How Does FAS Affect People?

Fetal alcohol spectrum disorder (FASD) describes a group of permanent symptoms experienced by people who were exposed to alcohol in utero (during pregnancy). There are currently five conditions that make up FASD, including fetal alcohol syndrome (FAS).

FAS is characterized by prenatal alcohol exposure (PAE), craniofacial (head and face) differences, neurodevelopmental abnormalities (including behavioral issues), and growth impairment. Unfortunately, up to 5% of first graders in the United States have FASD.

Although FAS is an incurable lifelong condition that is underdiagnosed, treatment can improve its symptoms. This article will discuss the symptoms, diagnosis, treatment, and prevention of FAS in children and adults.

Fetal Alcohol Syndrome: Facial to Behavioral Effects

Prenatal alcohol exposure is the leading preventable cause of congenital (present at birth) conditions in the United States. When consumed during pregnancy, alcohol crosses the placenta and enters the fetus’s bloodstream.

The result of alcohol on a developing fetus can lead to craniofacial differences, growth impairment, neurodevelopmental disabilities, and behavioral issues. Research shows that alcohol exposure at specific times during pregnancy can affect the brain in various ways, resulting in a spectrum of brain disorders.

Although severe FAS can be recognized at birth, diagnosis is usually made between 8 months and 8 years old when the features of FAS are most prominent, with one study finding an average diagnosis age diagnosis of 4 years old. Here are the common symptoms of fetal alcohol syndrome.

Head and Face Symptoms

Craniofacial symptoms of FAS in children and adults may include:

• Microcephaly (small head)
• Low nasal bridge
• Wide-set narrow eyes
• Mild ear anomalies
• Smooth ridge between the upper lip and nose
• Thin upper lip
• Micrognathia (small jaw)
• Short neck

Growth Impairment and Physical Symptoms

Growth impairment and other physical symptoms of FAS in children and adults can include:

• Small brain size
• Short stature
• Low body weight
• Poor coordination
• Poor vision and/or hearing
• Sleeping/sucking problems as a baby

Neurodevelopmental Symptoms

Neurodevelopmental symptoms of FAS in children and adults may include:

• Developmental delays
• Poor concentration
• Inability to problem-solve
• Attention deficit
• Poor organizational skills
• Speech problems
• Memory issues
• Lack of cause-and-effect reasoning
• Dysmaturity (varying levels of maturity)

Behavioral Symptoms

Behavioral symptoms of FAS in children and adults can include:

• Anxiety
• Depression
• Impulsiveness
• Mental health problems
• Poor academic experience (suspension, expulsion, dropping out)
• Legal troubles (incarceration)
• Sexual promiscuity
• Requiring dependent living

FAS in Adults

Children don’t outgrow FAS. It is a lifelong condition affecting people through adulthood. However, most studies have not researched FAS symptoms in people over the age of 30.

Although more research is necessary, some studies show that the craniofacial differences of people with FAS may improve during or after adolescence. The traits most likely to persist are a thin upper lip and a smaller head circumference.

Physical symptoms such as growth impairment remain unchanged during adulthood, with persistent shorter stature. Brain maturation can become prolonged, and aging can accelerate.

Unfortunately, people with FAS are more likely to experience legal troubles, have secondary mental health diagnoses, and have higher rates of suicide. People with FAS have better outcomes if they experience a supportive and loving environment during childhood.

One study found life expectancy is significantly reduced compared to people without FAS (most often due to external causes such as suicide, accidents, or overdose of alcohol or drugs).

Quantity of Alcohol Linked to Fetal Alcohol Syndrome

There is no safe amount of alcohol at any time during pregnancy. Even a small amount of alcohol can have adverse effects on a growing fetus. Alcohol seems most damaging in the first trimester (three months) of pregnancy but can affect the fetus at any time during the pregnancy.

A U.S. study of pregnant adults from 2018–2020 found 13.5% reported current drinking and 5.2% reported binge drinking in the past 30 days. Binge drinking and regular heavy drinking are associated with a higher risk of FAS.

A single episode of binge drinking, especially during the first few weeks of pregnancy, can lead to FAS. Having four or more drinks within two hours is considered a single binge-drinking episode for females.

Because many people do not know they are pregnant during those first few weeks, the risk of FAS increases if you drink alcohol and have unprotected sex.

Types of Fetal Alcohol Syndrome

Alcohol was not viewed as dangerous for pregnant people until 1973 when the diagnosis of FAS was first implemented. However, the Food and Drug Administration (FDA) did not make a public awareness announcement about the side effects of alcohol use during pregnancy until 1977.

