What is fetal alcohol spectrum disorder (FASD)?
Fetal alcohol spectrum disorder (FASD) is a general or "umbrella" term used to describe disabilities caused when a person drinks alcohol while they are pregnant. FASD includes any of the following diagnoses:
- fetal alcohol syndrome with sentinel features
- fetal alcohol syndrome without sentinel features
Signs and symptoms of FASD
The effects of FASD are not always obvious at birth. Often, behavioural and learning problems are not noticed until the child is old enough to go to school.
Some people with FASD have a mixture of specific facial features and developmental problems. Many children with FASD do not have specific facial features.
Problems with development and learning
Children with FASD may have one or more of the following problems:
- uneven cognitive profile (they have strengths in some areas but significant weakness in others); cognitive skills include attention, memory and problem solving
- slow learning, short attention span, hyperactivity, impulsivity or memory problems
- learning disabilities, especially with reading, comprehension and abstract math
- delays in speech and language, for example, receptive language disorder, and social difficulties with language, such as interrupting, talking out of context or chatting with no content
- weak executive function skills, including difficulties with organization, planning and reasoning
- inability to manage money, for example by saving and budgeting
- inability to understand cause and effect
- difficulties with emotional regulation
Sensory integration problems
Children with FASD may have problems with sensory integration. These problems may involve one or more senses, such as:
- sensitivity to touch; the child may not be able to tolerate tags in shirts or seams in clothing
- seeming to need more touch than other children; for example, the child may need tight hugs
- seeming to not feel or communicate pain
- getting upset with bright lights or noise
- noticing smells more than others
- being bothered by "every little thing"
These problems may occur in combination. A child with FASD could be hypersensitive to bright lights but crave deep pressure or touch.
Behaviour and mood problems
Babies with FASD may:
- be irritable, nervous or sensitive to sound and light
- cry often
- be very quiet and not very responsive
- have difficulties with sleep
Children and teens with FASD may have one or more of the following problems:
- behavioural problems, such as aggressive or defiant behaviours
- mental illness, such as anxiety, depression or psychosis
- drug and alcohol problems
- anger control problems or violence
- impulse control problems such as stealing or confabulating (misremembering or producing false memories) or lying frequently
Poor judgment, impulsivity and the inability to connect an action with its consequences are the hallmarks of FASD. As a result, people with FASD are at high risk for getting in trouble with the law.
Physical problems
At birth, babies may have one or more of the following:
- low birth weight (less than 2.5 kg or 5 lb 8 oz)
- small head size
- specific facial features may include thin upper lip, flatness under the nose and smaller eyes
Other physical problems may include:
- small height and/or weight
- bone, joint or muscle problems
- hearing problems
- repeated ear infections
- visual and eye problems
- genital defects
- heart defects
- kidney problems
FASD is caused by drinking alcohol during pregnancy
FASD can happen when a pregnant person drinks any type of alcohol, including beer, wine, hard liquor or coolers. Alcohol crosses the placenta from parent to baby. Any amount of alcohol during pregnancy can cause FASD.
- Pregnancies are at higher risk of FASD when a pregnant person has one or more drinks per day, or seven or more drinks on average per week, or four or more drinks on any one occasion.
- Recent evidence suggests that even one drink per day may cause behavioural problems.
The kinds of problems the baby may have depends on when the parent drinks during the pregnancy:
- Since the brain is developing during the entire pregnancy, the brain is always being affected if the mother drinks alcohol regularly.
- Drinking alcohol during the first trimester increases the chance that the baby will have a small brain, physical problems and/or severe intellectual disability.
- Drinking alcohol during the second trimester increases the chances of spontaneous abortion (miscarriage).
- Drinking during the third trimester, and during nursing, can affect intelligence.
Not all babies who are exposed to alcohol during pregnancy will have FASD. We do not yet understand why some babies are affected and others are not.
FASD is common
FASD affects at least 4% of people living in Canada. This means that there are over 1.5 million people with FASD living in Canada today.
How FASD is diagnosed
There is no specific blood test that diagnoses children with FASD. Making a diagnosis of FASD requires involvement of a multi-disciplinary team. The assessment may include:
- asking about the pregnancy and the child's birth
- doing a physical exam including assessing facial features
- a developmental/cognitive assessment: testing the child's cognition, academic skills, memory, motor functioning, speech and language, attention, executive functioning, adaptive skills and mental health
There is no cure for FASD
There is not a specific treatment for FASD. However, it is important to diagnose FASD early to improve outcomes.
- Physical and occupational therapy can often help.
- A child with FASD should have psycho-educational testing to find specific strengths and difficulties. This will help the child get services in school.
- Social workers can help the family connect to appropriate community resources and deal with challenging family issues.
Preventing FASD
The only way to prevent FASD is by not drinking alcohol when pregnant.
If you are pregnant or think you might be pregnant, do not drink alcohol. If you have a problem with drinking, talk to your doctor or another health professional. They may be able to help you stop drinking or to cut back on your drinking as much as possible.
How to help your child with FASD
The help your child needs depends on which areas of the brain are affected by the prenatal alcohol exposure and the way those brain injuries are expressed in your child's behaviours. No two children with FASD would have the same problems and need the same type and degree of support. It is important that your child has a comprehensive developmental/cognitive assessment to inform their specific support needs.
FASD lasts throughout a child's life
The effects of FASD are lifelong. The problems change as the child grows up. Behaviour and mood problems such as alcohol and drug abuse, depression, psychosis and aggressive behaviour may develop in the teenage years.
Some individuals with FASD have difficulties learning from consequences and, if lacking supports, may develop problems with the criminal justice system.
People with FASD may have difficulty managing their own lives or being totally independent as adults. They may need some kind of support their whole lives to be successful.
Resources
Canada FASD Research Network: canfasd.ca
References
Cook, J.L., Green, C.R., Lilley, C.M., Anderson, S.M., Baldwin, M.E., Chudley, A.E., . . . Rosales, T. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. Canadian Medical Association Journal (CMAJ), 188(3) 191–197. doi: 10.1503/cmaj.141593
Popova, S., Lange, S., Chudley, A.E., Reynolds, J.N., Rehm, J., May, P.A., & Riley, E.P. (2018). World health organization international study on the prevalence of fetal alcohol spectrum disorder (FASD): Canadian component. CAMH Publications. The Institute for Mental Health Policy Research & Centre for Addiction and Mental Health. Retrieved from: https://canfasd.ca/wp-content/uploads/2018/05/2018-Popova-WHO-FASD-Prevalance-Report.pdf
Thanh, N.X., Jonsson, E., Salmon, A., & Sebastianski, M. (2014). Incidence and prevalence of fetal alcohol spectrum disorder by sex and age group in Alberta, Canada. Journal of Population Therapeutics & Clinical Pharmacology, 21(3), e395-e404. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/25381628/
