Primary disabilities
The primary disabilities of FAS are the functional difficulties with which the child is born as a result of CNS damage due to prenatal alcohol exposure. Often, primary disabilities are mistaken as behavior problems, but the underlying CNS damage is the originating source of a functional difficulty (rather than a mental health condition, which is considered a secondary disability).
The exact mechanisms for functional problems of primary disabilities are not always fully understood, but animal studies have begun to shed light on some correlates between functional problems and brain structures damaged by prenatal alcohol exposure.
Representative examples include:
Learning impairments are associated with impaired dendrites of the hippocampus
Impaired motor development and functioning are associated with reduced size of the cerebellum
Hyperactivity is associated with decreased size of the corpus callosum
Functional difficulties may result from CNS damage in more than one domain, but common functional difficulties by domain include:
Achievement — Learning disabilities
Adaptive behavior — Poor impulse control, poor personal boundaries, poor anger management, stubbornness, intrusive behavior, too friendly with strangers, poor daily living skills, developmental delays
Attention — Attention-Deficit/Hyperactivity Disorder (ADHD), poor attention or concentration, distractible
Cognition — Mental retardation, confusion under pressure, poor abstract skills, difficulty distinguishing between fantasy and reality, slower cognitive processing
Executive functioning — Poor judgment, Information-processing disorder, poor at perceiving patterns, poor cause and effect reasoning, inconsistent at linking words to actions, poor generalization ability
Language — Expressive or receptive language disorders, grasp parts but not whole concepts, lack understanding of metaphor, idioms, or sarcasm
Memory — Poor short-term memory, inconsistent memory and knowledge base
Motor skills — Poor handwriting, poor fine motor skills, poor gross motor skills, delayed motor skill development (e.g., riding a bicycle at appropriate age)
Sensory integration and soft neurological problems — sensory integration dysfunction, sensory defensiveness, undersensitivity to stimulation
Social communication — Intrude into conversations, inability to read nonverbal or social cues, "chatty" but without substance
Secondary disabilities
The secondary disabilities of FAS are those that arise later in life secondary to CNS damage. These disabilities often emerge over time due to a mismatch between the primary disabilities and environmental expectations; secondary disabilities can be ameliorated with early interventions and appropriate supportive services.
Six main secondary disabilities were identified in a University of Washington research study of 473 subjects diagnosed with FAS, PFAS (partial fetal alcohol syndrome), and ARND (alcohol-related neurodevelopmental disorder):
Mental health problems — Diagnosed with ADHD, Clinical Depression, or other mental illness, experienced by over 90% of the subjects
Disrupted school experience — Suspended or expelled from school or dropped out of school, experienced by 60% of the subjects (age 12 and older)
Trouble with the law — Charged or convicted with a crime, experienced by 60% of the subjects (age 12 and older)
Confinement — For inpatient psychiatric care, inpatient chemical dependency care, or incarcerated for a crime, experienced by about 50% of the subjects (age 12 and older)
Inappropriate sexual behavior — Sexual advances, sexual touching, or promiscuity, experienced by about 50% of the subjects (age 12 and older)
Alcohol and drug problems — Abuse or dependency, experienced by 35% of the subjects (age 12 and older)
Two additional secondary disabilities exist for adult patients:
Dependent living — Group home, living with family or friends, or some sort of assisted living, experienced by 80% of the subjects (age 21 and older)
Problems with employment — Required ongoing job training or coaching, could not keep a job, unemployed, experienced by 80% of the subjects (age 21 and older)
Protective factors and strengths
Eight factors were identified in the same study as universal protective factors that reduced the incidence rate of the secondary disabilities:
Living in a stable and nurturant home for over 72% of life
Being diagnosed with FAS before age six
Never having experienced violence
Remaining in each living situation for at least 2.8 years
Experiencing a "good quality home" (meeting 10 or more defined qualities) from age 8 to 12 years old
Having been found eligible for developmental disability (DD) services
Having basic needs met for at least 13% of life
Having a diagnosis of FAS (rather than another FASD condition)
Malbin (2002) has identified the following areas of interests and talents as strengths that often stand out for those with FASD and should be utilized, like any strength, in treatment planning:
Music, playing instruments, composing, singing, art, spelling, reading, computers, mechanics, woodworking, skilled vocations (welding, electrician, etc.), writing, poetry