Science and diagnosis of FASD

Download our memo about history, background, and distinctions between various diagnostic categories, including our package of diagnostic charts.

Download the TES Neurological Diagnostic Wheel.

i.                   Causes

If someone drinks alcohol while pregnant, her baby may be born with FASD. The impact of alcohol on the fetus can range in severity and is influenced by factors like how much, when and how often the mother drinks, and the mother and baby's genetic makeup and health.

FASD is a risk for women who might drink alcohol without knowing they are pregnant or who are unaware of the consequence of exposing the unborn baby to alcohol.

There are also many factors that can influence why a pregnant woman may drink, including poverty, unemployment, abuse, and family violence. She may drink alcohol to try to cope and then continue this behaviour while she is pregnant (PHAC 2008).

The effects of alcohol on the developing fetus can cause a range of physical disabilities, including brain and central nervous system disabilities, and behavioural problems. The effects that the child is born with are permanent and are known as primary disabilities. Secondary disabilities are disabilities that the child is not born with, but may have as a consequence of FASD. Some secondary disability may be prevented or mitigated through better understanding and appropriate interventions.


Diagnostic capacity is limited and what does exist is generally not funded by public health care plans. It is therefore not surprising that most individuals who have FASD do not know it. They may have grown up thinking they were “different”, or they may be diagnosed with something else. For an informed lawyer, judge, police officer, probation officer, or other criminal justice worker, it’s helpful to know how to recognize that a person before you may be affected by FASD.   

Canadian researchers and clinicians have played an important role in trying to reduce the chances of confusing FASD with another behaviour disorder, by refining the behavioural profile of FASD.  For example, to the untrained eye the restlessness and extreme impulsivity of individuals with FASD and Attention Deficit Hyperactivity Disorder may look the same.  But there can be crucial differences. Learning the particular reasons for the behaviour of people with FASD is helping psychiatrists and others develop appropriate interventions to deal with their unique problems.

Dr. Lori Vitale-Cox has developed a comprehensive memo for our site about the history, background, and distinctions between various diagnostic categories of what is now called FASD, together with a series of diagnostic charts. This memo may better help you lead evidence about your client’s specific diagnosis and how it might impact on their behaviours. Download it here

ii.                 Scientific papers

Abel, E. L. (1995). An update on incidence of fetal alcohol syndrome: Fetal alcohol syndrome is not an equal opportunity birth defect. Neurotoxicol Teratol 17:427-443. (Paid Version)

Centers for Disease Control and Prevention (CDC) (2002). Fetal Alcohol syndrome - Alaska, Arizona, Colorado, and New York, 1995-1997. MMWR 51: 433-435.

Clarren, S. K. and Smith D. W. (1978). The fetal alcohol syndrome. New Engl J Med 298:1063-1067. (Paid Version)

Flannigan, K., Pei, J., Stewart, M., and Johnson, A. (2018) Fetal Alcohol Spectrum Disorder and the criminal justice system. International Journal of Law and Psychiatry 57 (2018) 42-52.  

Jones, K. L. and Smith, D. W. (1973). Recognition of the Fetal Alcohol Syndrome in early infancy.  The Lancet, November: 999-1001. Version)

iii.               Diagnostic criteria

The term FASD, Fetal Alcohol Spectrum disorder, refers to the spectrum of physical and neurological conditions occurring as a result of prenatal exposure to alcohol. FASD is a developmental and behavioral disability. If you are a justice professional encountering clients with FASD who have been brought into the criminal justice system, understanding the diagnostic terminology of FASD can be confusing because there are many diagnostic terms in use.

Diagnostic terms within the FASD spectrum include:

FAS                  Fetal Alcohol Syndrome

pFAS                Partial Fetal Alcohol Syndrome

ARBD               Alcohol-Related Birth Disorder

ARND               Alcohol-Related Neurodevelopmental Disorder

ND-PAE            Neurodevelopmental Disorder-- Prenatal Alcohol Exposure

FASD-sff           FASD With Sentinel Facial  Features

FASD-w/o sff   FASD Without Sentinel Facial  Features

Download our memo about history, background, and distinctions between various diagnostic categories, including our package of diagnostic charts.

Download the TES Neurological Diagnostic Wheel