About Fetal Alcohol Spectrum Disorders (FASDs)

What it is

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person exposed to alcohol before birth. These conditions can affect each person in different ways and can range from mild to severe. People with FASDs can have lifelong effects, including problems with behavior and learning as well as physical problems. FASDs are preventable if a developing baby is not exposed to alcohol.

Signs and symptoms

A person with an FASD might have:

Behavioral issues

• Hyperactive behavior
• Difficulty with attention
• Poor reasoning and judgment skills

Learning challenges

• Poor memory
• Learning disabilities
• Speech and language delays
• Intellectual disability or low IQ
• Difficulty in school (especially with math)

Physical problems

• Low body weight
• Poor coordination
• Problems with the heart, kidneys, or bones
• Shorter-than-average height
• Vision or hearing problems
• Small head size
• Sleep and sucking problems as a baby
• Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum)

Causes

FASDs can occur when a person is exposed to alcohol before birth. Alcohol in the mother's blood passes to the baby through the umbilical cord.

There is no known safe amount of alcohol during pregnancy or when trying to get pregnant. There is also no safe time to drink during pregnancy. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she's pregnant. All types of alcohol are equally harmful, including all wines and beer.

Reducing risk

To prevent FASDs, a woman should avoid alcohol if she is pregnant or might be pregnant. This is because a woman could get pregnant and not know for up to 4 to 6 weeks.

It is never too late to stop alcohol use during pregnancy. Because brain growth takes place throughout pregnancy, stopping alcohol use will improve the baby's health and well-being.

Diagnosis

Different FASD diagnoses are based on particular symptoms and include:

Fetal alcohol syndrome (FAS): FAS represents the most involved end of the FASD spectrum. People with FAS have central nervous system (CNS) problems, minor facial features, and growth problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

Partial fetal alcohol syndrome (pFAS): When a person does not meet the full diagnostic criteria for FAS but has a history of prenatal alcohol exposure and some of the facial features, as well as a growth problem or CNS abnormalities, the person is considered to have pFAS.

Alcohol-related neurodevelopmental disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.

Alcohol-related birth defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child's birth (defined as more than 13 alcoholic drinks per month of pregnancy or more than 2 alcoholic drinks in one sitting). ND-PAE was introduced into the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) in 2013 as a condition for further study and a specifier for intellectual disability.

Areas evaluated for FASD diagnoses

The term FASDs is not meant for use as a clinical diagnosis. If your child is diagnosed with an FASD, the diagnosis will be for a specific condition under the umbrella of FASDs, as listed above.

Diagnosing FASDs can be hard because there is no medical test, like a blood test, for these conditions. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

To diagnose FASDs, healthcare providers look for:

• Prenatal alcohol exposure, although confirmation is not required for diagnosis
• Central nervous system problems (e.g., small head size, problems with attention and hyperactivity, poor coordination)
• Lower-than-average height, weight, or both
• Abnormal facial features (e.g., smooth ridge between nose and upper lip)

If you're concerned

If you think there could be a problem, ask your healthcare provider for a referral to a specialist (someone who knows about FASDs). Specialists could be a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staff members have special training in diagnosing and treating children with FASDs. To find healthcare providers and clinics in your area, contact FASD United's (formerly NOFAS) Family Navigator program which provides individuals living with FASDs and their family members and caregivers with expert, confidential support and referrals. FASD United also has a searchable Resource Directory.

At the same time as you ask your healthcare provider for a referral to a specialist, call your state or territory's early intervention program. Request a free evaluation to find out if your child can get services to help. This is sometimes called a Child Find evaluation. You do not need to wait for a healthcare provider's referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child's age:

Younger than 3 years old: Call your state or territory's early intervention program. Say, "I have concerns about my child's development. I would like to have my child evaluated to find out if they are eligible for early intervention services."

3 years old or older: Contact your local public school system. Even if your child is not old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education. Ask to speak with someone who can help you have your child evaluated.