Understanding Fetal Alcohol Spectrum Disorder and Its Impact on Mental Health

Fetal alcohol syndrome is one of several syndromes within a group of disorders known as fetal alcohol spectrum disorders (FASD), where a child experiences issues with growth, central nervous system problems, facial feature differences, and problems with attention span, learning, vision, and hearing. FAS is caused by alcohol consumption by a pregnant person. FASD results from prenatal alcohol exposure.

Having a fetal alcohol spectrum disorder can have profound effects on a person’s health, behavior, and overall well-being. Additionally, it can have mental health side effects and often results in psychiatric disorders.

Here, we’ll take a close look at the impacts that fetal alcohol syndrome and fetal alcohol spectrum disorders, in general, can have on the mental health of people who are affected.

What Are the Four Types of Fetal Alcohol Spectrum Disorders?

Fetal alcohol syndrome is one of four disorders that comprise fetal alcohol spectrum disorders (FASD). It’s estimated that FASD affects about 3%-5% of infants born in the United States.

The four types of fetal alcohol spectrum disorders are:

• Fetal Alcohol Syndrome (FAS), which involves issues with growth, central nervous system problems, facial feature differences, and problems with attention span, learning, vision, and hearing
• Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure, which causes problems with memory, planning, attention span, behavior, mood swings, and daily functioning
• Alcohol-Related Birth Defects, which can include issues with hearing, kidneys, heart, bones, or a combination of these issues
• Alcohol-Related Neurodevelopmental Disorder, which can cause intellectual disabilities and problems with behavior

As John C. Umhau, MD, MPH, CPE, retired senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH), explains, there is no level of alcohol safe to drink during pregnancy. “Even a small amount of alcohol at a critical time during pregnancy can cause problems for children, such as lower IQ, attention deficits, impulsivity, and birth defects,” he says.

Many People Consume Alcohol Before Ever Knowing That They're Pregnant

According to Dr. Umhau, most pregnant individuals try not to drink when they’re pregnant, but the problem is that more than half of people of childbearing age drink regularly and often consume alcohol before they know they’re pregnant.

What Happens to a Child With a Fetal Alcohol Spectrum Disorder?

FASD can affect children in profound ways—physically, mentally, and emotionally. A child’s overall emotional well-being is often compromised by FASD, says Kristina Uban, PhD, developmental neuroscientist and assistant professor at the University of California, Irvine - Program in Public Health.

“Emotional challenges often manifest in young children with an FASD as being frequently inconsolable (such as a temper tantrum), high-sensitivity to the emotions of those around them, and often hyperactivity that can be challenging for caregivers and teachers to navigate,” Dr. Uban explains.

Finally, much of this emotional upheaval is due to “alcohol’s ability to change the development of the brain and body systems that are important for optimizing emotional regulation later in life,” Dr. Uban describes.

“Childhood is a period of increased need to feel loved and belonging,” says Dr. Uban. “This challenging developmental stage is often more challenging with FASD brain alterations, and then even further amplified by common co-occurring experiences of feeling misunderstood or unsupported in navigating their FASD-related emotional challenges.”

Signs of a Fetal Alcohol Spectrum Disorder

The signs and symptoms of a fetal alcohol spectrum disorder (FASD) will differ from one child to another and depend on which type of FASD a child has.

Some possible symptoms of FASD include:

• Attention and memory issues
• Difficulty with coordination
• Impulsive or hyperactive behavior patterns
• Diagnosis with a learning disability
• School challenges
• Delays in language and speech
• Hearing and vision issues
• Sleeping difficulties
• Feeding and sucking issues during infancy
• A lower-than-normal body weight
• Short structure
• Heart, bone, or kidney issues
• Smaller than average head size
• Facial differences, such as a smoother-than-normal ridge in the area between the top lip and nose
  

The Mental Health Effects of a Fetal Alcohol Spectrum Disorder

FASDs can have striking mental health side effects among children who are affected. Let’s take a look at three of the most common mental health side effects.

Behavioral Issues

Behavioral issues from FASDs may vary widely from one individual to another, says Paul Linde, MD, psychiatrist and medical director of psychiatry and collaborative care at Ria Health. “Many exhibit increased irritability, jitteriness, impaired cognition with poor executive planning and functioning, difficulties with impulse control,” he says. “School performance can be poor due to these cognitive and learning deficits as well as behavioral issues.” In addition, many people with FASD have mild to moderate intellectual disabilities, Dr. Linde says.

Depression and Anxiety

The majority of people with an FASD will experience a mental health challenge, says Dr. Uban, and depression and anxiety top the list. “There are several pathways for this increased risk for mental health problems with FASD,” she explains. “One pathway is the frequent or complex physical health issues that can drive depression and anxiety.”

Cognitive and Attention Issues

People with an FASD are at increased risk of developing cognitive issues, says Jenelle Ferry, MD, neonatologist and director of feeding, nutrition and infant development at Pediatrix Medical Group in Tampa, Florida.

This may include difficulty with memory, paying attention, speech and language deficits, and lower IQ. In particular, the disorder called neurobehavioral disorder is associated with thinking and memory issues, says Dr. Ferry, as well as trouble with day-to-day living.

Psychological Disorders That Can Result From an FASD

According to research, about 90% of people with an FASD have at least one comorbid condition. Most of these conditions are psychological in nature and include:

• Depression
• Bipolar disorder
• Anxiety disorders
• Psychosis
• Schizophrenia
• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Attachment disorders
• Substance use disorder

Dr. Ferry explains that these disorders develop in part because of the profound effects that alcohol can have on developing fetuses. “Alcohol can interfere with the way that nerve cells develop and how nerve cells connect to each other in different parts of the brain, which therefore can affect their functioning,” she says.

Alcohol also constricts blood vessels and restricts blood flow to the placenta, resulting in reduced oxygen to the fetus, she explains. “Further, toxic byproducts formed from the process of breaking down alcohol can build up in the fetus's brain and cause damage,'' she adds.

How to Get Help for Fetal Alcohol Spectrum Disorder

Fetal alcohol spectrum disorders can have profound effects on children and families, but you are not alone. There are many resources out there to help you navigate these challenges. Here are a few to get you started:

• FASD United searchable resource directory
• FASD United Family Navigator program
• FASD United Circle of Hope network