Fetal Alcohol Spectrum Disorder or FASD is caused when alcohol is consumed while pregnant. To the fetus, alcohol is a behavioural teratogen. A teratogen is a substance that causes birth defects and a behavioural teratogen is a substance that also causes behavioural problems. Although prenatal alcohol exposure presents a physical risk to the baby, it is the behaviour that causes the family and the individual the most problems. It is important to remember that brain equals behaviour. Many parts of the brain can be affected as can a variety of organs, depending on the time in pregnancy and amount of alcohol consumed. The parts of the brain most commonly affected are:
§ The corpus callosum
§ Hippocampus
§ Hypothalamus
§ Basal Ganglia
§ Amygdala
§ Frontal Lobes
The most common physiological problems are:
§ The heart
§ Kidneys
§ Hearing [otitis media]
§ Vision
FASD is a grave and ubiquitous health problem affecting hundreds of thousands of families in Australia. Wherever alcohol is consumed, people will suffer, not just from the usual consequences of binge drinking resulting in violence and aggression, but also possibly from a higher incidence of FASD. There is also a critical lack of services where staff have been adequately trained to appropriately support families and individuals with the symptoms of this condition.
Prenatal alcohol exposure can cause often socially unacceptable and sometimes bizarre behaviour, problems at school, constant trouble with friends and peers, and as the children get older, they can experience many more difficulties. They may be unable to hold down a job, experience trouble with the police, mental health problems, addiction, and other equally serious complications. Perhaps the worst being that friends, family members, colleagues and others will believe that the affected person has control over their behaviour when this is clearly not the case with a cognitive impairment such as FASD. These expectations can create rifts within communities and eventually lead to family and relationship breakdown, homelessness, and suicide.
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[1]. The Australian Bureau of Statistics states that there are just over 260,000 births each year in Australia[2]. In the report on The Financial Impact of FASD[3], the SAMHSA FASD Center for Excellence stated that the United States has an annual birth rate of just fewer than 4 million[4], with 40,000 of those births alcohol affected. Extrapolated to Australia’s population, this rate suggests that each year a minimum of 3,000 babies will be born prenatally exposed to alcohol and it will often only be at puberty that the true extent of their disability will become clear.
SYMPTOMS AND CHARACTERISTICS OF FASD
Not everyone will have all the signs and symptoms outlined below. Effects will depend on the time of pregnancy during which alcohol was consumed, the amount that was consumed, the nutrition of the mother, other drug use, the general health of the mother and researchers have now found that [5]epigenetics also plays a part in the severity of the condition.
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. Other possible problems include:
Early Development
- Failure to thrive
- Tremors or jitters
- Seizures
- Feeding problems in infancy
- Sleeping problems
- Vision and/or hearing problems
- Difficulty with toilet training, wetting, or soiling
- Problems with personal hygiene
- Difficulty with the onset of puberty
- Problems with sexual functioning
Childhood Appearance
- Shorter or thinner than other children the same age
- Eyes may be wide-spaced, smaller than normal, slanted, droopy eyelids
- Lips may be long and | or there may be a smooth space between upper lip and nose
- Thin vermilion border (upper lip)
Communication | Speech
- Talks excessively and quickly
- Interrupts
- Not apropos conversational subjects
- Opinionated
- Speaks indistinctly
- Makes ‘off the wall’ comments
- Repeats phrases | words frequently, almost as though ‘acting’
Memory | Learning | Information Processing
- Poor | inconsistent memory
- Slow to learn new skills
- Does not seem to learn from mistakes
- Has difficulty linking cause and consequence
- Experiences slow information processing [possibly related to Central Auditory Processing Disorder]
Behaviour Regulation
- Poor anger management
- Fearless in the face of danger
- Mood swings
- Impulsive and compulsive
- Perseverative
- Inattentive [often diagnosed or mis-diagnosed as ADHD | ADD]
- Unusual activity level [high or low]
- Illogical lying
- Illogical stealing
- Unusual reactivity to sound, touch, light
- Fidgety, cannot sit still
Abstract Thinking | Judgment
- Poor judgment
- Unable to plan and execute
- Functions poorly without assistance
- Concrete, black or white thinking – does not understand idiom
Planning
- Needs help organising daily tasks
- Cannot manage time or money
- Misses appointments
- Has difficulty with multi-step instructions
Spatial Skills | Spatial Memory
- Gets lost easily, has difficulty navigating from point A to point B
- Poor memory for sequences and dates
Motor Skills
- Poor | delayed motor skills
- Overly active
- Poor balance | accident prone | clumsy
Social Skills | Adaptive Behaviour
- Poor social | adaptive skills
- Overly-friendly
- Attention-seeking
- Behaves notably younger than chronological age
- Few close friends | easily led | manipulated by others
- Laughs inappropriately
- Poor social | sexual boundaries
Academic | Work Performance
- Gives impression of being more capable than he | she actually is
- Tries hard and wants to please, but end result is often disappointing
- Has trouble completing tasks | school drop-out
- Has problems with school | job attendance
- Poor work history
If you suspect that a child | patient in your care may have this condition gather all the information that you have about the child and take it to your doctor. The 
FASD Screening Tool – under 18.pdf702.01 KB or the FASD_Screening_Tool__-_over_18.pdf740.73 KB can help you identify whether you child fits the FASD profile. Please remember that when completing this document it is NOT a diagnosis. A diagnosis can only be made by your doctor or a team of doctors. This document is a tool to give you more information with which to proceed.
If you are a service provider | medical professional, find out as much as possible about FASD. Without knowing about this condition you could be making life harder by referring your client | patient to programs that are inappropriate, expecting them to remember things which they cannot or asking them to change their behaviour when it is the people around the individual who should be changing theirs.
[1]http://www.ncbi.nlm.nih.gov/pubmed/15095471 accessed on the 10th February 2014
[2]http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/04FEBEF9C81FE6BAC A25732C002077A2 accessed on the 7th February 2014[3]http://fasdcenter.samhsa.gov/publications/cost.aspx accessed on the 7th February 2014[4]http://www.cdc.gov/nchs/fastats/births.htm accessed on the 7th February 2014[5]http://pubs.niaaa.nih.gov/publications/arh341/29-37.htm accessed on the 25th March 2014[6]http://www.fasdexperts.com/Screening.shtml accessed on the 24th February 2014
Support
Join the rffada on Facebook Email Elizabeth (Anne) Russell on elizabeth [at] rffada [dot] org
Join the rffada by emailing Elizabeth to request that you be placed on our database of almost 2000 people to receive regular updates.
Recovery Connection Provide education on addiction and recovery. Recovery Connection is dedicated to providing quality information and resources to help loved ones suffering from addiction to get the assistance needed. www.recoveryconnection.org/drinking-while-pregnant