Parenting a child with a disability often starts with a feeling that something doesn’t quite add up. Maybe your child is bright and verbal but can’t manage daily routines. Maybe school keeps calling about “behavior,” even though you’re doing everything you can. Or maybe you’ve collected diagnoses over the years — ADHD, learning disabilities, autism — yet none of them fully explains what you’re seeing.
For some families, that missing piece turns out to be Fetal Alcohol Spectrum Disorders, or FASD. And for far too many parents, it can take years to hear those four letters out loud.
To help make sense of FASD and all the ways we can support children who have it, we spoke with Roxanne Chang, MD, pediatrician at Harbor-UCLA Medical Center and assistant clinical professor at David Geffen School of Medicine at UCLA; Kelly Rain Collin, EdM, educational consultant and founder and director of Healthy Minds Consulting; Nate Sheets, behavior consultant specializing in FASD and author of Essential FASD Supports; Shannon Iacobacci, MS, FASD specialist, non-attorney special education consultant, founder of Embracing the Brain, and parent advocate; and Eileen Devine, LCSW, therapist, parent coach, consultant, and trainer.
FASD stands for Fetal Alcohol Spectrum Disorders. Dr. Chang explains that FASD is an umbrella term, not a single diagnosis, and is composed of a group of conditions that can occur in a person exposed to alcohol before birth.
“It encompasses four different diagnostic entities,” she explains — although now there is a fifth one under a different diagnostic schematic. “The original four were medical diagnoses, and they are fetal alcohol syndrome, alcohol-related birth defects, partial fetal alcohol syndrome, and alcohol-related neurodevelopmental disorders. So FAS, partial FAS, ARBD, and ARND. It can sound very confusing, and I can tell you that the diagnostic schema is not the easiest.” Let’e explore each of these, plus the fifth diagnostic entity, with information from the CDC website.
Fetal alcohol syndrome (FAS) is the most involved diagnosis on the FASD spectrum. Children with FAS have differences in their brain and nervous system development, along with certain facial features and growth differences. These brain-based differences can affect things like learning, memory, attention, communication, vision, or hearing. Many children experience more than one of these challenges at the same time. Because of this, school can be difficult, and getting along with peers may take extra support.
Alcohol-related birth defects (ARBD) is a condition in which people have problems with the heart, kidneys, or bones or with hearing.
Partial fetal alcohol syndrome (pFAS) is diagnosed when a child doesn’t meet the full diagnostic criteria for FAS but has a history of prenatal alcohol exposure and some of the facial features and symptoms of FAS.
Alcohol-related neurodevelopmental disorders (ARND) present with problems with behavior and learning, and sometimes intellectual disabilities. These children might do poorly in school and have difficulties with math, memory, attention, judgment, or impulse control.
Neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE) is the newest diagnostic schematic, which has emerged as a “condition under study” since the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Dr. Chang explains that using the definition under ND-PAE probably makes a lot more sense and much easier: basically, you have to have the alcohol exposure and then deficits or challenges in three different domains. The goal of this newer diagnostic label is to better describe the brain, behavior, and mental health effects of prenatal alcohol exposure — whether or not a person has the physical features often linked to FASD.
She uses a mnemonic as a helpful way to remember the main areas involved:
Note: alcohol exposure is an important factor, but it isn’t always known. Some families have that information; others are navigating complex needs without a clear history. As Dr. Chang explains, “With foster and adoptive children, oftentimes we just don’t have access to prenatal exposure information — it is simply unknown or suspected.”
Dr. Chang explains that alcohol poses a unique risk during pregnancy because it passes directly from the pregnant parent to the developing baby. Unlike an adult body, the baby’s body can’t process or eliminate alcohol, which means it can build up and interfere with development.
You might be wondering whether you would need to have consumed a lot of alcohol for a child to have FASD. The simple answer is no, and this is where a lot of guilt, confusion, and stigma gets stirred up. Research shows that a very low amount of alcohol can have an impact on behavior. Dr. Chang tells us that “prenatal alcohol exposure happens in people going about their daily lives, it’s not just with addiction or alcohol use disorder. You don’t even need to have gotten drunk.”
She also tells us the reason why FASD is so prevalent is because:
Collin also adds something that is just emerging: “There is research that shows that fathers’ drinking habits also impact the fetal development of the individual. We don’t have a way to add a diagnostic term to that yet, so the diagnostic term still looks at mothers only, even though the research is now showing that a father’s drinking habits can impact the individual in similar ways. There’s lots of research emerging.”
