Foetal alcohol spectrum disorder — structured clinical viva

What is FASD / how diagnosed? Lifelong effects of prenatal alcohol exposure. Multidisciplinary diagnosis using a named framework (Hoyme domains; Cook Canadian with/without sentinel face; Astley 4-digit ranks). Document PAE, growth, face and neurobehavioural impairment — not a single blood test.^[1][2]

Must he have the face? No. Sentinel triad (short palpebral fissures, smooth philtrum, thin upper lip) supports FAS-range diagnoses, but FASD without sentinel facial features is valid when PAE and severe brain dysfunction criteria are met.^[2][1]

Medicine that fixes injury? No disease-modifying pharmacotherapy for core FASD. Treat comorbidities (ADHD, mood, sleep, substance use) carefully; antipsychotics only for severe behavioural risk after formulation and with monitoring.^[4]

Impulsive if IQ average? Classic profile: executive function, attention, memory and adaptive skills often lag what IQ alone suggests — functional impairment is real.^[5]

School and later law trouble. Scaffolding, accommodations, carer coaching, multiagency plan. Streissguth: high secondary disability rates; early diagnosis and stable nurturing care protect.^[3][4]

Sister and pregnancy. No known safe alcohol amount in pregnancy; support alcohol-free conception/pregnancy; non-judgemental contraception and alcohol help if needed. Quote prevalence order of magnitude if asked (Lange ~7.7/1000 global FASD in children/youth).^[4][6]

Name evidence. Hoyme 2016; Cook 2016; Williams AAP 2015; Mattson neurobehaviour; Streissguth 2004; Lange prevalence.^{[1][2][3][4][5][6]}