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FASD: Overview

Key points

  • Fetal alcohol spectrum disorder (FASD) is the leading known cause of preventable developmental disabilities in the western world.
  • There is no safe amount, time or type of alcoholic beverage to drink during pregnancy.
  • Early diagnosis and appropriate developmental and medical interventions can help people who have FASD. These interventions can reduce the chance of co-occurring secondary disabilities and improve the person's quality of life and long-term prognosis.

Introduction

Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe the range of effects that can occur in an individual whose mother consumed alcohol during pregnancy. FASD itself is not a diagnostic term.

According to the Canadian FASD Diagnostic Guidelines, FASD includes the following three diagnoses:

  • fetal alcohol syndrome (FAS) – the most severe and visibly identifiable form of FASD
  • partial FAS (pFAS)
  • alcohol-related neurodevelopmental disorder (ARND).

Prevalence

There are no national statistics on the prevalence of FASD in Canada; however, the most commonly cited prevalence rates among the general population of Canada are:

  • 1 per 1,000 for FAS
  • 9 per 1,000 for FASD.

A few studies conducted among subpopulations in Canada have found the following higher rates of FASD:

  • Children in care: 33 per 1,000 among permanent wards in Ontario, and 113 per 1,000 among children in care in Manitoba
  • Correctional population: 98.9 per 1,000 among adult male offenders in Manitoba, and 233.5 per 1,000 among youth offenders in British Columbia
  • Communities in remote areas: 25–48 per 1,000 in British Columbia and the Yukon (another study found 190 per 1,000 in British Columbia), and 101 per 1,000 in Manitoba.

Symptoms

Every person with FASD has a unique set of strengths and weaknesses, but every person with a diagnosis within the FASD spectrum has some brain dysfunction as a result of prenatal alcohol exposure.

The signs and symptoms of FASD are usually broken down into primary and secondary disabilities. The lists provided here reflect the primary and secondary disabilities commonly observed among people with FASD. Not every person will experience all of these disabilities.

Primary disabilities

The primary disabilities of FASD are those most closely related to the underlying central nervous system damage caused by prenatal exposure to alcohol. These include problems with:

  • adaptive behaviour
  • attention
  • cognition
  • executive functioning
  • memory.

Individuals with FASD may have trouble with:

  • abstract reasoning
  • organization
  • planning
  • understanding or recalling a sequence of events
  • connecting cause and effect relationships
  • regulating their behaviours and emotions.

Typical brain-based, primary disabilities related to FASD include:

  • inconsistent memory and recall
  • inability to filter out environmental or emotional distractions and sensory stimuli
  • slow and inconsistent cognitive and auditory processing
  • decreased mental stamina
  • difficulty interpreting and applying abstract concepts (e.g., managing money and time)
  • impulsivity and poor judgment
  • inability to predict outcomes (of their own or others' actions)
  • difficulty shifting from one context to another
  • resistance to change
  • inability to see another person's perspective
  • inability to recognize indirect social cues.

Physical signs and symptoms

Alcohol is a teratogen (an agent that can impair fetal development and cause birth defects) and can affect any organ or system of the fetus. People with FASD may have:

  • permanent vision and hearing problems
  • poorly developed bones, limbs and fingers
  • damage to the heart, kidney, liver and other organs.

Dysmaturity

Another common characteristic of people diagnosed with FASD is dysmaturity. This terms refers to widely varying levels of maturity in different areas of development, such as:

  • expressive language and language comprehension
  • social and self-care skills
  • awareness and regulation of emotions.

Secondary disabilities

Secondary disabilities occur later in life as a result of the primary disabilities associated with FASD. They include:

  • mental health problems
  • disrupted school experience (suspension, expulsion, and/or drop-out)
  • poor academic achievement and school failure
  • involvement with the law (trouble with authorities, charged with or convicted of a crime)
  • confinement (inpatient treatment for mental health and/or substance use problems, or incarceration for crime)
  • alcohol and other drug problems
  • sexually deviant behaviour
  • problems with employment
  • dependent living.

When combined with primary disabilities, these secondary disabilities increase the complexity of care the person requires and result in significant social and economic costs to society.

Cause

FASD occurs when alcohol in the mother's bloodstream passes through the placenta into the fetus' blood. The range and severity of symptoms are associated with various factors. These include:

amount of alcohol consumed

  • frequency of alcohol consumption
  • stage of pregnancy when alcohol is consumed
  • the mother's general level of health
  • the genetic make-up of the mother and fetus.

There is no safe threshold for alcohol use during pregnancy, and no safe time to drink during pregnancy. The best advice is to not consume any alcohol during pregnancy.

Read more about the effects of alcohol use during pregnancy.

Prognosis

Early diagnosis and intervention are keys to improving the quality of life of individuals with FASD. These interventions can prevent secondary disabilities, such as mental health and substance use problems.

Early diagnosis can also lead to appropriate intervention, counselling and treatment for the mother and may prevent the birth of other alcohol-exposed children.

Stigma, lack of knowledge or financial resources and lack of access to health care professionals may discourage parents from seeking help for their children.

Resources

Health Watch Table—Fetal Alcohol Spectrum Disorder (FASD) from the Developmental Disabilities Primary Care Initiative summarizes recommendations for diagnosis and care of people who have FASD.

References

Asante, K.O. & Nelms-Maztke, J. (1985). Report on the survey of children with chronic handicaps and fetal alcohol syndrome in the Yukon and Northwest British Columbia. Whitehorse, YT: Council for Yukon Indians.

Burge, P. (2007). Prevalence of mental disorders and associated service variables among Ontario children who are permanent wards. Canadian Journal of Psychiatry, 52, 305–314.

Fast, D.K., Conry, J. & Loock, C.A. (1999). Identifying fetal alcohol syndrome among youth in the criminal justice system. Journal of Developmental and Behavioral Pediatrics, 20(5), 370–372.

Fuchs, D., Burnside, L., Marchenski, S. & Murdy, A. (2005). Children with disabilities receiving services from child welfare agencies in Manitoba. Ottawa: Centre of Excellence for Child Welfare. Retrieved from http://www.cecw-cepb.ca/sites/default/files/publications/en/DisabilitiesManitobaFinal.pdf

Kowlessar, D.L. (1997). An examination of the effects of prenatal alcohol exposure on school-age children in a Manitoba First Nation community: A study of fetal alcohol syndrome prevalence and dysmorphology [Master's thesis]. Winnipeg, MB: University of Manitoba.

MacPherson, P. & Chudley, A.E. (2007). Fetal alcohol spectrum disorder (FASD): Screening and estimating incidence in an adult correctional population. Presented at the 2nd International Conference on Fetal Alcohol Spectrum Disorder: Research, Policy, and Practice around the World: Victoria, BC. Retrieved from http://events.onlinebroadcasting.com/fas/090707/ppts/correctional.ppt

Public Health Agency of Canada. (2003). Fetal alcohol spectrum disorder (FASD): A framework for action. Ottawa: Author.

Roberts, G. & Nanson, J. (2000). Best practices: Fetal alcohol syndrome / fetal alcohol effects and the effects of other substance use during pregnancy. Ottawa: Health Canada. Retrieved from http://publications.gc.ca/collections/Collection/H49-156-1-2001E.pdf

Robinson, G.C., Conry, J.L. & Conry, R.F. (1987). Clinical profile and prevalence of fetal alcohol syndrome in an isolated community in British Columbia. Canadian Medical Association Journal, 137(3), 203–207.


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