Diagnosis/Treatment of Children with FASD

"Without identification or diagnosis, parenting a child with FAS/FAE is like trying to find your way around Denver with a road map of Cincinnati." Diane Malbin

Diagnosis of FASD is important. Facial malformations tend to resolve as the child grows older, making diagnosis much more difficult. Children without the physical manifestations of FAS are often misdiagnosed with Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Pervasive Developmental Disorder or Conduct Disorder. It is important that people understand the dysfunction is related to alcohol exposure in utero that has caused damage to their brain. Proper diagnosis aids in treatment planning, understanding, and protected self-concept for the child.

Dysmorphic Facial features of child with FAS

4 month old child diagnosed with FAS at birth

Individuals with the full FAS diagnosis have pre-natal or post-natal growth retardation in height, weight, and/or head circumference below the 10th percentile when corrected for gestational age and some degree of Central Nervous System (CNS) dysfunction; typically seen in developmental delay, behavioral problems, learning disorders, or structural brain damage.  Confirmation of maternal alcohol consumption during pregnancy may or may not be known for the diagnosis of FAS.  Those individuals without the full FAS diagnosis (perhaps as many as 70% of all affected individuals) may never be correctly identified/diagnosed because they look perfectly normal.  These individuals are at very high risk. 

Early Intervention is a critical element in determining the prognosis for a child with FASD. The earlier in the child's life that medical, clinical and educational interventions can be provided, the better the outcome. Stable, structured, nurturing environments are necessary to support the child's growth and development. Special needs pre-school programs that are center-based and enroll parent and child can provide the most enriched experience. During the early years, the focus of treatment should be on establishing healthy parent/child relationships, motor and language development and sensory processing development. Medical and nutritional needs should be monitored as well. Meeting the caretakers needs is important also. Parents are often overwhelmed with the enormous job of caring for these children. Parent education and support, as well as respite services for families, is essential to maintaining positive parent/child relationships and stability in the home setting. These services must be available to foster and adoptive parents as well as the birth parent.

Therapeutic Interventions must focus on all areas of development. Frequently, the child's behavior becomes the target, without consideration of the child's degree of sensory, emotional and social levels of development. Although a clear plan for addressing behavior is necessary, the focus must be on meeting the child's needs. Many times the disorganized, aggressive or self-abusive behavior the child is exhibiting, stems from an under-aroused or over-aroused central nervous system (CNS). Children with FASD have difficulty taking in sensory information, integrating, organizing and processing it and then developing an appropriate social response. Some sensory channels (auditory, tactile) may be overly-responsive to input (sensory defensiveness), while others (vestibular, olfactory, gustatory) may be under-responsive to input. Sensory processing deficits can result in poor modulation of arousal and alertness resulting in emotional instability/lability, hyperactivity, behavioral disorganization and learning problems. An evaluation by an Occupational Therapist who has knowledge and experience in treating sensory processing issues can be very beneficial. "Sensory diets" can be initiated between home/school which can assist with normalizing sensory processing.

Another treatment intervention that may prove beneficial for these children is Auditory Integration Training (AIT).

Emotional and social development can be enhanced by labeling feeling states of the child or others. Model expression of feelings for the child and help them find safe ways to express their anger and frustration (hitting pillow, punching bag, etc.) Role play and mediate social situations so the outcome is positive. If the social situation is increasing the arousal level of the child, remove him/her from the situation before negative behavior occurs. Reinforce all positive behavior. Do not take it for granted. It is extremely difficult for these children to meet adult's expectations. Adapting the environment, the task, or your expectation will help these children experience a greater degree of success.

Psychotropic medication may be necessary and should be considered a critical component of the treatment plan. Some children with FASD present with a significant degree of impulsivity, hyperactivity, oppositional behavior and sleep disorders. Medication can often assist with these symptoms. The age the child can start medication and the type of medication necessary will depend upon the individual child's history and presentation. The child's pediatrician, a child psychiatrist, or neurologist can assess medication needs.