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Section 1
Diagnostic Features of Fetal Alcohol Syndrome

Question 1 | Answer Booklet | Table of Contents | Introduction

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In this section, we will discuss three different modes of diagnosis of clients with fetal alcohol syndrome. These different diagnostic modes include: physical and behavioral characteristics; emotional characteristics; and less severe characteristics. 

As you are already aware, there are several different disorders related to prenatal exposure to alcohol. These include possible fetal alcohol effects or PFAE, fetal alcohol effects or FAE, alcohol-related neurodevelopmental disorder or ARND and fetal alcohol spectrum disorder, or FASD, which is what this course mainly deals with. 

3 Key FASD Diagnostic Modes

♦ Mode #1 - Physical and Behavioral Characteristics
The first diagnostic mode deals with physical and behavioral characteristics. Clients who have FASD are often characterized by smaller eyes and head, a pursed mouth, and a malnourished look. Most of these physical characteristics can be observed at birth, with varying degrees of intensity. With regards to behavioral characteristics, FASD clients may have difficulty, especially as they mature, in evaluating a situation and using their past experiences to cope with the problems at hand. 

As FASD clients mature, manifestations of the damage become more and more prevalent.  Extremely high rates of mental illness as well as high rates of disrupted school experiences, trouble with the law, and alcohol and other drug problems are more widespread in clients with FASD. In early childhood and adolescence, a client with FASD may have difficulties generalizing information, matching words and behavior, predicting outcomes of events, and distinguishing fact from fantasy. When a client’s parents realize that their child has FASD, I find it useful to prepare them for the difficulties their son or daughter may face in the future.

Julie, age seven, was the adopted daughter of Rick and Jan. When she was first born, Jan noticed that there was something unique about the way Julie looked. Jan stated, "Her mouth looked like she was smiling, but I know for a fact that newborn infants can’t smile, their muscles aren’t developed. After she started walking, she got into all sorts of trouble. When I wasn’t looking, she grabbed the radiator and burned herself! I told her, ‘That’s hot, don’t touch it again.’ Even though she was three, she should have learned, but the next day she touched it again! And it’s the same with other mistakes. She doesn’t seem to connect her actions with their consequences!" 

At the age of five, Julie had been diagnosed with fetal alcohol syndrome. I stated to Rick and Jan, "Because Julie’s difficulty learning and memorizing is going to become more pronounced the older she gets, I feel that it is important for you to understand that she is going to need more attention from you. As you have already noticed, she doesn’t learn from her mistakes, so supervision is key. Also, patience with her is important because she does not understand that what she is doing is wrong." 

Think of your Rick and Jan.  How would you prepare them for the difficulties ahead?

♦ Mode #2 - Emotional Characteristics
The second diagnostic mode deals with emotional characteristics. Clients diagnosed with FASD are often extremely affectionate, even to people they do not know very well. This comes from a trusting nature, which can cause difficulty in a developing client. When he or she has so willingly placed trust in another person, an FASD client will not be able to understand if the other person causes him or her harm.

The FASD child knows no boundary of trust and even when that trust is broken, the client will continue to unreservedly place his or her faith in others. FASD clients will often remain naïve, despite their years, but they can also be grumpy, irritable, and rigid. They may become frustrated with their inability to interact normally with the world around them. 

Lionel, age 9, was a friendly young client. Although he had difficulty implementing learned material in everyday life, his IQ was relatively normal, as well as his verbal communication. However, his adoptive parents, Don and Stacey, were concerned with his indiscrimination towards strangers. 

Don stated, "We’ll take him to a park, and lose sight of him almost immediately because he’s gone to make friends!  And that’s all well and good when his friends are other children his age, but he goes up to complete strangers and engages them in conversation. I’m afraid, and so is Stacey, that one of his new friends is going to take advantage of his trusting nature and we will never see Lionel again!" 

