What social workers need to know about foetal alcohol spectrum disorders

by Martin Clarke – Learning and Development Manager – TACT Fostering & Adoption

Advice on consuming alcohol during pregnancy in the UK is woefully inadequate. Current official guidance given by midwives is: “It is better not to drink, but if you do, then 1 or 2 units, once or twice a week is alright”.

In Australia and Canada it is a lot simpler: “If you are pregnant, trying to get pregnant or think you may be pregnant it is safer not to drink alcohol.” This simple, clear and easy to remember advice would make a massive difference to a significant number of children.

Across the world, it is recognised that alcohol effects the unborn foetus and can have a dramatic impact upon it. This impact usually involves some element of neurological problems as alcohol is a “neuro-toxin”, literally a “brain poison”.

This neurological damage can be accompanied by physical manifestations also, but not necessarily.

The conditions

All the conditions caused by alcohol consumption by the mother during the pregnancy are jointly referred to as Foetal Alcohol Spectrum Disorders (FASD) and the one condition that many people are aware of is FAS (Foetal Alcohol Syndrome), where the alcohol causes facial dysmorphology, a smooth philtrum and a thin upper lip being the obvious features.

However, the vast majority of foetally affected children will not have FAS and there will be nothing visible to show they have been affected. This condition is Alcohol Related Neurological Disorder (ARND).

Children with ARND & FASD might have intellectual disabilities and problems with behaviour and learning. They might do poorly in school and have difficulties with maths, memory, attention, judgment, and exhibit poor impulse control.

Social workers, along with parents/carers, will start to notice the impact in terms of behaviours and emotions in a whole range of ways and will seek explanations for it, and at that point pre-birth exposure to alcohol neds to be considered before, or as well as, looking at ADHD or attachment issues.

Estimates across the globe suggest that 1/100 children, worldwide, are on the spectrum, with about 1/1000 having FAS.

However, given the particularly close relationship we in the UK have with alcohol – it is central to most of our rituals (weddings, christenings, funerals, leaving dos, stag nights, hen nights) and our everyday life – this figure is generally thought to be an under-estimate and most experts would agree that a figure closer to 3% or even 5% is much more likely to be accurate.

Children in care

Recent research (1) has also suggested that this figure jumps alarmingly when considering children in care, with 27% identified, within a very small audit, as being on the spectrum.

Looking at children being freed for adoption the numbers jumped again to suggest that up to 75% might, somewhere down the line, start to display the emotional and behavioural problems associated with FASD.

It is not surprising when we consider that 65% of children enter care due to neglect and abuse and a significant number of these will come from homes where alcohol plays a significant part.

These figures were given to the recently formed All Party Parliamentary Group (APPG) for FASD looking at this issue.

TACT (The Adolescent & Children’s Trust) was the only social work organisation invited to give oral evidence to the APPG for FASD, alongside presentations from education and health professionals as well as carers and adopters, and we were especially asked to explain why FASD needed more awareness and consideration by social workers.

We explained that, in common with the children in the wider community, FASD was an unrecognised condition in looked-after children with little awareness or training given to professionals.

The consequence of children going into permanent placements with either a “missed diagnosis” or a “mis-diagnosis” could be dramatic and only with an increased awareness of FASD through training could social workers ensure that these issues were addressed.

Rammifications

Unless trained and aware of FASD it is unlikely that professionals, including social workers, will consider pre-birth exposure to alcohol as an explanation for a child’s behaviour, which has these possible ramifications:-

• If ‘missed diagnosed’, many will just be viewed as ‘poorly behaved’, ‘non-compliant’ children and their parents risk being criticised for being poor carers as they are not receiving the support they need. In extremis this can also lead to family breakdown.

• If ‘mis-diagnosed’ they may instead be labelled or diagnosed as Autistic, or ADHD or having an Attachment Disorder. They would then be ‘treated’ accordingly, maybe with medication (Ritalin) or having expensive ‘talking therapies’, which are unlikely to work effectively.

• If FASD is not considered as a possibility, either now or in the future, bearing in mind that the neurological impact of alcohol does not usually present until children are at least 5 and maybe older, we will be placing children for permanence with unprepared carers. This is of particular concern considering the increase in special guardianship orders and kinship placements being made where the permanent carers will not necessarily have the same support and access to professional help as adopters and foster carers.

• Without the appropriate support, people with FASD have a high risk of developing secondary problems such as psychiatric issues, disrupted school experience and alcohol and drug problems.

FASD conditions are more common than appreciated, and while efforts must be made to educate and hopefully prevent children being brain damaged before birth by their mother’s alcohol consumption, we must also be aware that large numbers of children have been, and are being, born with this life-long condition.

In particular, given the high numbers in the care system and the implications for placing them in permanence, it is vital that social workers become familiar with FASD and question, at the earliest possible opportunity, whether pre-birth alcohol consumption might play a part in the child’s future.

(1) G Gregory Coram BAAF Adoption & Fostering Journal, October 2015