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Foetal alcohol syndrome and Foetal alcohol spectrum disorder (FAS/FASD)
Foetal alcohol spectrum disorder (FASD) is a term that covers a range of physical, mental, behavioural and learning problems caused by prenatal exposure to alcohol (NHS, n.d.). Alcohol can cross the placenta and damage the developing brain and body of the foetus, resulting in lifelong impairments. FASD is the leading known cause of intellectual disability in the Western world, and it is estimated that one in every 100 children is born with FASD (FASD Network UK, n.d.). FASD can affect various aspects of a child’s development, such as movement, vision, hearing, memory, attention, emotion, social skills and communication (NHS, n.d.). FASD also increases the risk of other health problems, such as heart defects, kidney problems and joint abnormalities (FASD Network UK, n.d.).
The diagnosis of FASD requires confirmation of prenatal alcohol exposure and evidence of central nervous system damage, as well as growth deficiency and specific facial features in some cases (American Academy of Family Physicians [AAFP], 2017). However, many children with FASD do not have observable physical signs and may have hidden impairments that affect their learning and behaviour (FASD Network UK, n.d.). Therefore, it is important to identify and support children with FASD as early as possible to prevent further difficulties and improve their outcomes. There is no cure for FASD, but interventions such as educational strategies, behavioural therapies and family support can help children with FASD to cope with their challenges and maximise their potential (NHS, n.d.; AAFP, 2017).
Signs and Treatment
Foetal alcohol syndrome (FAS) and foetal alcohol spectrum disorder (FASD) are conditions that result from prenatal exposure to alcohol and can cause a range of physical, cognitive, behavioural, and emotional problems in the child. According to the NHS, FASD can affect the child’s movement, balance, vision, hearing, learning, attention, social skills, mood, communication, and organ function (NHS, 2021). FAS is the most severe form of FASD and is characterized by distinctive facial features, such as small eyes, thin upper lip, and smooth philtrum (the groove between the nose and upper lip), as well as growth restriction and brain abnormalities (BMJ Best Practice, 2023).
The diagnosis of FASD can be challenging because the symptoms are often non-specific and vary depending on the timing, amount, and pattern of alcohol consumption during pregnancy. There is no definitive test for FASD, but a comprehensive assessment by a multidisciplinary team can help identify the condition based on the child’s history, physical examination, facial photographic analysis, neurodevelopmental evaluation, and exclusion of other causes (BMJ Best Practice, 2023). The diagnosis of FAS requires the presence of all three criteria: prenatal and/or postnatal growth deficiency, facial dysmorphology, and CNS dysfunction (BMJ Best Practice, 2023).
There is no cure for FASD, but early intervention and support can help improve the child’s outcomes and quality of life. The treatment of FASD should be individualized and tailored to the child’s specific strengths and needs. It may include medication for co-occurring conditions such as attention deficit hyperactivity disorder (ADHD), anxiety, or depression; speech and physical therapy to enhance communication and motor skills; educational and behavioural strategies to address learning and social difficulties; and family and community support to promote healthy development and prevent secondary problems such as substance abuse or criminal involvement (BMJ Best Practice, 2023; NHS, 2021).
The prevention of FASD is a priority, as the damage caused by prenatal alcohol exposure is irreversible and can have lifelong consequences for the child and the society. The only way to prevent FASD is to avoid alcohol consumption during pregnancy and while trying to conceive. Women who are pregnant or planning to become pregnant should be screened for alcohol use and advised about the risks of drinking during pregnancy. Women who have difficulty abstaining from alcohol should be referred to appropriate services for help (BMJ Best Practice, 2023).
Danger of misdiagnosis
FASD is estimated to affect 33.5 per 1,000 children in the United States and 22.8 per 1,000 globally (Lange et al., 2017). However, these numbers may not reflect the true prevalence of the condition, as many cases of FASD are unidentified or misdiagnosed.
One of the reasons for the misdiagnosis of FASD is the lack of specific biomarkers or diagnostic tests that can confirm the exposure to alcohol during pregnancy. The diagnosis of FASD relies on clinical criteria that involve assessing the facial features, growth, and neurodevelopment of the child, as well as obtaining information about the maternal alcohol consumption. However, these criteria can be difficult to apply in practice, as not all children with FASD have distinctive facial features or growth problems, and not all mothers are willing or able to report their drinking habits accurately. Moreover, some of the neurodevelopmental impairments associated with FASD, such as learning difficulties, attention problems, social skills deficits, and executive function impairments, can overlap with other conditions that have similar characteristics, such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), or genetic syndromes (Foundation for People with Learning Disabilities, n.d.). Therefore, some children with FASD may be mislabelled as having one of these conditions instead of receiving a correct diagnosis and appropriate support.
The misdiagnosis of FASD can have negative consequences for the affected children and their families, as they may not receive the optimal treatment and intervention that can improve their outcomes and quality of life. For example, some medications that are commonly prescribed for ASD or ADHD may not be effective or safe for children with FASD, as they may have different pharmacokinetics or adverse reactions to these drugs (Morris et al., 2019). Furthermore, some behavioural strategies that are beneficial for children with ASD or ADHD may not be suitable for children with FASD, as they may have different learning styles or motivational factors that require individualized approaches (Coles et al., 2016).
Additionally, some educational and social services that are available for children with ASD or ADHD may not be accessible for children with FASD, as they may have different eligibility criteria or funding sources that limit their options (Brown et al., 2015). Therefore, it is important to improve the awareness and recognition of FASD among health professionals and educators, as well as to develop reliable and valid diagnostic tools and guidelines that can facilitate the identification and management of this condition.
References
AAFP. (2017). Fetal alcohol syndrome and fetal alcohol spectrum disorders. American Family Physician, 96(8), 515-522. https://www.aafp.org/pubs/afp/issues/2017/1015/p515.html
BMJ Best Practice. (2023). Foetal alcohol spectrum disorder – Symptoms, diagnosis and treatment. Retrieved from https://bestpractice.bmj.com/topics/en-gb/1141
Brown, J.D., Bednar L.M., & Sigvaldason N. (2015). Causes of placement breakdown for foster children affected by alcohol. Child: care Health Development 31(5):591–599.
Coles C.D., Kable J.A., Taddeo E., & Strickland D.C. (2016). A comparison of motivational interviewing groups: Intervention for individuals with comorbid substance use disorders and foetal alcohol spectrum disorders. Alcoholism: Clinical & Experimental Research 40(9):1991–2000.
FASD Network UK. (n.d.). What is foetal alcohol spectrum disorder? http://www.fasdnetwork.org/uploads/9/5/1/1/9511748/fasd_overview.pdf
Foundation for People with Learning Disabilities. (n.d.). Foetal alcohol syndrome. Retrieved from https://www.learningdisabilities.org.uk/learning-disabilities/a-to-z/f/foetal-alchohol-syndrome
Lange S., Probst C., Gmel G., Rehm J., Burd L., & Popova S. (2017). Global prevalence of foetal alcohol spectrum disorder among children and youth: A systematic review and meta-analysis. JAMA Paediatrics 171(10):948–956.
Morris C.D., Smith I.E., Riley E.P., & Mattson S.N. (2019). Pharmacotherapy for individuals prenatally exposed to alcohol: A systematic review. Alcoholism: Clinical & Experimental Research 43(12):2492–2504.
NHS. (2021). Foetal alcohol spectrum disorder. Retrieved from https://www.nhs.uk/conditions/foetal-alcohol-spectrum-disorder/
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