FAS and FASD Clinical Indicators

FAS

The diagnosis of fetal alcohol syndrome (FAS) is based on four criteria:

1. prenatal alcohol exposure (confirmed or unconfirmed)

2. growth retardation

3. facial characteristics

4. neurodevelopment problems

See below for the specific clinical criteria for diagnosing FAS:

Growth deficits

Prenatal or Postnatal weight: < 10th percentile
Prenatal or Postnatal length or height: < 10th percentile

Facial characteristics

An individual must exhibit the three following features:

• Smooth philtrum

• Thin vermillion

• Small palpebral fissures

CNS abnormalities

There must be an abnormality in one or more of these three categories:

• Structural

• Neurological

• Functional 

Structural abnormalities:

• Head circumference at or below the 10th percentile

• Observation of abnormal brain structure from image studies

Neurological abnormalities:

• Neurological symptoms are not due to an external factor such as an insult or fever

• Deficits in neurological activity such as poor coordination, visual motor difficulties, nystagmus, or difficulty with motor control

Functional abnormalities:

• Evidenced by either global cognitive or intellectual deficits, or functional deficits.

• Global cognitive or intellectual deficits- Below the 3rd percentile or 2 standard deviations below the mean for standardized testing

• Functional deficits below the 16th percentile in at least three of the following: cognitive or developmental deficits, executive functioning, motor functioning delay, problems with attention or hyperactivity, poor social skills, or other (such as sensory problems, memory deficits)

Alcohol is a recognized human teratogen that can produce FAS and a variety of alcohol-related effects. The fetal brain is particularly sensitive to alcohol during the period of rapid growth in the third trimester. After exposure, the cerebral cortex exhibits abnormal patterns in the distribution of neurons and abnormal neurotransmission. The hippocampus and cerebellum have decreased cell numbers and altered neurochemical activity. The corpus callosum appears to be absent or poorly developed in many children, as shown by MRI testing. The size and volume of the cerebellum and basal ganglia are reduced.

There are many long-term effects of FAS. The majority of children who have been followed into adulthood have problems leading independent lives. Many young adults who do not receive appropriate support are unable to maintain continuous education, employment and relationships with family, friends and partners. Additionally, many have legal problems.

FASD

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.

FASD covers other terms such as fetal alcohol syndrome, alcohol-related neurodevelopmental disorder (ARND), partial fetal alcohol syndrome (PFAS), alcohol-related birth defects (ARBD) and fetal alcohol effects (FAE). People affected by FASD can have brain damage; facial deformities; growth deficits; mental retardation; heart, lung and kidney defects; hyperactivity; attention and memory problems; poor coordination; behavioral problems; and learning disabilities.