Social Dysfunction: A Key Deficit in Adults with Suspected and Confirmed FASD

Fetal alcohol spectrum disorder (FASD) is a complex diagnosis impacting behavioral, cognitive, educational, and vocational capacities. Social dysfunction is a core deficit associated with prenatal alcohol exposure. Over the past multiple years of my professional work with adults with suspected or diagnosed FASD, I have identified seven themes that consistently arise concerning social dysfunction in some individuals who have been exposed to alcohol prenatally. These themes are often exacerbated when misdiagnoses have been made, proper treatment has not been given, or familial and community supports have not been established. Confirmed based on interviews with caregivers and others professionals working with this population, I am pleased to present these themes to you here.

Boundary Problems. Some individuals with suspected or diagnosed FASD experience difficulties with establishing healthy boundaries with persons in their communities. Such individuals are often overly friendly with strangers or with persons known to them who do not wish to maintain in contact. This may manifest in violation of non-contact orders or unwanted sexual advances, as the comprehension of both verbal and nonverbal cues may be clouded. Friendship-Building Problems. Some individuals with suspected or diagnosed FASD experience difficulties in establishing healthy friendships with persons in their communities. As a result, they often have superficial friendships, sometimes with persons in younger age groups to match their maturity and developmental level. Lack of Cause-Effect Thinking. Some individuals with suspected or diagnosed FASD often lack the ability to foresee the consequences (especially the social consequences) of their actions, resulting in judgment deficiencies that come across as a lack of common sense. This may manifest in the ignoring of “good manners” and a lack of awareness of obviously risky situations. Person-Pleasing. Some individuals with suspected or diagnosed FASD often try hard to please others at their own expense. Hence, they may come across as naïve or easily fooled, as they have a perceived inability to say no to friends. This may manifest in being tricked into giving money or objects to other people, or being the scapegoat for the actions of others. Inappropriate Conversations. Some individuals with suspected or diagnosed FASD have an excessive need for attention, which sometimes manifests in talking more than is appropriate. The content of this speech may also be unusual, hyperbolic or socially inappropriate. Social Overstimulation. Some individuals with suspected or diagnosed FASD become overstimulated in social situations such as being in a crowded room or when strangers are present. This overstimulation may impact their ability to effectively socialize, resulting in indecisiveness. Lack of Emotion Regulation. Some individuals with suspected or diagnosed FASD may overreact to social situations, experiencing stronger emotions than are appropriate given the context. In contrast, they may also experience blunted affect, appearing disinterested in routine social interactions or conversations.