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by Sally Willbanks
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Fetal Alcohol Spectrum Disorder, or FASD, is the most common preventable cause of birth defects in the world, and yet I had never heard of it before.  It is 2.5 times more common than autism, and research suggests that between 3.1% and 9.9% of children in the US have it (numbers are as high as 18% in the UK. 18%!!).  How is FASD so prevalent but so unheard of?


FASD is a lifelong, brain-based disability that is caused by prenatal alcohol exposure.  Early intervention for people with FASD is extremely important, so diagnosing early is essential.  People with FASD can experience intellectual and/or behavioural problems that are lifelong and can become more complicated without intervention.  Sometimes children with FASD are recognizable due to small stature and specific facial characteristics (these could include: a smooth philtrum – the space between lip and nose; a thin upper lip; an upturned nose; flat nasal bridge and midface; epicanthal folds; and a small head circumference).  Not all children have these facial characteristics.  The other symptoms to look out for are very similar to the traits of autism and ADHD.  These include:


Impaired executive functioning

Impaired working memory

Poor behavioural regulation


Attention difficulties

Language difficulties

Sensory regulation difficulties



Poor motor skills

Poor social cognition



So, how do we tell the difference between FASD and autism/ADHD?  This is a difficult one. Often children with FASD are also autistic, and the most common comorbidity of FASD is ADHD.  The good news is that the early interventions for both are similar.  Speech, occupational, physical and behaviour therapies can help, as can some medications.  It is important to note that in people with FASD, ADHD meds do not necessarily help with ADHD-like symptoms and may cause aggression.  Parenting children with FASD is just as challenging as parenting autistic and ADHD children.  Typical discipline strategies do not work, as children with FASD aren’t able to learn or respond in the same way.  Most children with FASD do better with repetition and routines, consistency, structure, simplicity, simplified language and, of course, supervision.  As you can see, the crossovers between FASD, autism and ADHD are many.


FASD is not bound by gender, race or socioeconomic status.  Information on FASD needs to be more widespread so that women understand the dangers of drinking alcohol while pregnant, and so men and family members recognize the importance of supporting women through their abstinence.  While we celebrate neurodiversity, we appreciate that FASD is not genetic, and steps should be taken to educate the general public on this disability.

by Sally Willbanks


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