Clinical characteristics of fetal alcohol spectrum disorder

Fetal alcohol spectrum disorder (FASD) presents with a range of developmental impairments and physical features. Fetal brain injury can occur with or without physical clinical features of fetal alcohol spectrum disorder.

Note: Fetal brain injury can occur with or without physical clinical features of fetal alcohol spectrum disorder.

Physical clinical features of fetal alcohol spectrum disorder include:

  • disruption of facial development causing sentinel facial features (eg short palpebral fissures, smooth philtrum, thin upper lip)
  • microcephaly (occipitofrontal head circumference less than 3rd percentile)
  • growth impairment—prenatal (intrauterine growth retardation) as well as postnatal (due to long-term growth programming effects)
  • ‘minor’ and ‘major’ morphological changes or birth anomalies
    • minor—clinodactyly (curved 5th fingers), epicanthic folds, midface hypoplasia, altered palmar creases (eg ‘hockey stick’ configuration of upper palmar crease)
    • major—ocular, cardiac, renal or skeletal anomalies, hearing impairment.

People with fetal alcohol spectrum disorder appear to have increased rates of metabolic and cardiovascular problems.

The neurodevelopmental effects of fetal alcohol spectrum disorder can impact on multiple developmental and behavioural domains, and related functional skills:

  • language and communication
  • attention, impulse control, executive function
  • cognition, literacy, numeracy and memory
  • adaptive behaviour, daily living and vocational skills
  • motor skills
  • mental health and affect regulation.

This is no typical pattern of neurodevelopmental impairment in fetal alcohol spectrum disorder, as the brain injury and resulting sequelae vary from individual to individual, hence the term ‘spectrum’.

Note: Not all individuals with a history of prenatal alcohol exposure are physically or developmentally affected, or are affected to the same extent.