Constitutional Liabilities

Behavioural difficulties that appear to be genetic but are not the result of gene or chromosome abnormalities can often be attributed to constitutional liabilities. The word constitutional describes those characteristics that were acquired during development in the uterus and not through heredity. A liability refers to something that is a disadvantage to an individual. In short, a constitutional liability is a characteristic acquired in utero that is a disadvantage to the individual.

The first of three main types of constitutional liabilities relates to the physique or the form and structure of the human body. Attractive people, generally speaking, have advantages in life not shared by less attractive people. One need only look at the rich and famous to see that the majority of people in this category are attractive. Studies have shown that even incorrect impressions that a person is unattractive may enhance the risk of disorder (Noles, Cash, & Winstead, 1985). In extreme cases, some individuals undergo cosmetic surgery time and time again to correct perceived physical liabilities.

The second type of constitutional liability is physical handicaps. The results of embryologic problems (e.g., cleft palate, spina bifida), or drug-related effects (e.g., fetal alcohol spectrum disorder, central nervous system defects) are obvious, but the causes of many of the handicaps are not known.

This video provides some interesting information on fetal alcohol spectrum disorder, which is caused by the mother drinking alcohol while pregnant.  This disorder is 100% preventable and leaves the baby with a life long struggle, as many of the neurons in their brain are destroyed before they are even born.

Although it may be heartbreaking for parents to see their newborn with any deformity, cosmetic surgery for cleft palates can be quite effective. See Table 4.1 for “cleft facts” (Gordon Wilkes, 2004) and Figure 4.2 for a picture of a child with a cleft lip.

Table 4.1: Cleft Facts

• One in 700 babies are born with a cleft lip and/or palate. It occurs more often (one in every 350 births) among Asians and certain groups of native North Americans.

• A cleft lip occurs between the fourth and sixth weeks of pregnancy when portions of the upper lip do not fuse. A cleft palate occurs between the eighth and 12th week of pregnancy when the structures between the mouth and the nose fail to come together.

• 50 percent of patients have a cleft lip and palate; 30 percent only have a cleft palate and 20 percent only have a cleft lip.

• A cleft lip and cleft palate are more common in males.

• A cleft palate alone is more common in females.

• Only 30 percent of cleft lips and/or palates are hereditary.

• In the majority of cases the cause is unknown, but the risk is higher if the mother takes certain anticonvulsant drugs such as phenytoin during pregnancy, if she smokes or drinks heavily.

• If you have one child with a cleft lip, the chances of the next child having a cleft lip too is one in 25. If one child has a cleft palate, the chances of the next child having a cleft palate is one in 50.

• The Chinese were the first to surgically repair cleft lips in 400 A.D.. A lack of antibiotics and other technical know-how delayed the first surgical repair of a cleft palate until 1861 in Germany.

Figure 4.2: A cleft lip is a separation of the upper lip that can extend into the nose.

cleft lip

The last type of liability refers to primary reaction tendencies. Babies differ in how they react to various stimuli. Some babies are easily startled while others are quite placid. The differences in reactions are examples of primary reaction tendencies. The way the babies react appears to have been established before birth, some of which may be related to early hormonal influences in utero. Current studies suggest the mix of hormones before birth relate to gender preferences. The power of hormones!