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What are fetal alcohol spectrum disorders (FASD)?

Alcohol use during pregnancy is a leading preventable cause of mental retardation and learning disabilities in the U.S. (CDC, 2009). Fetal alcohol spectrum disorders or FASD is an umbrella term used to describe the continuum of effects associated with prenatal alcohol exposure, but is not intended to be used as a diagnosis. A number of factors can contribute to the severity of effects on the fetus due to prenatal alcohol exposure including the timing and quantity of alcohol use during pregnancy, the pattern of drinking (e.g. binges), genetic factors, nutrition, and other environmental factors.

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What is fetal alcohol syndrome (FAS)?

Fetal alcohol syndrome (FAS) is a combination of physical features and cognitive impairments that occur in some individuals who were prenatally exposed to alcohol. It is the most recognizable of the conditions caused by prenatal alcohol exposure. Although there is a lot of variability among individuals with FAS, the three main diagnostic criteria are:

 

  • Child with FASCentral Nervous System Effects – the brain is particularly sensitive to alcohol, and prenatal exposure can affect the structure and function of the cerebral cortex, hippocampus, cerebellum, corpus callosum, and basal ganglia resulting in cognitive disabilities, processing, learning, ad memory problems, and much more.
  • Growth Deficits – prenatal alcohol exposure can cause intrauterine and postnatal growth retardation resulting in decreased weight, length/height, and head circumference.
  • Facial Features – prenatal alcohol exposure can affect the development of a number of facial features resulting in small eye openings (short palpebral fissures), a smooth ridge between the upper lip and nose (philtrum), and a thin upper lip.

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What are the effects of prenatal alcohol exposure?

If some but not all of the characteristics of FAS (along with a history of prenatal alcohol exposure) are present, an individual may be diagnosed with one of the following conditions:

  • Partial FAS (pFAS)
  • Alcohol-Related Neurodevelopmental Disorder (ARND)
  • Alcohol-Related Birth Defects (ARBD)
  • ND-PAE
    • The DSM-5 introduced two new terms, both with the acronym ND-PAE: Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure and Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure.
    • Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure: In Section II, included in the diagnostic criteria for Neurodevelopmental Disorder is a category termed “Other Specified Neurodevelopmental Disorder” with an associated ICD- 9 code 315.8 and ICD- 10 code F88. This category is, “used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific neurodevelopmental disorders. This is done by recording “other specified neurodevelopmental disorder” followed by the specific reason.” (p.86)
    • Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure: ND-PAE in found in Section III (Conditions for Further Study). The proposed criteria are well written. However, as stated in the DSM- 5 (p.783), “These proposed criteria sets are not intended for clinical use; only the criteria sets and disorders in Section II of DSM- 5 are officially recognized and can be used for clinical purposes.”

 

Why is a diagnosis important?

Although a physician makes the diagnosis of FAS or one of the other FASDs, it is important for families, health and human services providers, educators, and others to be aware of the signs and symptoms of FASD. An accurate diagnosis can benefit the individual, family, and service system in a number of ways.

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What are the benefits of a diagnosis?

  • Provides answers and may lead to changes in expectations for individuals, families, and providers
  • Creates eligibility for services
  • Facilitates appropriate interventions and support

 

Do all kids with Fetal Alcohol Syndrome (FAS) have mental retardation?

 No.  Although FAS is a leading cause of mental retardation is U.S., studies have documented IQ’s of individuals with FAS ranging from 20 to 130.

Is there a treatment for FAS?

Although there is no known cure for FAS, there are many techniques and strategies used in working with individuals with FAS.  FAS is not a condition that can be outgrown, but that does not mean there is no hope.  Many documented techniques and strategies have been shown to positively impact the lives of people with FAS.  Early intervention and recognition is key.

Why do women choose to drink when they are pregnant when they know that alcohol can cause harmful effects?

Choice is not the issue for most women who drink large quantities of alcohol during pregnancy.  Alcoholism is a progressive disease that can prevent a women from maintaining a healthy lifestyle.  Other issues that are a factor in alcoholism include domestic violence, including sexual, verbal, and physical abuse; lack of available resources; and lack of access to care.  For more information on woman’s issues, check out SAMHSA’s Tip 51: Substance Abuse Treatment: Addressing the Specific Needs of Women.

Where can I find a Fetal Alcohol Spectrum Disorders (FASD) support group?

Check out the National Organization of Fetal Alcohol Syndrome (NOFAS) for a national directory of support groups (click here).

Where can I get current and accurate information on FASD?

There are many resources available that address the prevention, identification, and treatment of FASD.  Unfortunately, many web-based resources do not contain evidence-based information.  It is always a good idea to start with nation resources like, CDC, NIAA, SAMHSA’s Center of Excellence, these can be found on our resource page.  If you are looking for specific information please contact us, we are happy to help.