Psychiatric manifestations of fetal alcohol spectrum disorders
The psychiatric disorders most frequently recognized in children with fetal alcohol spectrum disorder (FASD) are attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).
Studies report that between 50 and 75% of children diagnosed with FASD meet criteria for an ADHD diagnosis.
In the case of ASD, the rates are more variable: reports cite rates of 2 to 5%. The prevalence of what is called broad autism spectrum disorder, that is, symptoms of the autism spectrum but not meeting the diagnostic criteria, is a matter of debate.
Clinical features of fetal alcohol spectrum disorders
Although it is widely accepted that communication and social comprehension difficulties are present in a large proportion of children with FASD and could even be considered a core deficit, there is debate about whether these should be labeled as ASD. Some experts recommend a comorbid (i.e., co-occurring) diagnosis of ASD when the diagnostic criteria are fully met; in other cases, when there are no repetitive and restricted behaviors causing difficulties and only difficulties in social comprehension or communication are present, a diagnosis of social communication disorder could be made as part of the clinical presentation of FASD.
How is treatment approached when there is comorbidity?
The treatment of ADHD comorbid with FASD is multimodal, with education for parents and teachers about the disorder and behavioral modification strategies that have been shown to be useful in these children, prescribed medications, and educational adjustments.
The treatment of ASD comorbid with FASD includes aspects of speech therapy, training in comprehension and social communication, and education for parents and teachers in managing the difficulties arising from the disorder.
Some children diagnosed with FASD have the added risk of having experienced extreme deprivation in institutions (orphanages) at an early age (between 6 and 24 months). A British research group ( English and Romanian Adoptee Study, ERA Study ) has shown that early deprivation lasting more than six months can cause various types of psychopathological disorders in some of the children exposed.
Neurological alterations in fetal alcohol spectrum syndrome
These described alterations are:
- "Quasi-autistic" characteristics.
- Problems developing appropriate relationships and in social functioning; Lack of attention.
- Hyperactivity and poor cognitive functioning.
Some children with FASD experience disruptive behavior, commonly known as conduct disorder . These can range from disobedience, defiance, and frequent, intense tantrums to severe outbursts of rage with agitation and physical aggression toward objects or people. These problems place a great deal of stress on parents and educational institutions, necessitating a multidisciplinary intervention involving specialized teams in educational guidance, psychology, psychiatry, and social work.
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