Alcohol is a Teratogenic Substance Of all the substances of abuse including marijuana, cocaine and heroin, alcohol produces by far the most serious neuro-behavioural effects to the foetus (IOM report to Congress 1996). Prenatal exposure is caused by alcohol crossing the placenta and within minutes, the level of alcohol in the foetus’ blood reaches maternal blood alcohol levels. Alcohol is a teratogen which can cause any type of physical malformation or neurological impairment which can impair learning and development.
This condition is preventable only when there is no prenatal alcohol exposure. The UK Chief Medical Officer guidance changed in 2016 to a recommendation that no alcohol be consumed in pregnancy and when planning a pregnancy.
Permanent and Lifelong Impacts Foetal Alcohol Spectrum Disorder (FASD) is a term used to describe the permanent impacts on the brain and body of individuals prenatally exposed to alcohol during pregnancy resulting in a spectrum of physical, neurological, emotional and behavioural regulation characteristics.
No two children with FASD are exactly alike, either behaviourally or physically. Some of the impacts may include: - Brain structure and neurological differences. - Attention, concentration and hyperactivity difficulties. - Academic achievement challenges. - Speech and language deficits e.g. great expressive but poorer receptive language. - Working memory and processing speed challenges. - Adaptive functioning impairments that become more recognisable with age. - Emotional regulation difficulties - Sociable and vulnerable with difficulty making or sustaining friendships . - Sensory impairments such as vision or hearing or being or sensory sensitivities. - Oppositional or defensive when requests are made. - Inconsistent performance - can do something one day but cannot the next. - Lack of abstract reasoning, cause & effect logic, fails to generalise - Identity challenges and issues with theory of mind.
Defensive behaviours develop when there is a poor fit between the person with FASD and the support they receive to navigate daily life. There can be issues with disrupted school experiences, vulnerability and exploitation, issues with mental health, legal issues, and difficulties with independence and employment if a young person's support needs are not being understood and met. They need early access to a thorough diagnosis, and access to practical and personalised support and services for individuals with FASD and their families to thrive. Gifts and Talents Individuals with FASD have their own unique areas that create challenges in their daily lives. They also have a unique set of strengths and gifts that when nurtured and supported, demonstrates their unlimited potential in those areas. Some common personal and skill areas include being caring, articulate, friendly, musical, artistic, creative, practical, athletic, animal skills, nature skills etc. Many who have been well supported are moving into fulfilled adult lives. Some are in professional careers, have attended university and are raising their own children. Prevalence Foetal Alcohol Spectrum Disorder (FASD) is the most common, non-genetic cause of learning disability in the UK (British Medical Association, 2007).
International research proposes that between 2%-5% of the population may be affected by FASD (May 2018). The most recent research in the UK (Cook 2021) highlights that for planning and commissioning purposes we need to be considering a prevalence rate of 3-4%.
It is often more prevalent in certain populations and whilst it is often quoted that more than 70% of children with FASD have progressed through care services, we see a rate of over 90% in our local services so it is not surprising that many parents are foster, adoptive and kinship carers.
Recognition Often the condition goes undiagnosed or is diagnosed for example as autism or ADHD rather than those conditions being recognised as comorbid presentations of FASD. Due to the level of children coming through the care services, attachment disorders are often viewed as the sole cause of presenting signs and symptoms and this can lead to misunderstandings about therapeutic support needs.
Increasing awareness and understanding of FASD and developing appropriate prevention, diagnostic and intervention services will create brighter futures for all who are affected by FASD in the UK.