Fetal Alcohol Spectrum Disorders (FASD) – identifying and responding in practice with families: Frontline Briefing (2017)

What are Fetal Alcohol Spectrum Disorders (FASD)?

Fetal Alcohol Spectrum Disorders (FASD) describe a range of preventable conditions that affect a developing fetus, when exposed to alcohol by a mother drinking alcohol whilst pregnant (Mukherjee et al, 2012a). Compared to other substances (such as marijuana, cocaine and heroin) alcohol produces by far the most serious neuro- behavioural effects to the fetus (BMA, 2016).

The range of FASD conditions has increasingly been recognised as a spectrum of presentation, affecting both brain and body (Mukherjee et al, 2012a; Popova, 2016). Each individual with FASD will have a different spectrum of mental and physical challenges which may vary from mild to very severe. Characteristics seen in individuals may include:

• The majority do not have clear or obvious physical features.
• Facial features of shorter eye opening (palpebral fissures); thinner upper lip and flat philtrum (the vertical groove in the middle of the upper lip) only occur in around five to ten per cent of cases.
• An ability to express themselves that is better than their ability to understand what is said to them.
• Processing information slowly, so providing information too quickly or too much at a time can lead to the information not being understood.
• Being superficially friendly, but not really understanding what is involved in two-way interactions.
• Finding integrating different sources of information a challenge.
• Becoming over-stimulated after failing to filter out unnecessary information such as background noise.
• Struggling with hyperactivity and inattention (the hyperactivity can often be directed or focused on meaningful tasks, which can mask these difficulties).
• Experiencing sensory processing issues - especially related to movement, tactile needs and hearing.
• Understanding things literally and not being able to see the ‘bigger picture’.
• Finding tasks that require more than one brain process difficult which, in turn, can affect decision-making such as with capacity related issues.
• Being sympathetic and superficially engaging on a one-to-one level, but lacking true empathy for others.
• Failing to read other people’s intentions and, because of that, sometimes being taken advantage of.
• A wide range of physical problems - including heart, eye and gut issues.

Note on terminology: After much discussion with the author and peer reviewers we have used the spelling ‘fetal’ rather than ‘foetal’ throughout this publication. Fetal is the internationally agreed (including by the UK) diagnostic term used by those working within this field.