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Fetal alcohol spectrum disorder

Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe a range of conditions and harms which have emerged as a result of prenatal alcohol consumption. It's also referred to as 'fetal alcohol syndrome and related disorders'.

You may be familiar with FASD when considering infant and maternal health, but there's less awareness of adolescents and adults with FASD who are presenting at drug and alcohol services for treatment.

Types of FASD

There are four diagnoses under the umbrella of FASD.

Fetal alcohol syndrome (FAS)

Confirmed exposure to alcohol in utero

Facial dysmorphology, including the following (which may become less obvious over time):

  • Flat midface
  • Small head circumference
  • Low-set ears
  • Flat philtrum (the area between the mouth and the nose)
  • Thin upper lip
  • Short epicanthal folds (the points of the eye next to the nose).

Growth retardation

Central nervous system dysfunction

Partial FAS (pFAS)

Confirmed exposure to alcohol in utero

Some but not all of the facial dysmorphology above

Either growth retardation or central nervous system dysfunction

Alcohol-related neuro-developmental disorder (ARND)

Confirmed exposure to alcohol in utero

Central nervous system dysfunction

Alcohol-related birth defects

Presence of congenital anomalies (e.g. cardiac, skeletal, renal, ocular), all of which are known to be linked to prenatal alcohol exposure

Source: Adubato & Cohen 2011.

The Department of Health and Ageing has requested the FASD Collaboration, led by the Telethon Institute for Child Health Research, to prepare Australian clinical guidelines for the diagnosis of FASD. These should be available in 2013.

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What to consider when thinking about FASD

People with FASD have an organic brain injury and, as a result, think and learn differently and are unable to make sense of information the way others do. People with FASD often have a hard time understanding that actions have consequences, and they can't always apply what they learn in one situation to another. Other challenges include:

  • Poor short-term memory
  • Lower IQ (although only 25% of people with FASD will have an IQ lower than 70)
  • Developmental delay
  • Difficulty setting goals and/or knowing if they're 'on track'.

Many people will see examples of these behaviours and difficulties every day but may not realise they're the result of a brain injury. Without understanding this condition it's easy to view each behaviour as an isolated problem rather than as a group of symptoms indicating a syndrome. In formal environments such as drug and alcohol or mental health programs (particularly when pressure is placed on the person), these challenges become even more evident.

FASD is difficult to identify at birth unless the condition is severe and the facial features of full FAS are evident. As a result, many people are not identified or diagnosed until they reach puberty. Many more live their whole lives without knowing they have a significant disability. By the time they reach their teenage years, the behaviours have become entrenched and secondary issues have often emerged, such as drug and alcohol and mental health issues.

It's these secondary issues that are often presented as the primary issue/diagnosis and typically are what will cause people to enter programs. As a result, insufficient account may be taken of a person's cognitive abilities, such as:

  • Linking cause and effect
  • Generalising learning, and
  • Working independently.

A person may then be vulnerable to experiencing extra stress and/or program failure due to the unrealistic requirements placed on them by the worker, service provider or program.

Secondary issues are often framed as being the problem. They are often seen to be intrinsic to the condition rather than a symptom or pattern of behaviours reflecting chronic frustration and failure. People experience poor fit for programs, services, employment and training because the cognitive impairment isn't always apparent at first meeting, so the person with FASD is placed in what seem to be appropriate situations but which in fact exacerbate their problems.

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What does this mean for your service?

If a client has a history which includes some or all of the following and a history of prenatal alcohol exposure, consider FASD as the possible cause of their situation:

  • Problematic alcohol and/or drug use
  • Contact with the criminal justice system
  • Mental health problems from a young age
  • Disrupted school experience, including expulsion or suspension
  • As an adult, regular contact with multiple social services such as housing, drug and alcohol, mental health, disability, employment and corrections
  • Jobs which do not last longer than six months
  • Poor academic results, especially in mathematics
  • A number of diagnoses (e.g. autism, Asperger's syndrome, attention deficit hyperactivity disorder, oppositional defiance disorder personality disorders).
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Find out more

For practical strategies for working with people with complex needs including FASD see Practice Tips for Workers.

Public Health Agency of Canada (2005) Fetal Alcohol Spectrum Disorder (FASD): A Framework for Action, Public Health Agency of Canada: Ottawa.

Government of Canada (2007) Fetal Alcohol Spectrum Disorder Factsheet, Government of Canada.

Stokes, J. (ed) (2012) Addressing Fetal Alcohol Spectrum Disorder in Australia, NIDAC (National Indigenous Drug and Alcohol Committee): ACT.

Russell Family Fetal Alcohol Disorders Association (rffada) website.

The National Organisation for Fetal Alcohol Syndrome and Related Disorders Website

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