Statistics show us that 1 in 20 people live with FASD, which is a pretty conservative estimate according to Dr. Chang, with only around 10% of those diagnosed with FASD having the associated facial features. She compares this to autism, telling us that FASD is much more common than autism, and yet there are so many more resources for autism. “How much do people know about autism? How little do people know about FASD? That includes the medical providers too. Most of these kids are probably being missed or passed off as ADHD or just having bad behavior,” she says.
One of the hardest parts about FASD is delayed or missed recognition — there is no lab test for FASD, and signs often show up long before anyone is talking about a diagnosis. As Dr. Chang explains, “It’s important for people interacting with a child — whether that’s a medical provider, educator, or mental health clinician — to recognize the signs and symptoms in the first place and put it on their radar.”
She recommends using the FASD mnemonic as a quick mental checklist: fetal alcohol exposure, adaptive skills deficits, self-regulation deficits, and developmental/neurocognitive challenges. “If you’re seeing issues in all of those areas, then you have to start thinking FASD. So the first thing is just recognition,” she says.
But as Devine points out, this isn’t always straightforward because FASD is a spectrum, and it can look very different from one child to another. For example, you might see things like delayed fine and gross motor skills, flat affect, or feeding difficulties. She shares how it could take her daughter, who is diagnosed with FASD, hours to just get through a bottle because she didn’t yet have the motor coordination to suck effectively. Developmental milestones were late from the very beginning.
But that early presentation isn’t true for every child with FASD. Some parents may first notice sensory processing differences: a child who becomes overwhelmed by loud noises, busy environments, or too much stimulation. But for many families, Devine says, the questions start later, often when behavior becomes harder to manage. Over time, other behaviors can escalate, becoming more intense and more frequent. That’s where things often start to feel really confusing and distressing for parents. “Behaviorally, they are more intense. They are really tricky. It’s confusing for the parent, and it feels like nothing works. That’s what parents tell me over and over and over again,” Devine says.
In real life, FASD can show up differently depending on your child’s age and setting, in a mix of behavioral, learning, and physical ways:
Overall, some kids may seem to have signs and characteristics such as:
The key to understanding FASD is understanding brain-based differences. This is the thread that flows through everything, from signs and symptoms to diagnosis to behavior to interventions and supports. As our experts tell us, this just means that there are brain-based differences because of how the brain was formed during pregnancy.
FASD is a physical disability because it’s a brain-based disability and the brain is a physical organ, even if it’s “hidden,” Collin tells us. “It primarily impacts the brain, the nervous system, and any other part of the body that was developing during the time the infant was exposed to alcohol during gestation — the liver, the heart, the ears, the eyes, etc. Any part of the body can be affected, and it will vary from individual to individual, but everybody with FASD, their brain and nervous system are impacted.”
She emphasizes this point because the brain isn’t something we can see, so most supports for children with challenging behaviors or learning difficulties aren’t rooted in having a physical disability: “Because it’s a physical disability, we need to think what do we do when we have a physical disability? . . . If you’re asking a student to do something and they can’t actually do it, telling them to do it over and over and over isn’t going to get you anywhere. But it’s not always apparent that it’s a can’t. It sometimes looks as if they won’t do something, and so that tends to be a big challenge,” she says.
Devine explains more about brain-based differences in this clip.
Getting an FASD diagnosis can feel surprisingly complicated, especially because families are often dealing with real-life challenges long before anyone names what’s going on. Often, families don’t even see the term “FASD” used in medical records. And again, the stigma is huge with FASD.
Iacobacci explains why that happens, why diagnosis still matters, and why stigma makes this step so hard for so many parents.
Are we talking about FASD?
Devine agrees, explaining that one of the biggest barriers is that, “societally, we don’t talk about it enough,” which means many biological parents may not even realize prenatal alcohol exposure is an issue to raise with a provider. Even when it does come to mind, she notes there can be a lot of shame, remorse, and regret, and that alone can make it harder to pursue an evaluation.
