Fetal Alcohol Spectrum Disorders

by

Mary Velasquez, Diana Ling, Kirk von Sternberg

• LAST REVIEWED: 21 February 2022
• LAST MODIFIED: 21 February 2022
• DOI: 10.1093/obo/9780195389678-0313

Introduction

Fetal alcohol spectrum disorders (FASDs) describe a range of effects that can occur in children whose mothers drank alcohol during pregnancy. These effects can include lifelong behavioral and learning problems and, in some cases, physical problems. Fetal alcohol syndrome (FAS) is a condition associated with the most severe physical and functional impairments. While FAS and the corresponding abnormal facial features, growth, and central nervous system problems are best known, clinicians should recognize that FASDs refer to the entire spectrum of problems, from mild to the most severe FAS impairments. FASD, risky drinking, and alcohol use in pregnancy are timely topics for social work focus, as growing rates of heavy alcohol use and binge drinking among women present serious health consequences. In the United States, up to one in twenty US school children are living with FASD. Moreover, negative outcomes from alcohol use during pregnancy and FASD occur in every social, economic, and demographic group, among social drinkers as well as heavier drinkers. Social workers across practice settings can support positive health and social outcomes by learning more about FASD, participating in screening, assessment, and referrals; providing FASD-informed services; and advocating for individuals and families living with FASD. Two behaviors must occur simultaneously to put any woman at risk of an alcohol-exposed pregnancy (AEP): (a) drinking alcohol, and (2) not using contraception effectively or at all. Nearly half of all pregnancies in the United States are unintended, and over half of US women (53.6 percent) of reproductive age report using alcohol, with up to 29 percent of women aged 21 to 24 reporting binge drinking. Among pregnant women, 1 in 10 report drinking alcohol during pregnancy. When alcohol use and pregnancy occur together, a woman may have a child with FASD. Therefore, when considering how to prevent an AEP and a possible FASD, a discussion with a woman who is drinking alcohol must include whether she is using contraception effectively. Social workers can put prevention into practice by screening clients for risky alcohol use (alcohol screening and brief intervention), talking to women about their drinking and contraception, and providing counseling and referral when needed. The key message is simple: No amount of alcohol is known to be safe during pregnancy. Despite the prevalence of FASD and the lifelong problems it can cause for individuals and families, the literature on FASD is relatively sparse compared to other areas of study. However, a body of literature on prevention, screening, referral, and treatment for women who are at risk for alcohol-exposed pregnancies and some excellent resources for working with individuals and families with FASD, along with a number of excellent online resources, is growing.

General Overviews

Adubato and Cohen 2011 is an excellent book with chapters from leading experts in the field and a compilation of current research. Bertrand and Dang 2012 and Hagan, et al. 2016 provide current conceptualizations of the harmful effects of alcohol exposure during pregnancy along with general overviews of FASD diagnostic and treatment issues. May, et al. 2018 is a groundbreaking report on the prevalence of FASD in a large-scale study of first grade children in the United States, and Lange, et al. 2013 presents prevalence rates in a meta-analysis evaluating individuals across child-care systems, such as foster care and child welfare settings, in twelve countries. Popova, et al. 2019 provides a meta-analysis of international prevalence rates that expands on the settings in Lange, et al. 2013 to include children in correctional, special education, and specialized clinical settings as well as Indigenous populations. Velasquez, et al. 2015 provides an overview of decades of research on the history of FASDs, outlines the most recent evidence-based FASD prevention practices, and provides resources for clinicians in diverse settings. This book includes detailed suggestions about how to talk with women about alcohol and contraception and offers case examples and “clinical pearls” throughout to highlight information specifically tailored to clinicians. Riley, et al. 2011 is a compendium covering the history of FASD as well as current research and resulting policy changes; this comprehensive work also addresses prevention and treatment approaches. Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 is an invaluable resource for social workers. As part of SAMHSA’s Treatment Improvement Protocol (TIP) series, this comprehensive guide outlines evidence-based FASD prevention, screening, and interventions for the clinical setting. A section on implementation is particularly relevant for social workers who are agency directors and program administrators. Williams, et al. 2015 provides a comprehensive review of FASD, epidemiology, diagnostic criteria, and health and mental health effects. It also focuses on prevention, screening, and treatment practices. Importantly, this report also provides information on the costs and economic impact of FASDs, both for individuals and for their families.

• Adubato S. A., and D. E. Cohen. 2011. Prenatal alcohol use and fetal alcohol spectrum disorders: Diagnosis, assessment and new directions in research and multimodal treatment. Oak Park, IL: Bentham Science.

  This book presents a compilation of FASD research by many of the top scholars in the field. It offers advice on screening and diagnosis, prevention, ways to intervene with pregnant women, and treatment approaches to ameliorate the effects of FASD throughout the lifespan. This is often used as a textbook in graduate courses relevant to women and alcohol.

