Most likely, you will need to bring up FASD to your doctor because the majority of doctors are not familiar with it.  In addition, FASD is a great impersonator, meaning its symptoms can look a lot like other disorders - ADHD, SPD, ODD, RAD and more.  If your loved one has an alphabet soup of diagnoses, and alcohol was consumed or suspected in-utero, it's time to talk to your doctor.  Proof Alliance (formerly MOFAS) has a good chart explaining the overlap of symptoms. 

The prevalence of FASD is between 2-5%, with at-risk groups such as foster care and adoption being higher. If you have a child whose history you are unsure of but was exposed to drugs in utero, the chance of alcohol usage is high.  

Use the Neurodevelopmental Profile List to get an idea of what FASD looks like at any age.  If you see symptoms, and you suspect or know of alcohol use inutero, it is time to talk to your doctor. 

Last thought on talking to your doctor.  Often a wait and see approach is advised, particularly with young children.  This is contraindicated for individuals with an FASD because people do not grow out of organic brain damage.  For the best outcome, people with an FASD need a diagnosis and intervention at an early age.  

Bringing photos of your loved one when they were an infant or toddler, may help identify facial features that become less prominent with age. Bring a clear history of the difficulties you have seen in your child, from infancy on. Records from school, such as IEPs, assessments, teacher reports and report cards are useful for insight.  Having clear examples of what you are concerned with at home is also important.  Filming aggressive behavior is recommended because it will bring clarity and speed up the process. Prepare to advocate strongly for your child.

Getting a diagnosis for your loved one is important.  It creates a platform for you to advocate from and it is considered a protective factor.  

At this time there are no diagnostic centers in Northern or Central California. NOFAS Northern California is working to change that - find out how. There are diagnostic centers in Southern California should traveling be an option.  If your child has the physical signs of the syndrome FAS, talk to your pediatrician about a referral to a geneticist or a developmental pediatrician.  Please be aware that these specialists may not recognize the disability.  A neuropsychologist can also diagnose if you are able to give them the appropriate information.  Writing out a timeline of history will help.  Please contact us for more information and help with your particular case or if you have a professional to recommend.  

When is it time to talk to my doctor?

What information should I provide to my doctor?

How do I get a diagnosis?

 

Discussions with your doctor around co-morbid health conditions are important.  People of all ages with FASD are medically high-risk patients and should be treated as such.  

 

  • Seizures: Make sure that the neurologist knows that there is an FASD or a suspected FASD.  Epilepsy occurs far more often. In addition, the response to medication for seizures appears to be different in affected people, with toxicity developing below therapeutic doses. 

  • Osteoporosis and osteopenia are common. If your loved one has these conditions or has multiple fractures talk with your physician.

  • Autoimmune disorders are also more common, especially in the adult years. 

  • A young adult may have signs of osteoarthritis, which typically occurs in older adults. Let the physician know this is part of FASD. Diseases of aging occur in FASD in young adulthood.

  • Difficulty with middle ear problems typically go away as a child gets older. This is not true in FASD.  Hearing loss is far more common.

  • Vision difficulties are also common.

  • Metabolic disorders occur often, especially in women starting in young adulthood.

  • Respiratory illness in the first few weeks of life is a red flag for FASD

  • Severe response to the flu

  • Suicide attempts occur more often. Let your physician or mental health provider know that “lethality of intent” is not a reliable way for them to assess who is most at risk.

  • Response to pain, seizure and psychotropic medication is often atypical and can include severe reactions. The recommendation is to start low and make medication changes slowly.

  • FASD is a common cause of birth defects. Heart and kidney defects occur.

  • Sleep disorders 

  • GI problems are common

Resource:

Popova, S. Co-morbidity of fetal alcohol spectrum disorder: A systematic Review and meta-Analysis. Lancet. 2016; 387 (10022), 978-987. 

Specific Medical Concerns and FASD

Regardless of their level of functioning, people with FASD tend to have the same generalized deficits - executive function, attention, working/visuospatial memory, language comprehension, abstract reasoning, adaptive behavior, emotional/behavioral functioning, and social cognition. Overall, people with FASD often have a profile where their developmental age is much younger than their chronological age.

Neurodevelopmental Profile