The Full Story?
'FASD is the most severe of the neurodevelopmental disorders in terms of its far-reaching impact on functioning across the lifespan, and requires a unique approach to support and understanding.
Those who are not appropriately trained or knowledgeable can often make assumptions due to the fact that many individuals with FASD can superficially present as more able than they actually are or where their ‘symptoms’ are misinterpreted as ‘behaviour’ due to spiky cognitive and neurodevelopmental profile.
There is also often the assumption that symptoms of FASD will improve over time, or a child will outgrow their emotion regulation challenges or poor adaptive functioning for example, when unfortunately, the opposite is true; the developmental gap continues to widen and diverge away from the norm over the course of childhood.
This necessitates increased, rather than decreased, need for support and services. FASD must be understood as an enduring brain injury, similar to any other acquired brain injury.'
Dr Cassie Jackson Consultant Clinical Psychologist
What is Fetal Alcohol Spectrum Disorder (FASD)?
Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodevelopmental condition associated with prenatal alcohol exposure. It can affect cognition, learning, memory, behaviour, communication, emotional regulation, sensory processing, and day-to-day functioning. Because presentation varies from person to person, timely recognition, comprehensive assessment, and appropriate support are essential.
Alcohol consumed during pregnancy passes through the placenta and reaches the developing fetus. Because the fetus has only a limited ability to metabolise alcohol, exposure may persist for longer and can disrupt development, particularly within the brain and central nervous system.
Clinical presentation can include brain differences in learning, memory, attention, communication, sensory processing, emotional regulation, and adaptive functioning. NHS guidance recognises FASD as a condition requiring high-quality assessment and support.
Why early diagnosis matters
Early identification and accurate assessment can improve access to appropriate intervention, education, and support planning. Timely recognition also helps families, carers, and professionals understand a person’s profile of needs and strengths, reducing the risk of misunderstanding and inappropriate expectations. The National Institute Health & Care Excellence Quality Standard (NICE) and SIGN 156 guidelines emphasise the importance of structured assessment pathways and coordinated support.
How FASD is diagnosed?
Assessment is guided by established clinical standards. In line with NICE Quality Standard QS204 and SIGN 156, diagnosis requires known prenatal alcohol exposure, or strong circumstantial evidence, together with clinically significant differences across at least three neurodevelopmental domains.
Comprehensive assessment should consider developmental history, functioning across settings, and the need for multidisciplinary input where appropriate.
FASD can significantly impact all brain domains:
• Attention
• Executive functioning, including impulse control and hyperactivity
• Motor skills
• Memory
• Neuroanatomy and neurophysiology
• Living and social skills, including social communication and adaptive behaviour
• Cognition
• Communication
• Emotional regulation
• Academic achievement
Common signs and challenges
FASD presents differently in each child, young person or adult with FASD. The profile of difficulties may vary in type and severity, and needs often change over time and across environments. The examples below are commonly reported features, although they are not exclusive to FASD and should always be considered within a full clinical and developmental assessment.
• Feeding and sleeping difficulties in infancy
• Slow information processing
• Memory difficulties, especially with working and short-term memory
• Problems with balance, coordination, motor planning, and sequencing
• Emotional regulation difficulties, including frustration and longer recovery time
• Challenges with attention, concentration, hyperactivity, and impulsivity
• Difficulty following directions or managing multi-step tasks
• Struggles with planning, organising, and other executive functioning skills
• Difficulty linking actions with consequences
• Poor judgement and increased vulnerability to influence from others
• Difficulty understanding abstract concepts, including time, money, and cause and effect
• Sensory processing differences, including over- or under-sensitivity to sound, light, touch, or smell
• Language and communication differences, including slower auditory processing
• Learning difficulties, commonly including maths
• Difficulties with transitions, routines, and generalising knowledge
Strengths
A balanced assessment should recognise strengths as well as areas of difficulty. Many children, young people and adults with FASD demonstrate strong social motivation, perseverance, warmth, and a willingness to engage.
Identifying strengths is important in care planning, intervention design, education, and longer-term support.
• Friendly, sociable, and eager to connect
• Chatty, verbal, and interested in others
• Helpful and hardworking with the right support
• Determined and resilient
• Motivated by relationships and a desire to be liked
Co-occurring conditions and support needs
FASD may co-occur with a range of additional health, developmental, sensory, educational, and behavioural needs. Presentation is often complex and may involve overlapping difficulties of up to 428 co-occuring conditions affecting every area of the body including communication, attention, regulation, adaptive functioning, hearing, vision, sleep, and physical health.
For this reason, assessment and intervention should be individualised, evidence-informed, and responsive to the person’s changing needs over time where early assessment is essential. A multidisciplinary approach is often beneficial in understanding the full clinical picture and planning effective support.
