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>Does the Amount of Exposure Matter?

March 30, 2011

>If you’ve been following this series, you know that back in 2003, when my husband and I stepped out on our adoption journey, we were under the (mis)impression that behavioral outcomes in children exposed to alcohol during pregnancy were linked to the amount of alcohol their birth mother consumed.

Although that was only 8 years ago, that was the era when our pre-adoption classes covered the attachment disorder known as RAD (Radical Attachment Disorder). A few therapists (who were viewed as radicals at that time) had begun insisting that attachment disorders actually fell on a continuum, with RAD being one extreme. But that information had not yet trickled down into every-day adoption parenting theory like it has today.

The same this is true of the disorder that was known eight years ago as FAS (Fetal Alcohol Syndrome). 2003 was the year the diagnostic umbrella was broadened to “FASD,” recognizing that a range of prenatal exposure could cause a range of problems.

Unfortunately, significant information can be known in the professional community for a long time before it trickles out into the adoption world.

A full decade before we embarked on our adoption journey, in 1993, this study was published: Fetal Alcohol Syndrome in Twins of Alcoholic Mothers. In it, two doctors evaluated children in their Fetal Alcohol practices identified as twins. Each pair of twins had the same level of alcohol exposure in utero because they shared the same mother at the same time.

In the identical twins in the study, both twins presented with similar levels of FAS. However, in the larger sample of fraternal twins, the incidence of exposure-related effects varied in some of the twin pairs. Because fraternal twins are genetically different, the authors concluded that genetics plays a significant role in mitigating or facilitating the toxic effects of alcohol consumed during pregnancy.

All the twins in the study are identified as having an “alcoholic” birth mother. That probably qualifies as “significant” exposure in terms of maternal alcohol use as reported in Korean referrals. Yet a few of the fraternal twins in the study had no measurable effects despite the fact that their twin did. Of the 32 children of heavy-drinking mothers, 4 who were fraternal twins had no detectable FASD.

I guess it depends how you look at it. 13% of the kids in this study escaped daunting amounts of alcohol clinically unscathed. 87% did not.

This study supports the U.S. Surgeon General’s warning that NO amount of alcohol consumption is safe during pregnancy. This was not issued until 2005, when Hope had already been home for a year. Because of this genetic component, the reported level of exposure in a referral is not predictive of the child’s future.

So what are parents to do? Please keep adopting children who have known alcohol exposure. However, if/when things get challenging, keep in mind the fact that your child was exposed –even if, like us, the reported amount of exposure was not of concern to you at the time you accepted the referral.

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