Understanding Fetal Alcohol Spectrum Disorder and Its Impact on Mental Health
Medically reviewed by Shaheen Lakhan, MD, PhD, FAAN
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Fetal alcohol syndrome is one of several syndromes within a group of disorders known as fetal alcohol spectrum disorders (FASD), where a child experiences issues with growth, central nervous system problems, facial feature differences, and problems with attention span, learning, vision, and hearing. FAS is caused by alcohol consumption by a pregnant person. FASD results from prenatal alcohol exposure.
John C. Umhau, MD, MPH, CPE
Even a small amount of alcohol at a critical time during pregnancy can cause problems for children, such as lower IQ, attention deficits, impulsivity, and birth defects.
Having a fetal alcohol spectrum disorder can have profound effects on a person’s health, behavior, and overall well-being. Additionally, it can have mental health side effects and often results in psychiatric disorders.
Here, we’ll take a close look at the impacts that fetal alcohol syndrome and fetal alcohol spectrum disorders, in general, can have on the mental health of people who are affected.
Related: Women and the Effects of Alcohol
What Are the Four Types of Fetal Alcohol Spectrum Disorders?
Fetal alcohol syndrome is one of four disorders that comprise fetal alcohol spectrum disorders (FASD). It’s estimated that FASD affects about 3%-5% of infants born in the United States.
The four types of fetal alcohol spectrum disorders are:
Fetal Alcohol Syndrome (FAS), which involves issues with growth, central nervous system problems, facial feature differences, and problems with attention span, learning, vision, and hearing
Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure, which causes problems with memory, planning, attention span, behavior, mood swings, and daily functioning
Alcohol-Related Birth Defects, which can include issues with hearing, kidneys, heart, bones, or a combination of these issues
Alcohol-Related Neurodevelopmental Disorder, which can cause intellectual disabilities and problems with behavior
As John C. Umhau, MD, MPH, CPE, retired senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH), explains, there is no level of alcohol safe to drink during pregnancy. “Even a small amount of alcohol at a critical time during pregnancy can cause problems for children, such as lower IQ, attention deficits, impulsivity, and birth defects,” he says.
Many People Consume Alcohol Before Ever Knowing That They're Pregnant
According to Dr. Umhau, most pregnant individuals try not to drink when they’re pregnant, but the problem is that more than half of people of childbearing age drink regularly and often consume alcohol before they know they’re pregnant.
“I remember one boy who had fetal alcohol syndrome despite the fact that his mother had avoided alcohol when she was pregnant,” Dr. Umhau shared. “Unfortunately, she had only stopped drinking after her pregnancy test came back positive.”
Related: How to Manage Panic Attacks During Pregnancy
What Happens to a Child With a Fetal Alcohol Spectrum Disorder?
FASD can affect children in profound ways—physically, mentally, and emotionally. A child’s overall emotional well-being is often compromised by FASD, says Kristina Uban, PhD, developmental neuroscientist and assistant professor at the University of California, Irvine - Program in Public Health.
“Emotional challenges often manifest in young children with an FASD as being frequently inconsolable (such as a temper tantrum), high-sensitivity to the emotions of those around them, and often hyperactivity that can be challenging for caregivers and teachers to navigate,” Dr. Uban explains.
Challenges like this emerge for several reasons, she explains. Part of it is a result of not always being supported effectively by the adults in their lives, including caretakers, medical providers, and school communities. These challenges are also due to issues like instability in their family (or foster care systems) that often occurs when being raised in the context of substance use disorders.
Finally, much of this emotional upheaval is due to “alcohol’s ability to change the development of the brain and body systems that are important for optimizing emotional regulation later in life,” Dr. Uban describes.
“Childhood is a period of increased need to feel loved and belonging,” says Dr. Uban. “This challenging developmental stage is often more challenging with FASD brain alterations, and then even further amplified by common co-occurring experiences of feeling misunderstood or unsupported in navigating their FASD-related emotional challenges.”
Frequently Asked Questions
How Can Alcohol Consumption Affect Developing Fetuses?
