FASD and ADHD: Differences and similarities
Primary School ResourcesThe purpose of this factsheet
This factsheet will assist teaching and support staff to better understand the differences and similarities between Fetal Alcohol Spectrum Disorder (FASD) and Attention Deficit Hyperactivity Disorder (ADHD).
Fetal Alcohol Spectrum Disorder & Attention Deficit Hyperactivity Disorder
Both FASD and ADHD are neurodevelopmental disorders. This means that they affect the growth and development of the brain and are associated with impairments in functioning in a variety of domains (e.g., cognitive, social, academic). However, they have very different causes. FASD is caused by prenatal exposure to alcohol. Alcohol is a teratogen – a toxin that passes through the placenta and can cause damage to the brain and body of a developing embryo or fetus. In contrast, there is no single cause of ADHD. It is influenced by both genetic and environmental risk factors, and their interplay.
Both disorders are quite common. FASD is estimated to affect 3.64% of the Australian population, whereas ADHD affects approximately 6 – 10% of children and adolescents and 2 – 6% of adults. There is no typical of pattern of impairment in individuals with FASD as the effects vary based on the timing and amount of prenatal alcohol exposure. Young people with FASD may experience difficulties in nine different neurodevelopmental domains. Step one in our guide to the referral and diagnostic process details each domain that could be affected. In Australia, young people with FASD most commonly experience difficulties with attention, executive functioning (e.g., planning, impulsivity, organisation), adaptive behaviour/social skills, communication, and academic achievement.
In comparison, individuals with ADHD experience consistent patterns of inattention (difficulty paying attention), hyperactivity (showing too much energy or moving and talking too much), or impulsivity (acting without thinking or having difficulty with self-control).
However, while there are differences between the two disorders, these may be subtle and difficult to recognise, particularly in the school environment. Additionally, there is also a high degree of overlap in the presentation of FASD and ADHD in a school setting. Therefore, it can be difficult to distinguish between FASD and ADHD based on presentation alone. It’s also important to note that there is a high degree of co-occurrence (known as comorbidity) between FASD and ADHD. Research indicates that 50% to 70% of young people with FASD may also have ADHD.
It’s important that teaching and support staff understand whether a child has FASD or ADHD (or both). The best practice treatment and support strategies differ between disorders, often due to subtle differences in neurodevelopmental impairments. For example, both children with FASD and ADHD often experience challenges with mathematics and arithmetic. However, research suggests this is due to specific difficulties with number processing in children with FASD and general deficits with attention and executive functioning in children with ADHD. Therefore, the supports must be tailored to meet the specific needs of each student. If FASD is not recognised as a potential diagnosis, interventions in the school setting may not fully address a student’s needs, leading to inadequate support. It’s essential for educators to consider the possibility of FASD alongside ADHD.
The table below highlights some of the differences and similarities between FASD and ADHD.
| Domain | FASD | Similarities | ADHD |
|---|---|---|---|
| Attention | Difficulties with focusing and sustaining attention to visual stimuli in particular. | Difficulties with sustained attention (focusing for a long period of time and resisting distractions). | Challenges with most domains of attention, including selective attention (focusing on a particular stimulus), divided attention (focusing on two or more things at the same time), and alternating attention (switching focus). |
| Executive functioning | Moderate to severe challenges with:
|
Both groups have difficulties with inhibition (controlling attention, behaviour, thoughts and emotions to overcome impulses and resist distractions) compared to typically developing children. |
Generally less severe challenges with executive functioning compared to children with FASD, most commonly with inhibition and working memory. |
| Adaptive and social functioning
(life skills that enable participation in day-to-day activities) |
Children with FASD experience significant challenges with daily living skills (e.g., age-appropriate personal care). These difficulties typically become more pronounced with age. |
Both children with FASD and ADHD have difficulties with adaptive functioning (including communication, daily living skills, and interpersonal skills) compared to typically developing children. Individuals with FASD typically have more severe challenges than those with ADHD. |
Adaptive functioning may improve with age, but children with ADHD still experience challenges compared to typically developing children. |
| Stimulant medication response for attention | There is very weak evidence that children with FASD may respond better to dexamphetamine-based medications compared to methylphenidate-based medications (e.g., Ritalin). UK and Canadian guidelines suggest these short-acting stimulants as a first-line treatment. |
For children and adolescents with ADHD, either dexamphetamine- or methylphenidate-based medications can be used as first-line treatment, depending on individual response. |
|
References
Australian Guidelines Development Group. (2024). Australian clinical practice guidelines for the assessment and diagnosis of fetal alcohol spectrum disorder.