Another factor is that professionals don’t ask about it. Devine tells us that in a typical pediatrician’s or doctor’s appointment, those questions are not being asked. This is especially true with the adoptive families she works with, where maybe they have a suspicion or they have confirmed use. “That can be a tricky conversation,” she says, “Especially if you have a connection with the birth family. How do you navigate that conversation without sparking the stigma, the shame, all of that kind of stuff that moms experience? It can be tricky. Starting with a pediatrician is always a great idea, and then usually they have specialists. It depends community to community whether it’s a developmental pediatrician, whether it’s an FASD-specific clinic where they can get a diagnosis.”
Iacobacci adds another layer: in the United States, families may not always see the term “FASD” used consistently in medical documentation. As she puts it, “FASD currently is not recognized as a diagnosis,” so parents may see other labels in records instead — such as alcohol-related neurodevelopmental disability (ARND) or neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE). She also points out that fetal alcohol syndrome (FAS) is a recognized diagnosis, but the criteria are narrower, which is one reason “FASD” is used in practice as a broader umbrella.
The first step in diagnosis: recognizing FASD Iacobacci tells us that usually, “Parents don’t seek a diagnosis of FASD, they stumble upon it.” How does that happen, you might be wondering? Well, she explains that parents might be feeling that something isn’t clicking with their child, and they can’t quite figure it out. They might be thinking, “Gosh, something's not clicking. I'm not figuring this out. It's not ADHD, it's not autism, but we're going and looking for something of that sort. A lot of people living with FASD are diagnosed with autism because there may not be that disclosure or knowledge of alcohol consumption during pregnancy,” she says. “But there is definitely a neurodevelopmental difference. And so there’s that overlap,” Iacobacci continues. “Parents often don’t go in seeking FASD unless they know there’s alcohol exposure, either through self-awareness or through the foster/adoptive systems — which is not very common that it’s disclosed. And there’s different ways that that knowledge can come about, but it’s really not something that we seek. We’re seeking something else, and then we’re stumbling upon it.”
Some parents even report being told in their foster classes that they should assume alcohol exposure because most kids who were exposed to drugs prenatally have also been exposed to alcohol. Read more about fostering to adopt in our article here.
If your child has collected multiple labels over the years and things still don’t quite add up, Dr. Chang explains why FASD is frequently overlooked and what providers should be watching for instead:
Note that Dr. Chang emphasizes that a formal diagnosis isn’t required to start supporting a child. If there is a known history of prenatal alcohol exposure and a toddler is showing signs like speech or language delays, that information alone matters. Even without an FASD diagnosis, she explains, it means keeping a closer eye on development and watching carefully for behavioral or learning differences over time. Early monitoring allows families and providers to step in sooner with supports, rather than waiting for that official diagnosis.
Does the child meet diagnostic criteria?
Once FASD is on the list, the next step is figuring out whether a child meets diagnostic criteria — and this is where things often get frustrating for families. FASD is commonly undiagnosed or often misdiagnosed (more on this later). Children may be diagnosed with autism or ADHD, but there is something missing —mental health providers are supposed to rule out a medical diagnosis before diagnosing with another condition, but they often don’t.
To start, Dr. Chang explains it this way: “For a diagnosis, it’s really fulfilling some kind of diagnostic criteria for one of the FASDs, and that will usually require looking — I know we just said facial features are rare, but we still look at them. Because if we have them, it’s just a very easy answer. So the facial features, the growth, the physical things.” But most of the time, diagnosis hinges on how a child functions, not what they look like. Dr. Chang says that more and more providers are using the DSM-5 ND-PAE framework (which we outlined earlier), and that approach focuses on three major domains: self-regulation, neurocognition, and adaptive living skills.
And here’s an important parent note: assessment doesn’t always require long, formal testing to get started. Diagnosing FASD usually isn’t about one test or one appointment. Instead, it’s a bigger-picture process that looks at how your child functions in everyday life.
Diagnosis is usually by a multidisciplinary team — including an MD. Providers often start with qualitative measures, such as clinical interviewing, which could entail conversations and observations — asking questions about learning, behavior, emotions, and daily skills — and seeing whether those patterns fit what we know about FASD. They may also ask about prenatal alcohol exposure, which can feel really uncomfortable or emotional for families, especially for birth parents.
That’s why it’s so important that these conversations are handled with compassion and without judgment. To better understand your child’s profile, providers will often review any evaluations your child already has, such as Regional Center assessments, IQ testing, or school-based IEP and psychoeducational reports. All of this information together helps paint a clearer picture of your child’s strengths and challenges, rather than relying on a single score or label.