I stated to Don and Stacey, "Although Lionel may not be able to learn the difference between friend and stranger on his own, you can facilitate his attributes and reduce the risk of harm by providing a structure for him. Instead of taking him to the park, organize a play day with other children in the neighborhood. The next time you take him to a park, encourage him to play games with the other children.  If he is otherwise occupied, he may be less inclined to talk to strangers." 

Think of your Lionel.  How could his or her parents prevent him or her from approaching possibly unfriendly strangers?

♦ Mode #3 - Less Severe Characteristics
In addition to physical, behavioral, and emotional characteristics, clients who have had less severe exposure to alcohol will display less severe characteristics and constitute the third diagnostic mode. As we discussed at the beginning of this section, there are different degrees of prenatal exposure to alcohol. Those clients whose parents were drinking prior to the revelation of the pregnancy, but quit after a positive pregnancy test, will often display less obvious characteristics of the brain damage.

Although the client may not exhibit the physical characteristics of clients with FASD, he or she may have less obvious behavioral problems. These abnormalities do not usually make themselves known until the client has been enrolled in school, when their parents can compare them to other children.

Janice, age 6, had been brought in to me after her teachers reported a severe deficiency in attentiveness.  Her mother, Macy, had thought that her daughter was merely curious and precocious. She stated, "Janice was always energetic and on-the-go at home.  I thought she was much more advanced than the other children, but the teachers tell me that she’s flighty and doesn’t sit still."  I asked Macy about alcohol usage during her pregnancy with Janice.

Macy stated, "She wasn’t really a planned pregnancy. My husband and I didn’t want children until we were a little more financially secure, but we weren’t the most careful of couples. I didn’t know I was pregnant with Janice until a month in, and I had been drinking regularly that entire time.  f I did this to her, I don’t know how I could live with myself!" 

I stated to Macy, "Janice’s behavior problems may have stemmed from the exposure to alcohol, but her symptoms are much less severe than other clients I have treated.  Her behavioral problems can be relatively easily treated with love and support.  By providing a structured environment at home, adjusting to the structured life at school will become easier for Janice."  We will discuss creating this structured environment in later sections. 

Think of your Janice.  What characteristics of prenatal exposure to alcohol does he or she exhibit?

In this section, we discussed three different modes of diagnosis of clients with fetal alcohol syndrome.  These different diagnostic modes included:  physical and behavioral characteristics; emotional characteristics; and less severe characteristics. 

In the next section, we will examine four secondary disabilities frequently found in FASD clients.  These four secondary disabilities include: mental health; frequent troubles with authoritative institutions; alcohol abuse; and inappropriate sexual behavior.
Reviewed 2023

Peer-Reviewed Journal Article References:
Acuff, S. F., Soltis, K. E., Dennhardt, A. A., Borsari, B., Martens, M. P., Witkiewitz, K., & Murphy, J. G. (2019). Temporal precedence of self-regulation over depression and alcohol problems: Support for a model of self-regulatory failure. Psychology of Addictive Behaviors, 33(7), 603–615.

DiBello, A. M., Carey, K. B., & Cushing, V. (2018). Using counterattitudinal advocacy to change drinking: A pilot study. Psychology of Addictive Behaviors, 32(2), 244–248.

Key, K. D., Ceremony, H. N., & Vaughn, A. A. (2019). Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma and Health, 4(2), 196–203.

Phelps, L., & Grabowski, J.-A. (1992). Fetal Alcohol Syndrome: Diagnostic features and psychoeducational risk factors. School Psychology Quarterly, 7(2), 112–128.

Wedding, D., Kohout, J., Mengel, M. B., Ohlemiller, M., Ulione, M., Cook, K., Rudeen, K., & Braddock, S. (2007). Psychologists' knowledge and attitudes about fetal alcohol syndrome, fetal alcohol spectrum disorders, and alcohol use during pregnancy. Professional Psychology: Research and Practice, 38(2), 208–213.

QUESTION 1
What are three different modes of diagnosis of clients with fetal alcohol syndrome? To select and enter your answer go to Answer Booklet.