Fetal Alcohol Spectrum Disorder: A Guide to Awareness and Understanding

Have you seen our publication FASD: A Guide to Awareness and Understanding? Click on the title to download a copy. If you prefer, contact our office to request an information package with the Guide and many other great resources.

What is FASD?

The term Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term referring to the range of effects that can occur in infants, children, youth or adults prenatally exposed to alcohol. The developing brain is the organ most vulnerable to injury and can be injured during the entire nine months of preganancy.

FASD is not a diagnostic term but a general descriptive term. The most common diagnostic terms within the spectrum of FASD are Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS) and Alcohol-Related Neurodevelopmental Disorder (ARND). These diagnostic categories represent the spectrum of effects and include mild to severe cognitive, behavioural, physical and sensory disabilities.

FASD is a lifelong disability. This means that the primary disabilities caused directly from the prenatal alcohol exposure last for a lifetime and even though the characteristics of the disabilities change as a child matures and progresses through the life stages, these primary disabilities are permanent.

Why Do Women Drink While Pregnant?

Drinking alcohol while pregnant and Fetal Alcohol Spectrum Disorder are sensitive issues. Moms do not intentionally harm their their babies with their drinking and there are many reasons why women drink alcohol when they are pregant. Many women do not know for some time that they are pregnant and the injury occurs early in the pregnancy. Others have an alcohol addiction and need help to stop using alcohol while pregnant – often the services they need to accomplish this are not readily available. Still others use alcohol to cope with the stresses of poverty, trauma or violence that they experience in their lives.

FASD is most often an Invisible Disability

Some primary disabilities, like facial characteristics, growth deficiency or obvious changes in neurological functioning are visible. However, for the majority of individuals affected by prenatal alcohol exposure, the disability is invisible to others. At the time of birth, and throughout life, it is difficult to detect the range of permanent impairments caused by prenatal alcohol exposure. The impairments we do see are often misinterpreted and the individual is thought of as as uncooperative, rude, lazy or misbehaving. The disability is then not recognized. This is one reason why FASD is commonly referred to as an invisible disability. Another factor that leads to the invisibility of FASD is the fear of families and individuals to talk about this disability. They fear the discrimination, negative reactions and the stigma that that is associated with FASD.

Prenatal exposure to alcohol changes the physical structures of the brain. Because the brain is out of sight, it makes it harder for families and professionals to accept that FASD is a physical disablity and that individuals require support and accommodations just as those with an obvious physical disability do.

Common Characteristics

The disabilities associated with FASD include cognitive, behavioural, physical and sensory impairments. Listed below are just a few characteristics. For more information download FASD: A Guide to Awareness and Understanding or read through other Network Resources.

• Impaired ability to read social cues—cannot detect subtle, or even obvious, social cues and thus have disordered responses
• Impulsive actions and poor ability to delay gratification—lives in the moment and wants immediate results
• Grandiose aspirations and expectations—impaired understanding of what is possible or realistic
• Lack of inhibitions—may be overly friendly or too direct in approaching others
• Poor understanding and use of personal boundaries and personal space
• Lack of understanding ownership leading to stealing or giving away valuable possessions
• Struggles with regulating emotions—unpredictable mood swings, anger, explosiveness, violence possibly triggered by seemingly minor events
• Slower cognitive pace—needs extra time to process information
• Slower auditory processing—understanding verbal information takes longer, responses may seem out of context or off topic
• Reduced ability to pay attention---shorter attention span or more distractible
• Difficulty and impairments with executive functioning---prioritizing, organizing, reasoning, planning, initiating and following through, may start but not finish, set goals but not know how to achieve goals
• Trouble with abstract thinking---problems with math, time, money, emotions
• Problems generalizing—what is learned in one setting is not readily transferred to another, one experience does not carry over to other similar experiences, difficulty seeing a relationship between two events or connecting separate events
• Poorly functioning sensory system—high or low pain tolerance, increased or decreased sensitivity to light, sound, texture, smell, movement or combined stimulation
• Over reactive to stimuli—unable to filter out varying forms of sensory input, difficulty knowing which sensory messages are important/unimportant
• Under reactive to stimuli—brain does not seem to focus on any one type of stimuli, shows little reaction to sensory input
• Sleep problems—trouble falling asleep, staying asleep or trouble waking, staying awake

Secondary Disabilities

Children, youth and adults living with FASD must face each day with great determination. They are living in a world that often does not “fit” them very well. Most people around them do not recognize the primary disabilities associated with FASD or understand that each person affected by prenatal exposure to alcohol will have a unique blend of strengths and struggles. Over time, this persistent lack of recognition and lack of understanding combined with high unattainable expectations, ineffective support strategies and limited accommodations leads to a state of chronic “poor fit” (Malbin, 2006). The result is the development of what we commonly refer to as secondary disabilities.

Secondary disabilities and characteristics include serious issues like mental health problems, educational struggles, employment problems, invovlement with the law (criminal behaviour or victimization), inappropriate sexual behaviour, addictions to alcohol, illegal drugs, prescriptions, gambling, poverty, homelessness, struggles with parenting and isolation. Secondary disabilities tend to stack up and become worse if effective services and support are not available.