Foetal alcohol spectrum disorder (FASD)

First UK estimates of children who could have conditions caused by drinking in pregnancy revealed

According to a study published by the University of Bristol in November 2018

Up to 17 per cent of children could have symptoms consistent with foetal alcohol spectrum disorder (FASD) according to new research published in Preventive Medicine.

The UK has the fourth-highest level of prenatal alcohol use in the world, but no estimates existed from a population-based study on how many people may have FASD. FASD is a group of lifelong conditions caused by exposure to alcohol in pregnancy that affect learning, behaviour and can cause physical abnormalities.

Researchers from the University of Bristol and Cardiff University worked with clinicians to assess a wide range of information on mothers drinking in pregnancy and studied the development of 13,495 children from Bristol’s Children of the 90s study.

They applied a screening tool and found that up to 79 per cent of children in the sample were exposed to alcohol in pregnancy and that up to 17 per cent screened positive for symptoms of FASD

Dr Cheryl McQuire, a researcher in epidemiology and alcohol-related outcomes at the University of Bristol, led the research and said:

“Our results showed that a significant number of children screened positive for features consistent with FASD. The results are based on a screening tool, which is not the same as a formal diagnosis. Nevertheless, the high rates of prenatal alcohol use and FASD-relevant symptoms that we found in our study suggest that FASD is likely to be a significant public health concern in the UK.

“These results are important because without UK estimates of FASD prevalence, awareness will remain low and children, teenagers and adults will continue to find it difficult to seek diagnosis and to access the support they may need.

Dr Raja Mukherjee runs a diagnostic clinic for FASD at Surrey and Borders Partnership NHS Foundation Trust and contributed towards the research. He said:

“It shows that it is a disorder that is seemingly hidden in plain sight that we need to pay attention to. Unless we start looking for it we will continue to miss it. If we fail to diagnose it then those affected individuals will continue to be affected by a lack of support and have a subsequent impact on them and wider service.  These results can be the first step in helping us in the UK to realise it is no longer a condition we can ignore.”

However, there is some dispute about the conclusions drawn from the study, for example, Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:

“To summarise my views: yes, this study does provide some useful information, but I don’t think we can rely on it to estimate how common FASD is in the UK. There are good reasons why the researchers’ estimates of up to 17% of children having FASD symptoms are very likely to be an overestimate of the percentage of children who actually have FASD in the UK, and quite possibly it overestimates a lot. Does that mean that FASD is not really a problem in the UK? That’s absolutely not the case – the relatively high rates of drinking alcohol during pregnancy mean that FASD could well be more of a problem here than elsewhere. I agree with the researchers that research using more reliable methods of finding out the extent of FASD should be done. Is the Chief Medical Officer’s advice to avoid alcohol in pregnancy changed by any of this? Absolutely not.”

IRCT would welcome further research into this problematic area. A child with FAS may have the same presentational difficulties as children who have experienced postnatal developmental trauma (abuse and/or neglect) and two points arise:

  1. There is a need for all agencies working with children to understand both complex trauma and behaviours emanating from FAS.
  2. There is an urgent need to campaign for compensation to be paid to victims of FAS.

In December 2014 the BBC reported:

A child born with foetal alcohol syndrome is not legally entitled to compensation after her mother drank excessively while pregnant, the Court of Appeal has ruled. 

The seven-year-old girl was born with severe brain damage and is now in care.

Lawyers argued her mother had poisoned her foetus but appeal judges ruled she had not committed a criminal offence.

The case was brought by a council in the North West of England, which cannot be named for legal reasons.

It had been argued the woman ignored warnings and drank a “grossly excessive” amount of alcohol while pregnant.

She consumed eight cans of strong lager and half a bottle of vodka a day, the court heard.

Three appeal judges at the Court of Appeal had to rule on whether or not the girl was entitled to a payout from the government-funded Criminal Injuries Compensation Scheme as a victim of crime.

But Lord Justice Treacy said an “essential ingredient” for a crime to be committed “is the infliction of grievous bodily harm on a person – grievous bodily harm on a foetus will not suffice”.

This raises significant ethical, moral and legal questions which need addressing as a matter of urgency. While victims of developmental trauma can claim compensation when they have suffered physical and/or sexual abuse and but those suffering the effects of FAS aren’t able to. If the law were changed and criminal compensation could be successfully gained, would the mother necessarily be regarded as a criminal and should, instead support be offered to the mother as well as more support to the child?

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