September is Fetal Alcohol Spectrum Disorders (FASD) Awareness Month

Fetal alcohol spectrum disorders (FASDs) is an umbrella term used to describe the range of effects that can occur in an individual with prenatal alcohol exposure. These effects can have lifelong implications including physical, mental, behavior, and/or learning issues.

The term FASD encompasses the following conditions:

• Fetal Alcohol Syndrome (FAS)

• FAS is on the most severe end of the FASD spectrum. It describes people with the greatest alcohol effects, causing signs and symptoms so distinct that the diagnosis is based on special measurements and findings in each of the 3 following areas:

  • Three specific facial abnormalities: smooth philtrum (the area between nose and upper lip), thin upper lip, small palpebral fissures (the horizontal eye openings)
    

  • Growth deficit (lower than average height, weight or both)

  • Central nervous system (CNS) abnormalities (structural, neurologic, functional, or a combination of these)

• 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 abnormalities, as well as a growth problem or CNS abnormalities that person is considered to have partial FAS (pFAS)

• Alcohol-Related Neurodevelopmental Disorder (ARND)

• People with ARND do not have abnormal facial features or growth problems, but do have problems with how their brain and nervous system were formed as well as how they function. These individuals may have:

  • Intellectual disabilities

  • Behavior or learning problems

  • Nerve or brain abnormalities

  In particular, a 2011 federally convened committee that reviewed the science noted that these children are most likely to have problems with neurocognitive development, adaptive functioning, and or behavior regulation.

• Neurobehavioral Disorder Associated with Pre-Natal Alcohol Exposure (ND-PAE)

• In addition to confirmed prenatal alcohol exposure, these individuals have impairment of neurocognition, self-regulation, and adaptive functioning. ND-PAE combines deficits is these three areas in conjunction with the following:

• Evidence of prenatal alcohol exposure

• Childhood onset of symptoms
  

• Significant distress or impairment in social, academic, occupational, or other important area of function

• Alcohol-Related Birth Defects (ARBD)

• People with ARBD have problems with how some of their organs were formed and or how they function, including:

  • Heart

  • Kidney

  • Bones (possibly the spine)

  • Hearing

  • Vision

  These individuals also may have one of the other FASDs.

FASDs can happen only when a pregnant woman consumes alcohol. The alcohol crosses the placenta and enters the baby's blood where it can damage the developing brain and other organs leading to an FASD. Developing babies have the same blood alcohol concentration as their mother, but they lack the ability to process or metabolize alcohol. 

No amount of alcohol use is known to be safe for a developing baby before birth. Any amount of alcohol, even a glass of wine, passes from the mother to the developing baby. Wine, beer, or distilled spirits (vodka, rum, tequila, etc.) all pose a risk. FASDs are 100% preventable if a woman does not drink alcohol during pregnancy.

Alcohol causes more harm than heroin or cocaine during pregnancy. The Institute of Medicine says, “Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” 

1 in 100 babies have FASD, nearly the same rate as Autism.  FASD is more prevalent than Down Syndrome, Cerebral Palsy, SIDS, Cystic Fibrosis, and Spina Bifida combined. Alcohol use during pregnancy is the leading preventable cause of birth defects, developmental disabilities, and learning disabilities.

The National Organization on Fetal Alcohol Syndrome (NOFAS) has created some fact sheets to educate people about FASDs. Some of these fact sheets that may be of interest are:

• FASD: What everyone should know
• FASD: What school systems should know
• FASD: What young people should know

No one treatment is right for every child, as FASD and its constellation of symptoms differ from one child to another. FASDs need a medical home to provide, coordinate, and facilitate all the necessary medical, behavioral, social, and educational services.

• Many types of available treatments include but are not limited to:
• Developmental services
• Educational interventions
• Behavior modification
• Parent training
• Social skills training
• Medications and other medical therapies
• Transition planning
• Advocacy in school and the workplace
• Referral for community support services
• Coordination across the specialists, partners, and needed supports
• Primary care in a high quality medical home setting with care integration

Treatment plans should be adaptable to the child's and family's needs, plus include close monitoring and follow-up.

FASDs last a lifetime. There is no cure for FASDs, but identifying children with FASDs as early as possible can help them reach their potential. Research has shown that early identification and enrollment in treatment can significantly improve an affected child's development and life.