What is FASD?
What are Fetal Alcohol Spectrum Disorders (FASD)?
FASDs are preventable lifelong disabilities that affect all socioeconomic and ethnic communities. Alaska has a high rate of alcohol consumption, including use during pregnancy, and we pay for this disability in our health care, education, social service, and criminal justice systems.
FASDs are a collection of diagnoses and disabilities that can result from prenatal exposure to alcohol. The effects of this prenatal alcohol exposure can include physical, behavioral, and cognitive symptoms. These symptoms can range from mild to severe; no two individuals with an FASD are affected the same way.
According to the Centers for Disease Control and Prevention a person with an FASD might experience any of the following conditions:
- Low body weight
- Poor coordination
- Learning disabilities
- Attention difficulties
- Executive functioning deficits (e.g. poor reasoning and judgement skills)
- Problems with the development of their heart, kidneys, or skeletal system
- Growth deficits
- Characteristic facial features (e.g., smooth philtrum, thin upper lip)
The most well-known type of FASD is fetal alcohol syndrome, or FAS. However, FAS is not common and is often considered to be the "tip of the iceberg". It requires the presence of specific facial features, small growth, and evidence of a significant level of brain dysfunction. The facial features are only impacted by alcohol exposure that occurs during the 3rd to 4th week of pregnancy.
Other conditions along the spectrum can include alcohol-related neurodevelopmental disorder (ARND), alcohol-related birth defects (ARBD-evidence of structural damage from alcohol such as the facial features of FAS or other skeletal or organ abnormalities), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE which is a diagnosis in the American Psychiatric Association DSM-V appendix).
In Alaska, FASD diagnostic teams use the University of Washington FASD 4 Digit Code diagnosis system so diagnosis terms on this continuum include:
- Partial FAS (person has small growth OR facial features of FAS but not both plus they have significant brain dysfunction)
- Static Encephalopathy (brain impact is same as for FAS, pFAS but no growth or face signs) and
- Neurobehavioral Disorder (clear brain impact but not to level of above 3 diagnoses)
Both Static Encephalopathy and Neurobehavioral Disorder are examples of ARND.
Research estimates the prevalence of FASDs in the United States to be 50 per 1,000 (approximately 1 in 20) which is higher than autism spectrum disorders (approximately 14 per 1,000) or Down syndrome (1 per 1,000). We do not have FASD prevalence data for Alaska but the state does track the prevalence of FAS.
Because alcohol is a well-studied teratogen, we know that alcohol exposure at any time during the pregnancy can result in Fetal Alcohol Spectrum Disorders (FASDs). Teratogens can alter both the structure and function of developing fetal cells. The impact on each baby is highly variable and unpredictable. The mother’s or baby’s genetics or epigenetics, timing and dose of the alcohol, the mother’s nutrition status, her general health, age, stress level, and any medications or other substances that she is taking at the same time can all influence how the alcohol may be impacting the baby. The baby’s blood alcohol level is the same (or higher) than the mother’s but the baby’s body size is significantly smaller.
Recent research is also finding that heavy alcohol use by the father around the time of conception can be associated with the child developing FASD-like symptoms.
The vast majority of people with FASD have a “hidden” disability so too often their symptoms can be mistaken for something else, such as Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, or autism to name a few. As a result, the treatment they receive may not be correctly tailored to their specific brain-based disability needs.