FETAL ALCOHOL 

SPECTRUM DISORDERSThe Basics
Understanding Fetal Alcoho

Spectrum Disorders

This section includes:• Fetal Alcohol Spectrum Disorders (FASD)• Terminology• FASD Facts• Cause of FASD• FASD and Alcohol• Alcohol and Women• FASD and the Brain• Number of People With an FASD
Fetal Alcohol Spectrum 

Disorders (FASD) 

• Umbrella term describing the range 

of effects that can occur in an individual whose mother drank alcohol during pregnancy 

• May include physical, 

mental, behavioral, and/orlearning disabilities with possible lifelongimplications

• Not a diagnosis

+
Terminology

• Fetal alcohol syndrome

• Term first used in 1973 by Drs. Smith and 

the University of Washington

• One of the diagnoses used to describe birt

defects caused by alcohol use while pregn

• A medical diagnosis (760.71) in the Intern

Classification of Diseases (ICD)
Terminology

Pregnancy

+

Alcohol

May result in

• Fetal alcohol effe• Alcohol-related b

defects (ARBD)

• Alcohol-related 

neurodevelopmendisorder (ARND)

• Partial FAS (pFA
FASD Facts

• 100 percent preventable• Leading known cause 

of preventable mental retardation

• Not caused on purpose• Can occur anywhere and 

anytime pregnant women drink 

• Not caused by biologic 

father’s alcohol use

• Not a new disorder
Cause of FASD

• The sole cause of FASD is women drin

alcoholic beverages during pregnancy.

• Alcohol is a teratogen.

“Of all the substances of abuse (including co

heroin, and marijuana), alcohol produces by far 

serious neurobehavioral effects in the fetu

—IOM Report to 
FASD and Alcohol

• All alcoholic beverages are harmful.• Binge drinking is especially harmful.• There is no proven safe amount of alcoho

during pregnancy.
FASD and Alcohol

• Binge = 4 or more 

drinks on one occasion for a women, 5 or more for a man

• Drink = 12 ounces 

of beer, 5 ounces of wine, or 1.5 ounces of hard liquor

=
Size Matters

Beer

12 oz 5 oz 1.5 oz 3 .5 oz 
Size Matters

12 oz. 16 oz

VS.
Alcohol and Women

• If a woman is pregnant, it does not mat

form the alcohol comes in.

• Wine spritzers, alcohol pops• Beer• Wine coolers• Light beer, nonalcoholic beer

Chec

label

for 

alcoh

conten
FASD and the Brain

• Prenatal alcohol exposure causes brain • Effects of FASD last a lifetime.• People with an FASD can grow, impro

function well in life with proper suppor
FAS and the Brain

Permissio
FAS and the Brain

A BC

AB

A. Magnetic resonance imaging showing the side view ocontrol subject with a normal corpus callosum; B. 12-yeand a thin corpus callosum; C. 14-year-old with FAS an(absence due to abnormal development) of the corpus caSource: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images providHealth & Research World 18(1):49–52. 
FAS and the Brain

A

These two images are of the brain of a 9-year-old girShe has agenesis of the corpus callosum, and the largthe back of her brain above the cerebellum is essentiaspace.

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provHealth & Research World 18(1):49–52. 
Number of People With an F

• No one knows for certain how many 

individuals are born each year with an FASD.

• No one knows how many 

individuals are living with an FASD.

Photo pro
Prevention and Risk Reduct

This section includes:• Prevention Is the Only Solution• Talk About Alcohol Use• Who Needs To Know• Raise Awareness in Schools• Raise Awareness in the Community
Prevention Is the Only Solu

• Ask all women of childbearing age abo

alcohol use:

• Ask routinely at every medical appointmen• Ask at appointments in various systems.• Ask in a nonjudgmental manner.• Use effective screening tools. • Ask about possible prenatal 

exposure.

Photo 
Talk About Alcohol Use

• Talk about the effects of alcohol on an 

individual and on a fetus:

• Begin at an early age, such as elementary s• Indicate that stopping drinking at any time 

pregnancy will help the fetus.

Convey the message: If you’pregnant, don’t drink. If you drink, don’t get pregna
DONOT TAKE THE RISK
Who Needs To Know

• Women of childbearing age?• Women who have a history of alcohol o

drug use?

• Women who are at risk?• Teenagers?• Men?• EVERYONE!
Raise Awareness in School

• Ask the school to put up posters 

about drinking and pregnancy.

• Include information about 

FASD in health, science, andphysical education classes. 

• Hold an assemb

about the effecton a person and 
Raise Awareness in the 

Community

• Post FASD information in 

doctors’ offices, treatment centers, and community centers.

• Promote FASD Awareness Day 

(September 9). Visit www.fasday.com for 

information.

