In 2015, new Canadian Guidelines were submitted for publication to the Canadian Medical Association Journal (CMAJ). We have included all terms for your reference including historical terms.
Alcohol related birth defects (ARBD):
This requires confirmation of pre-natal alcohol exposure and birth defects that can include cardiac, skeletal, renal, vision or hearing deficits.
Alcohol related neurodevelopmental disorder (ARND):
This requires reliable information of pre-natal alcohol exposure and evidence of neurodevelopmental abnormalities and/or evidence of a complex pattern of behaviour or cognitive abnormalities inconsistent with developmental levels.
In FASD, these are behaviours that are driven by the dysfunction in the brain. Examples include: attentional issues, impulsivity, naiveté, emotional issues, inappropriate social behaviours, inability to communicate needs effectively, and so forth. In children these issues impact their ability to bond socially and to succeed in school. These issues continue as the child ages and impact the teen’s or adult’s ability to succeed in the community in work, education and training, and leisure activities.
At the core of those living with FASD are the many challenges they face due to the brain injury and damage resulting from pre-natal exposure to alcohol. These challenges result in poor school and work performances and undesirable behaviours.
The following is a brief list of brain function definitions:
- Cognition – Overall level of thinking capabilities and measured by IQ.
- Attention – Ability to focus on things without being distracted by nearby moving objects or sounds.
- Memory – Remembering recent events immediately (short term) or from the distant past (long term) and being able to apply stored memory from the recent or distant past to new situations appropriately. It includes visual-spatial (what you see), auditory (what you hear), and verbal (what you say) memory. Working memory is the ability to use stored information in short-term situations (i.e. picking up groceries without a list).
- Language – To learn language and be able to communicate learned information. This is also the ability to understand what is shared (receptive communication) and to respond (expressive communication).
- Social Communication – Knowing how, and being able, to act appropriately with friends, family and society in general regardless of social situation.
- Motor skills – Fine motor skills involves writing and drawing (finger work). Gross motor skills involve body and large muscle movement, such as walking, running, lifting objects, etc.
- Soft Neurological damage – Problems related to the CNS, including difficulty with balance and coordination.
- Hard Neurological damage – Problems related to the central nervous system that can include small head size and seizure disorders.
- Adaptive Behaviour – Age-appropriate behaviours critical for independent and safe living. Examples of adaptive behaviours include: cleanliness, ability to maintain employment, money management, food preparation abilities and social skills.
Central nervous system (CNS):
The CNS is one of the two main divisions of the nervous system of the body. It is made up of the brain and spinal cord. The CNS deals with information to and from the peripheral nervous system.
Co-existing mental illnesses:
Many individuals with FASD develop co-existing (AKA co-occuring) mental illnesses due to misdiagnosis and/or lack of proper supports. Common co-existing mental illnesses with FASD are: schizophrenia, attention deficit hyperactivity disorder (ADHD) and depression.
Any time describing an unborn human’s development prior to its designation as a fetus (prior to three months of development).
A fetus is an unborn, developing human, usually described from three months after conception until birth. It is also noted as the beginning of when a being takes the form of physical human characteristics.
Fetal alcohol spectrum disorder (FASD):
FASD, until 2015, was an umbrella term capturing four specific diagnoses: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol related neurodevelopmental disorder (ARND) and alcohol related birth defects (ARBD).
Since 2015, it is a diagnostic term used to describe both neurological brain damage and physical anomalies as a direct result of alcohol exposure to a fetus or embryo during pregnancy. The word “spectrum” is used to describe the wide-ranging effects in individuals with the disability.
Fetal Alcohol Spectrum Disorder with Sentinel Facial Features (SFF):
Confirmed pre-natal alcohol exposure FASD with/SFF (confirmed PAE). Newer term to include those with reliable confirmation of being prenatally exposed to alcohol AND having the facial features associates with FAS.
Fetal Alcohol Spectrum Disorder without Sentinel Facial Features (SFF):
Confirmed pre-natal alcohol exposure FASD without SFF (confirmed PAE). Newer term to include those with reliable confirmation of being prenatally exposed to alcohol without developing the facial features associated with FAS.
Fetal Alcohol Effects (FAE): A term used to describe the invisible effects of pre-natal alcohol exposure. This term was replaced by the diagnoses of pFAS and ARND.
Fetal alcohol syndrome (FAS), with confirmed pre-natal alcohol consumption:
Requires reliable information that a mother consumed alcohol during pregnancy, which is called pre-natal alcohol exposure (PAE). It includes the physical findings of facial differences, small growth and impairments in brain function. *CMAJ
Fetal alcohol syndrome (FAS), without confirmed pre-natal alcohol consumption:
Same as above, but without confirmed maternal alcohol consumption. *CMAJ
This refers to a disability that is not apparent because it lacks obvious physical characteristics. FASD is often described as an “invisible disability.” Having an invisible disability can make things more challenging for those with FASD, as those who do not understand it may struggle to accept the disability when he or she looks “normal.”
This describes a variety of mental disorders that can be diagnosed by a health care professional and are listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 or its equivalent). These are health conditions that affect thinking, mood and/or behaviour. Mental illness is associated with depression, anxiety disorders, schizophrenia, bipolar disorder, suicide and more.
More commonly referred to in modern society as “mental disability” and/or “cognitive disability,” mental retardation is a term that is still regularly used within the medical community to describe below normal Intelligent Quotient (IQ) levels.
Partial fetal alcohol syndrome (pFAS), with confirmed pre-natal alcohol consumption (FAS):
Requires reliable information that a mother consumed alcohol during pregnancy, and some (but not all) of the physical differences and impairments in cognitive and social abilities associated with FAS. *CMAJ
Peripheral nervous system (PNS):
The second part of the nervous system that connects the CNS to the limbs and organs in the body – also described as a “connection relay.” Deficits in this system may result in problems in motor skills and/or sensations.
These are disabilities specifically related to the impacts of pre-natal alcohol exposure, in other words, these are disabilities that the individual is born with. Primary disabilities can be noticeable in any or all of one’s physical, behavioural, sensory and cognitive functioning.
These can be a combination of disabilities that may result from misdiagnosis or no diagnosis as well as significant environmental factors. Commonly, these secondary characteristics include homelessness, risk-taking behaviours, poverty, routine contact with law enforcement, relationship issues, chronic unemployment, substance abuse and addictions.
The part of the brain that responds to incoming information using the body’s five senses. Characteristic of individuals with FASD is sensory dysfunction, which includes not feeling cold weather, poor sense of taste and smell, increased pain thresholds, hearing loss, etc. These disorders continue throughout one’s entire lifespan.
A medical term used to refer to a variety of brain injuries that are “permanent and unchanging” brain damage. Prenatal exposure to alcohol can be a cause of static encephalopathy.
A teratogen is something that can cause a birth defect. It could be a prescribed medication (i.e. Accutane or Thalidomide), a street drug, alcohol use, or a disease (i.e. measles) present in the mother which could increase the chance for the baby to be born with a birth defect.
Alcohol is the most dangerous teratogen in the world to the embryo and fetus. On average, a developing fetus grows 150 million brain cells each day – the introduction of a teratogen can result in irreversible damage and numbers to these and other cells.