Fetal Alcohol Spectrum Disorder or FASD
describes a range of effects that can
occur in an individual who is prenatally
exposed to alcohol.  The effects can
include physical, mental, behavioural and
learning disabilities. FASD is a lifelong,
brain-based disability that impacts
individuals, their families and society.
For educators it is critical to
understand that prenatal alcohol
exposure may cause a differently
structured brain and that in most cases
no physical or facial characteristics
are visible.  According to the updated
Canadian FASD diagnostic guidelines
published in early 2016, there are two
medical diagnosis of FASD: FASD with
sentinel facial features and FASD
without sentinel facial features.  For
FASD with sentinel facial features, there
are three criteria. First; three specific
facial features must be present; a
shortened eye opening, a smooth or
flattened philtrum (which is the groove
under your nose) and a thin upper lip.
Secondly; at least three of ten assess
brain domains need to show a significant
impairment. The brain domains include
motor skills, neuroanatomy,
neurophysiology, cognition, language,
academic achievement, memory, attention,
executive function, affect regulation
adaptive behavior, social skills or
social communication.  Finally, there needs
to be reliable evidence that the alcohol
exposure occurred during pregnancy.
However with this particular diagnosis,
if the three facial features are present
in a severe way, the diagnosis can be
made without the confirmation of alcohol
exposure.  Another key piece of
information that we want to share about
this diagnosis is that it is relatively
rare.  In a survey of over half of the
Canadian FASD diagnostic clinics only
2.1
percent of individuals assessed received
this diagnosis that was formerly known
as Fetal Alcohol Syndrome.  Now for FASD
without sentinel facial features two, one,
or none of the facial features need to
be present.  According to the literature
the majority of individuals do not show
any of the facial features.  As with the
first diagnosis, at least three of the
ten brain domains must be impacted in a
significant way.  It's important to note
that the facial features do not reflect
the degree of the brain disorder, and
finally with this diagnosis there needs
to be reliable evidence of alcohol
exposure during pregnancy.  When we
understand the criteria for an FASD
diagnosis and the social stigma that
exists with FASD, it becomes clear why so
many of our students may never see the
diagnosis and/or are often misdiagnosed
with other conditions. For more
information about the 2016 update to the
Canadian FASD diagnostic guidelines
please visit the displayed link.  Here are
some key understandings about FASD.
Research clearly shows that prenatal
alcohol exposure may disrupt or alter
the waves of brain develops.  The
developing brain is vulnerable
throughout pregnancy and various parts
of the body may also be impacted
depending on the timing and the amount
of alcohol exposure.  The learning and
behaviour challenges that we often see in
our students may be directly connected
to difficulties in specific brain
domains like memory and attention.  As was
mentioned earlier, in the majority of
cases there are no physical
characteristics evident.   FASD is largely
an invisible disability.  No two brains
are impacted in the same way.  The level
of impact is determined by various
maternal factors such as age,  health,
genetics,  nutrition and others as well as
the timing and the quantity of alcohol
consumed during pregnancy.  There is
insufficient
sientific evidence to indicate a safe
minimal amount of alcohol to consume
during pregnancy.  There is a significant
social stigma that still exists with
this condition so we must practice
sensitivity and understand that no woman
purposely sets out to hurt her baby.
Another important message for people to
know is that an injury can happen as
early as three weeks of pregnancy; a time
when most women do not even know they
are pregnant.  With this understanding we
begin to make links between brain
function and behaviour.  As educators we
start to look beyond the behaviours and
look for underlying causes for those
behaviours.  An important question we need
to ask is; are the behaviours we're seeing
intentional and willful or just a
response to not being able to meet the
expectation.  This understanding leads us
to an approach that focuses on knowing
our students and supporting the areas of
need rather than reacting or responding
punitively to the observed behaviour.  It
is this FASD informed approach that will
help educators to develop a web of
support that will enable our students to
have more success at school.
