What are the primary disabilities of FAS/ARND?
Possible facial features associated with FAS/ARND include:
- Short palpebral fissures (small eye slits)
- Short upturned nose
- Low nasal bridge
- Flat philtrum (vertical groove between the upper lip and nose)
- Thin upper lip
- Flat midface
- Small chin
- Simply formed, low set ears
Other possible physical defects include:
- Eye and ear defects
- Respiratory (lung) problems
- Heart murmur
- Limb reduction
- Low birth weight
- Hutchinson’s teeth
The following primary cognitive disabilities associated with FAS/ARND are caused by brain damage. Many of them overlap with diagnoses for other disabilities. Therefore many children will be misdiagnosed or underdiagnosed with such disorders as Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Obsessive Compulsive Disorder (OCD), Sensory Integration Disorder (SID), and Learning Disabilities (LD), among others:
- Developmental delays – often acts younger than his or her age
- Inconsistent performance – seems to “get it” one day and lose it the next. Leads people to believe that the child is intentionally being difficult.
- Hyperactivity – constantly in motion
- Impulsivity – says and does whatever comes to mind without thinking about consequences
- Attention deficits, distractibility – at times their lack of ability to stay focused on a task for very long is due to attention deficits; may also be easily distracted
- Disorganization – messy, can’t find things, unprepared for school or work
- Poor social skills – has problems making and keeping friends, doesn’t understand social cues or body language
- Literal thinking – doesn’t understand subtle jokes or statements that have double meanings; take things very literally. For example, don’t say, “Hit the road” when you mean “Leave” or “Cut it out” when you mean “Stop”.
- Difficulty with abstractions – struggles with abstract concepts such as math, money management, time, ownership, and consequences.
- Difficulty with transitions – needs help when switching from one activity to another. May become very involved in current activity and will have difficulty changing to a new one especially if it is felt that the current activity is incomplete.
- Memory problems – difficulty storing and retrieving information
- Processing deficits – may think more slowly, may only understand every third word of normally paced conversation.
- Ability to repeat instructions, but inability to put them into action – can “talk the talk but not walk the walk”
- Inability to predict outcomes or understand consequences and cause/effect – poor judgment
- Difficulty generalizing from one situation to another – a lesson learned in one situation does not carry over to a new situation.
What are the possible secondary disabilities of FAS/ARND?
Secondary disabilities are those that result from the primary disabilities. For example, due to damage to certain brain regions, a person with FAS/ARND may have poor judgment. This could lead to the secondary disability of getting into trouble with the law. Ann Streissguth, Ph.D. of the University of Washington, a pioneer and recognized authority in the field of FAS, completed a study in 1996 identifying these secondary disabilities. They include:
- Trouble with the law – secondary to poor judgment, inability to understand consequences, and boundary issues
- Mental health problems – secondary to damage to brain regions and chemical imbalances
- Disrupted school experience – secondary to developmental delays, inconsistent performance, hyperactivity, impulsivity, distractibility, attention deficits, disorganization, poor social skills, difficulty with abstractions, memory problems, processing deficits, difficulty with transitions
- Confinement – secondary to poor judgment and boundary issues
- Alcohol and drug problems – possibly self medicating to compensate for damage to brain regions and chemical imbalances
- Problems with employment – secondary to developmental delays, poor social skills, difficulty with abstractions like time, etc.
- Dependent living – secondary to difficulty with abstractions like time, money management, poor social skills, developmental delays
- Inappropriate sexual behavior – secondary to boundary issues, poor social skills, inability to understand consequences