About FASD
— The Overlooked Disorder
In 1996, the Institute of Medicine listed five diagnostic conditions under the Fetal Alcohol Spectrum Disorders (FASD) umbrella:
Type 1: Fetal Alcohol Syndrome (FAS) with confirmed maternal alcohol exposure
Type 2: FAS without confirmed maternal alcohol exposure
Type 3: Partial FAS with confirmed maternal alcohol exposure
Type 4: Alcohol-related birth defects (ARBD)
Type 5: Alcohol-related neurodevelopmental disorder (ARND)
In 2004, the Centers for Disease Control (CDC) clarified Type 1 FAS and added specific instructions for diagnosing each of the four criteria required for this condition: facial dysmorphia (abnormalities), growth problems, Central Nervous System abnormalities, and prenatal alcohol exposure (maternal drinking during pregnancy).
It is well established in the literature that alcohol is a teratogen that can cause extensive damage to the developing fetus. This damage typically involves the brain, which develops throughout the full nine months of gestation. In general, the more prenatal exposure to alcohol, the more damage to the developing brain within the fetus. However, we also know that even small amounts of alcohol on a regular basis or occasional binge drinking during pregnancy can affect brain development and related cognitive-behavioral functioning. Thus, mothers who drink only in the first weeks of pregnancy before they learn they are pregnant may expose their unborn children to the damaging effects of alcohol just like mothers who binge-drink and/or drink regularly throughout pregnancy. Some drugs can cause cognitive-behavioral dysfunction as well (e.g., cocaine). Most women with histories of drug use typically drink alcohol along with their drug use.
FASD conditions generally involve a complex combination of abnormalities that can have profound and lifelong effects on an individual’s ability to function in an organized and pro-social manner. Research has established that if FASD conditions are not diagnosed early in childhood and appropriately treated, a significant percentage of affected individuals will display adverse outcomes ("Secondary Disabilities") in adolescence and adulthood. One of these adverse outcomes is criminal behavior.
Unfortunately, there are very few specialists in the United States who are trained to diagnose and treat these conditions because education about FASD is not part of the standard curriculum in any medical school or graduate psychology program. As a result, most medical doctors and psychologists enter the workforce with limited knowledge about a condition that can involve significant and permanent brain damage. Because the observable physical manifestations of FAS (i.e., facial abnormalities and growth deficits) generally disappear during puberty, FASD conditions are difficult to detect in adolescents and adults, even for physicians trained in dysmorphology. Consequently, it is generally accepted in the field that accurate diagnosis of individuals over the age of 12 must involve multidisciplinary analysis from multiple perspectives, with emphasis necessarily on the neurological and cognitive-behavioral symptoms of FASD in lieu of observable facial dysmorphology and growth deficits.