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Recognizing Fetal Alcohol Syndrome in Adults

Medically reviewed by Dr. Po-Chang HsuJuly 22, 2024
Written by
On July 22, 2024

Table of Contents

Key Points

  • Prenatal alcohol exposure can result in fetal alcohol spectrum disorder (FASD).
  • The severity of symptoms varies widely on the spectrum, with fetal alcohol syndrome being the most severe.
  • FAS is a life-long condition with no cure; however, a proper diagnosis and assessment of needs, treatment, and support can help provide resources for areas of need.

Recognizing Fetal Alcohol Syndrome in Adults

Fetal alcohol syndrome (FAS) is a condition caused by prenatal alcohol exposure, resulting in the developing fetus being exposed to alcohol. This causes the baby to be born with developmental disabilities. It is estimated that 1%-5% of the United States population has fetal alcohol spectrum disorder (FASD).[1] The effects of FAS are experienced throughout the person’s life.

What is FAS?

Fetal alcohol syndrome (FAS) is a condition that is caused by a person drinking while they are pregnant, exposing the baby to alcohol in utero, which results in the child being born with disabilities. The FAS symptoms vary from person to person, but they are lifelong disabilities that impact behavior, learning, thinking, and physical development.[2]

Fetal alcohol spectrum disorder (FASD) is a range of conditions that are due to in-utero alcohol exposure. Fetal alcohol syndrome (FAS) is one of the most severe conditions on the fetal alcohol spectrum. FAS is a life-long condition, and there is no cure. However, it can be prevented by not consuming alcohol while pregnant. If you are pregnant and struggling not to consume alcohol it is important to seek treatment at an alcohol rehab or other treatment provider.

Symptoms of Fetal Alcohol Syndrome in Adults

The severity of fetal alcohol syndrome symptoms varies, hence why it is now considered a spectrum disorder. Some people have more significant problems than others. Symptoms of fetal alcohol syndrome may include any mix of issues with how the body develops, thinking, learning, behaviors, and functioning and coping in daily life. Symptoms of FAS may include:[3]

Physical Development Problems

  • Facial abnormalities typical of fetal alcohol syndrome: small eyes, a very thin upper lip, a flat nose bridge, and a smooth skin surface between the nose and upper lip.
  • Slow physical growth in utero and during childhood.
  • Delayed development: longer time to reach milestones, including sitting, talking, and walking.
  • Vision or hearing problems.
  • Smaller than average head and brain size.
  • Changes in how the heart, kidneys, and bones develop.
  • Poor coordination or balance.
  • Being jittery or hyperactive.

Learning and Thinking Problems

  • Intellectual disability and learning disorders: trouble with memory, learning, focusing, and thinking.
  • Difficulty understanding the resulting consequences of choices.
  • Poor judgment skills: difficulty thinking through issues, problem-solving, reasoning, and making decisions.
  • Short attention span and difficulty staying on and completing a task.
  • A poor concept of time makes it difficult to follow schedules, know what time to leave to arrive on time, and understand how long a task will take.
  • Trouble with organizing and planning or working toward a goal.
  • Trouble understanding and following directions.

Social and Behavioral Problems

  • Attendance, learning, behavior, and interaction in school are challenging.
  • Trouble getting along with others: struggling with communication and social skills.
  • Trouble adapting to change or switching from one task to another.
  • Behavioral issues such as controlling emotions and actions.
  • Problems managing life skills: telling time, self-care, managing money, and staying safe.
  • Being easily influenced by others or taken advantage of.
  • Quickly changing moods.

Challenges of Fetal Alcohol Syndrome in Adults

FASD characteristics are not unique. They are individually present in numerous other neurodevelopmental and genetic conditions, such as autism spectrum disorder, attention deficit hyperactivity disorder, and intellectual disability. Childhood trauma can also play a role. Getting an accurate diagnosis can be challenging and requires careful evaluation to diagnose and treat FASD properly. 

It is estimated that there are just as many people with FASD as there are with autism. FASD occurs in approximately 1%-5% of the population in the United States.[4] This number is higher than previously recognized and continues to be overlooked or misdiagnosed. One of the reasons behind this is the shame parents experience of having a child with FASD.

Other challenges of diagnosing FASD are the criteria are resource and service-intensive; to even receive a referral to the limited clinic that specializes in FASD, there needs to be a known prenatal alcohol exposure (this can be difficult for people who do not have a known family history), there is a limited recognition of FASD among primary care physicians, and most clinics focus on child diagnosis (there are limited resources at this time for adults with FASD).[5]

Assessment for FASD Diagnosis

Diagnosing FASD in adults requires a team of medical providers, just as diagnosing an infant or child. The team should consist of a physician, psychologist, and speech-language pathologist. Areas that are assessed and diagnostic criteria include: [6]

Medical Assessment

  • Confirmation of prenatal alcohol exposure based on reliable clinical observation, self-report of alcohol use, reports by a reliable source, documentation in medical records of positive blood alcohol concentrations, history of alcohol treatment, or other social, legal, or medical problems related to drinking during the pregnancy.
  • The presence of all three facial features that are highly correlated with prenatal alcohol exposure and FASD.