• Focus attention on

FASD. You can help the entire community.
Symptoms and Difficulties o

FASD

This section includes:• Overall Difficulties for Persons With an FAS• Primary Disabilities of Persons With an FAS• Typical Difficulties for Persons With an FAS• Secondary Disabilities of Persons With an FA• Factors Associated With Reduced Secondary 

Disabilities
Overall Difficulties for Perso

With an FASD

• Taking in information• Storing information• Recalling information when necessary• Using information appropriately in a 

specific situation 

Information
Primary Disabilities of Pers

With an FASD

• Lower IQ• Impaired ability in reading, 

spelling, and arithmetic

• Lower level of adaptive functioning; 

more significantly impaired than IQ

Streissguth, et al. (1996

Permission to 
Typical Difficulties for Perso

With an FASD

Sensory Integration Issues• Are overly sensitive to sensory input

• Upset by bright lights or loud noises• Annoyed by tags in shirts or seams in s• Bothered by certain textures of food

• Have problems sensing where their 

body is in space (i.e., clumsy)
Typical Difficulties for Perso

With an FASD

Memory Problems• Multiplication• Time sequencing

?
Typical Difficulties for Perso

With an FASD

Information Processing Problems• Do not complete tasks or chores and may 

be oppositional

• Have trouble determining what to do in a 

situation

• Do not ask questions because they want to 
Typical Difficulties for Perso

With an FASD

Information Processing Problems• Say they understand when 

they do not

• Have verbal expressive skills that often exceed 

level of understanding

• Misinterpret others’ words, actions, or body m• Have trouble following multiple directions

Straighten up your room and put your toys away. Do you understand?
Typical Difficulties for Perso

With an FASD

• Go with strangers• Repeatedly break 

the rules

• Do not learn from 

mistakes or natural consequences

• Frequently do no

point, level, or stsystems

• Have trouble wit

time and money

• Give in to peer p

Executive Function Deficits
Typical Difficulties for Perso

With an FASD

Self-Esteem and Personal Issues• Function unevenly in school, work, and deve• Experience multiple losses• Are seen as lazy, uncooperative, and unmotiv• Have hygiene problems
Typical Difficulties for Perso

With an FASD

Multiple Issues• Cannot entertain themselves• Have trouble changing tasks• Do not accurately pick up 

social cues
Secondary Disabilities of 

Persons With an FASD

• Mental health issues• Disrupted school 

experience

• Trouble with the law• Inappropriate sexual 

behavior

• Confinement in 

treatment facili

• Alcohol and dr

problems

• Dependent livin• Employment pr

Streis
Secondary Disabilities of 

Persons With an FASD

♦ = Age 6+

♦ = Age 12+

♦ = A

Percent of Persons With FAS or FAE Who Had Secondary 
Factors Associated With 

Reduced Secondary Disabil

• Stable home• Early diagnosis • No violence against 

oneself

• More than 2.8 years in 

each living situation

• Recognized dis• Diagnosis of FA• Good quality h

ages 8 to 12

• Basic needs me

least 13 percen

Streissg
Diagnosis

This section includes:• Diagnosing Fetal Alcohol Syndrome• Differential Diagnosis of Features of FAS• FASD and Mental Health Disorders• Risks to a Child of Not Accurately Identifyin

Treating FASD

• Risks to an Adult of Not Accurately Identify

Treating FASD

• Benefits of Identification and Treatment
Diagnosing Fetal Alcohol 

Syndrome

• Prenatal maternal alcohol use• Growth deficiency• Central nervous system

abnormalities

• Dysmorphic features • Short palpebral fissures

• Indistinct philtrum• Thin upper lip

Caucasian 

Source: Astley, S.J. 2004. Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code, Third Edition. Seattle: University of Washington Publication Services, p. 114.
Differential Diagnosis of Fe

of FAS

• Differential diagnosis is very importan

because:

• Many syndromes can cause features that 

FAS.

• Facial features alone cannot be used to d

FAS.
FASD and Mental Health Dis

• Prenatal alcohol exposure may lead to s

behavioral, cognitive, and psychiatric problems. 

• FASD is not a psychiatric disorder.• FASD can co-occur with a mental healt

or substance abuse disorder.