Is there a typical age for diagnosis?
There isn’t one “typical” age when FASD is diagnosed, but for many kids it happens later than parents expect. Dr. Chang explains that unless a child has clear physical features or major organ differences linked to alcohol exposure, most children aren’t diagnosed until after age three, and most signs fall into “behavioral dysregulation” instead. Also, many of the signs providers look for — things like neurocognitive deficits and deficits in adaptive living skills — simply don’t stand out in infancy.
As children get older and the demands of daily life increase, those gaps become easier to see. That’s usually when families start getting answers. Dr. Chang notes that more formal testing often happens after age three, especially when assessments require a child to sit through cognitive or psychoeducational testing.
What kind of doctor should you go to if you suspect FASD?
If your gut is telling you “this might be FASD,” it’s worth asking your pediatrician for a referral, but you’ll likely need someone who is specifically FASD-informed. Dr. Chang tells us that this would typically be a “developmental behavioral pediatrician who is actually FASD-informed — so many of them are not, and they don’t do FASD assessments — or it could be an interdisciplinary or multidisciplinary clinic that does FASD diagnoses.”
Parent takeaway: it’s okay to ask directly, “Do you assess and diagnose FASD?” If the answer is no or they don’t seem very informed or open, ask who they refer to.
Note that Violence Intervention Program’s FASD Medical Clinic at the LAC+USC HUB provides medical screenings and assessments for children suspected of being prenatally exposed to alcohol. To refer a child for an FASD medical screening or assessment, please follow this link.
The K.I.D.S. Hub Clinic at Harbor-UCLA Medical Clinic offers diagnostic services for children under age six with open Department of Children and Family Services (DCFS) cases. The Developmental Behavioral Clinic offers diagnostic evaluation, medical assessments, linkage to specialty services, and ongoing educational and medical monitoring and support.
Misdiagnosis is very common with FASD, and it’s not always because parents or providers are missing obvious signs — it’s often because FASD can look a lot like other conditions. Many of the traits associated with FASD overlap with autism or ADHD, especially challenges with attention, behavior, emotional regulation, and learning. And because knowledge of alcohol exposure isn’t always available, that missing piece can hinder diagnosis of FASD.
In the diagnostic process, Dr. Chang often sees kids with FASD labeled with ADHD and learning disabilities first, and sometimes autism as they get older. She explains that many kids “will present with ADHD” and learning difficulties, and that FASD executive functioning differences can look like ADHD: “The executive functioning deficits will look a lot like ADHD, but oftentimes are more severe. And medications may help, but they’re not going to be the full story.” She also describes how kids can be misdiagnosed with autism when emotional regulation and social back-and-forth become harder over time, especially in the context of depression.
Sheets adds that diagnosis is often hard, especially when kids are younger and the executive dysfunction or differences will often have similar manifestations. Some parents might want to try medication for ADHD and feel unsure whether it’s the right step.
Sheets explains, “I’m not discounting things like looking for a diagnosis or maybe trying medication. Especially for something like executive functioning, if you can get on medication and that gives you a boost, I’m an advocate for that. I’ve experienced it myself, and I’ve seen it with many of my clients where we’re a little hesitant to give medication (because we don’t know if it is FASD or ADHD). For some, we eventually try an ADHD medication and we see some improvement in executive function. At the same time, people with FASDs in particular will have really different responses to medications, and depending on the complexities of the situation, you might try medication and it’s a disaster. So you have to go through certain trials and weigh the benefits and drawbacks of whatever the negative outcomes of that might be.”
Dr. Chang emphasizes that at the end of the day, support has to match the child’s actual functioning, not just the label. She points out that some kids are diagnosed with autism and labeled as having “lower support needs” (often called level 1 autism), but their adaptive skills and cognitive needs don’t match what people assume about autistic kids with lower support needs, so the services they receive don’t match the need. The guiding principle is: treat the profile you see — especially adaptive skills, executive functioning, memory, and regulation — and don’t let a label hide the support needs.
Kids with FASD can also have more than one diagnosis at the same time. In fact, most people with FASD have at least one co-occurring condition. This can include anxiety or depression, ADHD, bipolar disorder, sensory processing differences, oppositional defiant disorder, or autism. When these diagnoses pile up, FASD can be missed — even though it may be the underlying brain-based condition connecting many of the challenges parents see day to day.
