Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems. Cause and Prevention FASDs are caused by a woman drinking alcohol during pregnancy. There is no known amount of alcohol that is safe to drink while pregnant. There is also no safe time to drink during pregnancy and no safe kind of alcohol to drink while pregnant. To prevent FASDs, a woman should not drink alcohol while she is pregnant, or even when she might get pregnant. This is because a woman could get pregnant and not know for several weeks or more. In the United States, half of pregnancies are unplanned. Signs and Symptoms FASDs refer to the whole range of effects that can happen to a person whose mother drank alcohol during pregnancy. These conditions can affect each person in different ways, and can range from mild to severe. A person with an FASD might have: Abnormal facial features, such as a smooth ridge between the nose and upper lip (this ridge is called the philtrum) Small head size Shorter-than-average height Low body weight Poor coordination Hyperactive behavior Difficulty paying attention Poor memory Difficulty in school (especially with math) Learning disabilities Speech and language delays Intellectual disability or low IQ Poor reasoning and judgment skills Sleep and sucking problems as a baby Vision or hearing problems Problems with the heart, kidneys, or bones   Types of FASDs Different terms are used to describe FASDs, depending on the type of symptoms. Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) 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. The term fetal alcohol effects (FAE) was previously used to describe intellectual disabilities and problems with behavior and learning in a person whose mother drank alcohol during pregnancy. In 1996, the Institute of Medicine (IOM) replaced FAE with the terms alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). Diagnosis The term FASDs is not meant for use as a clinical diagnosis. CDC worked with a group of experts and organizations to review the research and develop guidelines for diagnosing FAS. The guidelines were developed for FAS only. CDC and its partners are working to put together diagnostic criteria for other FASDs, such as ARND. Clinical and scientific research on these conditions is going on now. Diagnosing FAS can be hard because there is no medical test, like a blood test, for it. And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS. To diagnose FAS, doctors look for: Abnormal facial features A person with FAS has three distinct facial features: Smooth ridge between the nose and upper lip (smooth philtrum) Thin upper lip Short distance between the inner and outer corners of the eyes, giving the eyes a wide-spaced appearance. Lower-than-average height, weight, or both Children with FAS have height, weight, or both that are lower than normal (at or below the 10th percentile). These growth issues might occur even before birth. For some children with FAS, growth problems resolve themselves early in life. Central nervous system problems The central nervous system is made up of the brain and spinal cord. It controls all the workings of the body. When something goes wrong with a part of the nervous system, a person can have trouble moving, speaking, or learning. He or she can also have problems with memory, senses, or social skills. There are three categories of central nervous system problems: 1. Structural FAS can cause differences in the structure of the brain. Signs of structural differences are: Smaller-than-normal head size for the person’s overall height and weight (at or below the 10th percentile). Significant changes in the structure of the brain as seen on brain scans such as MRIs or CT scans. 2. Neurologic There are problems with the nervous system that cannot be linked to another cause. Examples include poor coordination, poor muscle control, and problems with sucking as a baby. 3. Functional The person’s ability to function is well below what’s expected for his or her age, schooling, or circumstances. To be diagnosed with FAS, a person must have: Cognitive deficits (e.g., low IQ), or significant developmental delay in children who are too young for an IQ assessment. Or Problems in at least three of the following areas: Cognitive deficits (e.g., low IQ) or developmental delays Examples include specific learning disabilities (especially math), poor grades in school, performance differences between verbal and nonverbal skills, and slowed movements or reactions. Executive functioning deficits These deficits involve the thinking processes that help a person manage life tasks. Such deficits include poor organization and planning, lack of inhibition, difficulty grasping cause and effect, difficulty following multistep directions, difficulty doing things in a new way or thinking of things in a new way, poor judgment, and inability to apply knowledge to new situations. Motor functioning delays These delays affect how a person controls his or her muscles. Examples include delay in walking (gross motor skills), difficulty writing or drawing (fine motor skills), clumsiness, balance problems, tremors, difficulty coordinating hands and fingers (dexterity), and poor sucking in babies. Attention problems or hyperactivity A child with these problems might be described as “busy,” overly active, inattentive, easily distracted, or having difficulty calming down, completing tasks, or moving from one activity to the next. Parents might report that their child’s attention changes from day to day (e.g., “on” and “off” days). Problems with social skills A child with social skills problems might lack a fear of strangers, be easily taken advantage of, prefer younger friends, be immature, show inappropriate sexual behaviors, and have trouble understanding how others feel. Other problems Other problems can include sensitivity to taste or touch, difficulty reading facial expression, and difficulty responding appropriately to common parenting practices (e.g., not understanding cause-and-effect discipline). Prenatal alcohol exposure Confirmed alcohol use during pregnancy can strengthen the case for FAS diagnosis. Confirmed absence of alcohol exposure would rule out the FAS diagnosis. It’s helpful to know whether or not the person’s mother drank alcohol during pregnancy. But confirmed alcohol use during pregnancy is not needed if the child meets the other criteria Treatment FASDs last a lifetime. