Fetal Alcohol Spectrum Disorder (FASD)
To make an appointment
Call the New Brunswick Fetal Alcohol Spectrum Disorder (FASD) Centre of Excellence
Telephone: 506-862-3783
What is fetal alcohol spectrum disorder (FASD)?
- In Canada, over 1.4 million people are living with FASD.
- In Canada, over 3,000 children are born with FASD every year.
- In New Brunswick, about 250 children are born with FASD every year.
FASD describes the physical and/or neurodevelopmental disorder(s) affecting children whose mothers consumed alcohol during pregnancy.
In many cases, people with FASD do not have visible physical characteristics but their brain has been affected.
FASD refers to two medical diagnoses :
FASD with characteristic facial traits
- Combination of three characteristic facial traits
- Short palpebral fissure (small eyes)
- Flat philtrum (space between nose and upper lip, which is flat)
- Thin upper lip
- Prenatal exposure to alcohol confirmed or unknown
- Proof of gaps in at least three areas of neurological development or microcephaly in newborns and young children
FASD without characteristic facial characteristics
- Proof of gaps in at least three areas of neurological development
- Prenatal exposure to alcohol confirmed
“Risk of neurodevelopmental disorder and FASD associated with prenatal exposure to alcohol” is not a diagnosis but rather a category for people when:
- Prenatal alcohol consumption during pregnancy is confirmed;
- The person was too young when the assessment was performed or the assessment was incomplete because the person was unable to complete all the required tests.
Children born with fetal alcohol spectrum disorder (FASD) may have:
- A small head (microcephaly);
- Delayed growth;
- Problems with their heart or other vital organs;
- Problems with agitation or trouble sleep.
FASD may affect growth, the central nervous system, and sometimes the face.
In FASD cases, nearly one child out of 10 has facial abnormalities.
Babies may have trouble nursing, may cry a lot, or may sleep too much. People with FASD may refuse to eat or eat too much.
People with FASD are unpredictable.
The brain develops through the entire pregnancy from the 17th day after conception, i.e. the seventh week after the last menstrual period, when the new mother doesn’t yet know that she’s pregnant.
Alcohol affects brain development throughout the pregnancy.
- No time is safe. – No drinking must take place during the nine months of pregnancy.
- A sexually active woman who is not using contraception must not drink alcohol.
- No type of alcohol is safe during pregnancy.
- No amount of alcohol is safe during pregnancy.
Alcohol consumption during pregnancy can cause irreversible brain damage to an unborn child and result in lifelong difficulties in several areas.
Education
The person:
- Has problems at school, especially in math, reading, science, comprehension, organization, and abstract concepts.
Concentration and attention
The person:
- Is easily distracted, overexcited, inattentive, and hyperactive.
Thinking and reasoning
The person:
- Has difficulty reasoning, planning, problem solving, and understanding complex ideas.
Communication
The person:
- May express themselves correctly but without really understanding what they’re saying;
- May have language delays and difficulty understanding long conversations and instructions;
- Is able to repeat instructions but does not always follow them.
Memory
The person:
- Has problems with short- and long-term memory and working memory;
- Sometimes appears to be lying but is only filling in memory gaps when they can’t remember;
- Has trouble finding, selecting, organizing, and memorizing information.
Executive function
The person:
- Has trouble planning, linking ideas, solving problems, and organizing information;
- Has trouble understanding cause and effect relationships and foreseeing consequences;
- Has trouble controlling their emotions and is sometimes impulsive;
- Has trouble with transitions and changes;
- Often repeats the same mistakes;
- Has trouble with abstract concepts and time management.
Sensory area
The person:
- Is unable to accurately perceive what is going on around them;
- Is sensitive to light, noise, touch, odours, and food smells;
- May overreact or underreact to stimulation.
Everyday skills and social skills
The person:
- Does not always understand personal boundaries;
- Has trouble picking up social signals;
- Is sometimes socially vulnerable and easily exploited;
- Has trouble seeing things from someone else’s point of view;
- Lacks social and emotional maturity and sometimes acts like someone younger.
FASD is a lifelong disability. A child with FASD will become an adult with FASD.
Other terms used to describe FASD
In the past, various diagnostic terms have been used to describe the disorders caused by alcohol during pregnancy:
- Fetal alcohol syndrome (FAS);
- Prenatal alcohol exposure (PAE);
- Fetal alcohol spectrum disorder (FASD);
- Partial fetal alcohol syndrome (pFAS);
- Alcohol-related neurodevelopmental disorder (ARND).