Since that time, additional disorders associated with prenatal alcohol exposure have been discovered, leading to the term FASD. Each condition is diagnosed based on a set of specific characteristics, including evidence of PAE, facial dysmorphology, neurodevelopmental problems, and growth impairment. Here are the disorders that make up FASD:

• Fetal alcohol syndrome (FAS): The most advanced form of FASD, which expresses all the symptoms of FASD.
• Partial fetal alcohol syndrome (pFAS): Evidence of prenatal alcohol exposure expressing only a few of the diagnostic characteristics of FASD.
• Alcohol-related neurodevelopment disorder (ARND): Evidence of prenatal alcohol exposure and neurodevelopmental disabilities (cognitive and behavioral problems) but lacking in facial dysmorphology and growth impairment.
• Alcohol-related birth defects (ARBD): Evidence of prenatal alcohol exposure and congenital malformations, such as heart, kidney, and/or other malformations. ARBD is often accompanied by other FASD conditions.
• Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE): A psychiatric diagnosis confirming prenatal alcohol exposure and neurodevelopmental disabilities in three areas—thinking, behavior, and life skills.

Goal of Fetal Alcohol Treatment

Unfortunately, there is no cure for FAS. Treatment focuses on controlling the symptoms of the condition. Treatment strategies for FAS include nonpharmacologic and pharmacologic interventions.

Lifelong treatment is required and is more effective if collaborative care coordination occurs between all professional agencies. The families of people with FAS should also be included in treatment interventions.

Nonpharmacologic Treatment for FAS

Treatment without medications includes:

• Early intervention: Knowing early on if your child has FAS can significantly improve their development and quality of life. Many states provide early intervention services for children with FAS. If you suspect your child has FAS, reach out to your healthcare provider as soon as possible to start treatment.
• Multidisciplinary team: A team consisting of medical, psychological, behavioral, and social work professionals is essential for people with FAS.
• Parenting training: Parenting children with FAS can be difficult because they learn and cope differently. Participating in parent training teaches parents what they need to know to raise a child with FAS.
• Environment: Children with FAS who grow up in a supportive, loving, and kind environment have better outcomes than those who don’t.
• Nutrition: Studies show that children with FAS may not be getting enough protein, omega 3-fatty acids, various vitamins and minerals, and choline. Ensuring proper nutrition is essential for brain growth, especially for those with FAS.
• Exercise: There is growing evidence that exercise improves memory and brain function. Although more research is necessary, people with FAS most likely benefit from daily exercise.
• Behavioral interventions: Children and adults with FAS should be referred for services that provide mental health support, therapy, education, employment opportunities, criminal justice mitigation, healthy hygiene practices, and dependent living skills.
• Alternative therapies: Other ways to treat FASD include pet therapy, art therapy, yoga, relaxation, biofeedback, and acupuncture.

Pharmacologic Treatment for FAS

An estimated 50–90% of people with FASD are also diagnosed with attention deficit hyperactivity disorder (ADHD), and many other people have secondary mental health disorders such as depression and anxiety.

The use of stimulants in FAS is mixed. Some studies show it helps reduce hyperactivity but has little effect on improving attention.

First-line treatments for children with ADHD and FAS include methylphenidate- and amphetamine-derived stimulants.

• Methylphenidate stimulants: Ritalin (methylphenidate hydrochloride) and Concerta (methylphenidate hydrochloride)
• Amphetamine stimulants: Adderall (dextroamphetamine-amphetamine), Xelstrym (dextroamphetamine)

Non-stimulant medications that may be effective in some people with FAS are:

Other medications that treat the side effects of FAS include:

Abstaining From Alcohol to Prevent Fetal Alcohol Syndrome

The good news about FAS is that it is 100% preventable. About half of the pregnancies in the United States aren’t planned, leaving the opportunity for accidental alcohol use in the first few pivotal months of gestation.

If you are having unprotected sex and not using birth control, you must abstain from alcohol. The U.S. surgeon general also recommends abstaining from alcohol if you’re trying to conceive. If you’re currently pregnant, it’s never too late to stop drinking—reach out to a healthcare provider if you need help quitting alcohol.

Summary

FASD is caused by prenatal alcohol exposure, which is the leading preventable cause of congenital conditions in the United States. There are currently five types of FASD, including FAS, diagnosed by prenatal alcohol exposure, craniofacial dysmorphology, growth impairment, and neurodevelopmental problems.

FAS is permanent and incurable. Although there is no treatment for FAS, there are strategies that can improve its symptoms. No amount of alcohol at any point during pregnancy is safe. If you are consuming alcohol and trying to become pregnant or you are currently pregnant, reach out to a healthcare provider for help quitting.