Shining a Light on Fetal Alcohol Spectrum Disorder (FASD)

Fetal Alcohol Spectrum Disorder (FASD) previously known as Fetal Alcohol Syndrome refers to the physical and/or neurodevelopmental disorder that can result from prenatal alcohol exposure. It is now considered a spectrum disorder due to the wide range of developmental impairments.

The reasons for alcohol consumption during the prenatal stage of pregnancy can be attributed to many reasons. It has often been found to be a result of experiencing some type of trauma, addiction or a lack of education around the risks involved with this behaviour. It is the leading cause of disability that is non-genetic and due to its high prevalence, it has become a public health issue for all women, of all cultures and socio-economic backgrounds. However, this can be improved. FASD is preventable and with increased awareness and understanding through education and knowledge of the disorder, these statistics can be changed.

Alcohol travels around the body through the blood stream. For a woman who is pregnant, the alcohol travels further. It passes through the placenta and creates a blood alcohol level for the fetus that could be the same or higher than the mothers. The alcohol spends a lot longer in the blood stream of the fetus because their liver is unformed and incapable of metabolising the alcohol well or fast. It can damage and affect the growth of the baby’s cells which impairs the overall development of the fetus. It affects the formation of the important sheath the helps with the communication of messages within the brain and between the brain and the body causing neurons to not form properly. This causes damage to the central nervous system - the brain and the spinal cord and there is no way to repair the brain damage caused during development. This classifies FASD as a brain injury.

This damage leads to smaller brain size where not all of the brain is formed correctly. As a result there is significant impairment across all areas of development and the missing brain structures make it very difficult to develop some skills and abilities. There is commonly impulsive and challenging behaviours displayed in addition to motor and cognitive development issues as a result.

Diagnostic criteria for FASD includes considering the level of prenatal alcohol exposure, neurodevelopmental impairment and facial and physical features. It is classified into two types; FASD with three sentinel facial features, FASD without three sentinel facial features. To be diagnosed with FASD there needs to be impairment in at least 3 of the developmental areas. It is not uncommon that FASD is co diagnosed with disorders such as ASD, ADHD or ODD or misdiagnosed.

A diagnosis of FASD and developmental challenges leads to therapeutic intervention from a team of health professionals. Early and ongoing intervention is required to help individuals develop their skills and abilities to reach their best potential.

OT’s have role in diagnosis but more importantly in therapy to work on development in all functional areas including fine motor skills, gross motor skills, sensory processing, executive functioning, emotional regulation and behaviour management. OT’s can work with children and individuals living with a diagnosis of FASD to improve and expand their behaviour patterns and motor skills for better functional ability.

There has always been speculation about whether there is a safe consumable amount of alcohol that could be had during pregnancy but there isn’t. There is no proven evidence to support that any amount of alcohol at any time during fetal development is safe, so for this reason it is best to abstain.

FASD is a lifelong disability. Individuals living with this diagnosis will have their own way of ‘doing life’ and will have a unique and special set of skills. If you are working with or supporting an individual living with a diagnosis of FASD it is important to be strengths focused, that is building upon what they are good at. Support them to ‘give things a go’, extend themselves and encourage them to try something new. Give them rewarding and satisfying responsibilities to add further meaning to their lives and work with them on using positive behaviours and provide repeated opportunities to work on and harness their skills. Most importantly, be person centered and work with the person not the disorder.

The key to reducing the prevalence of FASD is awareness and education amongst the community. If you would like more information about FASD, access the National Organisation of Fetal Alcohol Spectrum Disorder (NOFASD). The organisation provides a hotline and several resources.

Hannan, J (2018) ‘Occupational Therapy and Fetal Alcohol Spectrum Disorder (FASD)’, National Organisation of Fetal Alcohol Spectrum Disorder.