Prenatal Alcohol Exposure May Be Driving Some Violent Behavior

The mass shootings that leap to public attention mask a larger, ongoing epidemic of day-to-day killings and gun violence, Carl Bell, M.D., a staff psychiatrist at Jackson Park Hospital in Chicago, told an audience gathered for the Washington Psychiatric Society’s Presidential Symposium on Violence Risk Reduction at St. Elizabeths Hospital in February.

Milbert O. Brown

“The existing evidence regarding the incidence of urban gun homicide flies in the face of conventional media analysis and public beliefs, which tend to focus attention on the sensational,” Bell said. “The causes of urban youth gun violence are multidetermined and extraordinarily complex, so a multipronged strategy is likely to get the best results.”

One focus of that strategy, Bell proposes, should be on decreasing the effects of fetal alcohol exposure—a factor he believes may be contributing to the violence on America’s streets.

“Recent data indicate that a large proportion of urban children of color in special education, juvenile justice, foster care, and mental health clinics have histories of neurodevelopmental disorders—most likely due to fetal alcohol exposure,” he said. These children have poor judgment and affect regulation and are easily frustrated, and at least some become violent.

The effects of alcohol on the etiology of violent behavior have likely been underestimated, asserted Bell. Up to half of the women who receive services at the hospital where Bell works don’t know when they are in the earliest stages of pregnancy and continue using alcohol, he said.

“If you ask them, they’ll say they stopped drinking when they became pregnant, but what they mean is they stopped when they knew they were pregnant.”

Bell has conducted several studies whose results suggest that roughly one-third of patients in Chicago’s poor communities may have a neurodevelopmental disorder associated with prenatal alcohol exposure. “Fetal alcohol exposure is a hidden epidemic in poor African-American communities ... ,” he wrote in the May 2014 issue of Psychiatric Services.

Managing fetal alcohol exposure and its consequences is not hopeless, said Bell. Recent research has pointed to the value of phosphatidylcholine supplementation both for pregnant women and their children. A recent study in the American Journal of Psychiatry reported that high-dose oral phosphatidylcholine taken during pregnancy resulted in fewer attention problems and less social withdrawal in offspring.

Researchers suspect the α7-nicotinic acetylcholine receptor gene CHRNA7, which “has been associated with schizophrenia, autism, and attention-deficit/hyperactivity disorder,” may play a role in this response, wrote Randal Ross, M.D., a professor of psychiatry and pediatrics at the University of Colorado School of Medicine, Aurora, and colleagues in the article posted online December 7, 2015. “Maternal phosphatidylcholine treatment may, by increasing activation of the α7-nicotinic acetylcholine receptor, alter the development of behavior problems in early childhood that can presage later mental illness,” the authors wrote.

“Choline supplementation can alter brain development following a developmental insult, and similar postnatal interventions may reduce the severity of some fetal alcohol effects,” said Bell.

Other researchers have found that treating children aged 2.5 to 5 years with a nine-month course of choline improved scores on memory tests.

Behavioral interventions have also proved useful, he said. Developing a community’s social fabric, encouraging adults to mentor youth, and offering programs to build social and emotional skills have proven to decrease risk-taking behaviors and youth gun violence.

Too often, attempts to solve the problem have focused solely on risk factors and how to ameliorate them, said Bell.

“But we must be smart enough to wrap at-risk youth in protective factors,” he said. “Public health interventions that focus on the protective factors that prevent the risk factors from becoming predictive factors are the recommended approaches.” ■