Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe impacts on the brain and body of individuals prenatally exposed to alcohol. FASD is a lifelong disability. Individuals with FASD will experience some degree of challenges in their daily living, and need support with motor skills, physical health, learning, memory, attention, communication, emotional regulation, and social skills to reach their full potential. Each individual with FASD is unique and has areas of both strengths and challenges.
No alcohol when planning a pregnancy, during pregnancy and while breastfeeding means no risk.
The parts of the brain most commonly affected are:
Hypothalamus – temperature, thirst, hunger, sleep, mood, sex drive;
Hippocampus – emotions, memory, spatial function;
Amygdala – emotions, survival, memory;
Corpus callosum – connects the two hemispheres, motor, sensory, cognitive performances;
Frontal lobe – executive function – the higher order thinking, problem-solving and decision-making
The most common physiological impairments are to the heart, kidneys, hearing and sight.
FASD is a serious public health and social issue affecting hundreds of families in Australia. FASD occurs wherever alcohol is consumed. There is a critical lack of services where staff have been adequately trained to appropriately support families and individuals with the symptoms of this condition.
Individuals living with FASD (diagnosed or not) can struggle with learning at school, find it difficult to follow instructions, to make and keep friends, and may be in constant trouble with friends and peers. Social and age structured expectations cannot be met and over the lifespan, FASD can present as socially unacceptable and sometimes unusual behaviour. This can lead to difficulties in employment, experience trouble with the police, mental health problems, substance misuse, and other equally serious complications.
Prevalence and Incidence
In the United States, it has been estimated that each individual with FASD will cost the government $2.9 million over his or her lifetime accessed on the 10th February 2014. The Australian Bureau of Statistics (7 Feb 2018)states that there are just over 260,000 births each year in Australia In the SAMHSA FASD Center of Excellence (2014) report on ‘The Financial Impact of FASD FASD Center for Excellence stated that the United States has an annual birth rate of slightly less than 4 million with 40,000 of those births exposed to alcohol during pregnancy. These figures suggest that each year the healthy development of more than 3,000 Australian babies could be impacted by fetal alcohol exposure and it will often only be in mid childhood that the true extent of their disability will become clear.
Unique to each individual, some or all of the following will be experienced.
Dysmaturity: Behaviour is symptomatic and skills to meet expectations set by others is noted to be younger than chronological age. Some argue that functioning could be at half the age. Consequently, the individual living with FASD may struggle in social relationships – with personal boundaries and be over-friendly or withdrawn. Often there is difficulty in understanding social cues and laughter or tears at inappropriate times can occur. To make friends, attention seeking can happen. With few friends a common experience, vulnerability to manipulation by others can be problematic.
Adaptive skills: Managing daily life tasks including personal hygiene, home management, financial management.
Motor skills: May be developmentally delayed with poor balance. May seem accident prone or clumsy.
Sensory systems: Linked to flight or fight response, there may be hyperarousal (over sensitive and reactive to light, sound, temperature, touch or smell) or it’s opposite.
Nutrition: Adverse reactions to different food types.
Communication and processing pace: Dependent on how fast the brain processes information, the individual living with FASD may talk excessively and quickly; interrupt others; find it difficult to join in topics of conversation; seem opinionated; make inappropriate comments or comments not in context with conversation; and repeat statements frequently.
Learning and memory: There is difficulty and inconsistency in remembering the details of some tasks and/or translating to different situations. A struggle to learn new skills can be common and often instructions need to be continually repeated. There is difficulty in learning from mistakes and in linking cause and effect.
Abstract thinking: difficulty organising and managing daily tasks; struggles to manage money or time and follow through on multi-step instructions.
Executive functioning: Unable to plan and follow through with task and difficulty is more evident with more complex tasks. Concrete thinking is evident.
Not everyone will have all the signs and symptoms outlined below. People with FASD may have trouble setting personal boundaries and observing other people’s boundaries. They often have emotional problems, can be impulsive, may not be able to sustain relationships, and often cannot anticipate consequences. They have difficulty paying attention, have poor organisational skills and have trouble completing tasks and managing time. Success is hard and in response, the individual living with FASD may give the impression of capability, and linked to this is the desire to please, to try hard.
Physical and Facial Appearance
About 10% of children exposed to alcohol during pregnancy will be shorter and/or thinner than other children the same age; the eyes may be wide-spaced, smaller than normal, slanted or with droopy eyelids. The distance between the upper lip and nose may be long and/or there may be a smooth space (philtrum) with a thin vermillion border (upper lip).
Behaviour is symptomatic of brain difference and regulation of actions can be difficult
- Poor anger management
- Fearless in the face of danger
- Mood swings
- Impulsive and compulsive
- Inattentive [often diagnosed or mis-diagnosed as ADHD | ADD
- Unusual activity level [high or low]
- Unusual reactivity to sound, touch, light
- Fidgety, cannot sit still
If you suspect that an individual in your care or you are supporting may be living with undiagnosed FASD gather all the information and take it to your GP. The FASD Screening Tool – under 18.pdf or the FASD_Screening_Tool__-_over_18.pdf can help you identify whether you child fits the FASD risk profile. Please remember this is a screening tool. It is NOT a diagnosis. A diagnosis can only be made by your doctor or a team of specialists.
If you are a service provider / medical professional, find out as much as possible about FASD. Without knowing and understanding this condition you could be making life more difficult by referring your client / patient to programs/specialists which are inappropriate in expectations. Rather, it is environmental changes which lead to success.