Understanding Fetal Alcohol Spectrum Disorder (FASD)
Fetal Alcohol Spectrum Disorder (FASD), caused by prenatal alcohol exposure, is a lifelong neurodevelopmental condition.
Effects vary, impacting physical, emotional, behavioural, and neurological functions. All people with FASD have many strengths. While incurable, early intervention and support can significantly improve outcomes by nurturing these individual strengths.
Co-occurring conditions
Prenatal alcohol exposure can affect many parts of the body. Such as:
- central nervous system
- vision
- hearing
- cardiac
- circulation
- digestion
- musculoskeletal
- respiratory
This means people with FASD may have co-occurring conditions. Cognitive function varies, ranging from typical to learning disabilities. FASD also ties in with other neurodevelopmental conditions like ADHD and Autism. This is common due to overlapping characteristics.
Support for difficulties associated with Fetal Alcohol Spectrum Disorder
Each child with FASD is unique, so support approaches vary. Encourage and celebrate individual strengths and needs. Not all strategies work for everyone. Try a few, assess their effectiveness, and adjust as needed.
Strategies to use can come from Somerset’s Graduated Response Tool or our Sensory Processing Handbook. You can also find strategies on the Somerset Emotional and Mental Health Route-map which you can find on the Somerset Children and Young People Health and Wellbeing website.
Professionals should know that a child or young person with FASD might seem to have normal thinking skills. However, if they struggle with planning and self-control (executive functioning), they will find it hard to use their thinking skills well, especially on tests. This is unless they get the right support.
The booklet below summarises difficulties you may spot and strategies and support to try. Covering both cognitive and behavioural areas of executive functioning:
- sustained attention
- working memory
- planning, prioritisation and time management
- organisation
- self-monitoring
- metacognition and goal directed persistence
- emotional regulation
- impulse control and response inhibition
- task initiation
- flexibility
- shifting focus
As well as communication and social skills, motor skills, and sensory integration.
Some children and young people with FASD will also be looked after children or previously looked after children. Professionals can consider seeking support from the virtual school team or Post Adoption Supporting Social Worker.
Top tips for Fetal Alcohol Spectrum Disorder
Some key top tips are listed below, but you can also find more in the booklet above.
- Remember that children and young people with FASD will be developmentally younger than their chronological age, on average half their chronological age and expectations should be adjusted accordingly.
- Recognising the individual needs of a child or young person is key, rather than taking a ‘blanket’ approach for everyone with FASD .
- People with FASD can have ‘spikey cognitive profiles’ and this can lead to assumptions that they are more able in some areas than they are, So it is important to recognise each individual’s strengths and weaknesses to best support them.
- It is important to remember that alcohol use during pregnancy can occur for a variety of reasons. Many do not find out they are pregnant until alcohol damage is done, stress, alcohol dependency, lack of knowledge and poor advice. We need to be understanding of mother’s situations.
- Challenging behaviour needs to be understood as a means of communicating a difficulty and need for support. It is not down to ‘bad’ parenting or intentional misbehaviour. Because children and young people with FASD have difficulty linking cause and effect, ‘typical’ behaviour modification strategies are unlikely to be effective but instead are likely to put a child who has FASD into a ‘shame’ state which can result in a trauma response of fight, flight, freeze.
- Traditional therapies may not be suitable for some behaviours due to brain changes caused by prenatal alcohol exposure. They can, in some cases, make things worse. Any therapies should be FASD -informed.
- Always keep instruction simple, allow for up to 20 seconds for a response, if you need to repeat do not change the order of your words otherwise the child will have to start processing the instruction again.
- Providing a sensory space and lots of sensory breaks will make a significant impact to the child or young person.
- Children and young people with FASD will need an enhanced transition when moving between educational settings; this will include early planning meetings with both schools, enhanced transition with a clear transition support package in place using a person-centred approach.