Fetal Alcohol Spectrum Disorder
Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe the range of brain damage caused by prenatal alcohol exposure, encompassing what is sometimes described as fetal alcohol effects (FAE), fetal alcohol syndrome (FAS), and alcohol-related birth defects (ARBD). Children on the fetal alcohol spectrum can appear to have a wide range of different disabilities.
ADHD, autism, Asperger syndrome, seizure disorder, obsessive-compulsive disorder, attachment disorder, oppositional-defiant disorder, and other developmental, neurological, and psychiatric disorders can all be coexisting or look-alike disabilities for alcohol-exposed children. A significant sensory thread runs through these disorders, and children with FASD can generally add sensory integration disorder to their long list of challenges.
No two children with FASD are alike. The severity and symptoms of prenatal alcohol exposure will vary with the amount of alcohol consumed, the part of the pregnancy in which it was consumed, and what part or parts of the brain were damaged as a result.
Many children on the fetal alcohol spectrum may show behaviors very similar to those described earlier for autism spectrum disorder. These other behaviors common to children with FASD may also be improved by occupational therapy with a sensory integration approach.
Children with FASD often have trouble controlling their movements and seem to be always moving. It is possible for them to have ADHD as a coexisting condition, but this excess movement sometimes more closely resembles the behavior of a child with sensory integration disorder who is seeking out movement to stimulate his vestibular and proprioceptive senses. Occupational therapy that concentrates on those senses, along with accessories like weighted vests or wiggly seat cushions, may be helpful for the child with FASD and do much to calm the behavior.
Early diagnosis and treatment are essential for children on the fetal alcohol spectrum, especially those who lack the distinctive facial features of fetal alcohol syndrome and therefore appear to be less affected. These children, whose impairments are no less severe but less easily recognized, often do worse in the long run due to lack of understanding, reasonable expectations, and accommodations.
Similarly, the inattentiveness sometimes seen in children with FASD may be more like the sensory integration challenge of a child who is either overstimulated by sensory information and can't concentrate on any one thing, or understimulated and can't be roused by anything other than very powerful information.
Children with FASD may boomerang between hyperactivity and inattentiveness, as the bold sensory input they seek in order to become more alert propels them all the way into overstimulation. Helping children better manage their levels of alertness is a major component of occupational therapy with a sensory integration approach.
Low Muscle Tone
Children exposed to alcohol prenatally are often floppy, without adequate muscle tone to keep their joints firmly set. Low muscle tone, or hypotonia, can cause a child to tire easily, move in rapid and uncontrolled ways, have a hard time sitting still, and struggle with tasks such as writing or eating with utensils that require a great deal of fine motor control. While hypotonia does not always go away with age and therapy, there are strategies and tools that occupational therapists can use to help children deal with it more appropriately.
Poor Stress Tolerance
Like many children with sensory integration problems, children on the fetal alcohol spectrum may have trouble in overly noisy or visually busy environments; places where restraint in physical movement is required and enforced; and situations in which expectations are out of line with their sensory needs. Stressful situations often lead to meltdowns, overreactions, and loss of control. Therapy to increase tolerance of sensory information, and strategies that reduce stress, can keep this from becoming an everyday occurrence.
Children with FASD, as well as children with sensory integration disorder, can be thought of as having a finite amount of self-control available to them on any given day. The various challenges they face draw from that self-control reservoir. Anything that reduces stress will help increase self-control, and vice versa.
The Big Picture
Again, not every child with sensory integration disorder has fetal alcohol spectrum disorder. One factor that may contribute to sensory integration disorder is some sort of brain damage, and alcohol is only one of the potential causes. If you believe that this could be the cause of your child's problem, or you have adopted a child whom you suspect may have been exposed to alcohol prenatally, occupational therapy with a sensory integration approach may be an important step in helping him to grow and develop.