Recognising FASD: Why diagnosis matters

Fetal Alcohol Spectrum Disorder (FASD) is a preventable condition caused by alcohol exposure during pregnancy. 

Despite its significant lifelong impact, FASD often goes undiagnosed in Australia.

This article explores the challenges of diagnosing FASD, highlights why early and accurate diagnosis matters, and outlines efforts to improve understanding and support for those affected.

What is FASD?

FASD includes a range of cognitive and functional challenges resulting from alcohol exposure during pregnancy. It can affect:

• learning
• memory
• emotion regulation
• behaviour
• health
• physical development.¹

People with FASD may have a short attention span and find it hard to organise, control impulses, think abstractly or stick to plans.^2,3

Along with other cognitive and functional challenges, the most severe form of FASD includes distinct facial features.²

The severity of FASD can depend on:

• how much alcohol was consumed during pregnancy
• when during pregnancy alcohol was consumed
• the parent's genetics, general health and use of other substances.¹

How common is FASD in Australia?

Currently, there’s no accurate data on how common FASD is in Australia.²

But a recent study from the University of Sydney suggests that around 3.6% of Australians may have FASD or about one child in every classroom.⁴

Because FASD often goes unnoticed, the real number could be higher, especially in vulnerable populations.^5,6

The good news is more Australian women are choosing not to drink during pregnancy. In 2022–23, 72% reported not drinking while pregnant, up from 65% in 2019.⁷

However, drinking before a pregnancy is confirmed is still common – 64% of women reported drinking before they found out they were pregnant.⁷

Even small amounts of alcohol can affect a baby’s brain development. So, the safest choice is to make the moment you start trying, the moment you stop drinking. ⁸

While these trends show growing awareness of the impacts of alcohol on pregnancy in Australia, FASD still often remains undiagnosed.⁶

What are the barriers to FASD diagnosis?

Diagnosing FASD can be challenging for several reasons.

Stigma is a major issue. Many parents fear judgment when discussing alcohol use during pregnancy. Health professionals may hesitate to ask about it to avoid making them uncomfortable. ^9,10

FASD diagnosis is complex. It needs a team of experts - like paediatricians, psychologists, speech pathologists and occupational therapists to work closely together. 

FASD may also resemble other neurodevelopmental conditions, like Autism or ADHD, making it harder to detect.^11,12

Sometimes, parents or carers may notice concerning behaviours and seek help. But health professionals may lack the tools or training to assess and diagnose FASD correctly.^13,14

Referral pathways aren’t always clear either, which makes it harder for families to get a proper diagnosis.¹⁵

And for a long time, there were only a few clinics in Australia that could assess and diagnose FASD, especially in rural areas. This meant long wait times and limited options for families. 

Why is diagnosing FASD important?

Getting a diagnosis can change lives. 

It helps make sense of things that may have felt confusing or overwhelming – for the person with FASD and for those around them.¹⁶

Because FASD affects people differently, diagnosis is key to finding the right support.

A diagnostic assessment looks at what someone is good at and where they might need extra support. It gives families, teachers, health professionals and the person themselves a clearer picture of their strengths and challenges.¹⁶

A diagnosis also helps shift how people see certain behaviours. Instead of judging someone as lazy or making poor choices, a diagnosis shows that these challenges are linked to brain injury – and that the person may need more support than usual to manage everyday tasks.¹⁶

With a diagnosis, individuals can access tailored help at home, in school and in the community. It can also open doors to services like the National Disability Insurance Scheme (NDIS).

Without a diagnosis or explanation for their experience, people with FASD may struggle with school or employment, mental health, substance use, or even the justice system.^1,16

But with the right support, they can live safer, healthier and more fulfilling lives.

Adult FASD diagnosis

FASD doesn’t go away with age – many adults live with FASD. But it’s often missed.

That’s because many health professionals are trained to spot FASD in children, not adults. In grown-ups, the signs can be harder to see. People may have developed coping strategies, or their symptoms might be confused for other conditions or mental health issues.¹²

Missing or misdiagnosing FASD can have a big impact on someone’s wellbeing – mentally, physically and socially.

Adults with FASD may face challenges in living independently, maintaining employment, and forming social connections. These difficulties can cause feelings of exclusion and low self-esteem, which can also increase the risk of mental health issues such as depression and anxiety.¹

For many adults, finally getting a diagnosis brings a huge sense of relief. It helps them make sense of past struggles and opens the door to the support they’ve needed all along.

Updated Australian guidelines for diagnosing FASD

In May 2025, Australia released updated national guidelines to help health professionals better assess and diagnose FASD. These updates build on the original 2016 guide and bring some important changes.¹⁷

The updated guidelines are shaped by the latest research and input from clinicians, researchers, people with lived experience, and Indigenous health leaders. 

The guidelines take a ‘life course’ approach – recognising that FASD isn’t just a childhood condition. It is designed to support assessment and diagnosis at every stage of life.

The diagnostic criteria have also been refined based on up-to-date evidence to improve accuracy in assessment and diagnosis. To support practitioners, the guide includes practical templates, a visual summary to aid clinical decision-making, and an Indigenous framework to support culturally appropriate assessments.

Importantly, the guidelines also highlight the voices of people with FASD and their families, recognising their insights as essential to assessment and care. A plain language summary of the guidelines helps families understand the process and what to expect.

By making the diagnostic process more accessible, these updates aim to reduce stigma, support early identification, and ensure people with FASD receive the help they need to thrive.¹⁷

How do I get a FASD diagnosis?

If you’re concerned about possible FASD, start by speaking with a GP or an experienced health professional.

Share any concerns about alcohol use during pregnancy and any learning or behaviour challenges. From there, you may be referred for further screening and assessment.

Where can I find more information and support?

• NoFASD National FASD Hotline (1800 860 613) – A service that provides free and confidential advice about FASD, including FASD assessment, diagnosis and referral options. 
• FASD Hub Service Directory – Find health professionals and services with FASD experience and expertise using this directory.
• NoFASD offers comprehensive information on FASD for parents, carers and families, as well as tailored resources specifically for adults living with FASD.

For health professionals

• Supporting alcohol-free pregnancy and safe breastfeeding – A free online course that aims to give healthcare professionals the tools, information and confidence to discuss alcohol use in a non-judgemental way with patients who are planning a pregnancy, are already pregnant or breastfeeding.
• The FASD Hub provides current information about diagnosis, training and education, and supports for health professionals. 
• Insight offers resources to support workers when working with people affected by FASD.