D
Risks to a Child of Not Accu

Identifying and Treating FAS

• Loss of family• Increased substance use• Premature death

Photo courtesy of 
Risks to an Adult of Not Acc

Identifying and Treating FAS

• Unemployment• Loss of family• Homelessness

• Jail• Premature dea• Increased subs

abuse
Benefits of Identification and T

• Helps decrease anger and frustration for indivi

families, providers, and communities by helpinunderstand that negative behavior results from disability and is not willful

• Helps people with an FASD succeed by focusi

they have trouble in certain programs

• Helps improve outcomes• Helps prevent future births of children with an 
Treatment

This section includes:• General Issues With FASD• Intervention Issues• Systems of Care for Persons With an F• Economic Costs of FAS
General Issues With FASD

• Often undiagnosed among persons with

facial features

• More difficulties seen in those without 

facial features and with higher IQs

• Adaptive functioning more impaired tha

intelligence
Intervention Issues

• Failure in traditional mental health treatmen

programs

• People with an FASD may know what they need 

do but cannot follow through

• Caregivers with unrecognized FASD often label

neglectful, uncooperative, or sabotaging treatmebecause they do not follow instructions

• Limited FASD-specific treatment services
Systems of Care for Person

With an FASD

• Health• Education• Social and community services• Legal and financial services
Systems of Care
Economic Costs of FAS

• FAS alone cost the United States mor

$4 billion in 1998.

• The average lifetime cost for each chi

FAS is $2 million.

• $1.6 million for medical care services• $0.4 million for loss of productivity

Lupton, Burd, and 
Economic Costs of FAS

• One prevented case of FAS saves:

• $130,000 in the first 5 

years

• $360,000 in 10 years• $587,000 in 15 years• More than $1 million in 30 years

Lupton, Burd, an

Increased s

through pre

0

200000400000600000800000

1000000

5 10 

Y

$ Saved
Outcomes

This section includes:• Strategies To Improve Outcomes for Person

FASD

• Strategies for Sensory Integration Issues• Strategies for Memory Problems• Strategies for Information Processing Problems• Strategies for Executive Function Deficits• Strategies for Self-Esteem and Personal Issues

• Strengths of Persons With an FASD• Paradigm Shift
Strategies To Improve Outco

Individuals With an FASD

• Ask about possible 

prenatal alcohol exposure at intake.

• Ask about substance 

use during medical appointments.

• Educate fam

and provideabout FASD

Dubovsky, Drexel University Colle

• Have 

diagnwork
Strategies To Improve Outco

for Individuals With an FASD

Strategies for Sensory Integration Issues• Simplify the individual’s 

environment.

• Provide a lot of one-to-one 

physical presence.

• Take steps to avoid sensory triggers.
Strategies To Improve Outco

for Individuals With an FASD

Strategies for Memory Problems• Provide one direction or rule at a 

time and review rules regularly.

• Use a lot of repetition.
Strategies To Improve Outco

for Individuals With an FASD

Strategies for Information Processing Problems• Check for understanding.• Use literal language.• Teach the use of calculators and 

computers.

• Look for misinterpretations of words or ac

and discuss them when they occur.

Tell me what 

you just 

heard me say.
Strategies To Improve Outco

for Individuals With an FASD

Strategies for Executive Function Deficits• Use short-term consequences 

specifically related to the behavior.

• Establish achievable goals.• Provide skills training and use 

a lot of role playing.

Pho
Strategies To Improve Outco

for Individuals With an FASD

Self-Esteem and Personal Issues• Use person-first language (e.g., “child with F

“FAS kid”).

• Do not isolate the person.• Address issues of loss and grief.• Do not blame people for what they cannot do• Set the person up to succeed. Congratulat
Strengths of Persons With a

FASD

• Friendly• Likable• Desire to be liked• Helpful

• Dete• Hav

insig

• Not 

Dubovsky, Drexel University College of Medici
Strengths of Persons With a

FASD

• Cuddly and 

cheerful

• Happy in an accepting and 

supportive environment

• Loving, caring, kind, 

sensitive, loyal, and compassionate 

• Energetic and ha• Fair and coopera• Spontaneous, 

curious, and involved

Pe
Strengths of Persons With a

FASD

• Highly verbal• Highly moral—deep 

sense of fairness

• Kind with youn

children and animals

• Able to particip

problem solvinappropriate sup

Phot
Strengths of Persons With a

FASD

• Build on strengths of persons 

with an FASD, such as giving them opportunities to help in the classroom.

• Use teaching strategies that focus on st• Find jobs that use the person’s strength

Photo co
Paradigm Shift

“We must move from viewing t

individual as failing if s/he does 

do well in a program to viewing 

program as not providing what 

individual needs in order to 

succeed.”

—Dubovsky
Resources

• SAMHSA FASD Center for Excellence: 

fasdcenter.samhsa.gov

• Centers for Disease Control and Prevention F

Prevention Team: www.cdc.gov/ncbddd/fas

• National Institute on Alcohol Abuse and Alc

(NIAAA): www.niaaa.nih.gov/

• National Organization on Fetal Alcohol Synd

(NOFAS): www.nofas.org

• National Clearinghouse for Alcohol and Dru

Information: ncadi.samhsa.gov

• These sites link to many other Web sites.