Fetal Alcohol Spectrum Disorder (FASD)


Fetal Alcohol Spectrum Disorder (FASD), often referred to as Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE), and other Alcohol-Related Birth Defects (ARBDs), are a series of birth disabilities related to alcohol. FASD is a pattern of mental and physical problems that may occur in some children whose mothers drank alcohol during pregnancy. While the baby is developing in the mother, any alcohol the mother drinks is passed to the developing child. Fetal Alcohol Spectrum Disorder is now regarded as one of the leading causes of intellectual disability in the US.

Children identified as having FASD experience lifelong behavioral, intellectual, and physical difficulties. Not all babies and children are affected the same way and the severity of symptoms is characterized along a spectrum of mild to severe problems. Some children may show no effects, while others may have severe intellectual disabilities and physical abnormalities. Children will not outgrow FASD, but the types of problems will change as the child grows older and faces new developmental challenges.

Drinking during any stage of pregnancy may cause FAS or FAE. The more frequently alcohol is used, the higher the risk to the baby. Binge drinking increases the risk of birth defects. To be safe, it is best if women avoid any alcohol if they think they may be pregnant.

Fetal Alcohol Spectrum Disorder is not one of the categories of disability specified in IDEA.  However, a child with FASD can certainly receive special education and related services if their disability adversely affects their education.  A child with FASD might be served under the category of Other Health Impaired (OHI), Specific Learning Disability (SLD), Intellectual Disability (ID), or another disability area. 

Physical Features 

  • Typical Child

    Alcohol-Affected Child
    May more easily be recognized between the ages of two and ten, and may not be as apparent immediately after birth or during adolescence or adulthood (about 90% of children with FASD have no physical features of the syndrome)
  • Thin upper lip
  • Small head circumference
  • Small eyes
  • Drooping eye lids
  • Short, upturned nose
  • Wide nose bridge
  • Lowset ears
  • Flattened midface
  • Smooth skin surface between the nose and upper lip
  • May have low birth weight, and may have trouble gaining weight
  • Head circumference may be smaller than normal
  • Deformities of joints, limbs, and fingers
  • Slow physical growth before and after birth (until puberty)
  • Vision difficulties or hearing problems
  • Poor coordination
  • Heart and skeletal abnormalities
  • Central nervous system damage
  • Structural abnormalities of the brain

Cognitive Development 
  • May have developmental delays
  • May include mild intellectual disability (IQ under 70) or lower intelligence (IQ 70 to 85) *Less than half have intellectual disability, and 90% have IQs in the normal range
  • May appear to be bright and outwardly normal
  • Memory deficits,including difficulty learning and remembering information
  • Working memory ability may be less than chronological (actual) age
  • May be better in reading and language, often poorer in math
  • Often hit what is called a “3rd grade wall” when facts and figures (concrete operations) move on to critical thinking (analytical) skills
  • Difficulty with abstract concepts
  • Poor problem solving skills
  • Lack of imagination or curiosity
  • Inability to understand concepts such as time and money
  • Do not develop logical approach to problems

Motor Development
  • Irritable as infants (e.g. don't eat well, don't sleep well, hyper-sensitive to sensory stimulation, and have a strong startle reflex)
  • Poor coordination / fine motor skills (e.g. holding objects)
  • Poor gross motor skills (e.g. crawling, walking, or running)
  • Hand tremors
  • May be diagnosed with Sensory Integration Disorder (SID)
  • May hyperextend head or limbs
  • Can exhibit hypertonia (too much muscle tone) or hypotonia (too little muscle tone), or both

Medical Problems
  • May have heart defects or suffer anomalies to the ears, eyes, liver, or joints
  • May show no physical symptoms at all, yet may still have significant damage to the brain and central nervous system
  • Failure to thrive
  • Organ dysfunction
  • Epilepsy
  • Sleep problems, such as trouble going to sleep and short periods of restless sleep
  • Possible ear infections, allergies, and asthma
  • Weak at sucking and grasping a nipple in infancy
  • Decreased appetite or difficulty retaining food
  • A mouth breather instead of a nose breather

Visual / Spatial Skills
  • Poor perception of visual information
  • Difficulty understanding spatial relationships
  • Trouble planning and organizing
  • Difficulty remembering several steps of a task
  • Can't remember order of steps

Auditory Processing
  • May be diagnosed with Central Auditory Processing Disorder (CAPD)
  • Unable to understand some sound sequences
  • Poor language comprehension

  • Hyperactivity and attention deficits
  • May have attachment disorder (an indiscriminate attachment to people or objects)
  • Failure to attach to people or objects
  • Difficulty learning from consequences
  • Vulnerable and naive
  • Stunted social development and social withdrawal
  • Immature behavior
  • Emotional outbursts
  • Poor impulse control
  • Poor judgment
  • Hyperactivity, inability to concentrate, and short attention span
  • Extreme nervousness and anxiety
  • Difficulty building and maintaining friendships and relating to groups

Strategies for Fetal Alcohol Spectrum Disorder