Dr. Famy and Colleagues Reply

To the Editor: We were pleased to hear that our recent article stimulated interest in the mental illness manifested by adults with fetal alcohol syndrome and fetal alcohol effects. As Abraham Rudnick, M.D., Dipl.Psych., and Asher Ornoy, M.D., point out, this was a first small pilot study.

The deletion of subjects with IQs of 70 or less was because of the administrative requirements of the Structured Clinical Interview. The fact that this restriction omitted only 9% of otherwise eligible subjects may be partly a manifestation of the difficulties of locating disabled people after they leave home and school. Comparison with IQ data from a Finnish study of 2-year-old children (Autti-Ramo et al., 1992) would be difficult because of marked differences in the age of the subjects, assessment tools, environment, and culture.

We agree with Drs. Rudnick and Ornoy that the severity of psychiatric symptoms should also be studied; such a study is already under way on our unit, involving subjects participating in a study of neuroanatomic and neuropsychologic deficits of fetal alcohol syndrome and fetal alcohol effects.

We also agree that dose/response issues and environmental factors are important considerations in studying the long-term impact of teratogens such as alcohol. These are best studied in longitudinal prospective designs where the dose is established prenatally, the environment documented prospectively, and the outcomes assessed developmentally. Recent prospective research reveals continuing effects of prenatal alcohol exposure on psychosocial and cognitive functioning (1) and alcohol problems (2) in 14-year-old offspring. Studies such as these can also address prevalence issues that are otherwise difficult to study in patient groups. The overall prevalence of fetal alcohol syndrome (e.g., diagnosed blind at birth) and alcohol-related neurodevelopmental disorders (as described by the U.S. Institute of Medicine [3] and assessed throughout the first 7 years of life) was at least 9.1 in 1,000 in a recent study (4).

The hypothesis suggested by Drs. Rudnick and Ornoy—that people with schizophrenia and fetal alcohol syndrome or fetal alcohol effects may have different structural anomalies of the brain—may be correct, but this work is only in its first stages. Recent magnetic resonance imaging studies show hypoplasia of the corpus callosum with both conditions, but the geometry of the callosal alcohol effect is different and less sharply localized than the group difference with schizophrenia (5; unpublished study by F.L. Bookstein et al., 1998). It is premature to draw conclusions about the differential neuropathology of schizophrenia and fetal alcohol syndrome. We agree with Drs. Rudnick and Ornoy that much more research is needed and hope that these brief interchanges will stimulate additional work at other centers.