Fetal alcohol spectrum disorder​

From: Chapter 8, "Diagnosis," in Acting Out (© 2007)

Alcohol can damage the brain and body of a fetus. Fetal alcohol spectrum disorder (FASD) is a broad term describing birth defects and conditions in people whose mothers drank alcohol when they were pregnant. When speaking about FASD, health care providers may use other terms to refer to specific effects and conditions resulting from a fetus's exposure to alcohol. These terms include:

• fetal alcohol syndrome (FAS)
• partial fetal alcohol syndrome (pFAS)
• alcohol-related neurodevelopmental disorder (ARND)
• alcohol-related birth defects (ARBD). 

Symptoms of FAS

The physical symptoms of FAS can include a small head or body, distinct facial features and brain damage. The physical symptoms of ARBD can include heart defects, hearing difficulties, vision problems and joint problems.

Young people with FASD can experience a range of physical, mental, behavioural and learning problems, including:

• poor organizational skills
• poor concentration, attention and memory
• trouble speaking well
• trouble learning to read
• trouble adapting to change
• poor judgment and problem-solving skills
• socially inappropriate behaviours
• poor ability to control impulsive behaviours (acting without thinking)
• low tolerance for frustration
• low level of understanding
• poor ability to learn from experience.

These problems can vary in intensity and can affect those with the disorder throughout their lives. Some people may have just one or two problems; others may have many. The types of problems young people with FASD have can also change as they get older.

Aggression is not directly associated with FASD. Some of the problems that young people with FASD experience may, however, increase the chance that they will behave aggressively over the course of their lives. For example, those who lack the ability to understand that their behaviours could provoke negative consequences, or who lack the ability to learn from experience, may get into trouble with the law. Indeed, a high percentage of youth in the criminal justice system have been identified with FASD.

Managing FASD

While the abnormalities, disabilities and negative behaviours associated with FASD are permanent, some of them can be altered with early intervention programs. Such programs focus on young people who are just starting to show behavioural problems. Young people diagnosed with FASD can be managed so they don't have the opportunity to make poor choices. They can also be helped to develop socially acceptable behaviours and, above all, maintain their self-esteem. The best treatment programs for FASD use a variety of approaches.

Young people with FASD often benefit from a calm, highly structured environment and a consistent routine in which there are clear expectations that can be externally influenced and monitored. Treatments for young people with FASD most often do not involve instructing them to develop internal motivation and controls.

If you work or volunteer with young people who have (or who you think might have) FASD, the following ideas may help in your interactions with them:

• Begin conversations by addressing the young person directly.
• Always make eye contact, and wait until the young person is paying attention before speaking.
• Provide a calm, quiet atmosphere with limited visual distractions.
• Speak slowly and pause between sentences.
• Warn of any changes to routine in advance.
• When giving a set of instructions, give them one at a time and then repeat them.
• Don't use words or expressions that have more than one meaning.
• Make sure that the young person not only can repeat rules, but can also understand their meaning.
• Post notes in obvious places to remind the young person of the tasks that need to be done.

If you are teaching young people who have been diagnosed with FASD, you may also find it effective to reduce your academic expectations and stress the teaching of basic life skills—skills that will enable young people to look after themselves in the future. In some cases, young people with FASD may behave in ways that resemble the behaviour of those with ADHD, and you may find some of the treatment approaches used to help young people with ADHD to be useful.