Fetal Alcohol Spectrum Disorder: Common Signs and Symptoms
Fetal Alcohol Spectrum Disorder
Fetal Alcohol Spectrum Disorder (FASD) causes untold harm, pain and shame for both mothers and their children. The lifetime consequences of a mother consuming alcohol during pregnancy and causing her infant to suffer brain damage are terrible and the fact that society is critical and judgmental, makes it even worse.
What Causes FASD?
FASD is a preventable but incurable brain injury caused by mothers consuming alcohol during pregnancy. The amount of alcohol required to cause this disability is unknown but no “safe” amount has been determined for drinking during pregnancy and doctors recommend that pregnant women abstain, altogether.
According to the Canada Fetal Alcohol Spectrum Disorder Research Network, one in every 100 babies are born with FASD, that is, approximately 3,000 babies a year; in Canada, over 380,000 people live with this developmental disability.
Degrees of Impairment
There are degrees of impairment and a wide range of problems associated FASD. In its most extreme form, Fetal Alcohol Syndrome, there are physical problems which include facial deformities, and internal organ abnormalities, as well global cognitive delays. In less severe forms, Partial Fetal Alcohol Syndrome and Alcohol Related Neurodevelopmental Disorder (ARND) children have cognitive impairments, problems with impulse control, memory, judgment and social interaction, difficulties maintaining schedules, and adhering to rules.
The majority of children with the full blown syndrome are identified early and they and their families or foster families, receive assistance. However, the majority of children affected are not readily identifiable, are not diagnosed, and do not receive any support. As few as 11% of children receive a diagnosis before the age of six years.
Secondary Problems
Because children with FASD are challenging to raise, parents and teachers struggle to help them. As a consequence, the children struggle with poor self-esteem, depression, and anxiety, and are at high risk of developing secondary mental health and social disabilities such as depression and substance abuse, school failure, unemployment, homelessness, and incarceration.
Many children with FASD are placed in foster care which brings the potential for other serious problems, such as attachment disorders and in some instances, abuse and exploitation.
Diagnosis
Early diagnosis is critical because, although the treatment options are limited, the diagnosis helps parents and teachers understand the child’s exasperating behaviours and promotes a more sympathetic environment for the child. According to Health Canada, children who are diagnosed and receive on-going supports are less likely to develop the secondary disabilities, such as homelessness and incarceration. Not only do the children need supports but parents and teachers need ongoing supports, as well.
Presently, the diagnosis of FASD requires a multidisciplinary assessment team including a physician, psychologist, occupational therapist and speech-language pathologist. The cost on average, is about $3,000. This is a considerable sum but when we consider the lifetime cost for one individual with FASD –estimated by the Centers for Disease Control and Prevention in 2002, to be $2 million- it doesn’t seem very much.
Public health campaigns haven’t worked
40 years of public health campaigns warning about alcohol use during pregnancy haven’t resulted in lower rates of FASD. It’s unlikely that the information hasn’t been disseminated, even in rural and northern communities where rates are higher, so clearly something more is needed to address the problem.
Support for pregnant mothers, especially teens, is critical. Pregnant moms who are drinking large quantities of alcohol need support groups and medical assistance, both during and after pregnancy. They also need mental health assessments and treatment for their mental health problems and addictions. It’s pretty clear that disapproval and rejection are both ineffective and costly.
Improving diagnostic processes to identify infants and toddlers as early as possible, is equally important because current research into neuroplasticity –the brain’s ability to find ways around defective or damaged circuitry – offers hope for FASD patients. Specialized daycare programs for infants with FASD designed to stimulate, enrich, and support children and their families, could likely result in much better outcomes.
FASD is a complex problem that requires multiple layers of expertise and resources. The development of successful programs will require research –based experimentation which will initially be expensive but, in the long run, may greatly decrease societal costs.
Rory
Rory is six. He has been in foster care since he was a year old and he’s lived in five different homes. He’s very cute and affectionate, except when he’s not. He hits and kicks when he doesn’t get what he wants or doesn’t like his dinner or bedtime, and looks confused when he’s asked why he behaves the way he does. Some days he know his letters and numbers but the following day he can’t recall a thing that he learned. When he’s sent to his room to think about some transgression or aggression, he says he doesn’t know why he is being punished and he really doesn’t seem to understand. When asked how he might know when he’s “mad” he says, “I do this” and he makes a fist and punches the sofa pillow.
Examples of typical problems in functioning and behaviours include:
Mastering a new skill one day but not remembering it the following day.
Forgetting established rules and routines.
Making intrusive or unwelcome comments or gestures.
Impulsive shouting, running, grabbing, or poking.
Lack of insight about behaviour and intentions.
Obsessive rituals.
ADHD and FASD
Whereas ADHD is mostly genetic, FASD is caused by alcohol use during pregnancy. Children with FASD have symptoms which are similar to and may be included in a diagnosis of ADHD but the core problem is a brain injury, not a brain style. These children are not primarily impulsive and inattentive as children with ADHD but have core learning challenges which interfere with their comprehension of norms and rules, their judgment, and their memory. A large percentage have significant global cognitive deficits, as well.
Stigma
A significant percentage of children with FASD are in Foster Care and the stigma associated with learning disabilities and developmental delays is compounded by the stigma of being in Foster Care. A study in Alberta found that 52% of children in care had FASD.
More support for foster families
Foster families, in particular foster mothers, are severely challenged and frequently under assisted in coping with children who have FASD. Earlier diagnoses and specialized education plans for the children are essential but individualized behavioural strategies and help with implementing them are what foster moms really need, as well as a lot of empathy and appreciation.
Looking Forward
Since we can’t cure FASD, we need to put a lot of effort into preventing it and that means providing support for young women and girls. We need better and more available sexual health education, mental health treatment, addictions programs, and supports for pregnant teens.
When a child is born with FASD we need to put resources in place to prevent that child from being rejected and stigmatized which means educating and supporting foster parents, teachers and communities.
Resources
Ellen Rodger and Rosie Gowsell, Fetal Alcohol Spectrum Disorder (Understanding Mental Health Series), Crabtree Publishing Company, 2014.
Barry Carpenter, Carolyn Blackburn and Jo Egerton (Ed), Fetal Alcohol Spectrum Disorders, Interdisciplinary Perspectives, Routledge, 2014.
About The Author
Janet Morrison, M.A. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.
Listen to our podcast episode on FASD: Episode 10 | What We Know About Fetal Alcohol Spectrum Disorder (FASD)