Texas Health and Human Services / Texas Health Steps

The Provider’s Role in Detecting Subtle FASD

No laboratory test confirms the presence of FASD. Clinical presentations may be mild or even subthreshold, and the classic facial anomalies of fetal alcohol syndrome may not be present in all disorders on the spectrum.

Children with subtle FASD may be undiagnosed or misdiagnosed, or the diagnosis may be delayed. Many symptoms of FASD appear similar to those of autism spectrum disorder (ASD) in young children and attention-deficit/hyperactivity disorder (ADHD) in older children.

Physical findings, the presence of developmental problems and behavioral concerns, and poor academic performance should trigger the consideration of FASD as a potential diagnosis.

Symptoms of FASD

Symptoms in toddlers and preschool-aged children may include:

  • Delays in speech, language and gross motor skills
  • Erratic eating habits
  • Erratic sleeping habits
  • Extreme sensitivity to touch; insensitivity to touch
  • History of sucking problems as an infant
  • Lack of stranger anxiety
  • Poor ability to adjust responses to external stimuli
  • Poor or limited abstract thinking
  • Poor physical coordination
  • Rage

Symptoms in school-age children may include:

  • Academic challenges, which worsen with time
    • Difficulty applying learning to new settings
    • Difficulty taking in new information
    • Intellectual disability
    • Learning disabilities
    • Poor memory
    • Problems learning math
  • Behavior issues
    • Blaming others for problems
    • Difficulty perceiving and interpreting interpersonal information
    • Difficulty with attention
    • Emotional disconnection; social isolation
    • High need for stimulation
    • Hyperactive behavior
    • Poor impulse control
    • Poor reasoning and judgment skills
  • Social difficulties
    • Difficulty connecting cause and effect
    • Immaturity
    • Poor personal boundaries
    • Poor receptive language skills
    • Possible fascination with knives and/or fire
    • Vivid fantasies and inappropriate repetition of thoughts or actions
    • Volatility, with impaired reasoning
    • Vulnerability to peer pressure/influence; high levels of suggestibility

Source: U.S. Department of Education, Office of Special Education Programs (2017)

Comparing Symptoms of FASD and ASD

Children with subtler forms of FASD may be misdiagnosed with ASD. However, differences are notable. The difficulties associated with FASD begin at birth, whereas symptoms of ASD may begin after a period of normal growth. The following differences between the disorder spectrums may guide an appropriate diagnosis.

  • Behavior

    Like children with ASD, children with FASD may experience difficulty with change and transitions.

    Children with FASD may have problems with balance as well as fine and gross motor coordination. They do not, however, exhibit the characteristic movements and behaviors of children with ASD, such as repetitive body movements (for example, hand flapping, rocking) and ritualistic behaviors (for example, touching a favorite object before bed).

  • Language and Communication

    Children with FASD may be slow to develop verbal communication and have difficulty with verbal receptive language. Expressive language ultimately develops, and their verbal communication is typically not significantly impaired. They tend to be spontaneously talkative, and echolalia is uncommon.

    In contrast, children with ASD have difficulty with verbal and nonverbal communication, including problems in both expressive and receptive language. They may have robotic and formal speech patterns, and echolalia is more common. Some children with ASD do not develop spoken language.

  • Social and Relational

    Children with FASD may struggle socially, or they may be outgoing and able to relate to others and share enjoyment. They express a range of emotions and understand humor.

    Children with ASD tend to remain aloof and prefer to be alone. Some may find it difficult or impossible to relate to others in a meaningful way. They may lack the ability to spontaneously share enjoyment, express emotions and understand humor.

Source: SAMHSA FASD Center for Excellence

Provider Resources

In the Resources, you can access:

  • AAP’s Fetal Alcohol Spectrum Disorders professional tools and resources, including the Flow Diagram for Medical Home Evaluation of Fetal Alcohol Spectrum Disorders

Main Menu