Collin tells us that “there are over 400 co-occurring health conditions with FASD, and any one of those health needs could be impactful to school in and of themselves, let alone FASD, which is impactful because of the neurological challenges.” For example, a child could have FASD and a heart condition and a liver condition, and “if you have a number of these other things going on in your body that aren’t apparent on the outside but that cause you some discomfort, even if it’s underlying discomfort that might not be recognizable to the individual, but their body is somehow out of sorts, it’s going to impact their nervous system functioning. It’s going to bring them closer to that fight, flight, freeze piece all the time, and so they’re going to be super easily triggered. So looking at health components is a huge, huge piece as well.”
Overall, FASD rarely shows up on its own, and research helps explain why so many families feel like their child’s challenges are so wide-reaching. In one large review, researchers looked at 127 studies and found that 428 different conditions can co-occur with FASD. These conditions can affect nearly every system in the body, including the central nervous system (including the brain), vision, hearing, heart and circulation, digestion, muscles and bones, and the respiratory system.
Looking more closely at FAS, the research found that more than 90 percent of individuals had co-occurring conduct-related challenges because their brain-based differences were under-supported. About eight in ten had communication disorders that affected understanding or expressing language. Seven in ten had developmental or cognitive disorders, and more than half had difficulties with attention and hyperactivity.
As Dr. Chang often reminds families, FASD is not just about learning or behavior. “It’s a whole-brain and whole-body disorder. So it’s not just a neurodevelopmental disorder,” she explains. Some children have congenital differences that are clearly linked to prenatal alcohol exposure, such as certain midline heart defects, kidney issues, or gastrointestinal conditions. These tend to be more obvious and are often identified at birth or when children are very young, and they fall under alcohol-related birth defects. Those medical conditions can come with their own long-term health impacts.
Beyond those early-identified issues, Dr. Chang notes that there are other physical health concerns that may emerge over time. Families and clinicians report things like migraines, kidney-related issues, and endocrine conditions in adolescents and adults with FASD. While research is still catching up in some of these areas, one thing is clear: chronic health conditions occur more frequently in people with FASD, reinforcing the need to think about care in a whole-body, whole-life way, not just through a behavioral or developmental lens.
If you’re parenting a child with FASD and feeling overwhelmed by behavior, you’re not alone. It’s the biggest challenge parents share with us, and the one our experts hear about most. Devine tells us that so many of the parents she works with have been living in a place of chronic distress for years. Not just their kids, but them too. No matter what they do — consequences, bribes, threats, timeouts — it feels like things are just getting worse. At the heart of behavior challenges in FASD is one core issue: the brain. Iacobacci explains that many of the behaviors parents find most challenging are misunderstood because we’re often looking at them through a traditional behavior lens. In the moment, it’s easy to think, “They’re being defiant. I asked them to do something, and they’re refusing. They’re melting down on purpose.”
But what if instead we pause and think: “Is this something my child’s brain can actually handle right now?” Maybe the behavior isn’t willful at all — maybe it’s a signal that the task is too demanding, the expectations are too high, or the skills just aren’t there yet. It’s not that your child won’t do it — it’s that they can’t.
Behavior is often also intertwined with shame for parents. As Iacobacci tells us, “The greatest challenges would be behaviors and being misunderstood by society, by professionals, by teachers.” Because when a child is experiencing behavioral symptoms because of their brain-based difference, Iacobacci says the perception in society is, “‘Oh, you’re a bad parent, you need parent training, you need to learn how to parent this child.’ It’s one of the hardest things because we’re already in the trenches. We’re already co-regulating, we are advocating, we are doing all of the things that we need to do. And that’s really super hard to hear from others.”
Together, our experts explain why many common behavioral approaches fall short for kids with FASD and why focusing on compliance instead of regulation, connection, and brain-based needs can do more harm than good. Here’s what they want families to understand about why these approaches often don’t work.
Devine reminds us that when we understand behavior as brain-based, we also start to see how often our kids are navigating environments that aren’t set up for them. They’re constantly running into expectations they don’t yet have the tools to meet — and when that goes unrecognized, overwhelm builds. Over time, that overwhelm can show up as anxiety, aggression, shutdowns, or emotional outbursts. Those behaviors aren’t the problem; they’re signs of a poor fit between the child and their environment.