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. The Best I Can Be: Living with Fetal Alcohol Syndrome-Effects (Revised) (Mom's Choice Awards Recipient) Forfeiting All Sanity: A Mother's Story of Raising a Child with Fetal Alcohol Syndrome Fetal Alcohol Syndrome: A Guide for Families and Communities 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 A child who is diagnosed at a young age can be placed in appropriate educational classes and get the social services needed to help the child and his or her family. Early diagnosis also helps families and school staff to understand why the child might act or react differently from other children sometimes. Loving, nurturing, and stable home environment during the school years Children with FASDs can be more sensitive than other children to disruptions, changes in lifestyle or routines, and harmful relationships. Therefore, having a loving, stable home life is very important for a child with an FASD. In addition, community and family support can help prevent secondary conditions, such as criminal behavior, unemployment, and incomplete education. Absence of violence People with FASDs who live in stable, non-abusive households or who do not become involved in youth violence are much less likely to develop secondary conditions than children who have been exposed to violence in their lives. Children with FASDs need to be taught other ways of showing their anger or frustration. Involvement in special education and social services Children who receive special education geared towards their specific needs and learning style are more likely to reach their full potential. Children with FASDs have a wide range of behaviors and challenges that might need to be addressed. Special education programs can better meet each child’s needs. In addition, families of children with FASDs who receive social services, such as counseling or respite care have more positive experiences than families who do not receive such services. No two people with an FASD are exactly alike. FASDs can include physical or intellectual disabilities, as well as problems with behavior and learning. These symptoms can range from mild to severe. Treatment services for people with FASDs should be different for each person depending on the symptoms. Early Intervention Services There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development. Early intervention services help children from birth to 3 years of age (36 months) learn important skills. Services include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has an FASD or other developmental problem. Even if your child has not received a diagnosis, he or she might qualify for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children younger than 3 years of age who are at risk of having developmental delays may be eligible for services. The early intervention system in your state will help you have your child evaluated and provide services if your child qualifies. In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal diagnosis. Types of Treatments Many types of treatments are available for people with FASDs. They can generally be broken down into five categories: Medical Care Medication Behavior and Education Therapy Parent Training Alternative Approaches Medical Care People with FASDs have the same health and medical needs as people without FASDs. Like everyone else, they need well-baby care, vaccinations, good nutrition, exercise, hygiene, and basic medical care. But, for people with FASDs, concerns specific to the disorder must also be monitored and addressed either by a current doctor or through referral to a specialist. The types of treatments needed will be different for each person and depend upon the person’s symptoms. Types of medical specialists might include: Pediatrician Primary care provider Dysmorphologist Otolaryngologist Audiologist Immunologist Neurologist Mental health professionals (child psychiatrist and psychologist, school psychologist, behavior management specialist) Opthalmologist Plastic surgeon Endocrinologist Gastroenterologist Nutritionist Geneticist Speech-language pathologist Occupational therapist Physical therapist Medication No medications have been approved specifically to treat FASDs. But, several medications can help improve some of the symptoms of FASDs. For example, medication might help manage high energy levels, inability to focus, or depression. Prescription bottlesFollowing are some examples of medications used to treat FASD symptoms: Stimulants This type of medication is used to treat symptoms such as hyperactivity, problems paying attention, and poor impulse control, as well as other behavior issues. Antidepressants This type of medication is used to treat symptoms such as sad mood, loss of interest, sleep problems, school disruption, negativity, irritability, aggression, and anti-social behaviors. Neuroleptics This type of medication is used to treat symptoms such as aggression, anxiety, and certain other behavior problems. Anti-anxiety drugs This type of medication is used to treat symptoms of anxiety. Medications can affect each child differently. One medication might work well