Fetal Alcohol Spectrum Disorder:
A Preventable Epidemic
Barry S Parsonson PhD
Explore & Applied Psychology
International
FASD: Causes
• FASD is caused by maternal consumption of
alcohol during pregnancy;
• Alcohol affects developing neural and physical
systems differentially according to timing in
relation to fetal development stage, amounts
consumed and duration of exposure;
• The minimum amount causing some effect is
currently not known, hence advice against all
alcohol consumption when pregnant;
• FASD is thus entirely preventable!
FASD Diagnosis
• There are four internationally agreed classes
of FASD based on assessment of severity using
a 4-digit code relating to FAS characteristics;
• FAS, PFAS, ARND, & ARBD:
• In each case, confirmed evidence of maternal
prenatal alcohol misuse is required;
• DSM-V does not include FASD as a diagnosis
although it is described and identified as a
“Condition for further study”!
FASD Diagnosis 1-FAS
• Fetal Alcohol Syndrome (FAS) is the most
severe form. It includes:
• Facial Anomalies (small eye slits, thin upper
lip, smooth philtrum) and Microcephaly;
• Growth Deficiency (height or weight <10%ile)
• CNS Damage with evidence of structural
and/or functional brain abnormality;
• Confirmed Prenatal Alcohol Exposure (needed
if cluster of facial anomalies not present).
Facial Anomalies of FAS
FASD Diagnosis 2-PFAS
Partial Fetal Alcohol Syndrome (PFAS) is
characterised by:
• Growth Deficiency (height or weight <10%ile)
• CNS Damage with evidence of structural
and/or functional brain abnormality;
• Confirmed Prenatal Alcohol Exposure (Reliable
evidence of maternal alcohol misuse).
FASD Diagnosis 3- ARND
Alcohol Related Neurodevelopmental Disorder
(ARND) is characterised by:
• CNS Damage: Evidence of structural or
functional brain abnormality;
• Confirmed Prenatal Alcohol Exposure (Reliable
evidence of maternal alcohol misuse).
FASD Diagnosis 4-ARBD
Alcohol Related Birth Defects (ARBD) is classified
by:
• Physical Defects: Heart, Kidney or other
anomalies present at Birth;
• Confirmed Prenatal Alcohol Exposure: Reliable
evidence of maternal Alcohol Misuse.
FASD Prevalence
• A Base Rate of 1% of the School Age population is
estimated from a number of US, Canadian and
European Studies;
• Some communities have rates of up to 8.5%;
• Preliminary NZ data lead to guesstimates of at least
3000 school-age children with FASD;
• Accurate data are difficult to obtain and probably
underestimate the true situation.
• FASD is now the most common cause of ID.
Post-Natal FASD Effects on Cognition &
Learning
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Executive functioning (Planning, attention)
Memory (encoding, rote, working & spatial)
Reasoning (verbal, abstract, numerical)
Language (learning, comprehension, meaning)
Sensorimotor (visual/motor integration,
visual-spatial processing)
• Attention (short span, distractible, often
ADHD labelled)
Distribution of IQ Scores
FASD Effects on Communication &
Sensory Functioning
• Delayed Language Development
• Impaired receptive & expressive language
• Difficulties in language production &
comprehension affect learning
• Poor social communication affects relationship
building
• Hearing disorders found common in a small
FAS clinic sample
FASD Behavioural Effects
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Physical Aggression
Lying and Confabulation
Impulsiveness and hyperactivity
Cheating, stealing, bullying & animal cruelty
Lack of remorse
Emotional lability
Substance abuse & self-harming
FASD Lifespan Effects
Collectively, these Cognitive, Learning, Social,
Communication and Behavioural deficits have
lifetime effects. Data from samples indicate:
• Family life (85% of children in foster care FASD)
• Educational achievement (60% excluded)
• Mental Health (87% 5-13 y.o.; 23% adults suicide)
• Criminality (60% of FASD teens, many Prisoners)
• Relationship and Employment difficulties are
common.
Discussion Questions
• How do we, as a profession, intervene by way of
increasing awareness and promoting prevention?
• Education? Who, when, how?
• Increase Political and Public awareness? What
strategies might work?
• What about the “Binge Drinking” Culture – Does
it contribute? If so, how to change that?
• What can we offer to those on the FASD
spectrum? In Schools, Prisons, the Community?