Understanding FASD

Fetal Alcohol Spectrum Disorder, or FASD, is a lifelong condition that affects how a child's brain and body developed before birth, following exposure to alcohol during pregnancy.

If you are reading this because someone has raised FASD about your child, or because you are wondering about your own child's development, we want to say something clearly at the outset: this page is not about blame. It is about understanding, and about what helps.

A word about language, and about blame

The Australian guidelines deliberately use the term prenatal alcohol exposure. That wording is chosen carefully: it keeps the focus on the exposure itself rather than on a mother's behaviour, and is intended to reduce blame and shame.

Many women drink before they know they are pregnant. Many were never told there was a risk, or were given different advice at the time.

There is usually more to it than that, too. Part of understanding a child is trying to understand the circumstances their mother was living in during that pregnancy, and being honest about how little can be known from the outside. She may have been living with violence at home. She may have had a condition of her own that was never recognised, named or supported. She may have been carrying things that nobody around her knew about.

We do not assume any of this. We also do not assume its absence. What we do is decline to pass judgement on a situation we were not in, because doing so helps no one, least of all the child in front of us.

Alcohol exposure during pregnancy is a risk factor, not a predetermined outcome. It does not mean a child will certainly have FASD, and no useful purpose is served by looking backwards with guilt.

What matters now is understanding your child, and getting them the right support.

Families also have a choice about language. Some prefer FASD. Some prefer "neurodevelopmental disorder associated with prenatal alcohol exposure." Some prefer their own words. All of these are respected here, and we will follow your lead.

If any of this raises something for you. Support is available, and you do not need a diagnosis or an appointment to use it. NOFASD Australia offers information and support to anyone affected by FASD, on 1800 860 613. If you are experiencing, or have experienced, family, domestic or sexual violence, 1800RESPECT is free and available 24 hours a day, 7 days a week on 1800 737 732. You are also very welcome to raise any of this with us.

Who FASD affects

FASD is under-recognised in Australia. It occurs across all parts of society where alcohol is consumed: every community, every background, every postcode.

There is a harmful and persistent myth that FASD is "an Aboriginal problem." It is not. Australia's FASD Indigenous Framework names this myth directly as harmful, because it drives both over-diagnosis and under-diagnosis. Neither serves children.

FASD is a lifespan condition. It does not end at eighteen, and diagnosis in adulthood is explicitly possible. Understanding can matter at any age.

How FASD can show up

FASD affects how the brain works, and it looks different in every child. Assessment looks carefully across nine areas of development and functioning:

• thinking and learning (intellectual ability)
• communication
• motor skills
• reading, writing and numbers
• memory
• attention
• planning, organising and problem-solving (executive functioning)
• managing emotions and behaviour
• everyday living and social skills

A child does not need difficulties in all of these. Diagnosis requires significant difficulty in three or more of the nine.

Importantly, the current guidelines are clear that this is about real-world function, not test scores alone. As the guidelines put it: "scores cannot be impaired; only a function can be impaired." So an assessment draws on how your child actually manages at home, at school and with friends, alongside direct assessment. The older approach of relying on a statistical cut-off has been left behind.

How FASD is diagnosed in Australia

Australia updated its FASD diagnostic guidelines in 2025. In plain terms, a diagnosis considers five things:

1. Prenatal alcohol exposure, confirmed above a low-risk level at any point in pregnancy, including before a pregnancy was recognised. There is no drink-count threshold; the guidelines deliberately do not set one. Where exposure cannot be confirmed and other causes have been excluded, the presence of the three sentinel facial features may be enough.
2. Pervasive neurodevelopmental impairment: significant difficulty in three or more of the nine areas above.
3. Functional impact: the difficulties meaningfully affect daily life and mean the child needs substantial support, judged against their developmental stage and cultural context.
4. Onset in childhood: the difficulties arise during development. This does not prevent a diagnosis being made later in life.
5. Not better explained by something else: other causes, including genetic conditions and other exposures, are considered.

About the facial features. Three "sentinel" facial features are associated with prenatal alcohol exposure. Under the 2025 guidelines these are recorded as a specifier, how many are present from none to three, and are no longer used to split FASD into separate sub-diagnoses.

