Child behaviour disorders linked to mums’ drinking while pregnant

Social workers need to be aware that the cause of challenging behaviour in children could  be prenatal alcohol intake. Knowing this, support can be planned. Julie Griffiths reports

“I placed a child when she was 16-months-old. Her birth mum was a heroin user but alcohol use was not really discussed. It just wasn’t a factor even though she was drinking heavily,” says social worker Pauline (not her real name).

The girl’s challenging behaviour was attributed to various factors over the years, such as new additions to the family and a move. It is only now, years later, that Pauline wonders if the difficulties could have been caused by the mother’s prenatal alcohol intake.

Foetal alcohol spectrum disorders (Fasd), an umbrella term describing a range of birth defects that occur to a child when their mother drinks during pregnancy, are seen in one in 100 children, according to international statistics. The prevalence among young people in the care system is likely to be much higher given that many children enter the care system because of alcohol or substance misuse in their families.

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Fostered children

In the US, it is estimated that 70% of children in the foster care population are affected by prenatal alcohol exposure to varying degrees. The figures for the UK are unknown because research is lacking but they are thought to be similar.

Yet it is a condition with which many social workers are unfamiliar. There are a wide range of symptoms, depending on the level of brain damage in the womb. Children with Fasd could have lower IQ, learning disorders, attention problems, speech and language difficulties and behavioural problems. Part of the problem for social workers is that all of these could be due to other medical problems or neglect.

Di Hart, principal officer in youth justice and welfare at the National Children’s Bureau, says that is notoriously difficult to work out cause and effect on a foetus when it comes to alcohol or substance misuse. She recalls working as a social work manager in a hospital and carrying out assessments on babies.

“It was very messy to tease out what were the effects of poor parenting, poor nutrition and substance abuse. Some signs are subtle and many don’t show up for years,” says Hart.

Dr Raja Mukherjee, consultant psychiatrist at the Surrey Borders Partnership NHS Foundation Trust, says this is true of Fasd. Those with severe Fasd have distinctive facial features and are often diagnosed early. But if the disorder is milder, it can take longer.

“It may not present until the child is at school because that’s when they are being challenged a bit more and have to do more for themselves,” says Mukherjee.

Lack of knowledge

Julia Brown, an adoptive mother of a child with Fasd, only discovered alcohol was behind development problems when her daughter was about five. The lack of knowledge and help available to the family prompted her to set up Fasd UK, which runs support groups and a helpline.

“We find that lots of social workers have never heard of Fasd or they’ve heard of it vaguely and don’t realise the big impact that alcohol has had on the child. But parents and foster carers need to know what they’re dealing with,” she says.

There is no cure for Fasd but support is available. Without this, the consequences for a child can be severe, according to Jacqui Le Vaillant, project manager for foetally affected children’s services at charity The Adolescent and Children’s Trust (Tact).

“We suspect that a high number of children who are moved from placement to placement due to behavioural difficulties have been prenatally exposed to alcohol misuse. Once children are moved repeatedly the view becomes ‘this child is beyond help’ yet the tragedy is that children with Fasd need a stable, structured home.”

Worryingly, Le Vaillant also believes the problem is a “ticking time bomb”. Research from the Joseph Rowntree Foundation last year showed alcohol consumption of women aged 16 to 24 – prime child-bearing age – rose from 7.3 units per week in 1992 to 10.8 in 2006.

This is one of the reasons that Tact is launching a training programme for social workers this spring. It will cover what Fasd is, how alcohol affects the foetus, what symptoms should prompt social workers to seek a diagnosis and how to ensure better outcomes for those affected.

Assessments

Tact carries out multi-disciplinary assessments of children thought to have Fasd, which include psychometric tests, facial photography and paediatric input. At £3,000 a time, the test is not cheap but more cost effective than providing for a child who has a series of placement breakdowns.

Social workers can also make use of a toolkit from Sunfield Research Institute, designed to improve practice, which includes a range of free information sheets.

Teresa Whitehurst, a research and development officer at Sunfield Research Institute, says if social workers are more aware of Fasd they can help flag it as a possibility to carers. An explanation about what behaviours to expect and ways to deal with them could make a big difference to both parents and children.

What is FASD?

Foetal alcohol spectrum disorder is an umbrella term describing the range of birth defects that can occur in an individual whose mother drinks alcohol during pregnancy.

Alcohol crosses the placenta and can cause physical, mental, behavioural and learning difficulties. The birth mother does not need to be an alcoholic to cause her unborn child to have FASD.

The condition is not one that is outgrown; it has lifelong implications.

Four criteria – growth deficiency, facial features, central nervous system damage and prenatal alcohol exposure – must be met for a full diagnosis. But many children who do not meet these criteria may still be affected.

What to do when a child has been identified with Fasd

● Explain the disorder to carers and its effect on behaviour. This might include difficulty in understanding how words relate to practical action, and the concept of cause and effect. Children may also ask the same questions over and over or make the same mistakes every day, in spite of being taught otherwise, because they have difficulty in learning from experience.

● Provide guidance on how to deal with behaviours and how to teach children differently. This includes modelling behaviours, rather than telling, to give children something to copy. Reward systems can also be useful, as can structuring activities into short chunks of time so the child does not lose concentration. Children with Fasd can be hyperactive so introducing frequent exercise breaks between tasks to give the child opportunities to run about and release energy can also help.

Related links and resources

Information on consultancy and training on working with children with FASD.

Fetal Alcohol Spectrum Disorders: A guide for Healthcare Professionals – British Medical Association.

Working Together for the Prevention of Fetal Alcohol.

Syndrome (Community Action Guide) – British Columbia Ministry for Children and Families, Victoria, Canada.

This article is published in the 28 January issue of Community Care magazine under the heading Drink link to childhood troubles

	We are giving you the opportunity to receive a free copy of Community Care Inform’s guide to how to engage GPs effectively in child protection work and to find out more about Community Care Inform by emailing Kim Poupart on kim.poupart@rbi.co.uk Community Care Inform is our subscription online information service for professionals working with children, young people and their families designed to help your knowledge base and make, and evidence, your decisions. Click here to request a free trial Click here to hear what our subscribers say about us www.ccinform.co.uk