studies III and IV were obtained through face-to-face data collection. Participants were 20 adults with FAS (mean age: 30 years) and a comparison group consisting of healthy individuals matched on gender and age. The results in Study III showed that the FAS group displayed deficits in the neuropsychological tests sensitive to cognitive and executive functions and social cognition. The results in Study IV, using the Addiction Severity Index interview, showed that the adults with FAS had problems with depression and suicidal ideation, which were common among them; but problems with substance use were not more common in the FAS group. The crime conviction rate was low, but many in the FAS group had been victims of crime. Based on the results in the empirical studies in this thesis, it was concluded that: 1) The psychological consequences were depression and anxiety, brought on by negative experiences throughout life; 2) The psychosocial consequences of importance were that criminality was uncommon among the adults with FAS who were studied. This could be explained by the fact that they had access to social, educational and financial support during childhood; and 3) The neuropsychological consequences entailed that impaired cognitive functions may be found in individuals with FAS even in adulthood. The conclusions indicate that FAS is associated with a complex chain of causes and consequences that interrelate from early childhood to adulthood. To ameliorate adverse adult outcomes, children with FAS need efficient interventions from welfare authorities. FASD is caused by maternal consumption of alcohol, and is therefore completely preventable.