July 17 2018

Australia’s hidden epidemic of alcohol harm

By Australian Psychological Society

Drinking alcohol in pregnancy may have a drastic impact on babies' brain development. But too often Fetal Alcohol Spectrum Disorder (FASD) is overlooked as a cause of children's behavioural and learning issues

Many behavioural, emotional and learning issues associated with FASD from alcohol exposure in the womb remain unrecognised in Australian children or are misdiagnosed as ADHD or autism spectrum disorder according to a leading neuropsychologist in child health and development.

How common is alcohol harm in babies?

Associate Professor Carmela Pestell of the University of Western Australia, a researcher at the Telethon Kids Institute, said as many as 60 per cent of expectant mothers in Australia report drinking, despite expert advice that there is no known safe limit for alcohol consumption in pregnancy.

While drinking alcohol during pregnancy does not necessarily result in harm, some estimates say that as many as 1.2 million Australians could be affected.  If true, this would make these issues more common than autism or ADHD.

Professor Pestell said: “We know that women do not intend to harm their babies, but many unhelpful myths persist that it is okay to drink during pregnancy. We do not know how much is actually safe to drink and so medical guidelines recommend that the safest option is not drinking. Many women are unaware of this, or lack support to give up drinking even when they are trying for a baby or breastfeeding.”

What is the effect of exposure to alcohol as a baby?

Experts say that alcohol exposure in utero is the leading preventable cause of intellectual impairment in Australian children. It can lead to a range of serious problems with emotions, behaviour and thinking abililties, as well as low birth weight and prematurity. The umbrella term for this neurological damage  is fetal alcohol spectrum disorder, or FASD.

Associate Professor Pestell said: “Children with FASD can suffer a raft of difficulties with thinking including their memory, learning, attention, planning, reasoning, speech and language.  They might have trouble taking care of themselves or forming social relationships, and problems controlling their emotions so challenging behaviour is common.”

Why is fetal alcohol spectrum disorder not diagnosed?

A lack of recognition of FASD among health professionals and educators meant many of those affected are misdiagnosed with better-recognised conditions. Confusingly, some of these conditions, such as ADHD, do coexist with FASD, which can lead to a complex array of symptoms.

Awareness of the more extreme presentations of the disorder – which includes characteristic facial features – has increased but these occur in only a small proportion of those affected. Diagnosis of many cases is made more difficult by the complexity of FASD, with each individual affected in a range of subtle ways, depending on the level of alcohol exposure and the point at which it occurred.

Many professionals also hesitate to suggest FASD because of the stigma associated with the disorder.

Why is FASD diagnosis and treatment so important?

Many children and adults with FASD are left undiagnosed, which leaves them vulnerable to blame for their difficulties and denies them effective treatment for what is potentially a lifelong disability. It also adds to the burden for families, school and communities who don’t understand why the individual is displaying challenging behaviour.

Associate Professor Pestell said:  “For adults, diagnosis provides a helpful explanation for why they have been struggling for so long, and what can assist them.  For children, it allows for important early intervention to target the specific cognitive, social, emotional, behavioural and educational difficulties they face.”

What other issues can FASD cause?

Untreated FASD can place individuals with FASD at risk of serious secondary issues, especially during adolescence and adulthood. “When issues are not managed well in childhood, adults can suffer with problems such as substance abuse and addiction and have mental health problems including a greater risk of suicide. Difficulties with reasoning and judgement make them more socially vulnerable.”

Research suggests that 90 per cent of individuals with FASD will have mental health problems, 60 per cent will come into contact with the justice system and have difficulties with securing employment.

What professional help is available for FASD?

Psychologists and other professionals are working to ensure those with FASD are equipped to manage the issues that arise from the disorder.

Associate Professor Pestell, with Dr James Fitzpatrick, director of PATCHES Paediatrics, is working to improve diagnosis among other health professionals and educators across Australia, thanks to a Federal Government grant.  A new online graduate certificate in FASD assessment and diagnosis has been established at the University of Western Australia to improve knowledge and aid the multidisciplinary care that best benefits those affected.

Professional assessment by psychologists is critical to identify the particular way FASD has presented in each individual.  Psychologists can also help adults or children to treat and manage the impact of their specific difficulties.

Associate Professor Pestell said: “Psychologists are also helping individuals with FASD and their carers and educators adjust to life with this complex disorder. It’s important that those affected know there is much that can be done to make life better for those with this under-recognised disorder and there is hope.”

Associate Professor Carmela Pestell is giving a free public talk on FASD in Perth on July 19, as part of the Australian Psychological Society’s series of free psychology events .