
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 is caused when alcohol is consumed during pregnancy, where it enters the bloodstream which then crosses through to the placenta and spreads rapidly into the amniotic fluid surrounding the fetus.
Alcohol is removed from the amniotic fluid far more slowly than the mother eliminates it from her own system, meaning that it accumulates and creates a ‘reservoir’ of alcohol around the fetus, which will be swallowed and circulated in the fetus’ system.
The fetus only has a limited ability to process the alcohol compared to the mother, and so the effect is prolonged; the impact to the developing central nervous system (the brain and spinal cord) can be significant causing a spectrum of needs.
Brain damage can include physical, mental, behavioural, and/or learning disabilities with lifelong implications including other structural deficits.
Due to central nervous system damage individuals with Fetal Alcohol Spectrum Disorder (FASD) often experience sensory processing challenges, these can manifest as being over-responsive, under-responsive or both, to various sensory inputs like touch, sound, light, and smells. This can lead to significant challenges in daily life, including difficulty concentrating, emotional regulation, and social interactions.
Early and accurate diagnosis is crucial.
When prenatal alcohol exposure is identified, employing 'ruling it in' strategies significantly enhances the chances of better outcomes and an improved quality of life. By deepening our understanding of Fetal Alcohol Spectrum Disorder (FASD), we can implement effective support and intervention strategies that make a meaningful difference and impact lives.
To meet threshold for diagnosis in accordance with NICE Quality Standards for FASD & SIGN 156 Guidelines, a child must have a documented history of prenatal alcohol exposure, or at least strong circumstantial evidence.
Children & adults will have least three deficits in the domains listed below:
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Attention
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Executive functioning including impulse control and hyperactivity
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Motor skills
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Memory
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Neuroanatomy / neurophysiology
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Living & Social Skills including social communication & adaptive behaviour
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Cognition
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Communication
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Affect (Emotional) Regulation
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Academic Achievement

Every child with FASD presents slightly differently, a 'kaleidoscope' of presentations; we call this the 'spectrum' of FASD where what is seen in one child might not be seen in another, here is a list of commonly seen signs and symptoms, but not exhaustive:
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Failure to thrive (baby)
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Feeding difficulties
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Sleeping (too much or very little)
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Poor social skills
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Lack of boundaries
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Slow information processing
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Memory; particularly working/short term, difficulty storing & retrieving information, inconsistent
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Motor control issues, balance, rhythm, strength, motor planning and sequencing
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Struggle to regulate; angry or frustrated & may take longer to calm, struggle to modulate their emotional state.
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Cognition; dealing with abstract concepts, such as maths, money management, time concepts
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Extreme under or over-sensitivity to sensory input
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Attention; struggle with selective, focused, sustained, and flexible attention, for example, in concentration, hyperactivity and impulsivity
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Difficulty following directions or connecting step instructions
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Executive Functioning; struggle to be able to find something to occupy themselves, struggle with their capacity for goal-directed behaviour, including self-regulation, working memory, planning, organising
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Difficulty linking actions with consequences
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Poor judgment & impulsiveness
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Highly suggestible / influenced by others / no stranger danger (highly vulnerable)
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Difficulty generalising knowledge
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Difficulty understanding abstract concepts
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Difficulty understanding cause-&-effect relationships
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May struggle with transitions
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May be prone to confabulation (making stories up using pieces of information from several different memories; they do this without thinking .... this is not lying but it may appear so)
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Learning difficulties (commonly but not limited to maths)
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Language - slow auditory processing pace, can struggle with using the right words for the right context (they can talk the talk but if you ask them about what they have just said they might not understand any of it)
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Receptive language is often much lower than expressive language
Strengths
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Friendly, likable: May be outgoing & sociable & have little anxiety about strangers
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Verbal, chatty: May be very socially interested (but not necessarily socially skilled)
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Helpful, hard-working: If you ask, they will do it. They can be very good workers with the right job & training however it needs to be supported
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Determined, resilient: They don’t hold grudges & will come back if rejected. Every day is a new day!
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Want to be liked: They will do whatever they can to have friends
There are 328 co-occurring (co-morbid) conditions which can affect various body systems and are often related to the central nervous system, vision, hearing, and cognitive abilities. The specific conditions and their prevalence can vary widely, within the FASD spectrum.
Important Considerations:
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The Spectrum:
It is crucial to remember that FASD is a spectrum, meaning the types of co-occurring conditions can vary greatly from person to person.
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Early Intervention:
Early identification and intervention can significantly improve outcomes for individuals with FASD and related conditions.
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Individualised Approach:
Because of the wide range of potential co-occurring conditions, it is essential to take an individualised approach to assessment, diagnosis, treatment & support.
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Ongoing Research:
Research is ongoing to better understand the complex interplay between FASD and other conditions, and to develop effective interventions
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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