Foetal Alcohol Spectrum Disorder (FASD) is a diagnostic term used to describe impacts on the brain and body of individuals prenatally exposed to alcohol during pregnancy. FASD is a lifelong disability. Individuals with FASD have their own unique areas of difficulties and may experience challenges in their daily living and need support with motor skills, physical health, learning, memory, attention, emotional regulation, and social skills. They also have a unique set of strengths and many are showing talents, that when nurtured and supported demonstrates their unlimited potential in those areas.
Foetal Alcohol Spectrum Disorders is an umbrella term for several diagnoses that are all related to prenatal exposure to alcohol. These are:
Foetal Alcohol Syndrome, FAS
Partial Foetal Alcohol Syndrome, PFAS
Alcohol Related Neuro-developmental Disorder, ARND
Alcohol Related Birth Defects, ARBD
Foetal Alcohol Spectrum Disorder (FASD) is the most common, non-genetic cause of learning disability in the UK (Plant, 1985; Autti-Ramo, 2002; British Medical Association, 2007). Research suggests that at least 1% of the population is affected by FASD meaning that 7,000 babies are born every year in the UK with Foetal Alcohol Spectrum Disorder. Recent international research (May et al 2018) highlights that between 2%-5% are typically affected and a recent UK study (McQuire et al 2018) proposed that between 6%-17% in a study showed signs consistent with prenatal alcohol exposure. More than 70% of children with FASD have progressed through the care service so it is not surprising that many parents are foster, adoptive and kinship carers.
Of all the substances of abuse (marijuana, cocaine, and heroin) alcohol produces by far the most serious neuro-behavioural effects to the foetus (IOM report to Congress 1996). Prenatal exposure is caused by alcohol crossing the placenta and within minutes, the level of alcohol in the foetus’ blood reaches maternal blood alcohol level. Alcohol is a teratogen which can cause any type of physical malformation and learning and behavioural challenges.
Often the condition goes undiagnosed or is diagnosed for example as autism or ADHD rather than those conditions being recognised as comorbid presentations of FASD. Due to the level of children coming through the care system, attachment disorders are often viewed as the sole cause of presenting signs and symptoms and this can lead to misunderstandings about therapeutic support needs.
Characteristics No two children with FASD are exactly alike, either behaviourally or physically. Some of the co-occurring, behavioural, social and learning characteristics may include: - Issues with attention, concentration or hyperactivity. - Academic issues, including specific deficits in mathematics & memory skills. - Very specific language deficits e.g. poor receptive language. - Short term or working memory issues - Adaptive functioning issues that grow more significant with age. - Challenges with emotional regulation - Social or relationship challenges including difficulty making or sustaining friendships despite being sociable. - Sensory impairments such as vision or hearing. - Sensory sensitivities. - Tendency to be oppositional or defensive when requests are made. - Inconsistent performance - can do something one day but cannot the next. - Lack of abstract reasoning, cause & effect logic, fails to generalise - Poor sense of self and issues with theory of mind.
Lifelong Impacts Defensive behaviours develop when there is a poor fit between the person with FASD and their world. These behaviours can be lessened or prevented with diagnosis and appropriate support. There can be issues with disrupted school experiences, mental health, legal issues, difficulties with independence and employment if a young person's support needs are not being understood and met.
Skills & Qualities One of the important things to remember is that people diagnosed with FASD will also have strengths and talents so it is important to find out what the person does well and encourage them in it. Some common personal and skill areas include being Caring, Articulate, Friendly, Musical, Artistic, Creative, Practical, Athletic, Animal skills, Nature Skills etc. Some are in professional careers, have attended university and are raising their own children.
This condition is preventable only when there is no prenatal alcohol exposure. The UK Chief Medical Officer guidance changed in 2016 to a recommendation that no alcohol be consumed in pregnancy and when planning a pregnancy.