Any alcohol consumption can affect a developing fetus, and you don’t have to have an alcohol addiction for your drinking to have impacts, says Dr. Uban. “Alcohol use disorders do, however, tend to result in more severe symptoms of FASD because of the higher doses and more frequent exposures to alcohol, making symptoms more challenging for the child to navigate without essential supports,” she explains.
Signs of a Fetal Alcohol Spectrum Disorder
The signs and symptoms of a fetal alcohol spectrum disorder (FASD) will differ from one child to another and depend on which type of FASD a child has.
Some possible symptoms of FASD include:
Attention and memory issues
Difficulty with coordination
Impulsive or hyperactive behavior patterns
Diagnosis with a learning disability
School challenges
Delays in language and speech
Hearing and vision issues
Sleeping difficulties
Feeding and sucking issues during infancy
A lower-than-normal body weight
Short structure
Heart, bone, or kidney issues
Smaller than average head size
Facial differences, such as a smoother-than-normal ridge in the area between the top lip and nose
Related: Signs Your Child May Be Struggling With Mental Health Issues
The Mental Health Effects of a Fetal Alcohol Spectrum Disorder
FASDs can have striking mental health side effects among children who are affected. Let’s take a look at three of the most common mental health side effects.
Behavioral Issues
Behavioral issues from FASDs may vary widely from one individual to another, says Paul Linde, MD, psychiatrist and medical director of psychiatry and collaborative care at Ria Health. “Many exhibit increased irritability, jitteriness, impaired cognition with poor executive planning and functioning, difficulties with impulse control,” he says. “School performance can be poor due to these cognitive and learning deficits as well as behavioral issues.” In addition, many people with FASD have mild to moderate intellectual disabilities, Dr. Linde says.
Depression and Anxiety
The majority of people with an FASD will experience a mental health challenge, says Dr. Uban, and depression and anxiety top the list. “There are several pathways for this increased risk for mental health problems with FASD,” she explains. “One pathway is the frequent or complex physical health issues that can drive depression and anxiety.”
Cognitive and Attention Issues
People with an FASD are at increased risk of developing cognitive issues, says Jenelle Ferry, MD, neonatologist and director of feeding, nutrition and infant development at Pediatrix Medical Group in Tampa, Florida.
This may include difficulty with memory, paying attention, speech and language deficits, and lower IQ. In particular, the disorder called neurobehavioral disorder is associated with thinking and memory issues, says Dr. Ferry, as well as trouble with day-to-day living.
Related: What Is a Genius IQ Score?
Psychological Disorders That Can Result From an FASD
According to research, about 90% of people with an FASD have at least one comorbid condition. Most of these conditions are psychological in nature and include:
Depression
Bipolar disorder
Anxiety disorders
Psychosis
Schizophrenia
Attention-deficit/hyperactivity disorder (ADHD)
Attachment disorders
Substance use disorder
Dr. Ferry explains that these disorders develop in part because of the profound effects that alcohol can have on developing fetuses. “Alcohol can interfere with the way that nerve cells develop and how nerve cells connect to each other in different parts of the brain, which therefore can affect their functioning,” she says.
Alcohol also constricts blood vessels and restricts blood flow to the placenta, resulting in reduced oxygen to the fetus, she explains. “Further, toxic byproducts formed from the process of breaking down alcohol can build up in the fetus's brain and cause damage,'' she adds.
Related: DSM 5 Criteria for Substance Use Disorders
How to Get Help for Fetal Alcohol Spectrum Disorder
Fetal alcohol spectrum disorders can have profound effects on children and families, but you are not alone. There are many resources out there to help you navigate these challenges. Here are a few to get you started:
Frequently Asked Questions
What is the life expectancy of someone impacted by an FASD?
The life expectancy of people with an FASD depends on several factors, including how severe the condition is and what type of support is received.
One study found that people with fetal alcohol syndrome had a much lower mortality rate than the general population, with an average age of 34 years old.
When does the alcohol consumption affect a developing fetus?
The damage from alcohol consumption starts right away, in the womb, and in the earliest weeks of pregnancy, before you even realize you’re pregnant. However, signs and symptoms aren’t always noticed right away, and are often most evident in the preschool and school age groups.
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