Specialized Assessment of Fetal Alcohol Spectrum Disorders (FASD)

Fetal Alcohol Spectrum Disorders (FASD) represent a range of disorders that can occur in an individual whose mother consumed alcohol during pregnancy.

The term “FASD” is not a diagnosis but is an umbrella term generally understood to include the following diagnoses: Fetal Alcohol Syndrome (FAS), the diagnosis given to the most profoundly affected children; Partial Fetal Alcohol Syndrome (PFAS) for children who display some but not all of the physical/neurodevelopmental characteristics of FAS; Alcohol-related Neurodevelopmental Disorder (ARND) for children who demonstrate cognitive or behavior impairment without the characteristic physical features; and alcohol-related birth defects (ARBD) for children with a physical malformation linked to maternal drinking without other symptoms.

The effects of prenatal alcohol exposure may include physical, mental, behavioral, or learning disabilities with possible lifelong implications. These disorders often co-occur with substance use and mental illness, and generally require modifications to traditional treatments for successful outcomes. More than 400 health conditions can co-occur with FASD[1]. Nationally, FASDs are under-diagnosed and are often misdiagnosed. A recent study found that 86.5% of youth with behavioral health disorders and an FASD had not been previously diagnosed, or had been misdiagnosed[2]. Additionally, issues of stigma surrounding FASDs may lead to under-reporting, disguising true prevalence.  The Center for Disease Control (CDC) estimates that up to 1 in 20 children in the US have an FASD; Massachusetts estimates range from between 2-5%[3].

The presentation of FASDs varies widely from person to person, and generally reflects the timing of exposure during pregnancy, amount of exposure, genetic susceptibility, and a number of other factors.  Deficits may span a very wide range of intellectual and social characteristic. For example, a child with a fetal alcohol related disorder may be diagnosed with Intellectual Disability despite having some areas of clear intellectual strength. Alternatively, a child with an FASD may be exceptionally bright, yet continually underperform in school. Often, children with an FASD exhibit peculiar social and emotional characteristics and may be misunderstood as having autism, or simply as being oppositional, defiant, hyperactive, or impulsive.

Parents and teachers of children with an FASD and are often perplexed by a child’s unusual learning style, inconsistent social and academic performance, and unpredictable behavior. Children with an FASD often do not “fit” well into traditional academic and social support services.

FASD by the Numbers

• 94% of individuals with an FASD also have a mental illness[4]
• 50% of adolescents and adults displayed inappropriate sexual behavior[5]
• 60% of people with an FASD have a history of trouble with the law[6]
• 50% of individuals with an FASD have a history of confinement in a jail, prison, residential drug treatment facility, or psychiatric hospital[7]
• 73-80% of children with full-blown FAS are in foster care or an adoptive placement[8]
•  Children in foster care with an FASD are often undiagnosed or misdiagnosed.[9]
• FASDs in North America are 17-19 times more prevalent in foster care and residential placements than in the general population.[10]
• 61% of adolescents with an FASD experienced significant school disruptions.[11]

FASDs are not well understood or even reliably identified within the primary care medical community. Fortunately, in 2013, the diagnostic description “Specified Other Neurodevelopmental Disorder—Prenatal Alcohol Exposure” (ND-PAE) was added as a psychiatric diagnosis, finally allowing clinicians to diagnose alcohol-related neurodevelopmental disabilities[12].

The Brenner Assessment Center uses both the ND-PAE criteria as well as the updated (2016) International Organization of Medicine criteria in our FASD diagnosis [13]. Our assessments include comprehensive neuropsychological examination and, if warranted, a dysmorphology exam by a physician with specialized training in alcohol-related birth defects.