Each individual with FASD has their own characteristics and is unique. Unfortunately, many children with FASD are labelled based on their difficult behaviours or their disabilities. Focusing on the problems or negative behaviours limits the possibilities and can sometimes conceal the person’s amazing strengths.
Focusing on the person’s strengths can make them more successful at school, at home, and in everyday activities. This helps build stronger ties with others, strengthen their self-esteem, and reduce their stress.
Structure, routine, and consistency help someone with FASD to manage their days better and experience everyday successes. People with FASD need structure in their daily activities because their brain has difficulty determining the necessary steps to accomplish these activities. We are unaware how much the brain plans every minute of every day, even for simple activities such as brushing your teeth, getting ready to go to school, or going through your bedtime routine.
Change is a source of confusion for people with FASD. Their brains have difficulty adapting to change and making transitions. Even the smallest change, such as putting the cereal away in a different cupboard, can trigger great confusion and a temper tantrum.
To help someone with FASD in their everyday activities, it is necessary to adopt a routine at home. As much as possible, their time must be planned. If a routine works, it must be continued and not changed!
It is essential to use visual supports and to divide tasks into simple components that can be done easily one at a time.
The damage to a fetus’s development during pregnancy depends on:
- The amount of alcohol consumed during the pregnancy;
- The point when alcohol is consumed during the pregnancy;
- The number of times that the fetus is exposed to alcohol during the pregnancy;
- How the mother’s body reacts to alcohol;
- How the fetus reacts to alcohol;
- The mother’s drug, medication, or tobacco use in addition to alcohol use;
- Exposure to x-rays, mercury, or certain other chemicals;
- Certain genetic factors of the mother or fetus.
Alcohol harms a fetus’s development. Mothers must not drink alcohol during pregnancy. No amount of alcohol is safe during pregnancy.
- A fetus’ brain develops throughout pregnancy; there is no safe time to drink alcohol during pregnancy.
- All types of alcohol harm the fetus (e.g. beer, wine, alcoholic drinks).
- Alcohol consumption is very dangerous to the fetus.
Here are the possible consequences of alcohol consumption during pregnancy:
- Child born with FASD;
- Miscarriage or stillbirth;
- Premature newborn or low birth weight baby;
- Permanent brain damage;
- Learning, memory, reasoning, and judgment problems;
- Vision or hearing problems;
- Slow growth;
- Birth defects (such as deformed bones or heart problems).
So why do women or girls drink alcohol during pregnancy?
- They don’t know they’re pregnant.
- They don’t know that alcohol is dangerous to a fetus.
- They underestimate the harm caused by alcohol since they know other women who drank during pregnancy whose children seem healthy.
- Drinking is the norm among their friends and it’s difficult for them to say no.
- They may drink to cope with difficult life circumstances such as violence, depression, poverty, or isolation.
- They may have an addiction to alcohol.
More than half of women drink alcohol before knowing they’re pregnant.
If a women learns that she’s pregnant, she must stop drinking as soon as possible and look after her health.
- If a woman drinks alcohol before knowing that she’s pregnant, she must speak to her doctor or nurse.
- If a pregnant woman is unable to stop drinking during her pregnancy, she must ask her doctor or nurse what support and services are available to help her.
- Non-alcoholic beer must be avoided. Some of these beers contain more alcohol than indicated on the label.
If a woman is pregnant or may become pregnant, she must not drink alcohol.
The fetus is developing through the nine months of pregnancy. Alcohol harms its development throughout the pregnancy.
No amount of alcohol is safe. If a woman is pregnant or planning a pregnancy, she must not drink alcohol.
A breastfeeding mom must not drink alcohol since it will enter her breast milk. The baby’s brain is growing even after birth.
It’s never too late to ask for help in stopping drinking.
A woman who reduces her alcohol consumption or stops completely at any point during her pregnancy will help her baby.
A woman who is having difficulty controlling her alcohol consumption or stopping drinking can ask for help from:
- Her doctor, midwife, or nurse;
- A Public Health nurse;
- Addiction Services.
The NB FASD Centre of Excellence provides prevention, diagnosis, intervention, and support services. The centre pays a great deal of attention to mothers’ needs and trauma and to previous trauma experienced by people with FASD and their families.
Prevention
FASD can be prevented.
To prevent FASD, a woman must not consume alcohol if she is pregnant or may become pregnant. For more information on alcohol and pregnancy, see the section “Pregnancy and alcohol.”
