What is the difference between FAS, FAE and FASD?

Fetal alcohol syndrome (FAS) was first coined in 1973 to describe individuals who had been prenatally exposed to significant amounts of alcohol and demonstrated a particular pattern of facial characteristics, growth delay and brain impairment.  Fetal alcohol effects (FAE) and possible FAE were terms used to describe an individual who had been prenatally exposed to alcohol and demonstrated concerns in brain development, but did not demonstrate the same facial characteristics and/or growth delay as those diagnosed with FAS. 

Research and experience have since evidenced that only a minority of individuals prenatally exposed to alcohol will actually demonstrate any facial anomalies or delayed growth.  The diagnosis of FAS, using these criteria, was missing many individuals who had an invisible disability but still required significant support.  Fetal Alcohol Spectrum Disorder (FASD) was developed as an umbrella term to capture broader range of disabilities that can occur from prenatal alcohol exposure.  While the diagnosis of FAS was still valid, the term FAE fell out of use.  Individuals who were once referred to as having FAE or possible FAE would likely be diagnosed with partial fetal alcohol syndrome (pFAS) or alcohol-related neurodevelopmental disorder (ARND).

In December 2015, the new Canadian guidelines for diagnosing FASD across the lifespan were published, changing the terminology again.  Fetal alcohol spectrum disorder (FASD) is now a diagnostic term in Canada, differentiating FASD with or with no sentinel facial findings.  See the 2015 diagnostic guidelines for more information on the changes.  The umbrella terminology of FASD is still used in the United States and other parts of the world, and is therefore found in most resources.


How can I tell if a person has FASD?

FASD is an "invisible disability," meaning that most people have no outward signs of the challenges they face.  Concerns are primarily demonstrated through learning and behavioural symptoms such as difficulties with memory, abstract language, daily living skills and reasoning.  Only a specially trained physician can diagnose FASD because each individual presents so uniquely, but you can read more about FASD in the Resources on FASD section of our website to help you better understand some of the common signs and symptoms.  If you have concerns for a child, youth or adult in your care, it is strongly recommended to refer them for a full assessment in order to get a better understanding of their strengths and needs whether or not they receive an alcohol-related diagnosis.


Can a father's drinking cause FASD?

The only cause of FASD is maternal alcohol use in pregnancy; mothers share a blood connection with the fetus throughout gestation and therefore have the most significant impact on development through nutrition and lifestyle.  There are other factors than can impact development, such as other substance use, paternal alcohol use, alcohol use in breastfeeding and more, but these effects are not included in the terminology of FASD.

Research has determined that if a man drinks significant amounts of alcohol prior to conception, this can detrimentally affect his sperm particularly in the area of sperm motility and his ability to reproduce.  While there have been preliminary studies indicating a link between paternal alcohol consumption and negative childhood outcomes, more research is required to determine the amounts and patterns of exposure found to be harmful, and the potential type and severity of effects. 

What we do know is that the main indicator of whether or not a woman will be able to abstain from alcohol throughout her pregnancy is whether or not she has the support of her partner, friends and family.  Fathers play a critical role in the prevention of FASD.


Does alcohol affect breast milk?

The American Academy of Pediatricians suggests that while nursing, mothers should avoid drinking alcohol because it can pass through their milk to the baby.  Furthermore, The National Institute of Child Health and Human Development conducted a study in which they detected significant differences in motor development at one year of age in those babies subjected regularly to alcohol through breast milk.  Health professionals recommend that the best course of action is to not drink at all while breastfeeding, in order to eliminate risk to the child during this time of still rapid brain development.  Storing unaffected breastmilk or expunging affected milk may be options for some women.


How can I increase my knowledge and support individuals living with FASD?

The asantecentre.org website provides links to many resources.  Our Resources section is a good place to start to find print, video and community services relevant to different age groups of individuals with FASD as well as various personal or professional relationships to individuals with FASD.  Check out the Events and News section for upcoming conferences or training sessions.  You can also contact the Centre for more specific information.


How much does an assessment cost?

Assessments provided through the Regional Health Authorities are available to children up to the age of 19 at no cost to the family through the CDBC Network.  Assessments provided through the Youth Justice FASD Program and the service eligibity pathway for Community Living BC's Personalized Supports Initative are also provided at no cost to the individual or family.

The costs associated with a private assessment can vary greatly depending on the assessment needs.  The Asante Centre is a not-for-profit agency, which means we are a charitable organization.  The Centre is committed to working to find continued funding in order to keep assessment costs to a minimum.  Exact costs of assessment are determined as a client proceeds through the initial referral process.


Can you make a diagnosis without a mother confirming prenatal alcohol use?

The assessment team cannot make an alcohol-related diagnosis without confirming prenatal alcohol exposure.  This information may come from the person's mother, other family members, birth records, facial characeristics associated with prenatal alcohol exposure, or other credible means.

If a person is not connected to his or her birth family, it may be difficult to gather this information.  If there is no confirmation, an alcohol-related diagnosis will not be made.  However, a comprehensive assessment will still help the person and his or her support network understand the individual's unique abilities and needs.  Many disability services can be accessed with or without the alcohol-related diagnosis, if the person meets other criteria for requiring support.


My child was diagnosed in the past.  Can I get a re-diagnosis for my child?

The key to this question is understanding the difference between an assessment and a diagnosis.  An FASD diagnosis only needs to be made once in a lifetime, assuming it meets the Canadian guidelines.  However, a person's abilities and needs change throughout their lifespan, and an updated functional assessment to evaluate the person's needs may be beneficial.  If the person's abilities have not been recently assessed, you may want to consider a psychology and/or speech-language assessment.

In other words, it is unlikely that what you want is a re-diagnosis, unless it is a second opinion that you are after, or the original diagnosis was made prior to the original Canadian Guidelines for Diagnosis were implemented in 2005 and there is a question of its validity according to the multidisciplinary team model (where each member of the assessment team is a specialist in his or her field, and can provide valuable insight into all aspects of the person's abilities).  It is more likely that you want to find out more about the person's abilities and areas of challenge, including what services the person might be able to access as he or she gets older.

A functional assessment is generally completed by a psychologist privately or in community services, and may also include a speech-language or mental health component.