ADD/ADHD Misdiagnosis: Fetal Alcohol Spectrum Disorder often mistaken for ADHD

I have often written about the huge problem of ADD/ADHD misdiagnosis. This problem makes me think of the old proverb that says: “If you only have a hammer everything looks like a nail!” Modern medicine have become so preoccupied with sticking the ADD label on kids that it is very often the first diagnosis that is reached for (This despite the fact that there is no objective standard with which to measure probable symptoms!). The upshot of this is that an ADD/ADHD diagnosis can often simply be down to what previous generations would have called ‘Ants in the pants’! At the other end of the spectrum it is, sadly, often the case that an ADD/ADHD diagnosis can prevent the discovery of more serious underlying conditions.
Recent studies have shown that symptoms associated with fetal overexposure to alcohol are often mistaken for ADD/ADHD.  Fetal Alcohol Spectrum Disorder (FASD) is a serious condition (or perhaps, more correctly, range of conditions) that afflict many children whose mothers used too much alcohol while they were still in utero. The impact that FASD can have on a child’s health and wellbeing can be nothing short of devastating and it is one of the reasons why alcohol is best avoided during pregnancy. Some of the most common effects of FASD include the following:
Stunted growth: Children with FASD tend to show up on the lower percentiles in terms of height and weight.
Skull and facial abnormalities: Some studies suggest a strong link between facial and cranial defects and alcohol overexposure.
Damage to the central nervous system: Perhaps the most serious impact of FASD is the havoc that it wreaks on the central nervous system. This can range from stunted brain growth to the development of serious neurological conditions (e.g. epilepsy and seizure disorders). This damage can also manifest itself in the  form of functional disabilities or development disorders. The most common among these are:
•    Problems with social/adaptive skills
•    Reduced memory capabilities
•    Lack of impulse control, attention, social perception and judgment
•    Sensory problems
•    Difficulty in mastering motor skills
It is obvious that this last list can very easily be mistaken for a description of what medical professionals are looking for when attempting to diagnose ADD/ADHD! This fact has serious consequences for those suffering from FASD. The abovementioned study, conducted by the University of Toronto in conjunction with the Hospital for Sick Children at Surrey Place Center, found that it is likely that many FASD children are not receiving appropriate help and care because of ADD/ADHD misdiagnoses.
The main area of concern that the study (which compared 33 children with FASD, 30 ADHD children and 34 children with no disorders) flagged up was the issue of social interaction. It is suggested that FASD children who are not correctly diagnosed early on are in grave danger of developing serious behavioral problems if the condition is not responded to correctly. One of the authors of the research report, Joanne Rovet, had the following to say about this: “In terms of social cognition and emotional processing, the core deficit in FASD appears to be in understanding and interpreting another’s mental states and emotions. These problems with social cognition and emotion processing may underlie the severe conduct problems seen in children with FASD.  It is imperative that these children receive assistance in social and emotional processing domains, specifically targeting interventions to deal with their unique deficits.”
This study shows, once again, how dangerous the current ‘trigger happy’ attitude to ADD/ADHD diagnosis can be. It also underlines that the problem of misdiagnosis can cut both ways. On the one hand it leads essentially healthy children into a system where they have to have to unnecessarily take dangerous drugs on a daily basis. It also keeps, on the other hand, children who need highly specialized care and treatment (as is the case with FASD) from receiving it because many physicians are almost conditioned not to look beyond the ADD/ADHD label.
If you suspect that FASD could be a factor in your child’s problems you should take heart. Many excellent interventions and treatment methods for the condition exist. It should therefore never be seen as a ‘life sentence’ to a low functioning and problem filled life. The most important thing is to simply get together the courage to take the first step. Many parents of FASD children hesitate to seek help, or to flag up maternal alcohol use during pregnancy as a possible factor, because of the social stigma that is sometimes attached to the condition. I want to urge you however to refuse to allow possible past mistakes to overshadow your child’s future. If you have the courage to seek it you will find that help is available and the condition can be successfully managed in most cases.
More information about the University of Toronto study can be found here.
More information about FASD, and about managing the condition, can be found here.