Most people with FASD do not have these features: around 83% do not. One reason is timing: the facial features only develop where alcohol was consumed during the first trimester, often before a pregnancy was known about. So a child's face tells you very little. The absence of facial features says nothing about whether a child has FASD, and a diagnosis can be made without any facial assessment at all.

This matters, because it is one of the main reasons FASD gets missed. Where the facial features are absent, FASD is commonly under-diagnosed, or mistaken for autism, ADHD or a behaviour disorder.

"At risk of FASD." The guidelines allow a designation of at risk of FASD for young children where assessment is not yet sufficient, for example where a child is very young or the picture is not yet clear. Waiting for certainty is not a reason to withhold support.

FASD alongside other conditions

FASD commonly occurs alongside other conditions, including ADHD, autism and language disorders, rather than ruling them out. A child can have FASD and ADHD; identifying one does not preclude the other.

This matters practically: children are sometimes given one label that explains part of the picture, while the rest goes unrecognised.

Cultural safety

Australia's FASD Indigenous Framework guides culturally safe assessment. In practice that means yarning and deep listening as legitimate ways of gathering a history; acknowledging history and building trust before getting down to business; plain language, visuals and an unhurried pace; assessment tools that are culturally appropriate rather than rigid Western norms; and shared decision-making in which the family decides what is culturally safest, including which words are used.

It also means considering trauma and other causes before attributing a child's behaviour to prenatal alcohol exposure.

What helps

A diagnosis is not the end point. It is a key that opens the right support. Understanding why a child finds certain things hard changes how families, schools and services respond. It shifts the question from "why won't they" to "what do they need."

Support is individual, and typically involves the people already around your child: family, school, and any allied health services involved in their care.

Arranging an assessment at Hunter Children's Clinics

Our paediatricians diagnose FASD.

Because a diagnosis looks at how a child is functioning across several areas of development, building a full picture usually takes more than one clinician. Depending on what your child needs, that may mean assessments completed by others in our team, psychology, speech pathology or occupational therapy, or, where it makes sense, by services elsewhere. Your paediatrician will explain what is needed for your child and help bring the pieces together.

The best place to start is a referral to our paediatric or psychology service. A GP referral is required before a first appointment with a paediatrician. You do not need a GP referral to see our psychologists.

One practical note on costs, because it can make a real difference. Where your paediatrician refers your child to one of our psychologists for a neurodevelopmental assessment, that assessment can attract a Medicare rebate. The same assessment referred by a GP does not. It is worth knowing this before you start, as it is one reason beginning with a paediatric referral can be the more affordable route.

Rebate amounts are set by Medicare and change from time to time, so please check the current amount with Medicare or your GP. For fees and referrals, see our fees and referrals page, or call us on 02 4072 1877 and we can talk it through.

Support for families

NOFASD Australia is the national organisation supporting individuals, families and carers affected by FASD: 1800 860 613, nofasd.org.au. You may also find our resources for families page useful.

Frequently asked questions

Does a small amount of alcohol in pregnancy cause FASD?
No safe level of alcohol use in pregnancy has been identified, and risk increases with exposure. But exposure is a risk factor, not a predetermined outcome, and it does not mean a child will certainly have FASD. The guidelines deliberately set no drink-count threshold, because the relationship is not that simple.

Does my child need to have the facial features to be diagnosed?
No. Around 83% of people with FASD do not have the characteristic facial features, which only develop where alcohol was consumed in the first trimester. The features are recorded as a specifier when present, and a diagnosis can be made without any facial assessment.

Can FASD be diagnosed in an adult?
Yes. FASD is a lifespan condition and diagnosis in adulthood is explicitly possible.

Can my child have FASD as well as ADHD or autism?
Yes. FASD is not a diagnosis of exclusion and commonly occurs alongside other conditions.

What if we don't know whether there was alcohol exposure?
That situation is common and is accounted for. Where exposure cannot be confirmed and other causes have been excluded, the presence of the three sentinel facial features may be sufficient for diagnosis.

Is it too late to help my child?
No. Understanding how your child's brain works changes how the people around them respond, and that helps at any age.

This page is general information only. It is not a substitute for professional advice. Please speak with your GP, paediatrician or treating clinician about your individual child.