Fetal alcohol spectrum disorders

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Fetal alcohol spectrum disorders (FASD) are a group of disorders resulting from prenatal alcohol exposure, affecting brain development and potentially growth and multiple organ systems. A distinctive presentation may include microcephaly, short palpebral fissures, and prenatal-onset growth deficiency.

It can present with psychiatric features such as ADHD, anxiety, depression, behavioural dysregulation, and other mood or behavioural disorders. Autism spectrum disorder (ASD) and psychotic disorders have also been reported, although their association with FASD remains less well established. Psychiatric manifestations can persist into adulthood.

From a morphologic lens perspective, other features include (but are not limited to):

  • Microcephaly

  • Midface retrusion

  • Short palpebral fissure

  • Microtia

  • Short nose

  • Smooth philtrum

  • Single transverse palmar crease

  • Small nails

Other characteristic features include intellectual or developmental disability, impaired attention and executive function, learning and memory difficulties, motor and coordination problems, and difficulties with adaptive behaviour and social communication. Other congenital abnormalities may affect the heart, kidneys, eyes, and hearing.

Early diagnosis is important to identify neurodevelopmental, psychiatric, physical, and adaptive difficulties; provide appropriate educational, behavioural, developmental, and psychosocial support; and reduce the risk of secondary complications and improve functioning across the lifespan.

Selected references and further reading — Morphologic lens

Jones KL, Jones MC, del Campo M. Smith's recognizable patterns of human malformation. 8th ed. Philadelphia: Elsevier; 2021.

Reardon W. The bedside dysmorphologist: a guide to identifying and assessing congenital malformations. 2nd ed. Oxford: Oxford University Press; 2016.

Allanson JE, Biesecker LG, Carey JC, Hennekam RCM. Elements of morphology: introduction. Am J Med Genet A. 2009;149A(1):2-5. doi:10.1002/ajmg.a.32601.

Hennekam RCM, Biesecker LG, Allanson JE, Hall JG, Opitz JM, Temple IK, Carey JC; Elements of Morphology Consortium. Elements of morphology: general terms for congenital anomalies. Am J Med Genet A. 2013;161A(11):2726-2733. doi:10.1002/ajmg.a.36249.