Sentinel Facial Features

These facial features are highly correlated with prenatal alcohol exposure:

  • A short palpebral fissure
  • A smooth or flat philtrum
  • A thin upper lip

Neurodevelopment Assessment

The neurodevelopment assessment assesses for brain dysfunction that causes severe impairment in three or more of the following areas:

  • Motor skills
  • Neuroanatomy/neurophysiology
  • Cognition
  • Language
  • Academic achievement
  • Memory
  • Attention
  • Executive function, including impulse control and hyperactivity
  • Affect regulation
  • Adaptive behavior, social skills, or social communication.

Diagnosis Criteria

A diagnosis of FASD is made if the person meets one of the following criteria.

FASD with sentinel facial features

  • Simultaneous presentation of all three sentinel facial features AND
  • Confirmation of prenatal alcohol exposure or exposure unknown AND
  • Impairment in three or more of the neurodevelopmental areas

FASD without sentinel facial features

  • Impairment in three or more of the neurodevelopmental areas AND
  • Confirmation of prenatal alcohol exposure at a level that is known to cause neurodevelopmental problems.

Treatment and Support For Fetal Alcohol Syndrome in Adults

As the symptoms of FAS vary widely, adults should seek treatment based on their needs. For example, some people may have more physical health needs, while others may need more psychosocial support. There is evidence that adults with FAS experience a high rate of mental health conditions, particularly anxiety, depression, bipolar and ADHD. Adults with FAS should be provided the opportunity for mental health screening, assessment, and treatment if needed.[7]

Living with FAS as an Adult

Fetal alcohol syndrome is a life-long condition with no cure; however, a proper diagnosis and assessment of needs, treatment, and support can help provide resources for areas of deficit. Since the symptoms and severity of FAS vary so widely from person to person, interventions and support need to be tailored to the individual’s needs.

Medical Content Writer

Amanda Stevens is a highly respected figure in the field of medical content writing, with a specific focus on eating disorders and addiction treatment. Amanda earned a Bachelor of Science degree in Social Work from Purdue University, graduating Magna Cum Laude, which serves as a strong educational foundation for her contributions.

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Frequently Asked Questions About Fetal Alcohol Syndrome in Adults

Yes, it is still possible to have FAS without the associated facial features; you may also have a milder form and would instead be diagnosed with fetal alcohol spectrum disorder rather than the more severe FAS.

There is no known safe level of alcohol consumption while pregnant. There is also no established level of how many drinks or amount of alcohol one would have to drink that would be known to result in FAS. To eliminate risk, no alcohol should be consumed while pregnant.

No, fetal alcohol syndrome is a life-long condition with no cure. However, interventions can be implemented to identify and diagnose FAS, which may reduce the impact of the symptoms and limit its disabling effects.

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[1]U.S. Department of Health and Human Services. (n.d.). Fetal Alcohol Spectrum Disorders. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/research/fetal-alcohol-spectrum-disorders

[2,3 Mayo Foundation for Medical Education and Research. (2024, June 13). Fetal alcohol syndrome. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/fetal-alcohol-syndrome/symptoms-causes/syc-20352901 on 2024, June 16.

[4] Knispel, S. (2023, August 21). Thriving while living with fetal alcohol spectrum disorders (FASD). University of Rochester News Center. Retrieved from https://www.rochester.edu/newscenter/fetal-alcohol-syndrome-fasd-survivors-thriving-499312/ on 2024, June 16.

[5] Popova, S., Dozet, D., & Burd, L. (2020). Fetal Alcohol Spectrum Disorder: Can We Change the Future? Alcoholism, Clinical and Experimental Research, 44(4), 815-819. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217166/ on 2024, June 16.

[6] Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M., Baldwin, M. E., Chudley, A. E., Conry, J. L., LeBlanc, N., Loock, C. A., Lutke, J., Mallon, B. F., McFarlane, A. A., Temple, V. K., & Rosales, T. (2016). Fetal alcohol spectrum disorder: A guideline for diagnosis across the lifespan. CMAJ : Canadian Medical Association Journal, 188(3), 191-197. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754181/ on 2024, June 16.

[7] Coles, C. D., Grant, T., Kable, J. A., Stoner, S., & Perez, A. (2022). Prenatal alcohol exposure and mental health at midlife: A preliminary report on two longitudinal cohorts. Alcoholism, Clinical and Experimental Research, 46(2), 232. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867925/ on 2024, June 20.

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