What is Foetal Alcohol Spectrum Disorder? (FASD)

FASD covers a range of neurological impairments that may transpire in a child or adult, when their mother drank during pregnancy. FASD affects everyone differently, this is because each individual will have damage to different parts of their brain. FASD can cause structural impairments (small head) and functional damage which can be physical, behavioural, mental, and/or learning difficulties.

The FASD Range:

FAS: Foetal Alcohol Syndrome

FAS is at the extreme end of the spectrum. A person with FAS with have distinct facial features including a smooth philtrum, thin upper lip and small palpebral fissures. They will be lower than average in height, weight or both and will have abnormalities to the central nervous system and/or neurological function.

pFAS: Partial Foetal Alcohol Syndrome

This is when a person has a history of prenatal alcohol exposure and has some but not all the FAS criteria,

ANDR: Alcohol-Related Neurodevelopment Disorder

A person with ANDR will not have facial abnormalities or growth problems, but they would have problems with how their brain and nervous system functions and may include learning and behaviour difficulties, nerve and/or brain abnormalities.

ARBD: Alcohol-Related Birth Defects

ARBD affects how organs are formed and function, including the heart, kidneys, bones, hearing and vision.

ND-PAE: Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure

An individual with ND-PAE would have impairment of adaptive functioning, self-regulation and neurocognition.

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FASD can be difficult to diagnose, there is no specific test that can cover the diverse range of signs and symptoms. FASD also crosses over with many other disabilities and disorders such as ADHD and Attachment Disorder. Therefore, to make a diagnosis a Paediatrician would evaluate all possible information including physical, developmental, behaviour, day to day functioning, educational development, genetic testing (to rule out any genetic disorders and known background history of prenatal exposure to alcohol.

Treatment:

Foetal Alcohol Spectrum Disorder lasts a lifetime there is no cure or quick fix. However, research has shown that early diagnosis can help to support a child to reach their potential, improving a child’s development and life. There are a variety of treatments available including but not limited to, CBT, educational interventions, parent training and developmental services.

When we adopted Dave and Tilly, we made a decision to use Therapeutic Parenting Strategies. These strategies definitely work best for our children especially Dave, but are not always easy to maintain, especially when my basket is full! It is at these times, when I slip back into my previous Parenting mode, that I am soon reminded they do not work. At times, Therapeutic Parenting can be difficult, you will not always get it right. Identifying your own triggers will help you to make better choices. For me, when Dave is in full on melt down mode, I am very calm, but when Dave he is in the answering me back like a teenager mode or oppositional defiant mode that can trigger my previous Parenting mode. Mark and I try to work as a tag team, if one of us is not able offer a Therapeutic response we let the other take over.

Therapeutic Strategies include but are not limited to:

The following strategies are aimed at Primary age children. However, there are a variety of strategies for infants, toddlers, teenagers and adults too.

Clear boundaries and consequences: We use natural consequences such as if it is broken you can no longer use i. We have clear routines throughout the day. We have routines for

· Getting up

· Breakfast

· School day

· Lunch

· Play/activities

· Tea

· Bedtime

Attention problems: Structuring the day helps, we use visual calendars and timetables that I make using an app called Widget. Repetition is the key to a successful day. At the beginning of the week, we compile a menu for Breakfast, Lunch and Tea for the whole week because Dave likes to know what he his eating. Compiling this list eliminates some of his anxiety around eating

Tantrums or frustration: We find that Dave enjoys swinging (we have two in the garden) and rocking we have a see-saw, we also have a sand pit. When they are needing a break, they will go out into the garden and use the swings, see-saw and sand to self-regulate, we feel one of the benefits of Home-Schooling is that Dave and Tilly can go out into the garden whenever they feel they need a break. Music and Dancing works well for Tilly but not always for Dave.

In February 2021 Dave was diagnosed with FASD pending his genetic test results.

Source: CHAM, NHS, Adoption UK

Recommended reading: Foetal Alcohol Spectrum Disorder: Parenting a child with an invisible disability. By Julian Brown and Dr Mary Mather

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