Fetal Alcohol Spectrum Disorder
Information on diagnoses, intervention, support, and prevention
Fetal Alcohol Spectrum Disorder (FASD):
is caused solely by prenatal alcohol exposure
is the number one cause of intellectual disabilities and birth defects in the U.S, up to 1/20 school-aged children has an FASD
although parents with a substance use disorder have a higher likelihood of having a child with an FASD,
most children with FASDs are born to parents who do not have a substance use disorder
Maternal choline supplementation is effective in mitigating the effects of prenatal alcohol exposure
Choline supplementation shows promise in the treatment of young children with FASD
FASD is an umbrella term describing the broad range of birth defects and disabilities caused by alcohol exposure. Alcohol is a teratogen - like thalidomide, rubella, mercury - which means it causes birth defects. These effects may include physical, neurological, behavioral, and developmental disabilities with lifelong implications.
Some characteristics of FASD may include:
Low birth weight or short stature (height)
Speech and language delays
Dental issues - malocclusion, delay of permanent teeth, cleft palate, etc.
Difficulty understanding abstract concepts - metaphor, sarcasm, managing time or money
Facial abnormalities - approximately 10% of individuals with FASD have facial abnormalities such as smaller eye openings, flattened groove above upper lip, thin upper lip
Skeletal abnormalities - Permanent curving of the fifth finger (clinodactyly), permanent flexion contracture of a finger or toe (camptodactyly)
Hyperactive behavior - for which ADHD medications may not be effective
Impulsivity, poor judgment, difficulty learning from mistakes or generalizing knowledge
Poor social skills, developmentally younger than their peers, lower than expected adaptive intelligence
Organization, planning, and memory issues, difficulty with multi-tasking
Difficulty in school despite average IQ, especially with abstract concepts like math
Sensory processing disorder - sensitivity to light, sound, touch, smells, taste and food texture, over and under-sensitivity to pain
Poor self-management - may have tantrums "out of nowhere", tantrums may persist past early childhood, easily overwhelmed or overstimulated by environment
We also know that when we understand the brain injury of prenatal alcohol exposure and appreciate the brain differences of FASD, we can more effectively support individuals with FASD. This support includes protective factors* such as:
FASD-informed providers and teachers
caregiver support and training
stable nurturing home environment
These protective factors help individuals with FASD to build on their strengths and interests, to learn new skills to help them accommodate their weaknesses, and reach their developmental and educational potential.
*Petrenko, Christie L. M., et al. Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders:Identification of Systems-Level Barriers.Matern Child Health J. 2014 August;18(6):1496–1505
FASD is the number one cause of intellectual disability and birth defects in the U.S. It is currently estimated that FASD affects up to 5% of school-aged children - more common than autism, cerebral palsy, and Trisomy 21 combined. FASD is as common as asthma. The prevalence of FASD is much higher among adopted and foster children.
FASD is largely preventable. Given that approximately half of all pregnancies in the United States are not planned, the U.S. Surgeon General recommends that women who are pregnant, might be pregnant, or consider becoming pregnant should abstain from alcohol. Despite these guidelines, 1 in 7 pregnant adults report drinking alcohol in the past 30 days and over one third who report consuming alcohol engage in binge drinking, a pattern of consumption most harmful to the developing fetus.
One in seven pregnant adults in the U.S. report drinking alcohol in the last thirty days, 5.2% report binge drinking. In a 2017 study, of those pregnant women who used opioids non-medically, 51.2% binge drank alcohol.
62.6% of women aged 18-44 drink alcohol
35.3% of women aged 18-44 who drink, binge drink (4 or more drinks on one occasion)
Overall, one in ten pregnant women in Maine reported drinking in the last trimester. Six of Maine's sixteen counties have a rate of 10% or greater, Cumberland County, 1/6.*
Every year, from 2012-2021, 800-1000 Maine newborns were reported substance exposed
Every year since 2014, at least 50% of Maine child removals has involved a factor of parental substance use. *2014- 2020 CDC PRAMS Data
Alcohol is a teratogen. All teratogens, such as lead or thalidomide, cause birth defects. Alcohol can cause damage to any system of the body. It is particularly destructive to the brain of the fetus, causing damage to the structures, function, neurochemistry, and the brain's ability to grow and repair. Studies show, there is no safe level of prenatal alcohol exposure.
The placenta is not a barrier to alcohol. Alcohol is eliminated from the amniotic fluid at
3 - 4% the rate of the mother. This creates a prolonged alcohol exposure for the developing fetus. Changes in the fetus in the second trimester further prolong this exposure.
