Foetal alcohol spectrum disorder — diagnosis, neurobehaviour and management (MEQ)

(i) Definition and diagnostic framework. FASD is the umbrella for lifelong effects of prenatal alcohol exposure (PAE) on brain, behaviour, growth and (when present) face. Apply a named system: e.g. Hoyme 2016 (combinations of confirmed PAE, growth deficiency, sentinel facial features — short palpebral fissures, smooth philtrum, thin upper vermilion — and neurobehavioural impairment) or Cook 2016 Canadian categories of FASD with/without sentinel facial features requiring severe brain dysfunction domains, or Astley 4-digit ranks for growth, face, CNS and alcohol. This child has documented PAE, suggestive facial features and clear CNS/neurobehavioural impairment → multidisciplinary FASD diagnostic pathway, not ADHD label alone.[1][2]

(ii) Neurobehaviour and differentials. Expect executive dysfunction, attention dysregulation, learning/memory weaknesses and adaptive skills lagging IQ expectations.[5] ADHD alone: social-adaptive and PAE/dysmorphology history tip to dual FASD±ADHD framing. ASD: may co-occur; reciprocal social pattern and RRBs vs PAE adaptive profile. Trauma/kinship adversity: co-traveller — formulate both; do not erase teratogenic effects.[4][6]

(iii) Non-drug care and secondary disabilities. Environmental scaffolding (visual schedules, reduced cognitive load, consistent carers), school accommodations, carer coaching, disability supports, hearing/vision screens. Streissguth: high secondary disability rates (school disruption, legal trouble, confinement, substance use, inappropriate sexual behaviour); earlier diagnosis and stable nurturing care improve odds of escaping adverse outcomes.[3][4]

(iv) Pharmacotherapy principles. No disease-modifying drug for core FASD. Treat comorbidities: ADHD pathway (behavioural ± stimulant/non-stimulant, monitor growth/sleep/appetite/mood); cautious treatment of anxiety/mood/sleep; antipsychotics only for severe risk behaviour after functional analysis, lowest effective dose, metabolic monitoring, time-limited goals.[4][6]

(v) Prevention counselling. No known safe amount of alcohol in pregnancy; support alcohol-free pregnancy planning; treat alcohol use disorder and offer contraception to people of reproductive potential in the network; non-judgemental tone to enable disclosure and care.[4]