Fetal Alcohol Syndrome Disorder and Autism Spectrum Disorder

Fetal Alcohol Syndrome Disorder (FASD) and Autism Spectrum Disorder (ASD) are two of the most common developmental disabilities (DD) and neurodevelopmental disorders. As stated in the DSM-5, neurodevelopmental disorders generally co-occur which will be discussed and shown amongst similarities between FASD and ASD. Children with FASD are known to exhibit symptoms similar to ASD. Despite these two developmental disorders sharing similarities, they are two separate DD’s, and need to be acknowledged as so.

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Diagnostic Criteria

The DSM-5 states that for neurological disorders, the clinical presentation requires symptoms of delay, excess and deficits in achieving developmental milestones (i.e. social communication). For one to be diagnosed with ASD, they must show a deficit and delay in social communication and interaction skills. Another major diagnostic criterion for ASD would be the presentation of repetitive patterns in regard to interest, activities and behavior (American Psychiatric Association, 2013).  ASD has four severity levels: mild, moderate, severe and profound, whereas FASD has subtypes (Partial Fetal Alcohol Syndrome, Alcohol-Related Neurodevelopmental Disorder, and Alcohol-Related Birth Defects). The severity of ASD is dependent on the social communication impairments and restricted, repetitive behavioral patterns (American Psychiatric Association). Hoyme et al. (2006) state the main diagnostic criterions for FASD include facial phenotypes, central nervous system damage and dysfunctions, growth deficiency, as well as alcohol exposure before birth. They also expressed some concerns with FASD’s diagnostic criteria due to it being too vague and not assessing family and genetic history adequately. Hoyme et al. believe that diagnosing FASD would be easier if it included precisely defined diagnostic categories, operationally defined terms, as well as the emphasis of genetic and family background. 

Phenotypes

Medical Phenotypes

         FASD’s medical phenotypes include, but are not limited to, growth deficiencies and brain structural abnormalities. The physical phenotypes of FASD are small palpebral fissures, smooth philtrum, inner canthal distance, and a thin upper lip (Astley & Clarren, 1996). They believe that a frontal facial photograph can define FASD by acknowledging the physical phenotypes.

         ASD has similar medical phenotypes in terms of brain structural abnormalities, however, when it comes to physical phenotypes; ASD does not have as specific of a list. The DSM-5 states that both individuals with FASD or ASD have a higher probability of also being diagnosed with other emotional, mental and behavioral disorders such as depressive and bipolar disorders, anxiety disorders, stereotypic movement disorder, and attention-deficit/hyperactivity disorder. It is important that professionals keep an eye out for associated medical conditions such as cerebral palsy, and seizure disorders in those with neurodevelopmental disorders (American Psychiatric Association).

Behavioral Phenotypes

         Individuals with ASD are much more likely to not make friends in comparison to those without ASD (Orsmond et al. 2013). They believe that this is a result of low conversation ability, a deficit in functional skills, and having parental or community supports due to their disability. Simonoff et al. (2012) believe that the lack of mood regulation in those with ASD is another reason for their lack of relationships. Simonoff et al. describe severe mood problems as high levels of irritability which is presented through temper tantrums, as well as severe and prominent mood abnormalities, hyperarousal and increased reactivity to negative emotional stimuli. Those with FASD also face the difficulty of building and maintaining social relationships due to their similar social deficits.

         Individuals with FASD and ASD share a variety of behavioral phenotypes which include, but are not limited to, social deficits, a higher risk for educational disabilities, and difficulties achieving developmental milestones (Shields, B., Wacogne, I., & Wright, C., 2012). Those with FASD are more likely to become individuals with addiction in comparison to individuals with ASD. They are also more likely to become more involved in criminal activity. Astley and Clarren stress that those who have been diagnosed with FASD will live a lifetime with physical, intellectual, cognitive and behavioral disabilities; similar to those with ASD.

