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Evolving Understanding of FASD

When Fetal Alcohol Syndrome was first identified in our county in 1973, the emphasis was on sentinel features of the face that helped define the syndrome. For years, research and training focused on the face and only Fetal Alcohol Syndrome. In recent years, the field has come to recognize that the face is not important; the brain is. Much research now involves the study of individuals who do not have FAS but have been affected by prenatal alcohol exposure. The shift occurred when it was recognized that only 10% of affected people have the syndrome while 90% have an invisible disability, with no outward physical signs and the same brain damage. It is taking practitioners time to evolve with the research that the disability is a spectrum, just like Autism. In Northern California, it is still the case that many professionals

have heard of Fetal Alcohol Syndrome whereas they have not heard of Fetal Alcohol Spectrum Disorder. 


Research on FASD has also shifted to understanding the effects of epigenetics, the turning on and off of genes. One epigenetic effect in FASD is the prenatal priming of the fetus for the taste of alcohol.  Such priming may be one of the reasons substance abuse can be a big problem in this population.  Research is also looking at the genetic makeup of the mother as a possible reason why the effects of prenatal alcohol exposure can vary so greatly.

In the early years of study, mental health problems were viewed strictly as secondary disabilities that occur when the fit between the affected person and their environment was poor. Anxiety and depression occur at a very high rate in people affected by FASD.  Recent research has shown an anatomical reason why this is the case, the stress center of the brain is damaged by prenatal alcohol exposure. Anxiety is now recognized as a primary disability in FASD, part of the brain damage.  

New areas of research also include what happens in the adult years and an understanding of FASD as a whole-body disorder.  Adults with FASD have strongly advocated for this change.  Up until now, there has been little information as to what happens in the adult years and what supports will bring a better outcome.  In addition, adults have helped bring researchers to look at comorbid health conditions in FASD. It is now known that over 400 health conditions are comorbid with the disability, making people with FASD medically high risk.

Fetal Alcohol Spectrum Disorder has gone from being just the syndrome, FAS, to a recognition of a much wider phenomenon with much greater prevalence, and to an understanding that FASD is not just about the brain. It is about the whole body with a life long impact.

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