The term Fetal Alcohol Spectrum Disorder [FASD] embraces Fetal
Alcohol Syndrome [FAS], Partial Fetal Alcohol Syndrome and Alcohol
Related Neurodevelopmental Disorder [ARND].
The absence of the FAS facial features does not exclude the diagnosis of
brain damage from prenatal exposure to alcohol. Only 10% of those
afflicted will have the facial features. Only 15% will have an IQ below 70.
85% will have a normal range IQ or higher than average IQ. However, all
those afflicted with FASD have a low Adaptive Quotient as measured by
tests such as the Vineland Adaptive Behavior Scales.
Those afflicted with FASD demonstrate primary and secondary disabilities
to varying degrees depending on the quantity of alcohol taken, the
manner it is drunk eg binge drinking, the time in the pregnancy and the
health and nutrition of the mother.
Primary disabilities are the inevitable consequences of prenatal exposure
-Impaired spacial learning
-confabulation - often interpreted as lying
-attention disorders, easily distracted and perseveration -
-sensory problems- self mutilation
-impaired executive functioning i.e forming, planning and achieving goal
-low I.Q. [15% only ]]
-comorbid psychiatric illnesses [previously considered to be a secondary
-memory problems, short term memory for verbal and visual recall. [
when the verbal processing is good and visual poor it is known as a nonverbal
learning disability ]
These primary disabilities lead -
-to difficulty communicating-giving and receiving information
-takes everything literally - concrete thinking
-problems with planning and organizing
-impulsiveness, poor judgment, easily lead
-failure to learn from experience
-difficulty with abstractions, idioms, humor, sarcasm
-difficulty relating cause and effect, anticipating consequences
-difficulty appreciating others point of view
-problems expressing remorse or taking responsibility for behavior -frustration.
-bowel and micturition control problems
FASD is not just a central nervous condition. It also effects the peripheral
nervous system. Those afflicted with FASD have sensory abnormalities.
They may be over sensitive or under sensitive. Under sensory means
that they are less sensitive to external stimuli. They are less sensitive to
cold or physical pain. They have a need for sensory stimulation resulting
in inappropriate hugging and touching. Repetitive scratching, pulling hair
out, and more severe kinds of self mutilation [often interpreted as OCD
or attention seeking] provides comfort, especially in times of stress, that
others obtain from more normal sensory stimulation.
It is my observation that those with FASD exist in two states, 1 -a mind of chaotic,
uncontrolled and uncomfortable thoughts, usually described as being bored. and 2- a mind perseverating [ super focussed ], with or without physical activity.
They seek the second to escape the first.
What they perseverate on is determined by their particular set of cognitive, emotional, information processing, memory, expressive and sensory disabilities; as well as their early childhood experience and their immediate environment, including how others relate to them.
What they may perseverate on to soothe themselves extends from cutting, provoking others, to more acceptable behaviors, such as playing video games, reading and sports.
Alcohol and hard drugs are used to obliterate the 1st state of mind. Those with FASD can often stop using them providing they have an alternative focus of perseveration.
This is not true of Marijuana and Tobacco, which generally appear to have a specific action that reduces their multiple chaotic thoughts and allows them to focus on one process.
The “medicinal” use of pot is lost if it is used to excess, in which case it assumes the harmful role of other street drugs.
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The secondary disabilities are
-disrupted school experience
-trouble with the law
-inappropriate sexual behavior
-alcohol and drug problems -dependent living
-problems with employment
Previously mental health problems were considered to be a secondary
disability. It is now apparent that they are primary disability. 94% of those
with FASD will develop more than one psychiatric illness [comorbidity] as
defined in the Diagnostic and Statistical Manual of Mental Disorders [DSM].
Secondary disabilities are mitigated by a stable, nurturing home
environment and an early diagnosis. It is important to note however, that
serious secondary disabilities may still occur in spite of these positive
conditions being met.
The diagnosis is ideally made by a team of professionals using the 4-Digit
Diagnostic Code. The FAS Clinic at St. Michaelʼs Hospital, Toronto uses
this method. A history of maternal drinking is required unless the FAS
facial features are present.
Psychometric evaluation, including tests such as the Vineland Adaptive
Behavior Scale is required. Early childhood development and subsequent
school and social progress are reviewed.
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