(Other Health Impairments)
Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) includes fetal alcohol syndrome (FASDs) under “other health impairment,” which means…
“…having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome; and adversely affects a child’s educational performance.”
[34 code of Federal Regulations §300.8(c)(9)]
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.
The spectrum of alcohol-related diagnoses includes:
Fetal Alcohol Syndrome (FAS)
FAS represents the most involved end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with an FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems.
Alcohol Related Neurodevelopmental Disorder (ARND)
People with an ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgement, and poor impulse control.
Alcohol Related Birth Defects (ARBD)
People with ARBD might have problems with the heart, kidneys, bones, or with hearing. They might have a mix of these.
FACTS AND STATS
The Center for Disease Control estimates that .02-1.5 cases of FAS occur for every 1,000 births using medical and other records. In-person assessments may suggest higher estimates. There are a greater number of cases of FASDs than FAS. Prevalence varies by state.
In a recent article published in April 2019, CDC researchers found that approximately 1 in 9 pregnant women had at least one drinking of any alcoholic beverage in the past 30 days. About one third of pregnant women who reported consuming alcohol engaged in binge drinking (defined as having consumed four or more drinks on at least one occasion) in the past 30 days.
No amount of alcohol use is known to be safe for a developing baby before birth. Any amount of alcohol, even if it’s just one glass of wine, passes from the mother to the baby. It makes no difference if the alcohol is wine, beer, or liquor (vodka, rum, tequila, etc.).
FASD is more prevalent than Down Syndrome, Cerebral Palsy, SIDS, Cystic Fibrosis, and Spina Bifida combined. Alcohol use during pregnancy is the leading preventable cause of birth defects, developmental disabilities, and learning disabilities.
FASDs are caused by a woman drinking alcohol during pregnancy. Alcohol in the mother’s blood passes to the baby through the umbilical cord. There is no known amount of alcohol that is safe to drink during pregnancy or while trying to get pregnant. Alcohol can cause problems for a developing baby throughout pregnancy, including before a woman knows she’s pregnant. All types of alcohol are equally harmful
A developing baby can’t process alcohol. Developing babies lack the ability to process alcohol with their liver, which is not fully formed. They absorb all of the alcohol and have the same blood alcohol content as the mother.
To prevent FASDs, a woman should not drink alcohol while she is pregnant or even when she might get pregnant. This is because a woman could get pregnant and not know for several weeks.
If a woman is drinking alcohol during pregnancy, it is never too late to stop drinking. The sooner a woman stops drinking, the safer it will be for her and her baby.
CHARACTERISTICS AND DIAGNOSIS
Deciding if a child has FASD takes several steps. There is no one test to diagnose FASD, and many other disorders have similar symptoms. The following is an overview of the diagnostic guidelines. For more detail the full text here.
Abnormal facial features: smooth ridge between the nose and upper lip, thin upper lip, and a short distance between inner and outer corners of eyes.
Growth deficits: below average height, weight, or both. These issues can even occur before birth. For some children with FASD, growth problems resolve themselves early in life.
Central nervous system problems: when there is an issue with the central nervous system, a person can have trouble moving, speaking, or learning. Problems with memory, senses, or social skills may also occur. There are three categories of central nervous system problems.
- Structural: smaller than normal head size, significant changes in the structure of the brain as seen on brain scans such as MRIs or CT scans.
- Neurologic: there are problems with the nervous system that cannot be linked to another cause. Examples include poor coordination, poor muscle control, and problems with sucking as a baby.
- Functional: the person's ability to function is well below what is expected for his or her age, schooling or circumstances. (CDC, 2019)
Cognitive deficits or significant developmental delay in children who are too young for an IQ assessment.
Problems in at least three of the following area:
- Cognitive deficits or developmental delays (specific learning disabilities, poor grades in school, performance differences between verbal and nonverbal skills, and slowed movements or reactions)
- Executive functioning deficits (poor organization and planning, lack of inhibition, difficulty grasping cause and effect, difficulty following multistep directions, difficulty doing things in a new way or thinking of things in a new way, poor judgment, and inability to apply knowledge to new situations)
- Motor functioning delays (delay in walking, difficulty writing or drawing, clumsiness, balance problems, tremors, difficulty coordinating hands and fingers, and poor sucking in babies)
- Attention problems or hyperactivity ('busy,' overly active, inattentive, easily distract, and/or difficulty calming down, completing tasks, or moving from one activity to the next)
- Problems with social skills (lack a fear of strangers, be easily taken advantage of, prefer younger friends, be immature, show inappropriate sexual behaviors, and have trouble understanding how others feel)
- Other problems (sensitivity to taste or touch, difficulty reading facial expressions, and difficulty responding appropriately to common parenting practices such as cause-and-effect discipline)
Confirmed use of alcohol during pregnancy: confirmed alcohol use can strengthen the case for FAS diagnosis. Confirmed absence of alcohol exposure would rule out the FAS diagnosis. This criterion is not needed if the child meets the other criteria.
