Article Summary: Challenges of diagnosing fetal alcohol spectrum disorders in foster and adopted children

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FASD has been found to be 10-15 times more common among foster/adopted children, potentially affecting 17% of all children in foster care. However, many children remain undiagnosed or misdiagnosed. Misdiagnosis or undiagnosed FASD is common in the foster care system, due to caregivers’ lack of knowledge of the birth mother’s alcohol use during pregnancy.

This study examined the prevalence rates of undiagnosed FASD among foster/adopted children in the United States. Children who may have FASD but remain undiagnosed are disadvantaged,, as they are not directed to appropriate resources, support, or treatment options. An early diagnosis is important in receiving early interventions, which can drastically improve outcomes for individuals with FASD.

Main findings

  • Nearly twice as many children (71.4%) whose parents or relative(s) are not involved in their lives were categorized into ‘some features/unknown prenatal alcohol exposure (PAE)’ compared to 41.1% of children who live with a biological family member
  • 7% of children had severe or moderate growth restrictions, 31.3% had severe or moderate FAS facial features, and 21.7% had damage of the nervous system
  • Older children were more likely to be classified under ‘some features/unknown PAE’ than younger children. Older age may be linked to difficulty confirming PAE, since more time has passed since the birth
  • Adopted children were nearly 3 times more likely to be in the ‘some features/known PAE’ category than in the ‘FAS/pFAS’ category


  • Further training of health care professionals and social workers on the signs and symptoms of FASD is required
  • Screening practices for common disabilities seen in individuals with FASD should be conducted with children before age 6
  • Ensuring that adequate supports are available for children with FASD
  • Improving the stability of the environment for children with FASD in long- or short-term care

Take home message:
Unknown PAE often prevents early and accurate diagnosis of FASD, limiting children from receiving appropriate interventions. Confirming PAE can be challenging, due to the stigma around pregnant mothers consuming alcohol, or the inability to contact the birth mother once the child has been put into care.

This study shows the challenging nature of diagnosing FASD among adopted/foster children because of the difficulty confirming  PAE. It is important to conduct further research on the outcomes of individuals who may be suspected of having FASD, but where a diagnosis is not possible without confirmation of PAE.  This study also recognizes the need to improve ways to diagnose FASD without needing confirmation of PAE.

Authors: Ludmila N. Bakhiereva, Laura Garrison, Shikhar Shrestha, Janet Sharkis, Rajesh Miranda, Karen Rogers

 Journal: Alcohol

One Comment on “Article Summary: Challenges of diagnosing fetal alcohol spectrum disorders in foster and adopted children”

  1. I was told by a pediatrician that he was unable to give an official diagnosis because it is illegal for him to do so if the mother says she never drank during pregnancy. He said no doctor in the Sask Health Region is allowed to make that diagnosis on any foster or adopted child because they always go straight to the birth records and then they privately question the mothers. Only if a mother admits she drank during pregnancy that they will “possibly” make the diagnosis. But that is why there are so many here in my city of Prince Albert who are undiagnosed. The schools are spilling over with special needs kids who are not getting their needs met because of it. Then us foster parents are at our wits end because we have nowhere to turn for support. There is a high demand for foster parents here and it is no wonder that there is a great shortage of them. From our health care system to our schools to the jails…there is nowhere to turn and no hope in sight!!

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