In our latest blog, new SHAAP Steering Group Member Dr Patricia D. Jackson highlights the risks of pre-natal alcohol exposure, describes some key signs of FASD (Fetal Alcohol Spectrum Disorder) in children and young adults and shares her hopes for more work to be done on this topic.
Dr. Patricia D. Jackson OBE, FRCPCH, is an Honorary Fellow at the University of Edinburgh Department of Child Life and Health. As a member of the Scottish Government Preconception Health and Care Collaborative she has a strong interest in prevention of alcohol harm through better support and information to those planning a pregnancy.
I have recently been asked to represent RCPCH (Royal College of Paediatrics and Child Health) on the SHAAP Steering Group, which is a wonderful opportunity as alcohol affects children, young people and their families in many diverse ways. As a Panel Member for the Children’s Tribunal Scotland (the Children’s Hearing service) I am particularly aware of the ways alcohol in a family context can disadvantage children and young people in their upbringing.
From preconception, alcohol is an issue, with the important message from the Chief Medical Officer of ‘No Alcohol, No Risk’ in pregnancy often not heard clearly. There is a real need, which Scottish Government will hopefully be able to address in their new Preconception Health Advice, to be more open with women and their partners in speaking about the toxic effects of alcohol on the developing brain of the unborn baby, especially at the earliest stages, often before most women know they are pregnant. Open discussion will afford more opportunities to increase awareness of the importance of avoiding alcohol as soon as you plan to start a pregnancy. Or, if in a situation when stopping drinking alcohol is not possible then these discussions will ensure that individuals have information and support to know how best to avoid an unplanned pregnancy.
Children who are exposed to pre-natal alcohol in utero can be affected in many different ways depending on the amount of alcohol and when exposure happens. Some babies will have physical changes, e.g. to their heart, kidneys, bone structure, facial appearance but all those affected will have ongoing difficulties that relate to impairment of the development of their brain, with the challenges this presents for the development of life skills. The way in which the neural connections are made and regulated within the brain is disrupted and with less connectivity these children are often described as ‘10 second children in a 1 second world’. It takes them longer to absorb information and store it, and react to situations.
Just after birth they are often described as being difficult babies to settle, agitated, and with ongoing poor sleep patterns. So they will be difficult for any parent to manage and if you are a parent struggling with other issues and vulnerabilities, particularly if you have ongoing alcohol dependency in the household, then it is not surprising that without high levels of support these children often enter the care system, with their parents being unable to meet both their own and their child’s needs. Research studies show that between 20-30% of children in care are affected with pre-natal alcohol exposure, also known as FASD (Fetal Alcohol Spectrum Disorder). The usual prevalence of FASD in the population is 3-4 % (approx. 200,000 in Scotland).
In childhood, and while growing up, this inability to quickly and usefully process information can lead to them being vulnerable in education and social settings. They will appear articulate, but their understanding of what is said to them is poor. They may find it hard to regulate their emotions and become distressed and angry very quickly. Sensory and attention difficulties may make it hard for them to cope in certain environments and social situations.
I have included below a possible profile of an 18-year-old with FASD and you can see that their physical ability and speech may persuade others that they are functioning at a level commensurate with their age.
*With thanks to FAAST for the image.
It is not hard to see why there is a higher possibility of these young people being perceived as having challenging behavior and becoming excluded from school, rather than needing specialist support. Their behavior difficulties are often compounded by their ongoing poor sleep. Some may display communication difficulties similar to those of people with autism, and may also have this as a coexisting condition. Lack of proper peer friendships and an increased tendency to ‘follow the crowd’ without thinking of consequences can easily lead them to difficulties with minor offending, and with exclusion from school and little to fill their day, opportunities to offend are more available.
Recognising FASD and early signs of disconnection from school can alter this trajectory. If identified as recurrent non- attendees at school or as offenders, experiences with the judicial system can be problematic. If unaware that the child or young person has FASD (and only 1% of those in Scotland with FASD currently are likely to have a formal diagnosis) allowances may not be made for their comprehension difficulties. Additionally, in a stressful situation these children and young adults will often adopt a desire to reduce the pressure by admitting to an offence they have not committed and confabulating a story around the offence. Even in a child centered system such as the Children’s Hearings, the young person may find it very difficult to understand the proceedings, and may either present as an over truculent adolescent, or agree to things that are not true. Supported in good care situations this can be ameliorated, but often the young person may still be in a chaotic family situation where alcohol use may still be a problem for adult members of the family. So interfacing with the youth judicial system can present real problems in accessing the right supports and without recognition of the underlying condition can be very frustrating for both child/young person, family and those attempting to support them. Not least because these children and young people have major difficulties with timekeeping and remembering appointments, and need constant prompts to ensure that they will turn up for any appointments offered. Knowing the person has FASD can make all the difference in offering appropriate and timely support. Without good support a significant number of people with FASD develop secondary mental health problems and again this is likely to lead them into conflict with the judicial system, perhaps because of homelessness, poverty leading to petty crime or challenging behavior because of anxiety and depression. It is also recognized that those with FASD have a higher risk of alcohol and drug addiction.
I very much hope that through SHAAP I can draw attention to the preventable alcohol harm that occurs unintentionally at the earliest stage of development of the baby in the womb, as well as the more recognized damage to the child and young person that can occur by being exposed to a household where adult alcohol use is a concern. Better information on avoiding alcohol affected pregnancy will result in fewer children and young people having life affecting neurodevelopmental challenges. But in the meantime a better understanding of why children with FASD are more likely to become involved with the judicial system and why special approaches and supports are necessary for them is needed. With this support the outcomes for children and young people can be transformed.
SHAAP Blogposts are published with the permission of the authors. The views expressed are solely the authors’ own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems (SHAAP).
Information links:
Scottish Intercollegiate Guideline Network (2019) (SIGN) 156: Diagnosis and Management of Children and Young People Exposed Prenatally to Alcohol.)
The National Organisation for FASD: https://nationalfasd.org.uk/
FASD Hub Scotland: https://www.adoptionuk.org/fasd-hub
FAAST Team: https://faast.ed.ac.uk
Abernethy, C. et al. Determining the pattern and prevalence of alcohol consumption in pregnancy by measuring biomarkers in meconium. https://fn.bmj.com/content/fetalneonatal/103/3/F216.full.pdf
Alcohol Focus Scotland Parental Drinking in Scotland 2018 (low-res-4362-parental-drinking-in-scotland.pdf (alcohol-focus-scotland.org.uk))
Skorka, K et al., (2020) Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review. Alcoholism: Clinical and Experimental Research, Volume 44, Issue 6 p. 1175-1188.
Streissguth, AP et al. J. (2004) Dev Behav. Ped. 25(4) 228-38
Dr. Patricia D. Jackson OBE, FRCPCH
Dr. Patricia D. Jackson OBE, FRCPCH, is an Honorary Fellow at the University of Edinburgh Department of Child Life and Health. As a member of the Scottish Government Preconception Health and Care Collaborative she has a strong interest in prevention of alcohol harm through better support and information to those planning a pregnancy.