The key feature of an FASD diagnosis is not the presence or absence of facial features, but rather central nervous system (CNS) damage. Alcohol use during pregnancy can cause permanent structural, neurological and functional impairments to the developing fetal CNS. Structural damage can include damage to the corpus callosum or microcephaly (small head size). Neurological damage may include seizure disorders, sensory processing disorders and motor and balance difficulties. Functional impairments can include attention and impulse control problems, hyperactivity, learning disorders, memory deficits, and disorders of communication and executive functioning.
Fetal Alcohol Spectrum Disorders
FASD is not a medical diagnosis but might be thought of instead as an umbrella term over the different diagnoses on the spectrum of disorders that are caused by prenatal alcohol exposure.
The diagnoses on the FASD spectrum include:
FAS (Fetal Alcohol Syndrome)
Three features are present, including facial features, growth deficiency at some point in the individual’s life, learning and behavioral problems from central nervous system/brain damage. Diagnosis may be possible without confirmation of maternal alcohol consumption during pregnancy, although documentation of alcohol exposure is ideal.
pFAS (partial Fetal Alcohol Syndrome)
An individual with this diagnosis might have FAS type facial features or a deficiency in growth along with learning and behavioral problems from central nervous system/brain damage. Confirmation of maternal alcohol use during pregnancy is required for accurate diagnosis.
ARND (Alcohol Related Neurodevelopmental Disorder)
Someone with this diagnosis might have normal facial features and average growth patterns but will have problems with learning and behavior that stem from central nervous system/brain damage. Confirmation of maternal alcohol use during pregnancy is required for accurate diagnosis.
ARBD (Alcohol Related Birth Defects)
A person with this diagnosis might have skeletal abnormalities, heart defects, cleft palate, kidney or other internal organ problems, and vision or hearing problems.
FAE– Fetal Alcohol Effects
Is a term that has recently, and more accurately, been replaced with ARND or pFAS (2005).
FASD occurs in approximately 1:100 births in the U.S. That’s nearly double Cerebral Palsy, Spina Bifida and Down Syndrome combined (Incidence of fetal alcohol spectrum disorders – Minnesota Statistics – CDC 2006; National Statistics – March of Dimes; NOFAS 2004). In Minnesota, as many as 8,500 babies are born every year with prenatal alcohol exposure. (CDC, Data and Statistics, 2006).
The damage caused by alcohol use during pregnancy is permanent and an FASD results in a lifetime disability. Children and adults with an FASD can certainly grow and learn and build on skills, but it is important to remember that many of the behaviors and learning problems are the result of brain damage that will not change. We can, however, change our teaching approaches and allow for more success in the lives of individuals living with an FASD.
Screening in Adults
These red flags can help determine whether or not an adult should be referred to a clinic for a possible diagnosis of an FASD.
Red Flags for Referral:
- Adult was raised in foster care or adopted
- History of chemical dependency/child protection
- Adult has received many diagnoses such as ADHD, Autism, Reactive Attachment Disorder, Bi-Polar Disorder, etc.
- Adult is easily distracted, hyperactive, inattentive, impulsive
- Adult consistently displays extreme behavior (aggression, emotional instability)
- Adult has been involved with the criminal justice system
- Adult gives inconsistent answers to questions, or can repeat a rule but fail to follow it
- Adult makes the same mistakes repeatedly
- Adult displays difficulties in holding a job
It is also very important to determine whether or not there was maternal alcohol use during pregnancy. These red flags are indicators to help establish whether or not this occurred.