The Centre:
- Distributes information and delivers training and awareness-raising sessions with the goal of developing an FASD-free community;
- Distributes literature;
- Offers telephone or in-person consultations to pregnant women with addictions. Based on their needs, the Centre puts women in touch with mental health services, addiction services, and other community resources.
Diagnosis
It is recommended to assess children as early as possible to:
- Determine their needs;
- Reduce the impact of FASD on their development;
- Prevent secondary problems such as:
- Low self-esteem;
- Depression, anxiety;
- Failure at school;
- Drug and alcohol problems;
- Problems with the law;
- Inappropriate sexual behaviour.
FASD must be diagnosed by a specialized multidisciplinary team. This involves a physical assessment, language assessment, motor skills assessment, and brain and nervous system development assessment.
Initial assessment
The initial assessment determines whether a child’s behaviour and learning difficulties may be related to alcohol.
The first step is to confirm whether the mother consumed alcohol or other substances during pregnancy that could have affected the fetus.
Tobacco, radiation (x-rays), mercury, certain chemicals, illegal drugs, and even some prescription medications (e.g. antidepressants) can harm the fetus and magnify the effects of alcohol.
If the child or adolescent meets the admission criteria, they are referred for a diagnostic assessment.
Admission criteria for a diagnostic assessment
- Permanent resident enrolled in New Brunswick Medicare
- Age: 0 to 18 years
- Alcohol consumption by mother during pregnancy (confirmed or suspected)
- Consent of the parent or guardian
- Developmental and behavioural disorders
When the Centre receives a referral, a community coordinator or First Nations liaison officer contacts the parents or legal guardian of the child or adolescent on a confidential basis. The coordinator or liaison officer offers:
- Help filling out administrative forms;
- Support to the family during the assessment;
- Support to the family after the diagnosis.
The initial assessment is done in consultation with:
- The child’s daycare or school;
- Mental health, legal, and social services (as needed).
If the first assessment is positive, the child is referred to the Dr. GeorgesL.Dumont University Hospital Centre, in Moncton, for a diagnostic assessment.
Diagnostic assessment in Moncton
The diagnostic assessment takes four days. The assessment is done at the Dr. GeorgesL.Dumont University Hospital Centre by a specialized team made up of a:
- Pediatrician;
- Occupational therapist and speech-language pathologist;
- Psychologist.
During the first three days, the child meets with the psychologist, occupational therapist, and speech-language pathologist.
On the morning of the fourth day, the pediatrician meets with the child and their family. The multidisciplinary team then meets to discuss the results of the child’s assessment. The child’s loved ones and caregivers are invited to attend this meeting. The multidisciplinary team then:
- Makes an accurate and complete diagnosis;
- Makes recommendations based on the child’s needs;
- Prepares the preliminary report that will be given to the family during the afternoon meeting.
Guests may include:
- The school principal, teachers, and guidance counsellor involved;
- Cultural interpreters;
- An addiction counsellor;
- Social workers;
- Staff from mental health services, correctional services, etc.
A meeting with the family or legal guardian takes place on the afternoon of the fourth day. That same day, the family or the legal guardian receives the diagnosis, a preliminary report, and recommendations.
After the diagnosis:
- If FASD is confirmed, the people taking care of the child and the staff in the child’s school (as well as other professionals involved in the lives of the child and their family) are invited to receive training on the condition. FASD involves permanent brain damage. The training helps people understand FASD and how to better help the child. It also helps the parents or tutor determine and obtain the support that the child will need during their life.
This assessment is helpful in finding the best ways to help children with FASD in their everyday lives.
Intervention and support
The regional community coordinators and the First Nations liaison officer:
- Work with the family and community to find the resources recommended at the time of diagnosis;
- Inform the family and community about the community resources available;
- Bring together health professionals working to raise awareness among their colleagues and the population about FASD and its consequences;
- Help people with FASD, their families, and caregivers before and after the diagnosis;
- Offer training to employers (to help them better understand their FASD employees) and to school, college, and university staff;
- Offer support and intervention services to children or adults with FASD.
Who can receive the centre’s services?
- The family of a child aged 0 to 18 who has been exposed to alcohol or other substances during pregnancy and the professionals supporting them
- An adult having been diagnosed with FASD and those providing supporting
Who can request the centre’s services?
- A health professional or a family member of a child
- The family of an adult having been diagnosed with FASD or someone taking care of that adult.