https://child-health-research.centre.uq.edu.au/australian-guidelines-assessment-and-diagnosis-fetal-alcohol-spectrum-disorder
Crocker, N., Vaurio, L., Riley, E. P., & Mattson, S. N. (2009). Comparison of adaptive behavior in children with heavy prenatal alcohol exposure or attention-deficit/hyperactivity disorder. Alcoholism, Clinical and Experimental Research, 33(11), 2015–2023.
https://doi.org/10.1111/j.1530-0277.2009.01040.x
Hen-Herbst, L., Tenenbaum, A., Elber-Dorozko, S., & Berger, A. (2025). Overlap between the Fetal Alcohol Spectrum Disorder (FASD) and Attention Deficit Hyperactivity Disorder (ADHD). Lernen und Lernstörungen, 14(4), 213–224.
https://doi.org/10.1024/2235-0977/a000496
Jacobson, J. L., Dodge, N. C., Burden, M. J., Klorman, R., & Jacobson, S. W. (2011). Number processing in adolescents with prenatal alcohol exposure and ADHD: differences in the neurobehavioral phenotype. Alcoholism, Clinical and Experimental Research, 35(3), 431–442.
https://doi.org/10.1111/j.1530-0277.2010.01360.x
Kautz‐Turnbull, C., & Petrenko, C. L. M. (2021). A meta‐analytic review of adaptive functioning in fetal alcohol spectrum disorders, and the effect of IQ, executive functioning, and age. Alcoholism, Clinical and Experimental Research, 45(12), 2430–2447.
https://doi.org/10.1111/acer.14728
Khoury, J. E., & Milligan, K. (2019). Comparing Executive Functioning in Children and Adolescents With Fetal Alcohol Spectrum Disorders and ADHD: A Meta-Analysis. Journal of Attention Disorders, 23(14), 1801-1815.
https://doi.org/10.1177/1087054715622016
Kingdon, D., Cardoso, C. and McGrath, J.J. (2016). Research Review: Executive function deficits in fetal alcohol spectrum disorders and attention-deficit/hyperactivity disorder – a meta-analysis. Journal of Child Psychology and Psychiatry, 57(2), 116-131.
https://doi.org/10.1111/jcpp.12451
Mattson, S. N., Calarco, K. E., & Lang, A. R. (2006). Focused and shifting attention in children with heavy prenatal alcohol exposure. Neuropsychology, 20(3), 361–369.
https://doi.org/10.1037/0894-4105.20.3.361
May, T., Birch, E., Chaves, K., et al. (2023). The Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder. The Australian and New Zealand Journal of Psychiatry, 57(8), 1101–1116.
https://doi.org/10.1177/00048674231166329
Peadon, E., & Elliott, E. J. (2010). Distinguishing between attention-deficit hyperactivity and fetal alcohol spectrum disorders in children: Clinical guidelines. Neuropsychiatric Disease and Treatment, 6, 509–515.
https://doi.org/10.2147/ndt.s7256
Sawyer, M. G., Reece, C. E., Sawyer, A. C., Johnson, S. E., & Lawrence, D. (2018). Has the prevalence of child and adolescent mental disorders in Australia changed between 1998 and 2013 to 2014?.
https://doi.org/10.1016/j.jaac.2018.02.012
Thapar, A., Cooper, M., Jefferies, R., & Stergiakouli, E. (2012). What causes attention deficit hyperactivity disorder?.
https://doi.org/10.1136/archdischild-2011-300482
Tsang, T. W., Rosenblatt, D. H., Parta, I., & Elliott, E. J. (2025). Estimating the prevalence of Fetal Alcohol Spectrum Disorder in Australia.
https://doi.org/10.1111/dar.14082
Tsal, Y., Shalev, L., & Mevorach, C. (2005). The diversity of attention deficits in ADHD.
https://doi.org/10.1177/00222194050380020401
Weyrauch, D., Schwartz, M., Hart, B., Klug, M. G., & Burd, L. (2017). Comorbid mental disorders in fetal alcohol spectrum disorders: A systematic review.
https://doi.org/10.1097/DBP.0000000000000440
Young, S., Absoud, M., Blackburn, C., et al. (2016). Guidelines for identification and treatment of individuals with attention deficit/hyperactivity disorder and associated fetal alcohol spectrum disorders based upon expert consensus.
https://doi.org/10.1186/s12888-016-1027-y