Models of Service Delivery

A large piece of support for individuals with either FASD or ASD is educational assistance. This can be specific to an educational assistant in the classroom or being placed in a learning environment specific towards learning and developmental disabilities. Unfortunately, due to funding cuts in the educational field; these supports are not always available to those who need them, and then the individuals with disabilities such as FASD or ASD tend to have more difficulties within the classroom and in their social skills.

Sansosti (2013) worked as advocates for individuals with ASD and found that effective school-based services include development implementation, evaluation of instructional strategies, and constant information and assistance from school psychologists. They state that due to the growing numbers of students with ASD, these services and supports need to be more accessible and stable for students in order to achieve and promote academic success.

A common service delivery for those with FASD include prevention services and family empowerment networks. Wilton & Plane (2006) analyzed and implemented a family information, referral and support network for those affected by FASD. This network can be used by the children or families and provides educational training to those who are interested. They state that it is the responsibility of health professionals to not only recognize those at risk of FASD, but to refer families to the appropriate intervention services to ensure the safety and development for those involved. They discuss how mothers of those with FASD face a lot of shame and stigmatism, and how although those feelings are understood; they do not help the current problem, and we need to focus on the prevention measures rather than blaming.

Similar to Wilton and Plane, the Government of Yukon proposed an FASD prevention service model in 2014. This model was created and implemented due to the prevalence in Aboriginal populations. This project will assist governments and health care professionals to bridge together in hopes of preventing FASD in children, and further educating mothers, families and others in this disability. They have similar beliefs to Wilton and Plane, and state that by addressing this growing concern immediately will allow for a more understanding, helpful and supportive environment for those involved.

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Evidence-Based Interventions

All patients have the right to effective treatment, and this is a core principle of behavior analysts. The Behavior Analyst Certification Board states that Applied Behavior Analysis (ABA) is one of the more effective interventions for ASD, and this is due to the direct observation, functional analysis, and measurements between behavior and environments. ABA is reliant on empirical support and is a successful correction of main deficits within ASD, and acts as an assistant for restoring abilities. This form of intervention is also effective in those with FASD due to the similarities the two disorders share in deficits. Tools such as social stories, token economies, and modeling are used to reward a client’s accelerate behavior (i.e. completing schoolwork), as well as rewarding the absence of a decelerate behavior (i.e. temper tantrums, or off-task behavior).

Conclusion

Although FASD and ASD are two separate developmental disabilities; they have similar social and educational deficits which means that they can be treated similarly depending on circumstance. Both require educational support for those involved, and through education we can support families and individuals with these disabilities. A lack of information can lead to discrimination, stigmas and ineffective treatment for those with developmental disabilities.

It is important to ensure that regardless of the disability, the client is always receiving the most effective and responsible treatment, and that if the treatment is no longer effective; it is to be eliminated immediately. Individuals with FASD and ASD will need constant support whether it is empathy from loved ones, educational assistance, or behavioral analysts.

Together, professionals can work together to assure the effectiveness and rightful treatment of clients with developmental disorders. This can be through treatment implementation, public educational workshops, support networks, and proper screening, diagnoses and referrals.

References

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text Revision)
• Behavior Analysts Certification Board. (2014) Applied Behavior Analysts treatment of Autism Spectrum Disorder: practice guidelines for healthcare funders and managers.
• Astley, S. and Carren, S. (1996) A case definition and photographic screening tool for the facial phenotype of fetal alcohol syndrome. The Journal of Pediatrics, (129)1.
• Hoyme, H., May, P., Kalberg, W., Kodituwakku, P., Gossage, J., Trugillo, P., Buckley, D., Miller, J., Aragon, A., Khaole, N., Viljoen, D., Jones, K., and Robinson, L. (2006) A practical clinical approach to diagnosis of fetal alcohol spectrum disorder: clarification of the 196 institute of medicine criteria. Journal of Pediatrics, 115(1), 39-47.
• Orsmond, G., Shattuck, P., Cooper, B., Sterzing, and Anderson, K. (2013) Social participation among young adults with an autism spectrum disorder. Autism Developmental Disorder, (43)27.
• Wilton, G., and Plane, M. (2005) The family empowerment network: a service model to address the children and families affected by Fetal Alcohol Spectrum Disorders