Characteristic facial features in a child with fetal alcohol syndrome. These includes a smooth philtrum, thin upper lip, and small palpebral fissures. Other associated features may include an upturned nose, underdeveloped ears, flat nasal bridge and midface, epicanthal folds and small head circumference (source: Darryl Leja, www.nih.gov). 

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... alcohol spectrum disorders (FASD) is an educational term which recognises the range of effects resulting from maternal alcohol consumption. The medical diagnoses within the spectrum include the most recognised part of the spectrum, fetal alcohol syndrome (FAS), as well as problems with behaviour and the brain with no obvious external signs, when alcohol related neurodevelopmental disorders (ARND) may be diagnosed (British Medical Association, 2007). Also included in the spectrum are alcohol related birth defects (ARBD) and partial fetal alcohol syndrome (pFAS). Prenatal exposure to alcohol can lead to intellectual and developmental delays and differences which impact on children's learning in all areas of the curriculum and require a particular teaching approach and learning environment. Possible physical disabilities include facial differences (see figure 1), growth deficiencies, major organ damage, and skeletal damage, as well as hearing and vision impairments. Damage to the brain (central nervous system damage) results in developmental disabilities, which can include general learning difficulties, communication delays/disorders, behavioural, social and emotional difficulties, and sensory difficulties (Mattson and Riley, 1997). The severity and type of fetal damage caused by maternal alcohol use depends on a variety of factors including: • level and duration of drinking • pattern of drinking • timing of alcohol used (stage of fetal development) • blood alcohol level • genetic influences • maternal age and health – physiological effects • use of other teratogens (poly- substance use and abuse) • postnatal factors (such as caregiver/child interactions and home environment). There is no period during pregnancy at which alcohol can be drunk without risk to the developing foetus, although there are sensitive periods for particular organs. The central nervous system (brain and spinal cord) are vulnerable throughout pregnancy (see figure 2). Children and young people with FASD may account for as many as one in 100 children (Autti-Ramo, 2002) with difficulties ranging from mild to profound. This means that some children with FASD will have needs that are evident at birth, easily diagnosed and recognisable by educators as in need of support. However, other children with FASD will have hidden needs, making the educator’s role more challenging. In addition, under- diagnosis (sometimes referred to as misdiagnosis), when conditions such as autistic spectrum disorder or ADHD are diagnosed instead of FASD, can mean that children are presented with a curriculum or intervention which is only partially suitable for their needs. In some cases, children are misunderstood and labelled as wilful, non-compliant and oppositional. It is not uncommon for children to be diagnosed with oppositional defiant disorder (ODD) as a result of this misunderstanding, when in fact children lack either the ability to understand instructions and requests or remember them for sufficiently long periods to complete them. The impact of FASD on children’s development changes over time as children mature. If FASD is not recognised in early childhood, difficulties for children increase as they progress through the education system, resulting in so called secondary disabilities such as poor mental health, disrupted school and ultimately criminal activity. Primary difficulties are as ...