Researchers know, just by comparing two brains, which one was exposed to alcohol. The alcohol-exposed brain is smaller, smoother, flat.
Children with full fetal alcohol syndrome also have distinctive facial features -- their eyes are close together and the area beneath their nose is flat.
HOW DOES ALCOHOL AFFECT THE BRAIN?
Jeff Wozniak, a neuropsychologist at the University of Minnesota, wants to look below the surface. A machine similar to an MRI lets him zoom in for a closer look at the brains of children between the ages of 10 and 17 who were exposed to alcohol before birth.
"What we're doing is looking at a milder group of children, who have some abnormalities in terms of their cognitive development, their intellectual development. They have less obvious physical findings," says Wozniak.
The cutting-edge project doesn't aim to diganose fetal alcohol spectrum disorders. Rather, Wozniak says, it's a way to understand what happens to the brain when a pregnant woman drinks.
Wozniak says the microscopic brain tissue he's studying is surprisingly like the children -- disorganized.
"We associate that with less efficient handling of information. It shows up in terms of differences in processing speed, and in some cases, differences in concentration skills. And it may also contribute to some of the other cognitive problems that we see," says Wozniak.
Wozniak is studying children in the Midwest, while other researchers travel the world to understand how to better diagnose alcohol exposure.
FAS IN OTHER COUNTRIES
Dr. Eugene Hoyme, chairman of pediatrics at Sanford Health, is known around the world for developing diagnostic criteria for this disorder. Hoyme says many countries deny alcohol consumption during pregnancy is a problem.
Hoyme uses Italy as an example, where drinking wine has been part of the culture for 2,000 years. He says many doctors refuse to even discuss the effects of that behavior.
"We did a study and the prevalence is 2 percent in Italy, and 1 percent in the United States. The Italians still have a hard time believing that's really true, and it's just because [wine] is like mother's milk to them," says Hoyme. "Part of it is, as a society we don't accept alcohol is a problem and we don't do a good job educating physicians about it."
Hoyme says while alcohol use is accepted in nearly all cultures, it's most prevalent in the villages of South Africa. As a result, there are more children in that country who are alcohol-exposed than anywhere else in the world. Eight percent of first grade children in South Africa suffer from brain damage, and Hoyme says the rate is so high because many of the farm workers are paid in wine.
Hoyme is trying to find a way to diagnose children earlier -- perhaps in infancy.
"If you can identify a child very early in life, and you can institute early intervention, then perhaps in the long run the outcome will be greatly improved," says Hoyme.
EARLIER DIAGNOSIS MEANS EARLIER TREATMENT
Early intervention means teaching the child techniques to better understand what is happening around them. For a child with FAS, it's a life of confusion and poor judgment. Many of these children have a hard time in school.
According to Marcia Maltaverne, an education specialist with the South Dakota Center for Disabilities, FAS kids are usually hyperactive and they fidget. These are signs often misinterpreted as bad behavior.
"They can't really tell you, 'Oh, I'm overloaded with sensory stimuli.' We need to educate first the parents, and the service providers," says Maltaverne. "Then we need to educate these kids themselves to recognize, 'This is my disability. These are the things I'm really good at. These are things I need some help with, and when this happens this helps me.'"
Maltaverne says the solution can be simple, like giving the kids a quiet place to calm down or even a ball to squeeze. She says earlier diagnosis would help parents and children learn these tools earlier, so by the time they're in school they know what works best.
MAJOR NEW STUDY UNDERWAY
One of the groundbreaking studies into fetal alcohol exposure is taking place in Sioux Falls. The Safe Passage study is the largest of its kind, and will follow 12,000 pregnant women over the next seven years. The women are in South Dakota, on Indian reservations in North Dakota, and in South Africa.
At a clinic in Sioux Falls, a pregnant woman, who wants to be anonymous, lies back in an exam room. Her gown is raised and her stomach is exposed. She's 22 weeks pregnant.
Kathy Harris, a nurse who helps gather the data for the study, is trying to find the fetal heartbeat. The baby just switched positions so it's difficult to get an accurate reading.
Monitoring the fetal heartbeat lets them detect movement inside the womb. It's all recorded on a computer connected to the heart monitor.
Harris also asks the pregnant woman a series of questions about her eating and drinking habits, and other specifics about her pregnancy.
"We do that three times during the study, and the questions vary," says Harris. "When she delivers we see mom and baby about 12 to 18 hours after delivery. We measure the baby's vital signs and respiratory rate. We take its temperature and blood pressure. We watch any movement. Any time the baby whimpers, sighs, suck, move its head, cry we record it."
What they're looking for is the maturity of the baby's central nervous system. They'll see mom and baby again and have several phone conversations for a year after birth. If the baby dies, they'll do an autopsy.
It's a way to have what's called forward data, instead of looking back after something bad happens. It's a large study that will try to answer several questions -- including why some children exposed to alcohol develop FAS and others don't.
"I think that's a question that remains unanswered for medical and educational communities," says Amy Elliott, the project's coordinator. "I also hope to provide some further definition around other disorders in the FASD family."
Elliott is also looking at how alcohol and drug use affect child mortality, like stillbirths or Sudden Infant Death Syndrome. Elliott says they're including alcohol and drug use in the study because drinking alcohol doesn't exist in isolation.
It'll be years before any conclusive results are available from these studies. One thing seems to be consistent for many researchers looking at fetal alcohol syndrome -- the more they reach out to women and talk about the dangers of drinking and pregnancy, the more likely it is there will be fewer children who need their research.