When a pregnant woman drinks alcohol, the changes this causes in brain development of her unborn baby are permanent. The brain damage does not repair itself over time. Children cannot be cured of the damage caused by alcohol use during pregnancy. But the effects can be reduced. These are called “protective factors.” We talk about protective factors later in this section.

There are two kinds of impacts FASD can have on people. These are called “primary disabilities” and “secondary disabilities”. Primary disabilities are the direct result of alcohol on the unborn baby. Secondary disabilities occur after birth, as a result of the primary disabilities.

Primary disabilities
Primary disabilities are divided into four categories. These categories are:

  • cognitive disabilities (problems with thinking or learning)
  • behavioural disabilities (actions)
  • physical disabilities (body and health)
  • sensory disabilities (information from senses)

Cognitive disabilities
Cognitive functioning refers to intellectual processes and mental tasks. People use many cognitive processes every day. For example, every day you likely take in, store, find and use information. You also learn from experiences and predict outcomes based on experiences, you pay attention to the world around you, make decisions and solve problems. Each day you will use many more cognitive processes but from these examples you can see how important cognitive abilities are to our successful functioning.

Here are some examples of what impaired cognitive functioning might look like in everyday life for a person with FASD:

  • slower cognitive pace—needs extra time to process information
  • slower auditory (hearing) processing—understanding verbal information takes longer, responses may seem out of context or off topic
  • difficulty with prioritizing, organizing, reasoning, planning, initiating and following through, may start but not finish, set goals but not know how to achieve goals
  • trouble with abstract thinking—problems with math, time, money, emotions
  • problems generalizing—what is learned in one setting is not readily transferred to another
  • difficulty with memory—forgetful, loses items, repeats the same mistake over and over
  • poor judgement—impaired decision making, inability to differentiate between safety and danger, trouble knowing what is important or not important, trouble with predicting outcomes
  • trouble with problem solving, making choices or making decisions—cannot think of possibilities or an alternative other than what is happening right then
  • “confabulation” or untruths—filling in the blanks and storytelling that might be perceived as lies, not understanding the difference between truth and fiction
  • inconsistency–-varying learning abilities, personal changes from day to day
  • communication problems—speech and language problems, can repeat rules but does not understand what the rule requires, inaccurate or not logical responses to questions

Behavioural disabilities
People’s behaviours are controlled by brain functions. Much of our behaviour is linked to social and emotional development. Because our brains control our behaviours it makes sense that a damaged brain creates disordered behaviours. Some examples of behavioural disabilities experienced by people affected by FASD are:

  • problems getting along with others
  • impaired ability to read social cues—cannot detect subtle, or even obvious, social cues
  • impulsive actions and poor ability to delay gratification—lives in the moment and wants immediate results
  • grandiose aspirations and expectations—impaired understanding of what is possible or realistic
  • lack of inhibitions—may be overly friendly or too direct in approaching others
  • poor understanding and use of personal boundaries and personal space
  • struggles with regulating emotions—unpredictable mood swings, anger, explosiveness, violence possibly triggered by seemingly minor events
  • blaming others and defiance—struggles to see link between their own actions and what has happened
  • impaired ability to recognize a range of emotions or express emotions so they may appear to be emotionless or have a “flat affect”
  • poor ability to express empathy—differences in bonding and attachment
  • “perseveration”—this means getting stuck on an issue, idea or place; extreme focus; rigid and inflexible behaviour pattern
  • being easily influenced, overly trusting, naive and gullible
  • “dysmaturity” which means acting socially, emotionally, and cognitively younger than your chronological age
  • vulnerable to peer pressure and influence—easily led by others
  • sleep problems and fatigue—seems to sleep too much or not enough, lacking an internal clock, disordered sense of time
  • being over active—inability to self-calm or regulate energy levels
  • easily overwhelmed and may shut down entirely as a response
  • change and transitions in activities or plans are hard—may seem confused or react badly to changes in routine

Physical disabilities
Some people affected by FASD have physical signs, but not all people have physical signs or medical issues. If they do, here are some signs they might have:

  • delayed motor development—slow to meet developmental milestones
  • problems with fine and gross motor skills—this will be most noticeable when children reach school age and begin classroom activities with their peers
  • poor hand-eye coordination
  • poor balance or coordination—appears clumsy or awkward
  • lower height or weight
  • distinct facial feature
  • problems with hearing
  • poorer functioning or poorly developed body systems (including skeletal, muscular, renal, circulatory)—this can lead to further physical health problems later in life

Sensory disabilities
The sensory system gives us the ability to taste, smell, touch, hear, see, know our body position, and perceive movement sensations. Some signs of sensory disabilities in children affected by FASD are:

  • poorly functioning sensory system—high OR low pain tolerance, increased OR decreased sensitivity to light, sound, texture, smell, or movement
  • under-reactive to stimulation—can’t seem to focus on any one type of stimulation, shows little reaction to sensory information
  • sleep problems—trouble falling asleep, staying asleep or trouble waking, staying awake
  • sensory seeking behaviours—seeking out a sensation by swinging, climbing, jumping or spinning
  • avoiding sensory behaviours—avoiding sensory information, like avoiding noisy crowds, bright lights, busy places, or being touched
  • unusually high activity level (slow to settle down) OR low activity level (shuts down)
Remember: It is different for each child who is affected by FASD. There is a lot of difference from child to child in how many and how severe primary disabilities will be. And none are exclusive to FASD. These problems can be caused by other risk factors, too, like living a stressful life in poverty or not having access to good prenatal care.

Here is a quote from a service provider in our community about the importance of supporting parents and children affected by FASD:

Audio Transcription:

“Dealing with children with FASD is always an issue. They are not as compliant and can have disruptive behaviours that disrupt the home even more. The parents are doing the best they can and these aren’t bad kids. We need to help parents and grandparents, who are also doing a lot of childcare. They need ideas about how to deal with a child who is causing havoc in the home, how to calm the situation down and calm themselves down, because time outs don’t work with kids who are hyperactive.”