A diagnosis of FAS requires the presence of all three of the following things:
- All three facial features
- Growth deficits
- Central nervous system problems. A person could meet this criteria if there is a problem with the brain structure, even if there are no signs of functional problems.
No two people with an FASD are exactly alike. FASDs can include physical or intellectual disabilities, as well as problems with behavior and learning. These symptoms can range from mild to severe. Treatment services for people with FASDs should be different for each person depending on the symptoms. There is no cure for FASDs, but research shows that early intervention treatment services can improve a child’s development.
Studies have shown that some protective factors can help reduce the effects of FASDs and help people with these conditions reach their full potential. These factors include: early diagnosis; involvement in special education and social services; loving, nurturing, and stable home environment; and absence of violence. (CDC, 2019)
Types of Treatment:
- Medical Care: concerns specific to the disorder should be monitored and addressed by a current doctor or though referral to a specialist.
- Medication: no medications have been approved specifically to treat FASDs. But several medications can help improve some of the symptoms of FASDs. For example, medication might help manage high energy levels, inability to focus, or depression.
- Behavior and Education Therapy: may include friendship training, specialized math tutoring, executive functioning training, parent-child interaction therapy, and parenting and behavior management training.
- Parent Training: children with FASDs might not respond to the usual parenting practices. Parent training has been successful in educating parents about their child's disability and about ways to teach their child many skills and help them cope with their FASD-related symptoms.
- Alternative Approaches: with any disability, injury, or medical condition, many untested therapies become known and are promoted by informal networks.
Common areas of concern in the classroom:
- Easily frustrated
- Poor fine and gross motor skills
- Poor attention
- Lack of organizational skills
- Problems with concrete thinking
- Poor peer relations
Strategies for teachers:
- Place the child near the front of the room to help them focus
- Allow the students to have short breaks when necessary
- Create borders around children with FAS/FASD such as armrests, footrests, and beanbag chairs. This helps them feel more secure and calms them.
- Before the bell rings to go home, stop the activity and give them enough time to prepare and exit the classroom.
- Have them perform one task at a time. To make sure they understand, have them repeat the instructions. If the activity is brand new, walk through it with them first.
- Taking notes can be difficult and may create a distraction as the child may focus more on writing than the context of the lecture. Provide them with a copy of the teacher's or another student's notes. Because their handwriting is often poor, a computer may be a better way for them to complete their assignments.
- Behavior problems become more apparent as children enter grade school. Often, a slight bump from a fellow student feels like a push to someone with FAS/FASD. This may result in an outburst or fight. Punishment is not always the best answer since FAS/FASD children may not understand why they are being punished. Try defusing the situation as calmly as possible and moving into a new activity.
- Using visuals, concrete examples, and hands-on learning makes school easier. If one technique is not successful, try something new. Children with FAS/FASD can learn - they just need to use different paths to get there.
- Encourage success and reward positive behavior with praise or incentives. Positive reinforcement should be immediate.
For additional information, please visit the NOFAS website below for information and links to websites developed for teachers working with students diagnosed with FASDs.https://www.nofas.org/education-and-fasd/
1876 Minnehaha Ave. W.
St. Paul, MN 55104
Formerly MOFAS, the Proof Alliance is a national leader in prompting awareness about the effects of prenatal alcohol exposure and advocacy for individuals and families impacted by FASDs. They provide education on the impact of alcohol use during pregnancy and champion efforts for enabling individuals with FASDs to reach their full potential.
Children’s Research Triangle (CRT) is dedicated to the healthy development of children and their families. Their mission is to provide research driven services that improve the quality of life for all children with special needs or those who are at risk for developmental, behavioral, psychological, or educational problems.
National Organization on Fetal Alcohol Syndrome (NOFAS)
1200 Eton Court, NW
Washington, D.C. 20007
NOFAS is dedicated to eliminating birth defects caused by alcohol consumption during pregnancy and to improving the quality of life for those affected individuals and families.
This organization helps families and friends recover from the stress of living with a friend or relative who has a drinking problem. Alateen is a recovery program for young people and is sponsored by Al-Anon members.
Last updated March 2020.