GRAPEVINE, TEX. – The behavioral and cognitive defects in children with fetal alcohol effects may be partly attributable to genetic psychiatric disorders, researchers reported in a poster presentation at a meeting sponsored by the American College of Medical Genetics.
“Physicians need to ask about psychiatric and behavioral illnesses in families when diagnosing children with fetal alcohol effects [FAE],” said Helga V. Toriello, Ph.D., director of genetics services, Spectrum Health, Grand Rapids, Mich. “Acquiring a family history is important, because they suddenly may be dealing with genetic factors rather than alcohol.”
While the diagnostic criteria for fetal alcohol syndrome are firm, the criteria for fetal alcohol effects are less clear and may overlap with other psychiatric and behavioral disorders, she said.
Researchers at Spectrum and DeVos Children's Hospital, also in Grand Rapids, found that 95% of children thought to have fetal alcohol effects also had psychiatric or behavioral disorders and that 89% had a first-degree relative with a psychiatric or behavioral disorder.
The study included 100 children aged 3–19 years who had been seen to determine whether they had fetal alcohol syndrome. None of the children fit the criteria for fetal alcohol syndrome and thus could be considered to have FAE.
But after conducting family histories, the researchers found a high rate of psychiatric and behavioral illnesses such as bipolar depression and attention-deficit disorder, not only in the children but in first-degree relatives.
“This raises the question of how much of the behavioral problems are due to psychiatric illness or alcohol exposure,” she asked. “A genetic condition might be contributing to the child's behavior.”
Psychiatric and behavioral problems such as depression, anxiety, bipolar disorder, and attention-deficit hyperactivity disorder are known to be highly heritable.
Additionally, there appears to be a comorbidity of alcoholism and mental illness. For example, at least 20% of those with mood or anxiety disorders also have substance abuse disorder. And at least 20% of those with substance abuse problems also have mood or anxiety disorders.
The researchers found that children with bipolar depression had split verbal and performance IQ, executive dysfunction, and attention problems–all common features also reported in children exposed to alcohol.
Also, some individuals with psychiatric and behavioral illnesses have similar characteristics as those exposed to alcohol prenatally. For example, in bipolar depression, there is sexually inappropriate behavior, anger, hyperactivity, and learning disabilities, features also found in alcohol exposure.
Dr. Toriello said the researchers are not saying that alcohol does not have an effect, but it may not be the only reason for the child's behavior. “When we did a family history, there was a high frequency of one or both parents having a mental illness or behavioral disorder. It might be that a genetic condition is contributing to the child's behavior rather than strictly alcohol exposure.”