Red Flags for Maternal Alcohol Use:
- Mother received treatment for alcohol/drug problems
- Mother was diagnosed with alcohol/drug problems
- Child was removed from home due to alcohol/drug related problems
- Mother died due to complications from alcohol/drug abuse
- Other high risk behaviors such as DUI’s (Driving Under the Influence of alcohol or another drug), job or legal problems related to drinking
- Medical records indicate presence of alcohol/drugs at birth
Unfortunately, Fetal Alcohol Spectrum Disorders are often misdiagnosed before the accurate diagnosis under the FASD umbrella is reached. Adults may also have many other disorders that come from living with FASD without support. Because FASD can look like many other mental health diagnoses, adults may go undiagnosed for the primary disorder: FASD. Common misdiagnoses for individuals with an FASD include ADHD, Oppositional Defiant Disorder, Intermittent Explosive Disorder, Conduct Disorder, Autism, Bipolar Disorder, Psychotic Disorders, Antisocial Personality Disorder, Borderline Personality Disorder and Reactive Attachment Disorder. Adults with an FASD are often also labeled as lazy, defiant, or as habitual liars. However, with the right support, structure and supervision these children and adults can learn and be successful.
“The most outstanding characteristics of FAS are bad judgment and the inability to make the connection between an act and its consequences” (Dr. Ann Streissguth, Retired, University of Washington). Secondary disabilities are defined as those disabilities that a person is not born with and those disabilities that could be prevented or made less severe through better understanding and practical intervention. The following chart breaks down specific secondary disabilities that occur in individuals with an FASD. The percentages and information were adapted from Streissguth et al, 1996, which investigated life history interviews of 415 individuals affected by an FASD using 450 questions.
<tdwidth=”30%”>% of Patients with a FASD<td “>83% age 21 and over
|Mental Health/Psychiatric Problems: these problems affect children, adolescents and adults. FASD is often not recognized because it is not an official “mental health diagnosis” and therefore does not receive attention by mental health workers. Even when it is recognized, another diagnosis is often used to get reimbursement for treatment or services.||94%|
|Problems with Employment: individuals with an FASD have difficulty organizing tasks and activities, and also tend to have problems with the abstract concept of time, which can lead to the individual being chronically late.||83%|
|Patient in Dependent Living: managing and understanding the value of money is the most frequent difficulty. People with an FASD tend to spend what they have and repeatedly need help with saving money for food or housing.|
|Inappropriate Sexual Behavior: this is often due to poor judgment and lack of impulse control. There is also a risk for potential victimization of the person with an FASD. The combination of difficulty with good judgment and decision making, along with the desire to please others, can lead people with an FASD to be vulnerable to exploitation, manipulation and abuse.||45% age 12 and over|
|Disrupted School Experience: this can include suspension, expulsion, and higher drop-out rates.||43%|
|Trouble with the Law: poor concept of cause and effect, inability to predict consequences, and inability to apply lessons learned to different situations.||61%|
|Confinement for a Crime||35%|
|Mental Hospital Admission||23%|
|Alcohol and Drug Problems: people with an FASD have a biological vulnerability to substance abuse, often use substances to self medicate, have difficulties with issues of control, and display repeated failure in traditional addiction treatment programs.||26% age 12-20 & 48% age 21-51|
Lowering the Risk of Secondary Disabilities
There are several factors that lower the risk of secondary disabilities. Most important is early intervention, ideally before the age of six. With early intervention, the diagnosed child is able to grow up in a supportive and understanding environment. Whether the individual with an FASD is a child or adult, it is important that they live in a stable, nurturing, non-violent home and stay in that same home for at least three years. Frequent moving or being passed between foster families is not an ideal environment for a child or adolescent with an FASD. For adults, it is important that the group home or dependent living facility understands and is able to respond to the challenges specific to FASD.
This chart shows the different approximate levels of maturity for an 18 year old adult with an FASD. It shows how chronological age does not correspond with maturity or skill age. For example, a person with an FASD might be 18 years old but have the emotional maturity of a six year old.
|Skill||Developmental Age Equivalent|
|Chronological Age||18 Years|
|Expressive Language||20 Years|
|Money and Time Concepts||8 Years|
|Emotional Maturity||6 Years|
|Physical Maturity||18 Years|
|Reading Ability||16 Years|
|Social Skills||7 Years|
|Living Skills||11 Years|