Hit by the bottle

Maternal alcohol consumption during pregnancy can result in
physical and mental birth defects that are “the leading known cause
of mental retardation in western civilisation”, according to the
US’s National Institute of Alcohol Abuse and
Alcoholism.¹ This group of defects, called foetal
alcohol syndrome (FAS), was first identified in 1970.

Alcohol is a toxin that causes more damage to the developing foetus
than marijuana, heroin or cocaine.² Consumption of
alcohol during different pregnancy stages results in possible
additional damage at each of the stages as the foetus develops. FAS
usually results from heavy and prolonged alcohol consumption during
pregnancy, but studies have shown that a single high dose of
ethanol can kill nerve cells in the developing brain.
Frighteningly, for years doctors placed women in premature labour
on ethanol drips to slow down or prevent the onset of labour.

FAS is 100 per cent preventable, yet it is a problem that spans all
social, economic and racial boundaries. It is a permanent condition
that can have devastating effects on an individual and their
family. As with most syndromes, the severity and type of the
disability varies and is partly dependent upon whether the woman
has a gene type that metabolises more or less alcohol in her
body.

Its full characteristics include:

• Slower growth both pre and post natal.
• Central nervous system damage – resulting in intellectual
  impairment, developmental delay, behaviour disorders, short
  attention span, hyperactivity, and poor muscle tone and
  co-ordination.
• Facial abnormalities – dysmorphic facial features including
  some or all of the following: flat mid face or upper lip or both,
  low nasal bridge, small chin, short eye openings and snub
  nose.
• Other abnormalities of the eyes, ears, heart, liver, and palate
  may also occur.

Even if the above characteristics are absent, prenatal exposure
to alcohol can cause an “invisible disability” that manifests
behaviourally, known as foetal alcohol effects (FAE) or
alcohol-related neurological disorder. Many children have the brain
damage without the physical signs of full FAS, and may have an IQ
that is considered “normal”.

But this does not mean FAE and alcohol-related neurological
disorder are lesser problems. Because diagnosis is more difficult
for these children, they often fail to receive the vital medical
and social support they need, or are misdiagnosed as having
attention deficit hyperactivity disorder, reactive attachment
disorder or oppositional defiant disorder.

“What’s really sad is how many FAS and FAE kids go through life
undetected,” says Ann Streissguth of the University of Washington,
a specialist in FAS behaviour. “It takes a trained eye to spot FAS,
even in those who are severely affected. And in FAE, mildly
affected kids are often misjudged because they tend to be talkative
and outgoing. No one dreams their nervous systems are
impaired.”³

Infants with FAS or FAE can be irritable, have difficulty with
feeding and sleeping, and may be extra sensitive to sensory
stimulation. As children they often struggle with attachments, have
poor social skills or a poorly formed conscience, and may be naive,
prone to distraction, impractical and self-centred. They may be
unable to follow verbal commands or stay on task at all, and
friendships can be difficult. This affects their school life, often
necessitating special educational provision. One major
characteristic is their inability to connect an action with its
consequences. Yet some may be gifted in art, dance or music, and
most are outgoing, loving children who thrive on adult
attention.

A study by Streissguth found that fewer than 10 per cent of
individuals with FAS or Arnd achieve success in living and working
independently. The poor judgement and gullibility that appears in
childhood are not outgrown, and children and adults are quite
vulnerable to physical, sexual and emotional abuse. Many sufferers
drop out of school, experience mental health problems or find
themselves marginalised. Some researchers estimate that more than
half of the prison population are affected by prenatal exposure to
alcohol.

The existence and prevalence of FAS and FAE is widely accepted in
many countries including Canada, the US, Australia, New Zealand,
France, Germany, Japan, China and South Africa. The size of the
problem is indicated by figures from Canada and the US, which
suggest that out of 10,000 births, three will have muscular
dystrophy, four will have HIV, eight will have spina bifida, 10
will have Down’s syndrome, 20 will have FAS, and 100 will have FAE.
In the UK, estimates suggest that one baby in 500 is born with FAS,
while one in 50 has an alcohol-related disorder.

Yet there are real obstacles to widespread national recognition of
the problems that these syndromes pose. Many affected children are
born to families where several generations have abused alcohol, and
where dysfunctional behaviour has become the norm. A hallmark of
addiction is denial – families conceal their problems because of
social condemnation. In many cases, social care professionals will
need to be willing to dig down to discover whether there is an
alcohol problem in the past or present.

Whether they have the time, training or systems to allow for this
is questionable – and even if they did, could the system cope with
what might be uncovered?

We do not know how many children in the care system are affected by
FAS or FAE. The government is pushing for a 40 per cent increase in
adoptions by 2004, and adoptive families are likely to be
unprepared for the challenges these children present. Could
prenatal exposure to alcohol play a part in the number of adoption
placements that break down? Ironically, if these children are
diagnosed with FAS or FAE, they may become even harder to place.
Yet if no diagnosis is offered, they will never receive the support
they need to fulfil their potential.

Health professionals could achieve much by asking pregnant women
about their alcohol use and advising them on the risks. Yet the
training of these professionals in alcohol awareness is woefully
inadequate, and few would know what to look for once a baby is
born.

In education, too, increasing numbers of children are affected by
hyperactivity and show problems with behaviour and attention. Yet
the education sector is also inadequately informed and
prepared.

Drinks manufacturers suggest that alcohol is a socially acceptable
and healthy drug – a position mirrored, until recently, by the
tobacco industry. Yet the cost of providing lifelong medical,
social and educational support for just one person with FAS or FAE
is a huge drain on the economy. In the US, taxpayers spend $1.9bn
(£1.12bn) each year to treat children and adults with
diagnosed FAS, the country’s National Institute on Drug Abuse
estimates.

I believe that the government has a responsibility to:

• Provide support for sufferers and their families.
• Review guidelines and produce a national alcohol strategy that
  deals with alcohol use during pregnancy.
• Educate the public and professionals on the harmful effects of
  alcohol.
• Start an early education programme in schools.
• Address marketing of alcohol in the media.
• Examine statistics to define the connection between alcohol
  misuse, and juvenile delinquency, mental health, school drop-out,
  violence and abuse.

All these measures would go some way to preventing this syndrome
that can cause so much damage.

Alison McCormick is an independent social work
consultant and a volunteer for foetal alcohol syndrome awareness
group FAS Aware UK.
She can be contacted at
alibaz@btinternet.com 

References

¹ National Institute of Alcohol
Abuse and Alcoholism, Eighth Special Report, NIH
Publication No 94-3699, 1993 from
www.niaaa.nih.gov

² Institute of Medicine, report
to Congress, 1996

³ Foetal Alcohol Syndrome Aware UK website,
www.fasaware.co.uk.
 Or see
www.come-over.to/FAS/FASFACTS2tk.doc