She offers a powerful comparison: imagine a child who uses a wheelchair being told that they’ve had long enough to adjust — and now they need to stand up and walk like their classmates, or face consequences. Of course that child would become distressed, angry, or hopeless. They’re being asked to do something that’s impossible for them. “The same could be said for kids with FASD and other brain-based differences. It’s just more invisible, and so it happens to them all the time,” she says.
Sheets also reminds us that well-meaning advice from other parents, teachers, or school staff doesn’t always match real life. People who don’t fully understand a child or what’s actually driving their behavior may offer simple solutions that sound reasonable on the surface, but miss what’s really going on underneath.
Let’s talk common behavioral therapies. While there are multiple modalities of behavioral interventions, ABA and PBIS are often brought up more often than others, and they both involve some form of compliance and reinforcement system.
Applied Behavior Analysis (ABA) uses a functional-based approach to behavior that seeks to improve or teach specific behaviors in areas such as social skills, communication, self-care, and academics. ABA aims to teach, maintain, or reduce behavior based on a system of reinforcements.
Positive Behavioral Interventions and Supports (PBIS) is an evidence-based practice for reinforcing students' good behavior. PBIS involves establishing expectations for students, teaching students what those expectations are, and rewarding them when they meet those expectations to build a positive reinforcement system.
“Compliance-based therapy usually doesn’t work great with these kids. . . . It’s not just a matter of behavior – consequence, behavior – consequence. That’s where some of these strategies really differ,” Dr. Chang explains. She isn’t saying consequences never matter. She’s saying the “behavior to consequence to learning” model often doesn’t match the FASD brain profile — and can backfire.
She explains why learning from consequences can be hard in FASD: “Oftentimes their brain has difficulty linking and remembering a specific behavior to consequence, and predicting what will happen next . . . So The behavior consequence model doesn’t always work very well, and then, in fact, it can be emotionally damaging with repeated “failure” to behave in an expected way.”
Sheets tells us that while there are useful pieces within PBIS, the foundation is still a problem as it’s still rooted in compliance. Sheets points out that adults tend to define success as “this child listening to what I say, especially instantaneously.” And too often, adults want compliance even if the child is dysregulated, because “we don’t care if the kid is still upset inside, as long as they do what we want on the surface.”
For many neurodivergent kids, like those with FASD, that approach doesn’t work and can be harmful. What we actually want, Sheets says, is internal regulation as they experience expectations. “If they’re resisting, there’s a reason.” And those reasons are often tied to nervous system responses or the child’s connection with adults.
Certain behavioral interventions, such as PBIS and ABA, can also lack consistency. As Sheets explains, “If you ask one person what does this mean, their answer will be different than the next practitioner.” When everyone is working from a different definition, it often turns into adults just doing what they personally believe counts as ABA or PBIS — and that lack of clarity makes it hard for families to know what they’re actually getting.
Dr. Chang makes a really helpful distinction: in FASD, it’s often less about a single “treatment” and more about building “a whole-life management plan.” She adds, “It’s really thinking about all of the spaces that this child lives in and changing the environment around them. The key is changing the environment so that it supports their brain-based differences, because the challenges that the kid has are from more or less permanent brain injuries from the alcohol. . . . So it’s all about changing the environment around them to help them to thrive and succeed. . . . like you would for a child with a visible disability like cerebral palsy”
Dr. Chang explains all of this in more detail in this clip, including how support works best when adults take the lead: simplifying expectations, breaking down tasks, using visuals, and staying calm and connected in tough moments. This kind of co-regulation helps kids stay regulated enough to learn and participate, rather than constantly being pushed into fight-or-flight mode. The goal isn’t perfect behavior — it’s helping our kids feel safe, supported, and capable across the places they live their lives, especially at home and at school.
For many families, the best approach means moving away from traditional, consequence-based behavior strategies and toward approaches that focus on connection, regulation, and prevention. Kids with FASD often struggle with memory, impulse control, and overwhelm, so learning through punishment or repeated consequences just doesn’t work the way we hope it will — and over time, it can actually hurt their confidence.
As a certified facilitator of the FASCETS Neurobehavioral Approach, Iacobacci tells us that this approach helps parents and caregivers view behaviors through the lens of the brain because “when a brain works or functions differently, then that’s when we see behaviors.” And this could be for FASD or for other brain-based differences, such as autism, dementia, and traumatic brain injury. Through FASCETS, the focus is on patterns of behavior and an individual’s strengths to build in accommodations that actually work.