Only 10% of individuals with FASD have facial abnormalities. Facial abnormalities (and the co-occurring brain injury) such as smaller eye openings and a thin upper lip, occur when the fetus is exposed to alcohol in the third week of development, when many people do not yet know they are pregnant.
The nutritional supplement choline shows promise in the treatment of children with FASD. Children in this study, ages 2-5, who received choline had higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder than the placebo group.
Maternal choline supplementation shown effective in mitigating effects of prenatal alcohol exposure.
Jacobson, Sandra, et al. Efficacy of Maternal Choline Supplementation During Pregnancy in Mitigating Adverse Effects of Prenatal Alcohol Exposure on Growth and Cognitive Function:A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Alcohol Clin Exp Res. 2018 Jul;42(7):1327-1341
Early assessment and diagnosis of an FASD can reduce the risk, incidence, and impact of secondary and co-occurring conditions such as learning disabilities, mental illness, addiction, school failure, social deficits, and interactions with the criminal justice system.
Appropriate and early access to evidence-based interventions can favorably impact some of the common challenges experienced by children with an FASD, including speech and language development, executive functions, academic skills, visual motor integration, and fine motor coordination.
Diagnoses under the FASD umbrella:
FAS - Fetal Alcohol Syndrome
pFAS - Partial Fetal Alcohol Syndrome
ARND - Alcohol related neurodevelopmental disorder
DSM 5 315.8 "Other specified neurodevelopmental disorders"
*Hagan, Joseph F. Jr, MD, et al. Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure. PEDIATRICS Volume 138, number 4, October 2016:e20151553
Olson, Heather Carmichael. Advancing Recognition of Fetal Alcohol Spectrum Disorders: the Proposed DSM-5 Diagnosis of Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE). Curr Dev Disord Rep (2015) 2:187–198 DOI 10.1007/s40474-015-0056-4
Fetal Alcohol Spectrum Disorder is an umbrella term describing a broad range of adverse developmental effects that can occur in an individual with prenatal exposure to alcohol. A child or adolescent with an FASD may have a combination of physical, neurodevelopmental, neurocognitive, and behavioral problems with each manifesting a range of severity. It is not known how many people in the United States have an FASD. Several initial studies, using active case findings of school-aged children, indicate that 1% to 5% of children in the United States may have an FASD.
AAP FASD Live Webinar Training for AAP Members and Staff
"The American Academy of Pediatrics (AAP) established the Fetal Alcohol Spectrum Disorders (FASD) Regional Education and Awareness Liaisons (REAL) Champions Network in 2016. The goals of the FASD champions network are to meet the identified needs to improve pediatricians' capacity for early identification of at risk children and to address the role of stigma and bias in addressing prenatal alcohol exposure with families and caregivers. Champions are prepared to lead trainings and facilitate webinars and Grand Rounds presentations using the training modules developed under the auspices of the Improving FASDs Prevention and Practice through National Partnerships collaborative."
For more information on the FASD Champions Network or to schedule a training session at your site, contact Josh Benke, Program Manager, FASDs, at firstname.lastname@example.org or 630-626-6081.
"The University of Minnesota FASD program was created in 1978 and today brings together pediatricians, neuropsychologists and occupational therapists to help make recommendations to teachers, social workers and others to provide you and your child with comprehensive, coordinated care. FASD has no cure, but children with FASD can function well when given the right support system."
Pan American Health Association World Health Organization
"Target audiences include physicians, psychologists, allied health professionals, social workers, and other providers that may encounter individuals affected by FASD. It is ideally used as a supplement for in-person training by experts in the fields of dysmorphology, epidemiology, and neuropsychology."
Olson, Heather Carmichael, et al. Responding to the Challenge of Early Intervention for Fetal Alcohol Spectrum Disorders. Infants & Young Children.2007;20(2):172–189
Olson, Heather Carmichael and Montague, Rachel A. Prenatal Alcohol Use and FASD:Diagnosis, Assessment and New Directions in Research and Multimodal Treatment. An Innovative Look at Early Intervention for Children Affected by Prenatal Alcohol Exposure. 2011 Chapter 4:64-107
Wozniak, Jeffrey, et al. Diagnosis, Epidemiology, Assessment, Pathophysiology, and Management of Fetal Alcohol Spectrum Disorders. Lancet Neurol. 2019 Aug;18(8):760-770
Families Moving Forward
Families Moving Forward (FMF) "...is based on the idea that children with FASD have brain-based difficulties - neurological impairments - that are the underlying cause of many learning and behavioral problems. Caregivers learn Positive Behavior Support, Motivational Interviewing, and other evidence-based techniques. 'Reframing' and 'accommodations' help them change their own attitudes and how they manage the child, which leads to improvements in the child's behavior. Remote Training is available for mental health professionals and agencies."
