Is It Fetal Alcohol Spectrum Disorder (FASD), Or Is It Autism?

FASD does not have to happen if all women, with the support of the father, are avoiding alcohol when pregnant or planning to become pregnant. There is no safe time during pregnancy to drink and there is no safe amount to drink during pregnancy. This has been known by experts in this country since around 1973.

Men do not have babies, so why would they have to stop drinking? If it is not a problem for the man to stop drinking, then he should be supportive of the woman carrying his child. My husband was an alcoholic and drug addict and would not have been able to quit drinking at that time.

It is necessary to understand the damage to the brain to know what the behaviors are related to. With a diagnosis, the clinician wants to know if the mother drank for the diagnosis. It is necessary to have a mother drinking during pregnancy to establish the diagnosis.

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Sometimes FASD is diagnosed as ADHD as there are similarities. Treatments may not work when treating ADHD when it is FASD. It is easier to treat ADHD with medication than FASD. Many people do not want the label either. It is way more common to hear ADHD.

A psychologist I spoke with had adopted a child that she believed to be FASD. Because the birth mother would not admit that, the diagnosis was not made. He was diagnosed with Autism. She said she believed there were more services and support with this diagnosis and even if the birth mother would change her mind, she would keep him with the Autism diagnosis.

I attended my first training on FAS/FAE in 1976. I had my first baby in 1975. I drank when pregnant with my first child. After taking that training we were told that we were now the experts as there were no other or very few other experts in the country.

Most people think of FASD as facial features, small head size, and stature. That person is on the more extreme end of the spectrum. Some will say because it is visible, there are more services available and more understanding.

The facial features are developed in early pregnancy. Maybe at three weeks, showing at eight weeks, if I remember right. I am not an expert. This information can be checked on.

My first child is on the spectrum. She has very few noticeable symptoms that could relate to being FASD. She is very smart with a high IQ. Being on the spectrum does not mean you have a 70 or lower IQ. I diagnosed my daughter as being FAE, shortly after the training as there was no way to be diagnosed in my state at the time. That happened much later.

When pregnant with my second child in 1977/78, due to that training in 1976, I did not drink alcohol or take any drugs, including caffeine and tobacco. I was a 2-3 pack-a-day cigarette smoker. It was a good thing to do that for me as I never restarted smoking.

I am not sure how it may have affected my baby as I was in withdrawal and did not have an easy pregnancy. That baby weighed 10 pounds, 6 ounces, and was diagnosed with sudden infant death syndrome (SIDS) at one month of age after he quit breathing. I cannot be sure but I thought perhaps my withdrawals triggered that.

I do not consider myself an expert, although I continue to take training and give training over the years. I have found the experts to be the parents/caregivers raising children on the spectrum. I am a co-facilitator for an FASD parent/caregiver support group now that meets monthly. Due to the pandemic, participation is down. It is now on zoom and that has not built-up attendance by much.

What I notice in the support group meetings is it does normalize the caregivers/parents' experience by meeting. Parents are accepted for whatever they may be going through, their parenting is not being judged due to the actions of their child.

Support is the most important thing in the group. Next would be resources that one family can inform other families of. Then there is having a short respite from parenting monthly, as some parents do not take a break from their children for themselves.

Depending on the age of the child there is someone that has been there and can be supportive and even talk about what they tried and what they did that worked.

We are reminded that our children are not the way they are sometimes because they are just unruly, undisciplined children. It is how their brain works. Tough love is not the thing to do with our children. Remembering it is a brain thing that cannot be helped does help most.

Sometimes medications help, other times they do not. Some parents know and share what worked for their child, while others will say, that the same medication didn't work for their child.

Listed below are the different diagnoses from the Center for Disease Control (CDC) and some treatment comments along with protective factors from some of the experts:

Different Diagnosis: Fetal Alcohol Syndrome (FAS): FAS represents the most involved end of the FASD spectrum. People with FAS have central nervous system (CNS) problems, minor facial features, and growth problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others.

Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control.

Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): ND-PAE was first included as a recognized condition in the Diagnostic and Statistical Manual 5 (DSM 5) of the American Psychiatric Association (APA) in 2013. A child or youth with ND-PAE will have problems in three areas: (1) thinking and memory, where the child may have trouble planning or may forget material he or she has already learned, (2) behavior problems, such as severe tantrums, mood issues (for example, irritability), and difficulty shifting attention from one task to another, and (3) trouble with day-to-day living, which can include problems with bathing, dressing for the weather, and playing with other children. In addition, to be diagnosed with ND-PAE, the mother of the child must have consumed more than minimal levels of alcohol before the child’s birth, which APA defines as more than 13 alcoholic drinks per month of pregnancy (that is, any 30 days of pregnancy) or more than 2 alcoholic drinks in one sitting. CDC

Treatment FASD lasts a lifetime. There is no cure for FASD, but research shows that early intervention and treatment services can improve a child’s development.

There are many types of treatment options, including medication to help with some symptoms, behavior and education therapy, parent training, and other alternative approaches. No one treatment is right for every child. Good treatment plans will include close monitoring, follow-ups, and changes as needed along the way.

Also, “protective factors” can help reduce the effects of FASDs and help people with these conditions reach their full potential.1, 2

Protective factors include: Diagnosis before 6 years of age Loving, nurturing, and stable home environment during the school years Absence of violence Involvement in special education and social services

Streissguth, A.P., Bookstein, F.L., Barr, H.M., Sampson, P.D., O’Malley, K., & Young, J.K. (2004). Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects. Developmental and Behavioral Pediatrics, 5(4), 228-238.

Streissguth, A.P., Barr, H.M., Kogan, J. & Bookstein, F. L., Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Final report to the Centers for Disease Control and Prevention (CDC). Seattle: University of Washington, Fetal Alcohol & Drug Unit; August 1996. Tech. Rep. No. 96-06.