Lori Gertz was vilified last year when critics accused her of heartlessly sending her 7-year-old adoptive daughter Ellie 1,700 miles from their home in Long Grove, Ill., to be raised by strangers.
Ellie's violent outbursts began from infancy and progressed. At one point she threatened to kill her little sister and pulled her eight-month pregnant mother down a set of stairs.
The Gertz family -- Lori, a marketing specialist, and Craig, a lawyer -- sought help from every available social service agency, spending hundreds of thousands of dollars and consulting 39 doctors until they learned she had fetal alcohol syndrome disorder (FASD).
The insidious disorder includes an array of neurological deficits that can cause poor judgment, inability to bond and aggression.
By the age of 6 she had seen four psychiatric hospitalizations and made numerous suicide attempts. Specialists worried that Ellie, who could be at once charming and malicious, might one day fatally hurt her siblings, then 5 and 11.
Worried for the safety of her family and hopeful that Ellie might improve under the care of a couple from Washington state who had experience with FASD, Gertz made an excruciating choice -- to relinquish the daughter she said she still loves.
Now, as the alcohol-laden holidays approach, Gertz is speaking out: Don't drink during pregnancy, ever, and be "ultra-cautious" during childbearing years, she cautions.
"The legacy of FASD never wanes," she said.
According to the Centers for Disease Control and Prevention, about 125,000 women a year have serious alcohol problems throughout pregnancy.
Ellie's story, publicized nationally last September, has no happy ending.
After a 15-month honeymoon with her new family, Ellie again displayed meltdowns so aggressive that both families became embroiled in unfounded accusations of child abuse. Now they struggle to co-parent a child whose brain has been permanently damaged by her biological mother's drinking.
"This Mama couldn't kiss it better, and then her guardian Mama couldn't kiss it better," Gertz, now 48, told ABCNews.com "The thesis for all of this is prevention -- so stories like this don't need to be told."
"The pattern of her self-destructive nature didn't change with the shift in caregivers, which is an integral part of our ongoing story, because so many people skewered me for being this horrific person at the root of Ellie's problems," she said. "And everyone wanted her to recover with her new family."
That family did not want to share their side of the story with ABCNews.com for fear that they would compromise Ellie's anonymity and slow progress.
FASD affects about 40,000 newborns a year -- about one percent of all live births in the United States, according to the National Organization on Fetal Alcohol Syndrome (NOFAS). Two million adults are also affected by FASD.
Alcohol, like the carbon monoxide from cigarettes, passes easily through the placenta into the blood of a developing fetus, putting the child at risk. Because the fetus cannot break down the alcohol the way an adult can, its blood alcohol levels remain high for a longer period of time.
A fetus is most vulnerable in the first trimester and the extent of damage is determined by both the timing and pattern of alcohol use. The severity of the disorder can range from full-blown fetal alcohol syndrome, with facial deformities and growth deficiencies, to a spectrum of neurological disorders like Ellie's.
"Alcohol is a neurotoxin," said Tom Donaldson, president of NOFAS. "Why would you want to ingest any amount?"
"We see articles that say you can't tell a woman, even if she is pregnant, she can't have a drink on New Year's Eve or her anniversary or Christmas," he said. "Are you willing to take the risk? It's like saying to your child you can eat lead paint off just one window sill, but not four."
FASD is one of the leading causes of developmental disabilities and many doctors are not well-trained in diagnosis and few resources exist to help these children.
The disorder is still not recognized, although it is under consideration in the American Psychiatric Association's DSM-V.
When they reach the age of 18, an estimated 50 percent of those with fetal alcohol syndrome go on to have trouble with the law, according to recent articles published by the Harvard University journal, "Law and Psychiatry."
Many, like Ellie, have a normal IQ, but have poor executive-decision skills and maladaptive behavior.
"You are describing someone who doesn't understand right from wrong, doesn't learn from experience and is awkward in social situations," said Donaldson. "They act out."
The Gertz family first learned that Ellie had been exposed to alcohol in utero when the little girl was 3, after they received a letter from her uncle. Ellie's biological mother had abused crack cocaine, PCP, heroin and methamphetamine, but later doctors said alcohol had taken the greatest toll.
Ellie ran into traffic and hit her little sister Talia's head against the wall. She even attacked her school principal. To get Ellie the school services she needed, Gertz was able to get a diagnoses of bipolar and reactive attachment disorder.
But after exhausting all local resources in Illinois, the family was unable to afford the $160,000 a year for a residential treatment program, so Gertz entered into a third-party guardianship with the Washington couple.
"Our family was being destroyed," she told ABCNews.com last September, three months after Ellie had left.
The mother had fostered 150 children and has a teenage son with FASD. They continued to support Ellie financially, pay the couple a stipend and carried her on their health insurance policy.
At first she fared well, going to a Christian school with only six other children. But last spring, Ellie attacked a child and her teacher was forced to physically restrain her. A parent in an adjoining preschool filmed Ellie on her cell phone screaming, "They are trying to kill me," and called police.
Child Protective Services were called in to investigate both the school and Ellie's guardians, according to Gertz.
Gertz said she couldn't blame the mother for calling police, but no one checked her medical history.
"Here you have a child with a history of reporting [abuse] and it being unfounded," she said. "All they had to do was read the files and see the diagnostic stuff. They went right for the jugular."
The school was shut down for the summer, but later was absolved of any wrongdoing. The Washington family who was poised to adopt the child decided they could not handle her.
Ellie was sent back to her parents, who were able to stabilize her with a five-day hospitalization to change her medications and by adding homeopathic treatment. Slowly, she seemed to improve.
With open doors of communication both Gertz and Ellie's Washington family were able to work out a new agreement to co-parent.
"I do believe Ellie is a loving little person when she is not off the deep end -- she is adorable," said Gertz. "But she has this condition that makes her act without understanding the consequences."
Gertz worries about the challenges ahead, knowing that most adults with FASD end up in jail.
"I hope she survives her need to self-destruct and not kill herself by running into traffic or hurt anyone else," she said.
Gertz said the country needs a plan for a sustainable residential community for these children, once they reach adulthood.
"You hope for your child that they have more than you did, or have a successful, happy and even a simple life -- the ability to pay one's way and have a home and live apart on their own," she said. "I can't tell you what her functionality will be. What will happen when these children grow up?"