Petrenko, Christie L.M., PhD, Positive Behavioral Interventions and Family Support for Fetal Alcohol Spectrum Disorders. Curr Dev Disord Rep. 2015 Sep;2(3):199–209
Petrenko, Christie, L.M. PhD, et al. Prevention of Secondary Conditions in Fetal Alcohol Spectrum Disorders: Identification of Systems-Level Barriers. Matern Child Health J. 2014 Aug;18(6):1496–1505
Petrenko, Christine L.M. PhD, et al. The Association Between Parental Attributions of Misbehavior and Parenting Practices in Caregivers Raising Children with Prenatal alcohol exposure: A Mixed-methods Study.Res Dev Disabil. 2016 Dec;59:255-267
For Families/Caregivers and Individuals - adults and children - with FASD
The Neurobehavioral Model text: Trying Differently, Rather Than Harder Third Edition. Diane Malbin, MSW. An excellent primer on understanding the brain injury of FASD and how to understand and support a person with FASD in order to meet their fullest potential.
The National FASD Collaborative Project was created in late 2020 from a discussion within the NOFAS Affiliate Network, when a need was identified to increase effective supports and evidence-based training at a national level related to FASD. FASD organizations from around the U.S. joined forces under the notion that if we each "give a little," we can create more dynamic FASD systems of care nationally.
The first initiative of the Collaborative Project was the creation of a national support group calendar. The National FASD Collaborative Project is now offering 17 online FASD support groups to caregivers, birthmothers, and self-advocates nationally! These support groups are run by a range of leading organizations and experts in the field of FASD.
The support group calendar is an ongoing program through the National FASD Collaborative Project and over time, we hope to expand our support group offerings with the addition of new support groups by existing or new organizations.
FASD United is the leading voice and resource of the Fetal Alcohol Spectrum Disorders (FASD) community. Founded in 1990, it is the only international, non-profit organization committed solely to the prevention of prenatal exposure to alcohol, drugs, and other substances known to harm fetal development, and to supporting individuals, families, and communities living with Fetal Alcohol Spectrum Disorders (FASDs) and other preventable intellectual/developmental disabilities.
"Welcome to the Circle of Hope (COH)! The COH was founded in 2004 by NOFAS Vice President Kathy Mitchell. It is a network of women who have consumed alcohol during pregnancy and may have a child or children with Fetal Alcohol Spectrum Disorders."
FAFASD Families Affected by Fetal Alcohol Spectrum Disorder
FAFASD provides trainings about caring for, living with, working with, and supporting people with FASDs using the neurobehavioral (brain-based) model.
FAFASD Always Remember the Brain: 30 Strategies for Parents of Children with a Fetal Alcohol Spectrum Disorder
FASD in Adulthood
Understanding Behaviors of FASD
How do I know if I have an FASD?
Resource for parents, caregivers, teachers, and therapists
Brief Videos on Understanding FASD
The Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (POPFASD) is funded by the British Columbia Ministry of Education and has been in existence since 2006. A multi-district Steering Committee offers advice, direction and feedback. The mandate of our program is to increase educators’ capacity to meet the learning needs of students with Fetal Alcohol Spectrum Disorder.
These videos are sponsored by POPFASD. Presented by Dan Dubovsky MSW (formerly of SAMHSA FASD Center for Excellence) Presented in 2017.
Please go here for current research on the prevalence of FASD in the U.S., as many as 5% (1/20) children.
"Welcome to the Circle of Hope (COH)! The COH was founded in 2004 by NOFAS Vice President Kathy Mitchell. It is a network of women formed to support one another."who have consumed alcohol during pregnancy and may have a child or children with Fetal Alcohol Spectrum Disorders."
FASD United (Formerly NOFAS National Organization on Fetal Alcohol Syndrome)
Doctors, psychologists, epidemiologists, and researchers speak to the risk of prenatal alcohol exposure at any level.
American College of Obstetricians and Gynecologists ACOG
Alcohol use during pregnancy continues to be a concern in the United States. Ob-gyns are uniquely situated to help combat alcohol-related mortality and morbidity before, during, and after pregnancy.
ACOG's FASD Prevention Program is a CDC-funded initiative. Our goal is to empower health care providers to speak with their patients about abstaining from alcohol use during pregnancy by providing ob-gyns with the resources and tools they need to communicate with patients about this public health issue. We also develop and compile resources for patients including FAQs, referral and treatment recommendations, fact sheets, and other educational materials.
These approaches can be used to help women of childbearing age change their drinking behavior. They have been proven effective for use during office visits.