Devine shares more about this in this clip:
The concept of cognitive supports, introduced by Sheets, can be thought of simply as an adult making decisions with a specific thinking skill in mind. In other words, instead of expecting a child to just “try harder,” we adjust the environment or expectations based on how their brain is working in that moment. For example, if a child is struggling with attention, a parent might decide not to “push” homework right away, recognizing that attention itself is the barrier. Cognitive supports focus on skills like attention span, impulse control, or initiation, and might look like adjusting expectations, allowing extra time to transition, or changing how and when a task is introduced — then seeing what actually helps in real life. In this clip, Sheets dives more into cognitive supports:
Here are a few parent tips to take away:
Collin reminds parents that when FASD isn’t addressed early — especially in school — kids can be at much higher risk for serious long-term challenges, including involvement with the juvenile justice system. The tricky part? Many kids with FASD test well in the early years. Their cognitive scores and academic skills might look okay on paper, which can make it easy for schools to dismiss concerns.
But often, those gaps don’t show up until later, when the demands increase and the supports were never put in place. By the time a child is clearly struggling, they may already be far behind and dealing with multiple layers of difficulty, which makes support much harder.
“Early intervention is really key. And early intervention not just at age three, but kindergarten, second grade, even sixth grade — if that’s when you’re first noticing something. Getting the supports in there right away is really essential,” Collin says. “And IEP teams have a lot of ability to negotiate what is going to qualify a student and what is not. It’s not black and white, it’s an IEP team decision. There’s an opportunity for a discussion to happen that says, ‘You know what, even though they test well in the classroom setting, they are not doing well,’ or, ‘They need a lot of support,’ or, ‘We need to make sure that this piece is addressed so that they don’t continue to fall further behind.’ And being able to try to do as much [as possible] as early as possible can make a world of difference.”
After an FASD diagnosis, one of the most important next steps is connecting your child to disability services in your area. In California, that usually means trying to qualify for Regional Center services, but Dr. Chang and Iacobacci both explain that this can be very challenging for families.
The eligibility categories for Regional Center services are cerebral palsy, autism, intellectual disability (ID), epilepsy, or the "fifth category," which is used for conditions that are similar to intellectual disability and are not solely physical disabilities. Children with FASD might be eligible for Regional Center services, but it depends on their needs. They must have significant functional limitations in three different areas.
Because most kids with FASD have average IQ and cognitive scores, they often don’t qualify under the traditional intellectual disability category. They may be very verbal and appear capable on the surface, even though their adaptive living skills, memory, and executive functioning are significantly impacted. Because of this, families are often told they don’t qualify, or worse, that the challenges are “just parenting issues.”
Dr. Chang explains that the strongest path to eligibility is usually focusing on adaptive living skill deficits — the skills needed for daily life, independence, and adulthood. For some families, this means pushing for eligibility under Regional Center’s lesser-known fifth category, which applies when a disability functions like an intellectual disability, even if the IQ score doesn’t show it.
If a child does not have an intellectual disability but their adaptive living scores are significantly behind, parents could make an argument that treatment is similar to someone with an intellectual disability. They need to be able to demonstrate that the condition requires similar treatment.
Iacobacci adds that this gap in services is a huge problem because FASD is a lifelong disability; kids don’t outgrow it. Many individuals with FASD will need interdependence (utilizing support systems while maintaining personal autonomy), not independence, as adults, along with ongoing support for living skills, work, and daily functioning. And just like autism, FASD exists on a wide spectrum: some individuals will need minimal support, while others will need a lot — and both deserve access to services.
The good news is that some Regional Centers in California are starting to learn more about FASD and how to support individuals who have it, but families still often need to advocate strongly to get the help their children need. When applying for Regional Center services on behalf of your child, make sure Regional Center does full scale IQ testing and ideally a Vineland Adaptive Behavior Scales evaluation as part of the psychological assessment for eligibility. Many intuitive parents have adjusted naturally to help their children in daily tasks and may overrate what a child can do, so it is very important to be accurate and think about what your child can and cannot do without your reminders and hints. You could also talk to other parents of kids with the same diagnosis who have Regional Center and see what worked for them, what evaluations they got, or what arguments they made.
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