What Physicians Need to Know
Fast Facts:
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FASD is a spectrum disorder, like Autism
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The face does not count. 10% of affected people have FAS. 90% have the same brain damage but no outward physical signs of the disorder.
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FASD prevalence: 2 to 5% of every American has this disorder (CDC, 2014)
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FASD is much more common in key groups: foster care, adoption, criminal justice, mental health and homeless
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75% have a normal IQ. Adaptive functioning is typically significantly lower than IQ
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Cognitive, learning and behavior difficulties in a complex disorder
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90% co-occurrence of alcohol and drug use in pregnancy; Alcohol does the most damage
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Most affected persons are misdiagnosed or undiagnosed. Diagnosis by age 6 strongly predicts a better outcome in adulthood (IOM).
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Early intervention, specific to the diagnosis, is key
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Choline given during pregnancy and infancy can help to reverse some of the brain damage
Medical Professionals
People with Fetal Alcohol Spectrum Disorder are medically high-risk patients. Prenatal alcohol exposure can damage the development of every organ system in the body, depending upon the timing of exposure and when a specific organ develops. In addition to direct damage, prenatal alcohol exposure causes epigenetic changes, altering the function of genes in the body. Over 400 health conditions are co-morbid with FASD.
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AAP recommends a medical home with case management being vital
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Heart, lung, and skeletal difficulties are common birth defects.
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Diseases of aging are common in young adults
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90-95% of people with an FASD are diagnosed with a mental health problem
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23% will attempt suicide
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Atypical and severe reactions to psychotropic, seizure and pain medications
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Almost all are diagnosed with ADHD but research shows a different area of the brain is affected - reduced response to medication.
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Current mean life expectancy: 34 years
Before being identified as high-risk patients, a person with FASD first needs to be identified as having the disorder. Identification of health problems early on will lead to better outcomes and life expectancy for this population.
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Popova, S. et al. Co-morbidity in Fetal Alcohol Spectrum Disorder: A Systematic Review and Meta-analysis. Lancet. 2016; Mar 5;387(10022):978-987
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FASD - A Whole Body Disorder
Screening for Prenatal Alcohol Exposure
An Implementation Guide for Pediatric Primary Care Providers
"Research over the past 50 years has underscored the harmful effects of alcohol on the developing fetus and subsequent lifelong physical, behavioral, and learning disabilities. Screening for prenatal alcohol exposure (PAE) is a key component of health supervision visits for newborns and new patients according to Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (4th Edition)."
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; f88 (ICD)
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ND-PAE 318.5 DSM 5
Common misdiagnoses include ASD, Bipolar Disorder, RAD, ODD/Conduct Disorder, Borderline Personality Disorder, etc. These disorders can also be co-morbid.
Diagnosing FASD
Success is Possible
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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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AAP recommends a medical home. A medical home model is appropriate for adult patients too.
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Need help navigating health care, social service, job, and developmental disability services
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Often needs 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, improper treatment, involvement in the criminal justice system, homelessness, etc. These poor outcomes can be avoided
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Both AGOG and AAP recommend screening of all patients for prenatal alcohol exposure.
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See the AAP FASD Toolkit