A Preventable Malady

Ed Riley finds all the motivation he needs to continue his 35-year battle against  fetal alcohol spectrum disorders (FASD) whenever he spends time with children damaged in the womb by their mothers’ drinking.

“That’s where my real love is,” he says. “When I take people who do basic research to see the kids, it changes their lives. They’re studying this problem in a cell culture dish, and then you say, ‘This is why you’re doing it; it’s this little kid right here.’”

A distinguished professor of psychology at San Diego State and director of the university’s Center for Behavioral Teratology, Riley is world-renowned for his foundational research in the field of fetal alcohol exposure.

He and his SDSU colleagues—Sarah Mattson and Jennifer Thomas—have won awards, recognition and continual funding from the National Institute on Alcohol Abuse and Alcoholism, a program of the prestigious National Institute of Health (NIH). Their combined funding on FASD research exceeds $44 million.

Riley became interested in the behavioral effects of prenatal alcohol exposure in the mid-1970s, just after fetal alcohol syndrome (FAS) was first identified in children born to women who drank heavily during pregnancy.

Distinctive facial features

Early study of the syndrome focused on the small size and distinctive facial characteristics of affected individuals. But it soon became apparent that a child’s developing brain suffered the most from prenatal alcohol exposure, as evidenced by cognitive problems (learning, memory, attention) and behavioral problems (overactivity, poor communication skills), even in children lacking the physical characteristics of FAS.

Riley led the way in establishing alcohol as a behavioral teratogen—a substance that causes birth defects resulting in altered behavior or cognition, with or without associated physical attributes. In 1988, he and Mattson, then a graduate student, came to San Diego State University and began working with other area researchers involved in this emerging field of study.

“We started a line of research looking at changes in the brain and behavior based on exposure to alcohol,” Riley summarized. “We were really the first to show in a scientific exploration that you could have alterations in the brain and behavior in kids without the full-blown syndrome. We’ve also been among the first to look at interventions, both pharmacological and nutritional.”

Mattson explained the significance of their earliest studies. “By comparing children—those with FAS as defined by physical features and a second group known to have high levels of prenatal alcohol exposure but without the physical features of FAS—we discovered more similarities than differences in terms of cognitive deficits and behavioral effects.”

Magnetic Resonance Imaging (MRI) studies also confirmed brain anomalies in both sets of children. These early findings led to a shift in thinking and diagnostics. Today, the effects of prenatal alcohol exposure are viewed within a continuum known as the fetal alcohol spectrum.

Thomas joined the team in 1995, bringing additional expertise in brain development. She was also interested in the mechanisms by which alcohol causes damage to the fetal brain with the goal of discovering ways to prevent and treat its effects. As a result of Thomas’ input, the team is currently examining the effectiveness of various behavioral, pharmacological, and nutritional interventions for FASD. 

Improved screening and diagnosis

While the community of FAS researchers worldwide has grown over Riley’s career from a couple dozen to hundreds, the SDSU team, all psychology professors, remains in the forefront of advancements in the field.

Riley, Mattson and Thomas also coordinate an international consortium of institutions organized by the NIH to study the issue. Members have included Harvard, Emory and Indiana universities, as well as University College London, Queensland Institute of Biomedical Research in Australia and Folkhalsan Research Center in Finland.

With recent discoveries offering more specific indicators of fetal alcohol spectrum disorders than ever before, the SDSU researchers are now focused on improving screening and diagnosis to help identify affected children who don’t display the characteristic FAS physical features—and the sooner the better.

Early intervention could help prevent or mitigate problems in school and at home and could also prevent the secondary disabilities, such as school dropout, substance abuse, and trouble with the law.

“We’re talking about a condition as common as autism and ADHD,” Riley said. “It’s the most common developmental disorder that’s entirely preventable, and the most common cause of intellectual deficits that can be prevented. All we have to do is keep pregnant women from drinking.”

Easier said than done, he admits, even with growing attention to the risks, including a 2005 Surgeon General’s recommendation that “pregnant women and women who may become pregnant abstain from alcohol.”

In the meantime, Riley and his colleagues remain committed to helping kids with fetal alcohol spectrum disorders.
 
“The brain is incredibly plastic,” Thomas said. “We have evidence now that even after a child is born, we might be able to intervene—with drug or behavioral therapy—throughout that person’s lifespan. So just as we’ve identified a continuum of effects, there’s also a continuum of hope.”