Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe the range of effects resulting from the damage that can occur when an individual is exposed to alcohol in the womb, during pregnancy. Within the FASD spectrum there are three different diagnoses: Fetal Alcohol Syndrome, Partial Fetal Alcohol Syndrome, and Neurodevelopmental disorder, alcohol exposed. These diagnoses are characterised by neurodevelopmental symptoms such as challenges with learning and cognition, behavioural challenges, and mental or physical health concerns. Fetal Alcohol Syndrome and Partial Fetal Alcohol Syndrome are further characterised by specific physical features associated with pre-natal alcohol exposure.
Alcohol is a teratogen, a substance that can cause physical changes to the developing brain and other physical birth defects. There is no known safe amount of alcohol, and no known safe time to consume alcohol during pregnancy (see the Australian Guidelines to Reduce Health Risks from Drinking Alcohol).
One of the challenges in communicating the risks of alcohol consumption in pregnancy is that there are a range of factors that can either mediate or exacerbate the teratogenic effects of alcohol including:
- The amount of alcohol consumed (dose)
- The timing of exposure (what was developing at the time of alcohol exposure)
- The pattern of exposure (binge drinking is particularly high risk)
- Genetic factors
- Parent age
- Health of mother (nutrition, smoking, other drug use, etc.)
- Environmental factors (stress, socio-economic disadvantage, etc.)
This means that alcohol exposure impacts each pregnancy differently. It also means that symptoms of FASD can vary greatly from individual to individual. While some people with FASD have clear physical features related to their condition, in most cases the only indication of FASD is the presence of neurobehavioral symptoms such as learning difficulties, problems with behaviour and/or developmental delay.
Common characteristics of FASD include:
- learning difficulties
- cognitive deficits
- attention problems
- memory impairments
- speech and language impairments
- developmental delays
- sensory issues
- challenges developing and maintaining social relationships
- problems with fine and gross motor skills
Diagnosis for FASD requires an interdisciplinary team assessment. The diagnosis is still uncommon in Australia, and many cases of FASD therefore go undiagnosed and unrecognised. People with FASD are often diagnosed with other conditions such as ADHD prior to gaining a diagnosis of FASD.
All individuals with FASD will have a range of strengths despite the effects of the condition, and sometimes these strengths allow the individual to compensate for the deficits they may have in other areas. This can have the unintended consequence of making the condition seem less serious than it actually is, and the individual may appear to be more competent in certain areas than they actually are. Uneven development and variability in the way they present is common for people with FASD.
A key challenge of parenting a child with FASD, or working with an individual with FASD, is that the strategies and techniques commonly used to manage behaviour and assist with learning may not be effective for individuals with FASD. This is because these techniques requires strengths in areas where people with FASD typically have challenges. When the primary disabilities of FASD, that is those related to the brain impairment, are not understood and addressed appropriately, secondary disabilities such as mental health problems, drug and alcohol problems, misconduct problems, and disruptions to schooling can develop. This has wide reaching implications not only for the individual with FASD but also their family and the wider community.