Why my social work experience led me to specialise on foetal alcohol spectrum disorders

Q: What is foetal alcohol spectrum disorder?

LC: Foetal Alcohol Spectrum Disorders (FASD) is an umbrella term that is used to describe a range of ways in which a child is impacted by their mother’s drinking during pregnancy. These range from mild to severe learning disabilities.

The most prevalent problems are Foetal Alcohol Syndrome (FAS) and alcohol related neurodevelopment disorder (ARND), with the latter often hard to spot. I would be confident that any social worker reading this will have clients on their case load with ARND.

Q: What is the impact of FASD on children?

LC: Early diagnosis of FASD is important for the prevention of secondary disabilities, including mental ill health and substance misuse issues – issues that I know from my own experience are really prevalent in a social worker’s day. But evidence suggests that many children and adults go unrecognised and are untreated, or are incorrectly diagnosed and receive the wrong treatment.

The clinical features of FASD are varied but include the following: specific facial features (commonly associated with FAS), growth deficits, mental illness, hyperactivity & behaviour problems, attention and memory problems, poor coordination or motor skills, difficulty with judgment and reasoning, and impulsivity .

For children with FASD, developmental age will not usually correlate to chronological age. As social workers we can often set expectations/goals based on the chronological age of the child. If we can reframe our approach with the FASD child and offer interventions based on their developmental age the ‘success’ is more achievable.

Q: How much do social workers know about FASD?

LC: From my experience, social workers don’t know much about FASD. That’s not necessarily their fault, as the condition is still not recognised and taught enough in social work education, but it is alarming given that conservative estimates suggest that there are around 6,000 FASD births in the UK each year.

With up to 80% of births where a child has been exposed to alcohol during the pregancy leading to a child being admitted to care, that could equate to 4,800 children entering the care system each year linked to FASD. The social work profession needs to engage with this issue, and there needs to be greater awareness in our foster care system too.

Q: What’s your social work background and how did it lead to your current role?

LC: Over the last 27 years I’ve worked in the UK and Ireland in various social care and social work roles, but two key moves led to my current FASD role.

One was my decision to do a masters degree in child protection in 2006 after years as a practising social worker. I chose to research drug and alcohol use in pregnancy as a child protection concern.

The other moment that sticks with me happened during my practice as a senior social worker in community care back between 1999 and 2001. I was involved in a pre-birth case conference where the issue of substance misuse by the mother was a concern for her unborn child.

A doctor at the conference talked about the concerns for the unborn and the potential outcomes that the substance misuse might have on the child after birth. This idea of the pre-birth world having long lasting effects on the after birth world got me thinking.

In social work we are often guided by the external world and the environment that children are living in when making assessments of need. But what if it is not just the environment (the domestic violence, the parental mental health, the addiction to drugs or alcohol) that we need to factor in?

What if there is a brain injury in the child caused by alcohol before birth and this is contributing to family breakdown? These questions led me to my role.

Q: What’s your main message to social workers about FASD?

LC: Don’t automatically assume that the environment the child is coming from is the sole cause of their behaviours.

Many social workers also mention the fear of ‘stigma’ in addressing the potential issue of FASD in a child.

Yes, this is a complex issue in our child welfare system but what is clear from talking to birth mothers is that that, yes they had to deal with a ‘guilt’ of what their drinking had caused, but their overriding concern is getting the right and best help for their child. A lot hadn’t had access to the public health education on the dangers of their drinking.

The main thing is that this isn’t a blame message, it’s an education message.