Types of Fetal Alcohol Spectrum Disorders, Their Symptoms and Effects

Fetal alcohol spectrum disorders (FASD) are a group of conditions that can occur when an individual is exposed to alcohol before birth. The disorders range from mild to severe and are characterized by physical defects, such as dysmorphic facial features, and central nervous system problems, including structural, neurological and functional deficits.

The umbrella term FASD itself is not a clinical diagnosis because no medical test detects those conditions (Centers for Disease Control and Prevention [CDC], 2023).

“Individuals with an FASD need to be assessed within a patient- and family-centered medical home by clinicians with awareness about the effects of prenatal alcohol exposure for diagnosis, management, screening for co-occurring conditions, and referral/consultation when appropriate” (American Academy of Pediatrics [AAP], 2023).

Fetal alcohol syndrome (FAS)

Fetal alcohol syndrome (FAS) is on the severe end of the disorder spectrum, with both physical and neurodevelopmental features. A diagnosis of FAS must include the following three features:

Lower-than-average height, weight or both, and/or head circumference in the 9^th percentile and below.
Three specific dysmorphic facial features: reduced palpebral ﬁssure length, smooth philtrum and thin upper lip.
Any characteristic of neurocognition, self-regulation and adaptive functioning that results from a recognized neurodevelopmental or neurobehavioral deficit.

Partial FAS (PFAS)

Partial FAS (PFAS) is an uncommon diagnosis made when an individual’s disorder fulfills only some of the diagnostic criteria of FAS without all the features.

Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE)

Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is diagnosed when prenatal alcohol exposure results in neurocognitive, self-regulation and adaptive functioning impairments. The physical features of an FAS diagnosis are not required for an ND-PAE diagnosis.

Alcohol-related neurodevelopment disorder (ARND)

Alcohol-related neurodevelopment disorder (ARND) is characterized by neurodevelopmental and neurobehavioral effects of prenatal alcohol exposure. The physical features of an FAS diagnosis are not present for an ARND diagnosis.

Alcohol-related birth defects (ARBD)

Alcohol-related birth defects (ARBD) is an uncommon diagnosis that includes congenital anomalies of the bones, heart and kidneys, as well as hearing and vision. An ARBD diagnosis does not include neurocognitive and neurodevelopmental deficits.

Alcohol Consumption During Pregnancy

A 2022 CDC report cites research showing the prevalence of alcohol consumption among pregnant adults ages 18 to 49 years increased slightly during 2011 through 2018 and, based on self reports, continued to grow between 2018 and 2020 (Gosdin, Deputy, Kim, Dang, & Denny, 2022).

The estimates below are based on self-reported current drinking and binge drinking, using 2018–2020 Behavioral Risk Factor Surveillance System (BRFSS) national data (Ibid).

13.5 percent of pregnant adults reported current drinking.
5.2 percent of pregnant adults reported binge drinking.
- Those estimates are each 2 percentage points higher than 2015–2017 estimates.

Fast Facts: Prenatal Alcohol Exposure and FASD

Alcohol passes to a fetus via blood in the umbilical cord.
Alcohol is more concentrated in fetuses, and they do not process it as adults do.
Alcohol damages tissue in the fetus brain, heart, kidneys, liver and lungs.
No level of alcohol consumption has been determined to be safe while a person is trying to become pregnant.
No level of alcohol consumption has been determined to be safe during pregnancy.
A fetus can be affected by alcohol before a person is aware of being pregnant.

Effects of FASD

Individuals with FASD can experience physical, behavioral and cognitive deficits that vary in severity and have lifelong results, including the following.

Accessibility issues in the living environment
Costly medical procedures
Difficulty in school or keeping a job
Difficulty with daily living and self-care
Mental health issues
Social problems
Substance use disorders
Trouble with the law

Some effects of FASD, such as facial abnormalities, may be evident in infancy, while others develop over time. Behavioral and functional problems tend to become more noticeable once a child enters school.

Physical Defects

Facial Abnormalities	Growth Deficits	Other
Epicanthal folds Flat nasal bridge and midface Small palpebral fissures Smooth philtrum Thin upper lip Upturned nose	Low birth weight Lower than normal height Lower than normal weight	Deformities of joints, limbs and fingers Problems with the brain, heart, kidneys, liver and lungs Vision difficulties Hearing difficulties

Central Nervous System Problems

Structural	Neurologic	Functional
Abnormalities in brain structure Smaller head size	Poor coordination Poor muscle control Problems with sucking as a baby	Attention problems Cognitive deficits Communication challenges Executive functioning deficits Hyperactivity Motor functioning delays Problems with social skills

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