Getting help
If there are concerns about possible prenatal alcohol exposure or a pattern of neurodevelopmental differences consistent with FASD, an early referral for assessment is essential. Discussion with a GP, paediatrician, health visitor, or relevant specialist service can support next steps. Access to appropriate assessment, intervention, and ongoing support can improve understanding, guide planning, and promote better long-term outcomes.
Public health impact...
Alcohol is a teratogenic compound (ie a substance that interferes with the normal
development of the embryo or fetus) that readily crosses the placenta, potentially causing cell death and / or inhibiting cell growth. In the absence of a developed blood filtration system, the fetus is totally unprotected from alcohol circulating in the blood system.
Fetal Alcohol Spectrum Disorder (FASD) is considered to be the most common non-genetic cause of learning disabilities and neurodevelopmental conditions in the Western world.
Alcohol exposure in utero is the leading cause of neurodevelopmental damage, learning disabilities, and behavioural problems, but is also the most underacknowledged and misdiagnosed neurodevelopmental condition.
FASD is brain damage, it cannot be cured, reversed, or outgrown, and can have devasting secondary effects including children returning into care after being adopted, others ranging from school problems, substance abuse to mental health issues and ill-fated criminal justice encounters.
Suicide is now the most common cause of death under 35’s where the Office for National Statistics UK (ONS) data shows numbers have increased dramatically in recent years.
In a recent study youth aged 13-18 years with FASD required medical assistance due to suicide attempts at rates 5.5 times higher than the general population. Other researchers have reported suicide as a leading cause of death among individuals with FASD.
Initiatives like strengthening social supports, training professionals, carers and parents,
enhancing coping skills for families, providing hopefulness and positive future
outlooks, as well as identifying reasons for living, are critical for suicide
prevention.
There's no safe level of alcohol consumption during pregnancy, the NHS now recommends complete avoidance of alcohol is advised.
In some studies up to 75% of all children in care or leaving it have prenatal alcohol exposure; this data was collated before Covid 19, statistics suggest there was a sharp rise in drinking in women during this time.
'FASD is a significant public health issue in the Western world due to its high prevalence and potential for severe consequences. Increased awareness, early diagnosis, and appropriate support are crucial for improving outcomes for individuals with FASD'.
Adoption UK
'The government recognises that Fetal Alcohol Spectrum Disorder can have a significant impact on the early years development of children and on their life chances. As a result, schools must use their best endeavours to make sure a child or young person gets the special educational provision they need, this includes monitoring the progress of pupils regularly and putting support in place where needed, including arranging diagnostic tests where appropriate.'
'Pupils at school with medical conditions should be properly supported so that they have full access to education.'
Catherine McKinnell Minister of State (Education 2025)
Parliamentary debate; Department for Education 19 February 2025.
Source: Parliamentary notes HERE
The Impact of Covid 19
A spike in fetal alcohol harm is a UK negative outcome of the COVID-19 lockdown because of alcohol consumption combined with being homebound, feelings of extraordinary stress or fear, and restricted access to contraception.
Alcohol exposure in utero is the leading cause of neurodevelopmental damage, learning disabilities, and behavioural problems, but is also the most underacknowledged and misdiagnosed neurodevelopmental condition.
FASD is brain damage, it cannot be cured, reversed, or outgrown, and can have devasting secondary effects including leading to unknown numbers referred into the care system, children returning into care after being adopted, others ranging from school problems, substance abuse to mental health issues and ill-fated criminal justice encounters.
Public health messages have sadly too often focused almost exclusively on the alcohol side of the problem, while ignoring pregnancies.
Although we are in a post-COVID era, new cases of FASD will persist for decades and permanently compromise the lives and life chances of those affected.
FASD is both predictable and largely preventable but has been consistently ignored. This omission is a missed public health opportunity during the first wave of COVID-19.
Source:
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Popova, S ∙ Lange, S ∙ Probst, C ∙ et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis Lancet Glob Health. 2017; 5:290-299
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Mukherjee R, Hollins S, Abou-Saleh M, et al. Low level alcohol consumption and the fetus. British Medical Journal. 2005;330:375-6
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Popova S, Lange S, Probst C, et al. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health. 2017;5(3):e290-e9
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Lambie, I What were they thinking? A discussion paper on brain and behaviour in relation to the justice system in New Zealand https://apo.org.au/sites/default/files/resource-files/2020-01/apo-nid274051.pdf
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British Medical Association Alcohol and pregnancy: preventing and managing fetal alcohol spectrum disorders; British Medical Association, London
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Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerging infectious diseases. 2020 Mar 23;26(7)
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Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020 Jan;17(5):1729.
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Roozendaal B, McEwen BS, Chattarji S. Stress, memory and the amygdala. Nature Reviews Neuroscience. 2009 Jun;10(6):423-33
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Suicide Risk in Adolescents with Fetal Alcohol Spectrum Disorders Mary J O’Connor, Larissa C Portnoff, Michael Lebsack-Coleman, Katrina M Dipple
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