What is FASD? Fetal Alcohol Syndrome Disorders (FASD) are a spectrum of lifelong physical, mental and neurobehavioral birth defects associated with alcohol consumption during pregnancy. FASD ranges from full Fetal Alcohol Syndrome (FAS) to Prenatal Exposure to Alcohol (PEA). Other terms for FASD include Fetal Alcohol Effects (FAE), Alcohol Related Neurodevelopmental Disorder (ARND), and Alcohol Related Birth Defects (ARBD).

What is the incidence of FASD? The incidence of all FAS disorders is approximately 10 per1,000. The incidence of full FAS is approximately 2 per 1,000.

What are the symptoms of FASD? Individuals with full FAS may have short stature, small eyes, smooth upper lip, and some developmental delays. Most individuals with FASD do not have any physical symptoms. Almost all individuals with FASD have learning disabilities, memory deficits, stunted social development, and behavior problems.

Are individuals with FASD mental retarded? FAS is the leading known cause of mental retardation, but most individuals with full FAS have IQ in the normal range. They have good expressive language skills, but poor comprehension. They can read, but have trouble writing. They seem to have insights and understanding, but actually have problems with abstract concepts like time and money. Their ability to function in life is well below their IQ. Their emotional level of development is well below their chronological age. They may appear to be smarter than they actually are, and tend to be naïve and gullible.

Do persons with FASD have other disorders? Many persons with FASD have more than one disorder. Other disorders that may occur along with FASD include: Attention deficit disorder (ADD/ADHD), depression, Reactive Attachment Disorder (RAD), Bipolar disorder, Obsessive Compulsive disorder (OCD), pervasive developmental disorder (PDD), Asperger syndrome (mild autism), Tourette Syndrome, mental retardation, or developmental delays.

What does a person with FASD look like? These individuals may have apparently normal physical characteristics. Even a person with full FAS may not look unusual. The average untrained person will not recognize a person with FASD just by looking at him or her.

How does a person with FASD act? Not all individuals with FASD will behave in the same manner. Some may withdraw and shut down, others may become aggressive and belligerent. Most individuals with FASD have poor impulse control, are emotionally immature, and show poor judgment. This is due to dysfunction of parts of the brain that were damaged by prenatal exposure to alcohol, particularly the frontal lobes, which affect ability to make decisions and control inhibitions.

How does a person with FASD feel? Individuals with FASD are overly sensitive to environmental stimulation. They have difficulty coping with sensory stimulation like noise, crowds, being pushed or shoved. When they feel overwhelmed, they may withdraw and shutdown, or they may act in an aggressive manner. Most individuals with FASD are for the most part undiagnosed, misdiagnosed, or otherwise not recognized as having FASD, and are therefore at high risk of developing secondary conditions during adolescence and adulthood.

How well do individuals with FASD function? Most individuals with FASD have mental health issues, have disrupted school experience, have trouble with the law, and often exhibit inappropriate social and sexual behaviors. These individuals are at high risk of developing addiction to alcohol and other drugs, and are at risk of developing depression and suicidal tendencies. Those at higher risk are the ones without a diagnosis, with an IQ in the normal range. Because their disorder is not recognized, their actions and motives are misunderstood. Others have unrealistic expectations that cause stress, frustration, and anger.

Factors to Consider When Confronting an Individual with FASD:

Accountability: Aberrant behaviors have a basis in organic brain dysfunction, over which the individual has little control. Destructive and/or dangerous behaviors are reinforced in a maladaptive environment.

Arrested social development: Studies show that regardless of age, regardless of IQ, the person with FASD may have stunted social development, about that of a 4 to 6 year old child.

Communication skill deficits: Their ability to comprehend may be lower than would be expected, and their inability to read social cues accurately may interfere with their ability to understand the expectations of others. They may understand rules and consequences, but still may not understand why they are in trouble. The ability to process information is sporadic and unpredictable.

Co-occurring conditions: Symptoms of co-ocurring disorders mentioned earlier may mask those of the underlying FAS Disorder. Most will present with some attention deficit disorder (ADHD) and have problems processing information, understanding instructions, and controlling behavior.

Sensory Integration Disorder: Persons with FASD might be extra sensitive to external stimuli like sound and touch. They may feel overwhelmed by being arrested, jostled with other prisoners, noise and lights, and may feel the need to push back or lash out in defense, even if not seen as reasonable to others.

Behavior issues: Individuals with FAS are generally immature, have a grandiose sense of themselves, but have an unrealistic view of the world. They have difficulty handling everyday stress, may have trouble controlling their temper, and may be self-abusive. They may be unable to assess risk or danger, but may have unreasonable fears. They may have difficulty accepting the limitations of their disability.

Medications: Most individuals with FASD are helped by medications, including stimulants, anti-depressants, and antipsychotics. If medications are withheld or not taken, they may be increase of symptoms and decrease of control over behavior.

Sexuality issues: Individuals with FASD are at risk of being victims of sexual abuse and may also become perpetrators themselves, due to the combination of normal hormone influence with lack of impulse control and poor judgment. Emotional immaturity leads to peer interaction with younger individuals.

Independence: The person with FAS/ARND requires guidance, mentoring, structure, and supervision. Even in the best of circumstances, with good role modeling, effective medications, verbal and visual cues, and a supportive environment, when the person with FAS is left on his or her own, eventually there will be failure due to poor judgment and they will act on impulse without regard for the consequences. The high risk of making the same mistakes over and over require close monitoring 24 hours a day, 7 days a week.

· Understanding by all personnel of the nature of the FAS disability.

· Advocacy by a competent adult who knows and understands the individual and the disorder.

· Reasonable expectations that match his/her functional abilities (6 year old level).

· Facts explained in simple, concrete terms, which may need to be repeated.

· Assistance in carrying out instructions given by the court/judge/officer.

· Protection from predators due to emotional immaturity and social naivety.

· Assessments to determine functional ability (IQ and Adaptive Behavior).

· Long-term support services in order to function successfully in the community.

Sources of above information: National Organization on Fetal Alcohol Syndrome; studies by Anne Streissguth, PhD, Fetal Alcohol and Drug Unit, University of Washington; studies by Edward Riley, PhD, San Diego State University, Chair of the National Task Force on FAS; and Robin LaDue, PhD, Fetal Alcohol and Drug Unit, University of Washington. More information on FASD can be found at www.fasstar.com