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Fast Facts:

  • FASD is the most common known cause of developmental disability in the U.S.

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  • 90-95% of people with FASD have a mental illness; 87% of affected children have 2 or more mental health diagnoses

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  • 2 to 5% of every American has this complex, neurodevelopmental disorder. 

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  • FASD is more common than Autism Spectrum Disorders

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  • 75% of affected people have a typical IQ. 

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  • IQ specifically does not predict adaptive functioning in FASD 

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  • Only 10% of affected people have Fetal Alcohol Syndrome. 90% have an invisible disability and the same brain damage as FAS.

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  • The co-occurrence of drug and alcohol use is 90% in pregnancy.

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  • Alcohol is the strongest known toxin to the developing brain inutero. 

I am a mental health/substance use practitioner.  Why do I need to know about FASD?

Mental Health Professionals

  • ​Substance use Disorder: 35% of the affected population, starting at 12 years of age

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  • Atypical and often severe reactions to psychotropic, pain and seizure medications 

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  • Kidney and heart problems common in FASD with the use of medications

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  • Suicide: 26% of people with FASD attempt suicide. Because of cognitive deficits, lethality of intent cannot be used to determine who is at risk

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  • Emotional dysregulation is part of the brain damage - mood swings, rage reactions

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  • Most affected people are misdiagnosed or undiagnosed.

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  • Diagnosis by 6 years of age strongly predicts a better outcome in adulthood.

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  • 40% of patients in a large inner-city mental health clinic had an FASD (Carl Bell, MD, Frontline, PBS)

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  • All the developing neurotransmitter systems and HPA Axis can be damaged 

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  • Prevalence of anxiety and depression very high: these are primary disorders caused by brain damage

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  • Misdiagnosis is very common: ASD, Bipolar Disorder, Borderline Personality Disorder, RAD, Conduct Disorder, ODD

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  • Look for multiple mental health diagnoses or diagnoses that keep changing. 

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Mental health problems are almost universal

Neuro Profile

  • IQ does not predict adaptive functioning which is often lower than IQ

  • Adaptive functioning gets worse with age, even in those with typical IQ

  • The ability to learn from consequences is poor.

  • Limited understanding of danger.

  • Poor judgment and impulse control.

  • Poor affect regulation

  • Developmentally young

  • Memory deficits 

  • Language processing deficits even with high expressive language

  • Slow processing: 10-second kids in a 1-second world

  • Sensory processing disorder

With the above deficits in mind, traditional talk therapy methods may not work

FASD: Neurodevelopmental Profile

FASD and Treatment

  • Mental health and substance use treatment is specific to the diagnosis in FASD

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  • CBT, DBT, Motivational Interviewing are contraindicated without modification

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  • Group treatment is not recommended, due to difficulty in attention/focus, deficits in social thinking and language processing difficulties 

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  • There is an algorithm for the use of psychotropic medication in FASD across 4 mental health domains; 1st and 2nd line medications are included. 

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  • May need to use alternative approaches to treatment: Roleplay, art therapy, social problem solving/social thinking

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  • Discharge planning should include building a circle of support

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  • Specific recommendations for women requiring substance use treatment

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  • Zero tolerance policies not recommended

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  • Interventions specific to FASD have been developed

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  • For high anxiety patients they may need a support person, at least initially.  It is important to work with the family.

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What works, what doesn't

  • Over 400 health conditions are co-morbid with FASD. Every organ system in the developing body inutero can be damaged by alcohol, depending upon the timing of exposure.

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  • Diseases of aging are seen in adults in their 20’s and 30’s: osteoarthritis, osteoporosis, osteopenia, early menopause, early dementia, knee, and hip replacement, etc.

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  • Sleep disorders occur in 80% of the affected population: circadian rhythm disorders and sleep apnea, both peripheral and central.

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  • Autoimmune diseases occur at a much higher rate than the general population.

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  • Seizures: 23% of the affected population

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 A whole body disorder

Diagnosing FASD

FASD is a descriptive term, not a diagnosis. FAS occurs in only 10% of the affected population. Like Autism, Fetal Alcohol Spectrum Disorders occur on a spectrum. 90% of people with this complex, neurodevelopmental diagnosis have an invisible disability with the same brain damage as in FAS but without the cardinal facial features of the syndrome. 

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  • FAS: Can be diagnosed without confirmed PAE

  • ND-PAE 318.5 DSM 5; f88 (ICD)

 

Common misdiagnoses include ASD, Bipolar Disorder, RAD, ODD/Conduct Disorder, Borderline Personality Disorder, etc. These disorders can also be co-morbid. 

  • With early intervention, children and adults with FASD can do well

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  • Diagnosis by 6 years of age strongly predicts a better outcome in adulthood (IOM). Intervention is specific to the disability.

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  • Choline given before 6 months of age may reverse some of the brain damage.

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  • May need help navigating health care and social services

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  • May need support to maintain safety, housing, activities of daily living and work.

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  • Most people with FASD are undiagnosed or misdiagnosed, leading to a lack of services and improper treatment.

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Children, Youth and Adults with FASD can succeed:

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