for one child, but not for another. To find the right treatment, the doctor might try different medications and doses. It is important to work with your child’s doctor to find the treatment plan that works best for your child. Behavior and Education Therapy Behavior and education therapy can be an important part of treatment for children with FASDs. Although there are many different types of therapy for children with developmental disabilities, only a few have been scientifically tested specifically for children with FASDs. Following are behavior and education therapies that have been shown to be effective for some children with FASDs: Friendship training Many children with FASDs have a hard time making friends, keeping friends, and socializing with others. Friendship training teaches children with FASDs how to interact with friends, how to enter a group of children already playing, how to arrange and handle in-home play dates, and how to avoid and work out conflicts. A research study found that this type of training could significantly improve children’s social skills and reduce problem behaviors.2 Specialized math tutoring A research study found that special teaching methods and tools can help improve math knowledge and skills in children with FASDs.3 Executive functioning training This type of training teaches behavioral awareness and self-control and improves executive functioning skills, such as memory, cause and effect, reasoning, planning, and problem solving. Parent-child interaction therapy This type of therapy aims to improve parent-child relationships, create a positive discipline program, and reduce behavior problems in children with FASDs. Parents learn new skills from a coach. A research study found significant decrease in parent distress and child behavior problems. Parenting and behavior management training The behavior and learning problems that affect children with FASDs can lead to high levels of stress for the children’s parents. This training can improve caregiver comfort, meet family needs, and reduce child problem behaviors. Parent Training Children with FASDs might not respond to the usual parenting practices. Parent training has been successful in educating parents about their child’s disability and about ways to teach their child many skills and help them cope with their FASD-related symptoms. Parent training can be done in groups or with individual families. Such programs are offered by therapists or in special classes. Although each child is unique, the following parenting tips can be helpful:4 Concentrate on your child’s strengths and talents Accept your child’s limitations Be consistent with everything (discipline, school, behaviors) Use concrete language and examples Use stable routines that do not change daily Keep it simple Be specific—say exactly what you mean Structure your child’s world to provide a foundation for daily living Use visual aides, music, and hands-on activities to help your child learn Use positive reinforcement often (praise, incentives) Supervise: friends, visits, routines Repeat, repeat, repeat Families might need support from a family counselor or therapist. Parents might also benefit from local support groups, in which parents of children with FASDs can discuss concerns, ask questions, and find encouragement. Alternative Approaches With any disability, injury, or medical condition, many untested therapies become known and are promoted by informal networks. These therapies are referred to as alternative treatments. Before starting such a treatment, check it out carefully, and talk to your child’s doctor. Your child’s doctor will help you weigh the risks and benefits of these therapies. Some of the alternative treatments used for people with FASDs include: Biofeedback Auditory training Relaxation therapy, visual imagery, and meditation (especially for sleep problems and anxiety) Creative art therapy Yoga and exercise Acupuncture and acupressure Massage, Reiki, and energy healing Vitamins, herbal supplements, and homeopathy Animal-assisted therapy Get Help! If you think your child might have an FASD, talk to your child’s doctor and share your concerns. Don’t wait! If you or the doctor thinks there could be a problem, ask the doctor for a referral to a specialist (someone who knows about FASDs), such as a developmental pediatrician, child psychologist, or clinical geneticist. In some cities, there are clinics whose staffs have special training in diagnosing and treating children with FASDs. To find doctors and clinics in your area visit the National and State Resource Directory from the National Organization on Fetal Alcohol Syndrome (NOFAS). At the same time, call your state’s public early childhood system to ask for a free evaluation to find out if your child qualifies for treatment services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call. Where to call for a free evaluation from the state depends on your child’s age: If your child is younger than 3 years old, contact your local early intervention system. To find the contact for your state, call the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285. Or visit the NICHCY website, select your state and look for the heading "Programs for Infants and Toddlers with Disabilities: Ages Birth through 3." Learn more about early intervention If your child is 3 years old or older, contact your local public school system. Even if your child is not old enough for kindergarten or is not enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated. If you’re not sure whom to contact, call the National Dissemination Center for Children with Disabilities (NICHCY) at 1-800-695-0285. Or visit the NICHCY website, select your state and look for the heading "Programs for Children with Disabilities: Ages 3 through 5."