 Welcome to Module 1. In today's session we will be introducing the effects of prenatal alcohol exposure on the developing brain. Our objectives are to explain that due to the teratogenic or toxic properties of alcohol, prenatal exposure to alcohol leads to brain entry that is scattered across areas of functioning related to the progression or hierarchical way that the brain develops. The impact of alcohol on the developing brain affects individuals differently and this means that making predictions about specific strengths and challenges can be difficult both within and between affected individuals. However we do know based on the pattern of brain growth that the greatest areas of difficulty will typically be in regions of the brain that are further from the brainstem. We would like you to note three core messages when considering prenatal alcohol exposure and the process of brain development. First that alcohol is a teratogen. Second that the brain grows from bottom to top. And third because of the way the brain grows some regions are more impacted by alcohol than others. We will explain each of these three core messages further. Alcohol is a teratogen which means two things. One that alcohol can cross the placental barrier and two alcohol is capable of interfering with the development of the growing embryo and fetus. Although exact amounts of alcohol exposure needed to impact the developing brain are unknown, exposure to alcohol during pregnancy can impact development and can lead to a fetal alcohol spectrum disorder. It is the pattern of injury to the developing brain and the resultant impact on function that will be considered in the course of this and the following modules. The brain grows from bottom to top. It begins as a tube and it is from this tube that brain cells move upward and outward to gradually build the brain. Another way to think about brain growth is that it is like a cauliflower. Beginning with the stem the brain grows upward and outward. To support the way the brain grows first glial cells the support cells of the brain begin to move upward and outward branching off from the tube essentially forming scaffolding that supports the movement of the brain cells. The brain cells called neurons climb up the scaffolding moving to a specified location and in some cases replicating to form more neurons. Some neurons have a short journey, others have a long journey. When alcohol is introduced to the process of brain growth it may disrupt the cells in many ways damaging the basic scaffolding, confusing the neurons so they are unsure of where they need to go and or killing the neurons themselves. Which specific neurons are impacted depends on the timing and the amount of alcohol exposure. Consequently the impact to the developing brain is diverse and scattered. Because damage is so variable it is difficult to predict what challenges a specific individual with an FASD may face and it is important to remember that understanding one individual may not provide insight into another individual with an FASD. Similarly what may be a useful support to one person may not work with another. As a result of the variable pattern of impact caused by prenatal alcohol exposure it becomes crucial that we are able to respond to the needs of each individual in a flexible, adaptive way. A recipe card approach will not be effective. Rather we need to be prepared to be versatile in our interactions with individuals with an FASD. Although the impact of prenatal alcohol exposure on the brain is highly variable there are some areas of brain function that are more vulnerable to the impact of the alcohol. Consider the upward and outward progression of the neurons and glial cells that was just described. Which neurons may be more vulnerable to the exposure of alcohol, those traveling a short distance or those traveling a long distance? The correct answer is those with further to travel as there is a greater likelihood of misdirection and greater dependence on lower level systems to function effectively. The regions farther from the center are often referred to as higher cortical functions and include functions such as problem solving. Our basic functions, heartbeat and breathing are in the lowest region. In the middle are many of our species survival components including our fight and flight responses as well as our sexual drive. Thus in FASD we find the basic systems intact and the middle systems also known as the limbic systems generally functional but the higher systems required to manage those limbic systems for example management of a desire to fight to defend are most affected. So an individual with FASD may be very good at protecting themselves from a perceived threat either by fighting or running away but may not be as good at determining whether something really is a threat or deciding how best to respond to that threat given a specific context. Responding to an unintentional bump in a shopping mall or school hallway with a punch may reflect this misinterpretation of threat and a poor threat response and this behavior is a reflection of injury to the brain not an indication of mean or oppositional behavior. Thinking of the brain this way requires us to change our perceptions so that we can support alternatives rather than punish an individual for behavior that resulted from brain injury from prenatal alcohol exposure. In module one we have provided a brief introduction to the effects of prenatal alcohol exposure on the developing brain. Three core messages covered in this module were first alcohol is a tarratogen. Second the brain grows from bottom to top and third because of the way the brain grows some regions are more impacted by alcohol than others although exact amounts of alcohol exposure needed to impact the developing brain are unknown exposure to alcohol during pregnancy can impact development and can lead to a fetal alcohol spectrum disorder. How the developing brain is impacted depends on the timing and amount of alcohol exposure and is therefore highly variable. As a result it becomes crucial that we are able to respond to the needs of an individual in a flexible adaptive way. For example individuals with an FASD may have adequate limbic system functioning related to the fight or flight response and sexual drives but they struggle with higher cortical functions related to things like emotional problem solving and behavior management. In the next module we will explore brain functioning and FASD a bit further and explain how a process-based approach to understanding behavior is helpful when responding to individuals with an FASD.