Fetal alcohol syndrome (FAS) is one of the diagnoses on a spectrum of disorders under the fetal alcohol spectrum disorders (FASDs) umbrella. All disorders within this spectrum are caused by the mother consuming alcohol while pregnant, and can have significant physical, behavioral, social, and cognitive impacts.
What Is Fetal Alcohol Syndrome?
Fetal alcohol syndrome is diagnosed when a person has cognitive, social, developmental, and sometimes physical impairments due to being exposed to alcohol while in the womb. While exposure to many kinds of substances while in utero can cause similar impairments, the substance that causes the most neurological effects is alcohol.1
When someone consumes alcohol while pregnant, the alcohol passes to the baby through the umbilical cord, which can increase the risk of brain damage and growth difficulties.2 The combination of symptoms present indicates what diagnosis an individual will receive under the fetal alcohol spectrum disorders (FASDs) umbrella.
The different types of fetal alcohol spectrum disorders are:
- Fetal Alcohol Syndrome (FAS):Includes a combination of central nervous system issues, diagnostic facial features, and growth delays. FAS also typically includes social and behavioral problems.
- Alcohol-Related Neurodevelopmental Disorder (ARND):Includes symptoms of intellectual disabilities, academic struggles and behavioral issues.
- Alcohol-Related Birth Defects: Birth defects that impact the heart, kidney, bones, and/or the ears and hearing.
- Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE):A diagnosis from the American Psychiatric Association that includes social, cognitive, developmental and behavioral symptoms for a diagnosis and does not include medical/physical considerations of prenatal alcohol exposure.
There is no safe amount or type of alcohol to consume during any time of a pregnancy. However, one of the biggest issues in preventing FAS is that someone often doesn’t know that they’re pregnant until they are 4-6 weeks along. A 2014 study found that nearly 2 million people in the U.S. are at risk to have an alcohol-exposed pregnancy due to consuming alcohol while not using contraceptives.3
When people find out they’re pregnant, they don’t all stop drinking alcohol; a 2019 study of pregnant people found that 1 in 9 had consumed alcohol within the last month.4.Due to people drinking before they know they’re pregnant, or choosing to still consume after learning of their pregnancy, it is estimated that 1 out of 20 children have an FASD, but mostly go undiagnosed or are misdiagnosed.5
What Causes Fetal Alcohol Syndrome?
FASDs are not hereditary and are solely caused by someone consuming alcohol while pregnant. When a pregnant person drinks alcohol, the alcohol passes through the placenta and to the baby. A fetus cannot metabolize alcohol as quickly as an adult, so it causes a much higher blood alcohol content level.
This blood alcohol content level interferes with the fetus getting proper oxygen and nutrition, which can damage tissue and organs, and ultimately cause permanent brain damage. This brain damage is irreversible, and the child will instead have to focus on how to cope with these issues for the entirety of their life.6
Symptoms of Fetal Alcohol Syndrome
Symptoms of fetal alcohol syndrome can vary from child to child, but typically include a combination of physical, cognitive and behavioral symptoms. Some children have facial features that indicate the presence of FASD, including a smooth philtrum (the ridge between the nose and upper lip), an abnormally thin upper lip, a flat nasal bridge, and small/narrow eyes.7 While these facial features are helpful in diagnosing this disorder, some individuals do not have any or all of the diagnostic facial features, but they do have other physical and neurocognitive symptoms.
Physical Symptoms of fetal alcohol syndrome include:
- Low body weight
- Poor coordination
- Vision or hearing problems
- Problems with the heart, kidneys, or bones
- Shorter-than-average height
- Small head size
Developmental, social and behavioral symptoms of fetal alcohol syndrome include:
- Hyperactive behavior
- Difficulty with attention
- Trouble with emotional regulation (aggression, emotional volatility)
- Poor memory
- Difficulty in school
- Poor social skills
- Trouble adapting to change/switching tasks
- Vivid fantasies and perseveration
- Speech and language delays
- Intellectual disability or low IQ/functioning at lower IQ level than test levels indicate
- Poor reasoning and judgment skills
- Sleep issues
- Eating issues
- Learning disabilities
Diagnosis of FAS
Fetal alcohol syndrome is a medical disorder, so the diagnosis will come from a medical doctor. However, since there are often also developmental and social/behavioral symptoms, sometimes this is diagnosed using both a medical doctor and a specialized mental health professional. Diagnosis often includes a medical examination, taking a psychosocial history, and interviews with the individual’s mother/parents.
A mental health professional can make a diagnosis based on biopsychosocial symptoms without confirmation from a medical professional, but the diagnosis looks slightly different and is called Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure.8 A medical diagnosis is often needed to access certain supportive services using insurance.
Although the effects of fetal alcohol syndrome are irreversible, early diagnosis and intervention can make a huge impact. The earlier an individual with FASDs is connected to the appropriate resources, the more likely they are to function successfully and the less likely they, and their loved ones, are to become frustrated by this disability.
Effects of Fetal Alcohol Spectrum Disorder
While fetal alcohol spectrum disorders are irreversible, lifelong conditions, the struggles in different life stages can vary. Prenatal and early infancy impacts are primarily physical health implications. The primary struggles within childhood and adolescence are within social and school settings. Teens and adults with FASDs most prominent struggles are with social relationships, independent living, and the consequences of impulsive behaviors.
Perinatal Effects
“Perinatal” refers to the period of time when someone is pregnant and immediately following birth. Perinatal impacts on the baby are most prominent in physical deformities and increased health risks.
