Foetal Alcohol Syndrome (FAS)

What is Foetal Alcohol Syndrome (FAS)?

FAS comes under the banner of Foetal Alcohol Spectrum Disorders (FASD), which is a broad spectrum of completely preventable intellectual and developmental deficits in individuals, resulting from maternal alcohol consumption during pregnancy. FAS can cause a range of physical and intellectual disabilities. Possible physical disabilities include facial differences and major organ damage, as well as hearing and vision impairments. Damage to the brain results in developmental disabilities, which can include general learning difficulties, language, social or motor skills impairment, memory impairment and attention deficits, poor consequential thinking, and poor planning ability. Children affected by FAS can also face misunderstanding about the often hidden cause of their very challenging learning behaviours. (adapted from Blackburn, Carpenter and Egerton, 2009).

FAS was first explicitly written about in 1973 (Jones and Smith1) however it has been the subject of academic and social interest since the late 19th Century (Sullivan, 18992). Since that time research has focussed on the characteristics and diagnosis of FAS.

FAS covers quite a broad range of syndromes and presentations. Other relevant terminology is listed below

Foetal Alcohol Spectrum Disorder (FASD)
Alcohol Related Neurodevelopmental Disorder (ARND)
Alcohol Related Birth Defects (ARBD)
Fetal Alcohol Effects (FAE)
Pre-natal Alcohol Effects (PAE)

The only one of these terms that appears in a diagnostic manual, and therefore the only that can be formally diagnosed, is FAS, which appears in the ICD-10 diagnostic Manual. Each of the terms above is however a variation on the presentations seen in FAS.

The characteristics of FAS cover a range of physical, cognitive, social, behavioural and emotional markers (Gibbard et al., 20033 and Kodituwakku et al,. 20064).

Physical characteristics

Illustrastrated in the picture below.

Cognitive characteristics

Impaired IQ
Impaired executive functions (Working memory, impulse control, ability to plan etc.)
Slow information processing

Behavioural/emotional characteristics

Difficulty focussing attention
Anxiety problems
Disorganisation

Social characteristics

Emotional immaturity
Lack of social skills e.g. empathy, self-reflection

However caution should be exercised in using these characteristics to self-diagnose your child, their presence doesn’t necessarily mean that he or she has FAS and full multidisciplinary assessment is essential to determine FAS. The symptoms of FAS and those of Developmental Trauma overlap enormously (with the exception of the physical characteristics). In addition, many of the FAS related syndromes are not defined by the physical characteristics but by the neurodevelopmental signs listed above. There are no studies that have yet looked at separating the effects of FAS and related syndromes from the effects of Developmental Trauma or Reactive Attachment Disorder.

The current estimates regarding the prevalence of FAS is somewhere between 2 to 7 per 1000 live births (0.2 to 0.7%) and possibly as high as 2 to 5% for FAS and related disorders (see above) (May et al, 20095).

What is the difference between FAS and Developmental Trauma?

As detailed above there is no research out there at the moment to help us to separate what the difference is between these two clusters of problems. Differentiating between them is complex and requires very careful multi-disciplinary assessment. There is likely to be a high correlation between mothers who drink heavily in pregnancy poor ante-natal attachment or attunement and therefore it is an enormous challenge to determine which of these elements causes any particular child’s difficulties. Caution is needed when considering this complex overlap, the promise of a medical diagnosis can be very containing and/or reassuring but may lead to the wrong intervention if it is inaccurate. Also mistakenly diagnosing FAS may result in a focus on one particular element of a child’s difficulties and take focus away from the extreme effects of developmental trauma, but of course, the converse of this is also true.

Don’t lose hope that your child can still do well and succeed. They may well have some disadvantages in their academic abilities but every child has their particular skills, passions and abilities.

Just because your child has this diagnosis doesn’t mean that they won’t be helped by therapeutic parenting from you. Your emotional literacy and availability will still help your child to emotionally connect with you.

Read up about the particular cognitive problems that children with FAS have and encourage your child’s school to do the same. The reading list below may be helpful.

Pictorial routine sheets can be useful for all children who struggle with their executive functions(i.e. working memory, impulsivity, difficulties with planning). This is a laminated timetable, pinned to the wall, for various routines throughout the day/week. The order of the events, each represented by a picture, can be structured into a timetable with a brief description beside each picture. For example, for the morning routine, you could have a picture of an alarm clock followed by a picture of a child brushing their teeth followed by a cereal bowl and so on.

Your child is most likely to be able to pick up what social skills they lack e.g. empathy, self-regulation from you doing it for them within your relationship. This can take a long time so don’t lose heart if, after months of trying, you still haven’t moved on very much. It may be a developmental process that takes longer. This is more likely to be effective than overtly teaching them these things, though this won’t hurt if it’s done without disappointment in your child or activating their shame.