Fetal Alcohol Spectrum Disorder

Introduction

Fetal Alcohol Spectrum Disorder (FASD) is used as a collective term for a range of developmental abnormalities caused by maternal consumption of alcohol during pregnancy and include:

Fetal Alcohol Syndrome (FAS)
Partial Fetal Alcohol Syndrome (pFAS) 
Alcohol-related Birth Defects (ARBD)
Alcohol-related Neurodevelopmental Disorder (ARND)
Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure 

There is no official internationally agreed diagnosis criteria for FASD. The term is used to include all children who have been exposed to alcohol during pregnancy. It covers the full spectrum of need from those with mainly behavioural symptoms to those with physical defects.

Alcohol and Pregnancy

Alcohol is one of the most widely used drugs in the world and the health risks associated with its use are well established. It is also a teratogen, a substance that can cause damage to the developing foetus. Unfortunately, alcohol is chemically very similar to other useful substances found in the body and therefore the placenta does not filter it out. This means that any alcohol consumed during pregnancy passes directly into the fetus with the potential to interfere with developmental processes. 

All stages of pregnancy are susceptible to damage from alcohol and there is no safe amount that can be consumed.

Though alcohol use can damage the fetus at any time during pregnancy the first few weeks are particularly vulnerable. This is because the organs of the body including the brain are at their earliest stages of development and damage at this time can be significant. 

Though the majority of women tend to avoid alcohol when expecting a baby there are a significant number who consumed alcohol before discovering their pregnancy. This is particularly so for unplanned pregnancies. In studies, people tend to under estimate the amount of alcohol they consume and so it is difficult when conducting research on alcohol during pregnancy to get accurate data. Equally, women who gave up alcohol for the pregnancy rarely report their drinking habits before discovering their pregnancy. What this means is that the impact of consuming any alcohol any time during pregnancy is likely to be understated in studies of child development and behavioural conditions.

Fetal Alcohol Spectrum Disorder (FASD)

This umbrella term covering all alcohol related conditions is useful for including all individuals with development affected by alcohol. It highlights the continuum of sufferers from those with obvious birth defects and FAS symptoms to more subtle differences that can still significantly impact on the individual's learning and behaviour. FASD is estimated to affect 1 in 100 children though it is likely that a higher number of children have been more mildly affected by exposure to alcohol during pregnancy.

Intervention and Support

Like most developmental conditions early diagnosis and more importantly early intervention can improve the prognosis for the child. Additional support to develop language, play and social skills can help to reduce the difficulties that many will experience with school. Behaviour management strategies should reflect the nature of the child's difficulties and ensure support is given to avoid identified triggers. This is likely to include learning tasks involving multi-step instructions or tasks. Peer relationships may also present difficulty for children with FASD as they often have difficulty understanding and/or following social rules. Interventions which help to improve awareness of social rules can be very useful. Approaches such as Circle of Friends may also be useful to develop peer support and solutions.

Children with FASD often benefit from schools that provide:

additional support with developing literacy skills

visual scaffolding of learning steps through task boards

movement breaks

overlearning approaches

access to concrete examples particularly in maths and science subjects

a key worker who can provide regular pastoral support with managing peer relationships

Parent Support

Parents of children with FASD may benefit from parenting classes and access to support groups to assist them in managing their child's behaviour. Specific advice around managing risk-taking behaviour is often needed. All children can be challenging at times and the FASD child may struggle to respond to boundaries set by their parents. Use of visuals can often be more effective in securing compliance than verbal requests. Parents also may find that using distraction is a good way to avoid situations escalating. Strategies developed for managing children with PDA can often be useful for managing children with FASD. Social Stories, which explain social rules and socially desirable behaviours, can also be useful.