Perinatal effects of fetal alcohol syndrome include:
- Miscarriage
- Stillbirth
- Premature birth
- Sudden infant death syndrome (SIDS)
- Nursing issues
- Infant irritability
- Sleep-wake cycle issues
Effects in Childhood & Adolescence
While early diagnosis and interventions can make a massive difference in managing FASDs, many prenatally exposed children meet a majority of developmental milestones and don’t always raise red flags during pediatric check-ups and early childhood screenings. However, difficulties within social and academic settings become much more apparent between 9-11 years old in most children with fetal alcohol syndrome (grades 4th-6th grade).
Effects of fetal alcohol syndrome in childhood and adolescence include:
- Having multiple mental health diagnoses including: ADHD, bipolar disorder, autism, reactive attachment disorder, conduct disorder, etc.
- Emotional regulation issues
- Increased difficulty in social interactions
- Increased issues in academic setting, including struggling to function despite a normal IQ level
- Trouble switching tasks
- Difficulty connecting rules with consequences/taking responsibility for behaviors
- Speech and language delays
- Diagnosis of learning disabilities
Effects in Adulthood
Due to having to manage this disability differently, including the fact that many individuals do not get access to necessary supportive services until later childhood/adolescence, it typically takes an adult individual longer to successfully lead an independent life. While the previously mentioned symptoms are still present in adulthood, they result in very different consequences than they do within childhood/adolescence.
Effects of fetal alcohol syndrome in adulthood include:
- Struggling with concentration and completing tasks
- Aggression/inappropriate social conduct
- Involvement in the legal system
- Alcohol or drug misuse
- Problems staying in or completing school
- Problems with independent living/employment
- Inappropriate sexual behaviors
- Early death by accident, homicide or suicide
Fetal Alcohol Syndrome Treatments
While fetal alcohol syndrome is incurable, there are many interventions and treatments that can help a person to hit developmental milestones and function better. The sooner a child is diagnosed and connected to supportive services, the more likely they are to manage symptoms and to not develop secondary issues, such as poor self-esteem, anxiety, and depression.
The biggest protective factors are an individual growing up in a stable, loving and supportive home environment, as well as early diagnosis and connection to supportive services. Supportive services could include occupational therapy, speech therapy, special education services, medical support for physical deformities and complications, psychiatric treatment and medications, and mental health therapy intervention.
The Benefits of Therapy
While the developmental and physical aspects to this diagnosis need to be treated by specialists and medical providers, a mental health therapist is an important resource to help manage the emotional and social struggles of a FAS diagnosis. If you or a loved one would like to get connected to a therapist, finding a therapist may be the right call. An online online therapist directory is a good place to start looking.
Therapy can help people impacted by fetal alcohol spectrum disorders in the following ways:
- Child: A therapist can help your child with emotional regulation, strategies for attention/hyperactivity, and how to better navigate social interactions with peers.
- Adolescents/Teens: Therapists can help adolescents and teens with FAS on frustration tolerance, emotional processing, understanding rules and consequences, and with impulse control.
- Adults: Working with a therapist can help adults with fetal alcohol syndrome to have more fulfilling relationships, manage secondary diagnosis (such as depression and anxiety), develop healthier and safer coping patterns, work toward life goals and independent living, and improve impulse control.
- Parent coaching: Since children with an FASD diagnosis behave and respond differently than a child without fetal alcohol syndrome, parent coaching can be helpful to provide a home environment that nurtures your child. Parent coaching can help you alter your communication, routines, reinforcing positive behavior, and incorporating skills training that can help your child to be their best.
Prevention of Fetal Alcohol Syndrome
While there is no cure for fetal alcohol syndrome, it is absolutely preventable. It is never too late in a pregnancy to stop drinking to reduce potential damage. If you think you are pregnant, are trying to become pregnant, or could possibly become pregnant, it is safest for you and your future child to stop drinking alcohol immediately.
Final Thoughts
While understanding that this disorder is irreversible, there is still plenty of hope for individuals with FAS. Many individuals who have received this diagnosis have gone on to live full, productive and successful lives. Knowing the signs and symptoms of FAS can help you or a loved one to get a proper diagnosis and the support necessary to live your best and fullest life.
For Further Reading
- The National Organization on Fetal Alcohol Syndrome Circle of Hope/Birth Mother’s Network (in-person and online support)
- The Substance Abuse and Mental Health Services Administration (SAMHSA) drug and alcohol treatment facility locator: https://findtreatment.samhsa.gov.
- National Organization on Fetal Alcohol Syndrome – Resource Directory
- National Organization on Fetal Alcohol Syndrome – Living with FASD
- Helpful books on Fetal Alcohol Syndrome:
- “Fetal Alcohol Spectrum Disorder by Ellen Rodger and Rosie Gowsell
- “The Best I can be: Living with Fetal Alcohol Syndrome or Effects” by Liz Kulp and Jodee Kulp
- “When Rain Hurts: An Adoptive Mother’s Journey with Fetal Alcohol Syndrome” by Mary Evelyn Greene
- “Fantastic Antone Grows Up: Adolescents and Adults with Fetal Alcohol Syndrome” by Judith Kleinfeld
- “Forfeiting All Sanity: A Mother’s Story of Raising a Child with Fetal Alcohol Syndrome” by Jennifer Poss Taylor
- “Understanding Fetal Alcohol Spectrum Disorder: A Guide to FASD for Parents, Carers and Professionals” by Maria Catterick and Liam Curran.
