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


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

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