• Bertrand, J., and E. P. Dang. 2012. Fetal alcohol spectrum disorders: Review of teratogenicity, diagnosis and treatment issues. Handbook of children with special health care needs. Edited by David Hollar, 231–258. New York: Springer.

  DOI: 10.1007/978-1-4614-2335-5_12

  This chapter provides an overview of the abnormalities associated with FASDs, diagnostic criteria, treatment and interventions, prevalence, and policy implications. The chapter’s extensive coverage of FASD diagnostic criteria as well as a multidisciplinary framework for FASD diagnosis and treatment services is especially relevant for social workers and other providers.

• Hagan, J. F., T. Balachova, J. Bertrand, et al. 2016. Neurobehavioral disorder associated with prenatal alcohol exposure. Pediatrics 138.4: e20151553.

  DOI: 10.1542/peds.2015-1553

  This overview of neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) encompasses the behavioral and mental health symptoms of prenatal alcohol exposure for those with and without physical dysmorphia. Information related to ND-PAE clinical manifestation, diagnostic criteria and assessment, and service referral and case management is included. The coverage of diagnostic criteria, including differential and comorbid diagnoses, and ND-PAE services, is salient for social workers.

• Lange, S., K. Shield, J. Rehm, and S. Popova. 2013. Prevalence of fetal alcohol spectrum disorders in child care settings: A meta-analysis. Pediatrics 132.4: e980–e995.

  DOI: 10.1542/peds.2013-0066

  This meta-analysis of international studies provides an overview of the prevalence of FASDs and fetal alcohol syndrome (FAS) in child-care settings (e.g., orphanages, foster care, child welfare systems, adoption centers, and boarding schools). An important takeaway from the article is that the pooled prevalence rates of FASDs and FAS in child-care settings are substantially higher relative to the general population.

• May, P. A., C. D. Chambers, W. O. Kalberg, et al. 2018. Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA 319.5: 474–482.

  DOI: 10.1001/jama.2017.21896

  This article summarizes findings from a multi-site US study that investigated the prevalence of FASDs in four US regions. The study’s use of an active-case ascertainment approach is a significant strength, as this approach has been found to yield higher prevalence rates of FASDs in international and US studies. Importantly, study findings indicated that a substantial number of FASD-identified children had not received a prior diagnosis.

• Popova, S., S. Lange, K. Shield, L. Burd, and J. Rehm. 2019. Prevalence of fetal alcohol spectrum disorder among special subpopulations: A systematic review and meta-analysis. Addiction 114.7: 1150–1172.

  DOI: 10.1111/add.14598

  This meta-analysis of international studies expands on the work of Lange, et al. 2013 to provide the prevalence of FASDs and fetal alcohol syndrome (FAS) in special settings, including children in care, correctional, special education, and specialized clinical settings and Indigenous populations. The prevalence rate of FASDs and FAS in these settings was found to be ten to forty times that of the general population.

• Riley, E. P., S. Clarren, J. Weinberg, and E. Jonsson. 2011. Fetal alcohol spectrum disorder: Management and policy perspectives of FASD. Hoboken, NJ: Wiley-Blackwell.

  This book is a comprehensive resource for social workers and other providers. It covers the history of FASD as well as prevalence, prevention and treatment approaches, and policy implications.

• Substance Abuse and Mental Health Services Administration. 2014. Addressing fetal alcohol spectrum disorders (FASD). Treatment Improvement Protocol (TIP) 58. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  This is a comprehensive guide that outlines FASD prevention, screening, and intervention in clinical settings. It is an essential guide for any professional working with FASD-affected children, adults, and their families. The guide presents information regarding FASD screening and intervention for clinicians. Additionally, an implementation section on how to best incorporate the recommendations for FASD services is also presented for the consideration of agencies and program administrators.

• Velasquez, M. M., K. Ingersoll, M. Sobell, and L. C. Sobell. 2015. Women and drinking: Preventing alcohol-exposed pregnancies. Advances in Psychotherapy—Evidence-Based Practice 34. Toronto: Hogrefe.

  DOI: 10.1027/00401-000

  This book is geared toward psychologists, social workers, psychiatrists and other behavioral health providers. It summarizes the origins of FASD, issues associated with identification and diagnosis, and prevention and intervention strategies developed to decrease adverse pregnancy outcomes associated with alcohol-exposed pregnancies. The authors include “clinical pearls” and case vignettes throughout, and also describe “CHOICES,” a series of clinical trials from several federally funded prevention studies.

• Williams, J. F., V. C. Smith, and AAP Committee on Substance Abuse. 2015. Fetal alcohol spectrum disorders: Clinical report. Pediatrics 136.5: e1395–e1406.

  This report provides a comprehensive review of FASD, epidemiology, diagnostic criteria, and health and mental health effects as well as prevention, screening, and treatment practices. The report also contains important content on the health-care costs and overall economic effects associated with FASD for impacted individuals and families. Additionally, extensive information is presented regarding best practices for screening, intervention, and case management for health-care providers.