Understanding FASD: The Most Misunderstood Neurodevelopmental Condition
Understanding FASD: The Most Misunderstood Neurodevelopmental Condition
Fetal Alcohol Spectrum Disorder (FASD) is one of the most prevalent yet least recognised neurodevelopmental conditions globally. Despite evidence suggesting that more than 3% of the population may be affected, many professionals, including educators, medical staff, and social workers, remain unfamiliar with its characteristics and implications.
In the UK, awareness of FASD is significantly behind countries like Canada and the USA. We are failing to identify, support, and adapt to the needs of a substantial number of children and young people who are living with permanent brain damage caused by prenatal alcohol exposure. These children are in our classrooms, our foster homes, our GP waiting rooms. Yet they are often diagnosed with ADHD, autism, sensory processing disorder or attachment difficulties instead. The true root cause is missed entirely.
This blog is a starting point. A one-stop introduction for parents, teachers, paediatricians, prospective adopters and foster carers. My aim is not to shame or sensationalise, but to inform, equip, and inspire better understanding. Because only with knowledge can we improve outcomes for these children.
What Is FASD?
FASD is an umbrella term describing a range of physical, cognitive and behavioural difficulties resulting from exposure to alcohol during pregnancy. Alcohol is a known teratogen, meaning it causes damage to developing cells. It is, in fact, the most dangerous drug a pregnant person can consume. It is more harmful than heroin, crack cocaine, methamphetamine or nicotine.
Yet many people in the UK remain unaware of this. in 1981 The USA Untilnced guidelines confirming that no alcohol is safe during pregnancy however until 2016, our official guidelines allowed for alcohol consumption during pregnancy in moderation, sending mixed messages. Many women still believe a small glass of wine on a special occasion or later in pregnancy is harmless.
But the science says otherwise. Alcohol crosses the placenta and enters the baby's bloodstream. The baby's developing liver cannot metabolise alcohol effectively, resulting in direct exposure to toxic substances that affect cell development, especially in the brain.
The third trimester is particularly dangerous. This is when the cerebral cortex, which governs executive functioning, reasoning, regulation and memory, undergoes rapid growth. Any alcohol consumed during this time can cause lasting damage. That damage is invisible on a scan, but it is lifelong.
The Challenges of Diagnosis
FASD is chronically underdiagnosed. One reason is the stigma and difficulty in obtaining confirmation of prenatal alcohol exposure. In adoption and fostering, birth parents may not admit to alcohol use, and medical notes may be incomplete. I have experienced this myself. A paediatrician once told me my son likely had FASD but advised it would be easier to get him diagnosed with ADHD. Our geneticist told me he had all the traits, but without proof of alcohol use, they couldn’t formally diagnose him.
This means children with FASD are often misdiagnosed or not diagnosed at all. They are punished for behaviours that stem from permanent brain damage. Behaviours that cannot be trained out of them, ignored into submission, or bribed away with a star chart. These children need understanding, not blame. Support, not sanctions.
FASD in the UK: The Numbers
The statistics are sobering:
UK studies suggest that up to 3.2% of the population is affected by FASD—a higher prevalence than Down’s syndrome, cerebral palsy, SIDS and cystic fibrosis combined.
27% of children in care may have FASD, according to recent research (e.g. the Peterborough study).
Over 25% of pregnant people in Europe continue to drink during pregnancy.
These children are not rare. They are among us. But we don’t recognise them.
Common Features and Characteristics
Children with FASD may present with:
Cognitive and neurological differences:
Executive dysfunction: difficulties with planning, impulse control, emotional regulation and working memory.
Poor judgment and problem-solving.
Learn and forget pattern: they may know something one day, but forget it the next.
Sensory processing issues (hypo- or hyper-sensitive to light, sound, texture).
Communication challenges:
Good expressive language but poor comprehension.
Difficulty following multi-step instructions.
Literal thinking and trouble with abstract concepts.
Behavioural traits:
Extreme emotional outbursts or "meltdowns."
Poor impulse control.
Struggles with change and transitions.
Often crave physical play or stimulation.
Can seem much younger emotionally than their chronological age.
Social difficulties:
Difficulty interpreting social cues.
Naïveté and vulnerability to exploitation.
Prefer younger peers or solitary play.
Physical and medical traits:
May have characteristic facial features (smooth philtrum, thin upper lip, short palpebral fissures), but <10% of individuals with FASD show these.
Coordination problems and poor motor skills.
Toilet training difficulties.
It is also important to note that strengths can be abundant too: creativity, visual memory, honesty, humour, friendliness, and love of the outdoors.
Why Current Strategies Often Fail
Traditional parenting and classroom techniques often rely on behavioural incentives: reward charts, sanctions, timeouts, removing privileges. For children with FASD, these approaches can be ineffective or even harmful. Their behaviours are not always within their control. They may want to behave, but lack the neurological wiring to do so in the moment.
What they need instead:
Clear, consistent routines.
Simple, one-step instructions.
Visual aids and social stories.
Movement breaks and sensory regulation activities.
Empathetic adults who act as their external brain.
We must stop seeing these children as defiant or "bad" and start recognising the injury that underlies their struggles.
A Message for Prospective Adopters and Carers
FASD is significantly more common among children who are looked after or adopted. If you're considering adoption or fostering, it is vital to understand FASD—not just its features, but its lifelong implications. With the right support, children with FASD can thrive. But only if they are met with compassion, structure, and realistic expectations.
And a Message for Pregnant Women
There is no safe time to drink during pregnancy. The first 21 days affect organ development; the third trimester impacts brain development. Even occasional drinking, particularly in later pregnancy, can cause irreversible damage.
The message needs to be clear: no alcohol during pregnancy is the only safe choice. Not because we want to shame, but because we want every child to have the best chance.
Moving Forward
We owe it to our children—those already born and those yet to come—to do better. We must train professionals, support families, raise awareness and normalise compassion.
A star chart won’t fix brain damage. But informed, inclusive, tailored support can open a world of possibilities.
This is our responsibility. And it starts with knowing better, so we can do better.
