What is Fetal Alcohol Spectrum Disorder?
“ Fetal Alcohol Spectrum Disorder (FASD) refers to a complex range of brain injuries that can result from prenatal exposure to alcohol (PAE). It is an umbrella term that has evolved over time and is used to denote an array of developmental, physical, learning and behavioral conditions.”
“The bottom line is that pre-natal exposure to alcohol, in combination with other risk factors, may cause brain injuries, which are expressed in unique and individual ways. FASD can occur in all segments of society. Poverty, genetics, maternal stress, poor nutrition and other prenatal exposures can influence the severity of FASD. Prenatal exposure to alcohol, while not the sole component contributing to FASD, is a necessary one and therefore FASD is preventable.”
Source: Consensus Statement on Fetal Alcohol Spectrum Disorder (FASD) – Across the Lifespan Institute of Health Economics Consensus Statements Volume 4 – October 7 – 9, 2009
How is FASD Diagnosed?
National Guidelines outlining the diagnostic process for FASD have been in place since 2005 in Canada. These National Guidelines were most recently revised in 2015 (http://www.cmaj.ca/content/early/2015/12/14/cmaj.141593 ).
Making a diagnosis of FASD requires a multidisciplinary team and involves a complex physical and neurodevelopmental assessment. A multidisciplinary team is defined by the involvement of several professional specializations. Core team members will differ across the lifespan from infant to adulthood, these include: Pediatrician/Physician, Child Development Specialist, Psychologist, Occupational Therapists, and Speech Language Pathologists, and a Coordinator. The professional team assesses the following using their particular expertise; family history, maternal alcohol history, physical examination, differential diagnosis, sentinel facial features, and a neurodevelopmental or brain domain assessment. The National Guidelines also makes recommendations on nomenclature, or terms applied for FASD.
The 2015 National Guidelines define FASD as the term that has been adopted to describe a broader spectrum of presentations and disabilities resulting from alcohol exposure in utero.
The two current diagnosis for FASD include:
1) FASD with sentinel facial features and 2) FASD without sentinel facial features. A third “at risk for FASD” which accounts for clients that at the time of diagnosis do not meet the full criteria. This category is part of the guidelines but is not a diagnosis of FASD.
How does FASD affect the individual, their families/ caregivers? People affected by FASD may have significant difficulties with memory, attention, self-care, decision making, social skills and may experience mental health disorders such as depression and addiction. FASD is also often complicated by medical issues such as higher rates of heart disease, hearing and vision problems. FASD also has a dramatic impact on families. A family can be considered biological , adoptive or a foster family for the individual. FASD is a life-long disability and therefore individuals and families must be aware of the impact on their lives and supports that are available.
How can FASD be prevented? Prevention requires complex, culturally sensitive, multi-level initiatives that address very specific barriers and opportunities for learning, engagement and supportive change. To successfully prevent FASD it is critical to involve women, men, their support systems, community advocates, health promotion experts, researchers, health/social system planners and service providers in designing initiatives.