FASD is often called an “invisible disability.”  Unlike many other “birth defects”, the evidence of the physical damage done by prenatal alcohol exposure is often difficult to see, especially the neurological damage to the structure and function of the brain.  This prenatal brain damage results in cognitive and behavioral deficits which may be interpreted by others as willful behavioral choices but are, in fact, neurological disabilities.  

Remember that the facial features that are caused by prenatal alcohol exposure occur in less than 25% of people with an FASD, and that many people with an FASD have average or even above average intelligence, and good expressive language skills.

The invisible nature of the causal connection between neurological dysfunction and behaviors makes having been born with a Fetal Alcohol Spectrum Disorder particularly challenging.  Instead of receiving support and services like many children similarly born with a birth defect through no fault of their own, individuals born with FASD are frequently blamed for making especially poor choices over and over again.  The actual cognitive problems often go misdiagnosed and misunderstood. This can result in secondary problems such as low self esteem, self-destructive coping mechanisms, depression and frustration which often increase the longer the condition goes undetected.

Given the current high prevalence estimates of 2 – 5% of the population, and the extremely high percentage of undiagnosed children and adults, it is likely that anyone who provides services to adults or children will encounter someone with an undiagnosed FASD.  It is therefore extremely important that many types of service providers have access to easy tools for screening for FASD so they can make appropriate referrals for diagnostic assessment. Once a person with FASD is accurately diagnosed, they can start receiving the services and supports that anyone with neurological damage and development disability have a right to in our societies.

Here is a short list of people who are likely to encounter people with an FASD and who should be aware of and may find useful existing FASD Screening Tools:

  • Psychologists
  • Social Workers
  • Doctors – especially primary care MD’s
  • Dentists
  • Allied Health professionals
  • Teachers
  • Child Care workers
  • Birth, Foster, and Adoptive parents
  • Counselors and Therapists
  • AODA and Mental Health Treatment staff
  • Employers
  • Correctional staff
  • Attorneys
  • Judges
  • Neighbors, Relatives
  • Disability Eligibility Specialists

Despite the invisibility of many of the deficits associated with FASD, there are some commonly mentioned “red flags” that can trigger a referral for an FASD evaluation.


Risk Factors for  FASD (from FASD Regional Training Centers Curriculum Development Team, 2015)

  • Family history of substance abuse
  • Having a sibling with an FASD
  • History of being in foster/adoptive care or involvement with child protective services
  • Behavior problems that are not responding to traditional methods of behavior management
  • Diagnosis of ADHD with poor response to medication/therapies.


Five Red Flags for FASD

  • Intellectual Problems
  • Sensory integration problems
  • Behavior and mood problems
  • Physical Problems
  • Birth Defects


MAYO Clinic Symptoms of FASD

The severity of fetal alcohol syndrome symptoms varies, with some children experiencing them to a far greater degree than others. Signs and symptoms of fetal alcohol syndrome may include any mix of physical defects, intellectual or cognitive disabilities, and problems functioning and coping with daily life.


Physical defects may include:


  • Distinctive facial features, including small eyes, an exceptionally thin upper lip, a short, upturned nose, and a smooth skin surface between the nose and upper lip
  • Deformities of joints, limbs and fingers
  • Slow physical growth before and after birth
  • Vision difficulties or hearing problems
  • Small head circumference and brain size
  • Heart defects and problems with kidneys and bones
  • Brain and central nervous system problems


Problems with the brain and central nervous system may include:


  • Poor coordination or balance
  • Intellectual disability, learning disorders and delayed development
  • Poor memory
  • Trouble with attention and with processing information
  • Difficulty with reasoning and problem-solving
  • Difficulty identifying consequences of choices
  • Poor judgment skills
  • Jitteryness or hyperactivity
  • Rapidly changing moods
  • Social and behavioral issues


Problems in functioning, coping and interacting with others may include: 

  • Difficulty in school
  • Trouble getting along with others
  • Poor social skills
  • Trouble adapting to change or switching from one task to another
  • Problems with behavior and impulse control
  • Poor concept of time
  • Problems staying on task
  • Difficulty planning or working toward a goal
  • Sensory overwhelm



Below are links to several  FASD Screening Tools that will help you to identify children and adults who will benefit from referral for a diagnostic evaluation for FASD and related neurological deficits.  The actual diagnosis may be done by a team of several different specialists in FASD from several disciplines. There are some fairly consistent lists of “risk factors” for FASD that are mentioned in a number of publications.  Remember that the facial features occur in less that 25% of people with an FASD, and that 

Commonly Used Screening Tools for FASD:

Neurobehavioral Screening Tool (NST)

University of Wisconsin Department of Family Medicine and Community Health. Planning and Implementing Screening for Fetal Alcohol Spectrum Disorders in the Juvenile Justice System. Madison, Wisconsin: Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, 2018.  Appendix D  Page 35-36

Training for Medical Providers

Flow Diagram for Diagnosis and Referral to Specialty Clinic in the Medical Home

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This site is provided to families and professionals as an informative site on fetal alcohol spectrum disorders (FASD). It is not intended to replace professional medical, psychological, behavioral, legal, nutritional or educational counsel. Reference to any specific agency does not necessarily constitute or imply its endorsement, recommendation, or favoring by Orchids FASD Services.
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