Category — 2.1 Children with Nervous System Disorders: Fetal Alcohol Spectrum Disorder (FASD)

FASD is a group of disorders caused by prenatal exposure to alcohol. When a pregnant woman drinks, she could be doing considerable damage to her fetus. There are factors that seem to protect some fetuses from the damaging effects of alcohol. Such protective factors are not fully understood but seem to include a healthy diet and freedom from stress. This is why not all women who drink give birth to children who have FASD. The medical community appears to be divided on what a “safe level of drinking while pregnant” is. Some physicians state that it is ok to drink alcohol from time to time while pregnant. Others recommend complete abstinence (Personal Communication, Dana Brynelsen, 2012).

Prenatal exposure to alcohol can damage the development of many fetal organs, especially the brain. Different parts of the brain grow during different times during pregnancy. So drinking alcohol at any time during pregnancy may cause serious and irreversible brain damage.

FASD is a spectrum disorder. This means that different children will have different symptoms. Some children will exhibit serious learning and behavioral difficulties and others may only exhibit minor ones.

FASD is one of the leading causes of intellectual disabilities (mental retardation) in children. It is 100% preventable. That is, if a woman does not drink alcohol during pregnancy, her baby will not get FASD. This is very important to note because the incidence of FASD is 1 in 100 births. In some populations this rate can be as high as 1 in 4 births (Personal Communication, Dana Brynelsen, 2012).

The most serious disorder under the umbrella of FASD is Fetal Alcohol Syndrome (FAS). Some children with FAS have distinct facial features (Fig. 1) that could disappear or become less pronounced as the child gets older. Some of these features are:

Figure 1. Fatal alcohol syndrome

• Smaller head;
• Flat mid-face;
• Short nose;
• Think upper lip;
• Indistinct philtrum;
• Eyes that are somewhat almond-shaped.

FASD can and does affect all areas of development:

• Most children with FASD have some type of cognitive impairment. Some will have an intellectual disability (see full Glossary)  while others may have a learning disability. Many struggle with paying attention, concentrating and remembering things. Most will struggle with learning how to read, write and perform math operations. Most will have difficulties with their working memory and many will find it difficult to understand complex and/or abstract concepts;
• Many children with FASD struggle with cause and effect. That is, they do not seem to understand the consequences of their actions. For instance, a child with FASD may not fully understand that the reason their peer does not want to play with them anymore is because they keep hitting this peer. Many children with FASD also struggle understanding the concept of danger. For example, many children with FASD do not understand that if they cross the street without looking both ways, they may get hit by a car. That is why many of them appear to be serious risk-takers;
• Many children with FASD have imperfect language skills. They have a smaller vocabulary than their peers and seem to use very simple sentences when communicating with others. They struggle with understanding complex and multi-step directions. Children with FASD also struggle with pragmatic language. They often miss out on social cues. Many do not understand the concept of personal space (according to their culture);
• Many children with FASD have serious behavioral difficulties. They throw severe temper tantrums (that is, they may get down on the floor and cry and yell at others) (Fig. 2) and really struggle with impulse control. They sometimes engage in socially-inappropriate behavior (the inappropriateness of a certain behavior will vary from culture to culture) and struggle with the understanding and recognition of feelings, both in themselves and others;

Figure 2. Temper tantrum

• Some children with FASD experience difficulties with fine and gross motor skills. They may appear clumsy when they walk and run and may struggle when they hold pens, pencils and paint brushes;
• Some children with FASD will have difficulties with sensory integration;
• Some children with FASD will struggle with all aspects of adaptive functioning. They may be very late to get toilet trained. They may need help with eating and drinking, even in kindergarten (they will experience these difficulties even if they come from a culture that encourages independent eating and drinking as early as possible). Many will also need help getting dressed and taking a bath;
• Some children with FASD may experience high levels of anxiety.

Also, some children with FASD may have hearing and/or vision difficulties. They may also have medical problems, especially with their heart, liver and/or kidneys.

Some children with FASD display positive features which include:

• Having creative, musical and artistic abilities;
• Being friendly and affectionate;
• Being gentle and compassionate;
• Being funny and having a sense of humor;
• Being persistent and hard working;
• Being interested in and caring for animals;
• Being fair;
• Being good story-tellers.

Children with FASD could benefit from the following services:

• Special education: most children with FASD will be placed on an IEP, when they start attending school. They will benefit from the help of the school special educator, who will help them with all aspects of their academic skills. Special educators can also help children with FASD learn how to pay attention, understand cause and effect, and improve their concentration skills;
• Physiotherapy: children with FASD will benefit greatly from physiotherapy. The PT will help them improve their gross motor skills and will help them improve their sense of balance;
• Occupational therapy: OTs can help children with FASD improve their fine motor skills. OTs can help children improve the dexterity in their fingers, hold a pen or pencil properly, and use eating utensils. OTs with special training in sensory integration therapy can help children with FASD deal with any sensory processing difficulties they may have;
• Speech and language pathology (SLP): many children with FASD will benefit greatly from speech therapy. SLPs will help children with FASD improve their receptive and expressive language skills. They will also help them understand social cues and therefore improve their pragmatic skills;
• Behavior intervention (BI): BIs will help children with FASD learn how to improve their impulse control and minimize the frequency and intensity of their temper tantrums. They will also help these children understand cause and effect relations;
• Mental health: some children with FASD will benefit from psycho-therapy sessions, especially if they experience high levels of anxiety.

Children with FASD struggle with many aspects of development but they can and do improve with loving care and early intervention. With structured support, many of them can be successfully integrated into regular classrooms, where they belong.

see References

http://www.fasdoutreach.ca/

http://www.fasdoutreach.ca/elearning/learning-about-fasd

http://www.bced.gov.bc.ca/specialed/awareness/53.htm

http://www.fasdcenter.samhsa.gov/

http://www.child-encyclopedia.com/en-ca/home.html

http://www.gov.mb.ca/healthychild/fasd/fasdearly_en.pdf