Fetal Alcohol Spectrum Disorder (FASD)
Early assessment and interventions can result in better prognosis for the children.
FASD remains one of the commonest causes of Intellectual disability however the awareness amongst clinicians who see children with a possible FASD diagnosis is very poor. Brain development starts within the first 4 weeks of maternal pregnancy and the process continues in the child’s developing years. The Child’s brain is therefore very vulnerable to adverse environmental factors and exposure to toxic substances including alcohol.
Exposure to prenatal alcohol can affect brain growth, establishment of brain networks and connections. Prenatal alcohol exposure can also result in reduced blood flow to the infant as a result of placental insufficiency.
How do children with FASD present?
Children with FASD can present with physical as well as neurodevelopmental complications from prenatal alcohol exposure. The consequences of exposure include growth delay, physical and facial abnormalities, developmental delay, learning difficulties, behavioural difficulties and impact on some of the regulatory hormone in the body.
Children with FASD are also at risk of developing emotional and mental health difficulties.
Children with FASD can present with symptoms seen in disorders such as ADHD or ASD. The symptoms in these children is due to the effect of the brain damage from alcohol exposure and in some cases do not respond to the treatment strategies used in managing children with primary ADHD or ASD.
How is the diagnosis made?
The diagnosis of FASD is made when the child fulfills the following criteria
1. There are behavioural difficulties and neurocognitive difficulties meeting the profile of that seen in children with FASD
2. History of prenatal alcohol exposure
3. Physical features in some children typical for FASD
What does the assessment involve?
The assessment will require at least 2 visits with the Paediatrician and assessments by Therapist (Speech and Language Therapist, Clinical Psychologist and Occupational Therapist in some cases. The Paediatrician usually obtains a comprehensive history on the child’s birth and developmental history. The Paediatrician carries out a medical and developmental examination. Facial assessment is also carried out by the Paediatrician.
Does the diagnosis matter?
Early diagnosis of FASD results in better prognosis for the child/young person. Children with FASD may appear normal to their peers and teachers however their difficulties can be extremely impairing. They tend to have extreme memory difficulties amidst other neurocognitive difficulties which make it very difficult for them to live independently. Children with FASD are also at risk of significant mental health difficulties. The children with FASD have extreme learning problems at school and sometimes can struggle to cope in normal learning environments. Children with FASD could also have extreme challenges with their behaviours at home.
Dr Inyang Takon, a recognised specialist in FASD, gave a presentation on this subject to Parliament, in a bid to highlight the need for more understanding and resources for this all too common condition. (BMJ 13th May 2019).